Signs of Pre-Eclampsia in a Diabetic Pregnancy.
I know you can hear me in there. You are about 5 lbs of baby girl and when I sing to you while we're driving, you move around from side to side. (I hope you aren't trying to escape the sound of my tuneless voice. In my mind, and in my car, alone, with the windows rolled up, I'm fooled into thinking I sound pretty decent.)
So make sure you're listening now, because I need you and I to work together pretty closely for the next few weeks.
Yesterday, at the doctor's office, we were there for a routine visit but my damned blood pressure was a little spikey, coming in at 140/90. Much higher than what we see at home, which is closer to 125/73. (White coat syndrome, anyone?)
Our OB reacted immediately. She sent the nurse for my urine cultures and confirmed that protein was spilling into my urine. They took three more blood pressure readings, all which came back in the 130-140ish range. And then they did a quick measurement of you and your heartbeat.
"I know you have an ATU appointment today, but I want to send you over to labor and delivery for monitoring. Basically, I think you're showing signs of pre-eclampsia. I do not want to take any chances."
"Okay, what does that mean in terms of what happens next?" The words "labor and delivery" and in my vocabulary, but I wasn't planning on using them until ... oh, say the end of April.
"I want them to hook you and baby up to monitors and keep an eye on both of you for a few hours. If your blood pressure continues to climb, or if the baby shows any sign of distress, we may need to have her come today."
Baby, you feel enormous sometimes, all rolling around in there. I can feel your legs up about four inches past my belly button, and I can feel the swell of your pretty head closer to my pelvis. You take up a lot of room in this belly now, and when I'm trying to get up from the couch at times and need to roll a little on my side to launch myself upwards, I laugh because it's just ridiculous how big my pregnant belly has become.
But when the doctor said that you may need to come early - 33 1/2 weeks along kind of early - depending on the stress on both of our bodies? I couldn't help but picture just how small you are. We have five weeks left. I want you to stay put as long as possible.
"Today? That's like instant panic. Today? So should I call Chris?"
"Yes. Once we have you over at labor and delivery, and they monitor you, we'll be able to determine if you can go home today and tackle bed rest for a few weeks, or if we should keep you overnight and monitor you both, or if you should be admitted for a few days, or, and this hopefully is NOT the case - that she's coming today via c-section instead of in a few weeks."
Lots of information to digest. I called your dad from the foyer as I waited for the elevator and gave him the details. "Basically, she is probably not coming today. But she might be. And I'm freaking out a little bit. I think it's okay for you to wait to come up, just until I know what their plan is. They're not going to make any fast decisions - more ruling stuff out and ... honestly? I have no idea what's going on."
Little girl, I was confused. But after spending a few hours having blood drawn, blood pressures taken, and non-stress tests performed, things were looking a bit better. They did an ultrasound of you and you look strong and healthy (and round in the head, you cute little mess). They also scanned the placenta for any signs of detachment or calcification, and took measurements of the fluid level in your uterine apartment. Everything was looking good, except for the protein spill and the elevated blood pressure.
The doctors came to evaluate me. Us. And their main concern was the protein.
"We'd like you to do a 24 urine collection and stay overnight."
"Stay overnight for monitoring purposes? Are there concerns for me or the baby? Or are you just really eager for my pee?" It had been a few hours, I was hungry, and my hands were sore from texting Chris and keeping him updated on our situation.
"At this point, just the ... um, we just want your pee." (Baby, I love making doctors repeat back the odd things I've blurted out. Those awkward moments from them almost make the initial awkward moments from me worth it. Wait until we're at the pediatrician. I'm sure I'll embarrass you endlessly.)
"So can I do the collection at home instead of being admitted? And bring it back after 24 hours? Or is that risky in ANY way? I don't want to tell you guys what to do, I just don't want to hang out in the hospital purely for urinating purposes." (And also, I didn't have any back up pump supplies or clean clothes or anything to even read, so the idea of being trapped in the hospital for 24 hours, purely to offer up constant urine samples, made my head spin.)
"No, home is fine. So long as you can bring the samples back after 24 hours. And we'll need you on modified bed rest until further notice, because if pre-eclampsia progresses, we don't want any problems. You'll need to keep an eye on your blood pressure, and any headaches that might crop up, and if you have any pain in your upper right quadrant, you need to call your doctor immediately."
After discussing a few more items, they worked through my discharge paperwork and handed me two, enormous orange jugs for "collecting." "Here - you pee in this hat and then pour it into the jug."
"Excuse me? Into a hat??"
"Not an actual hat - this plastic thing. It's called a hat." The nurse tried to control the grin tugging at the corners of her mouth. They must have thought I was completely unscrewed.
"Ah, okay. I can do that."
And off we went, toddling back to the parking garage and heading home to your dad. Baby girl, we're almost there. If you can hang tight and stay strong for a few more weeks, that would be the best for both of us. It seems like we're not sure how soon you're coming these days, so it's up to you and I to try and hold out as long as we can, in good health. Everyone at the hospital is keeping a very close eye on us, and we're under the best care possible, so it's up to you and me for a little bit. We need to stay calm. And hydrated. And keep tabs on blood pressure. And stay calm. Did I mention calm? Calm would be good.
I love you so, so much. And when they tell me that "she looks beautiful" and "healthy" and "strong," I feel so proud of what you and I have done, and how far we have come. Daddy and I will take the best care we can of you, and we're almost ready to have you as part of our family. Almost. You just need to stay put and keep growing for a few more weeks, so when you arrive, you are as strong as you can be.
Be good. (And if you see my pancreas, give it a kick, would you? Maybe you can jump start that lazy thing.)