Just Keep Swimming

Have you ever had a theme song for a particular moment in life??  Well today, this is mine.  Though admittedly its not much of a song, and the lyrics are just a bit monotonous it does rise to the occassion as being both appropriate and about as boring as I would like the situation to refect.

Poor little fish Dora (from the movie Finding Nemo).  Swimming in oblivion but ohh what wonderful oblivion that is that I too would like to have amnesia for just 7-8 more weeks only to come to my senses just in time to reap the rewards - the safe and LATE delivery of baby Payton.

Today's going to be 1 part whine (and only a short one I promise) and 2-3 parts pg update.

I'm still at BC's Women's hospital.  Today is day 3 on the calendar (but still less than 48 hours) and I'm not 100% sure what the goal is for my stay and the anticipated discharge.  I do know that they want to make sure that this bleeding episode is finished. 

'They' know (with placental previa or not) that another bleeding episode is possible (and with the PP probable) and I believe it will be one of those "cross that bridge when we get there" but in the short term (a few days) we do what we can to tackle the problem close at hand.  One step at a time.

So for the record, this bleeding episode seems to have finished.  My belly remains tender but I'm confident that its because of the newly acquired position I've been forced into - bedrest. 

For the record, bedrest is hard. Physically its painful both on the buttocks and my sides/back which then radiates into my belly.  The best thing for our bodies is movement and with the lack of movement I can start to feel things tighten and seize up.

So back to my 1st hurdle - the recent bleeding episode.  There's been talk of me having an ultrasound.  Talk by the nurses, not yet by the doctors. So in my (very non medical) opinion there are a few options that may be staring us in the face and without an ultrasound to prove/disprove it, for now its just a best guess estimate.

1. I still have complete Placental Previa and the recent bleeding episode is from that, and subsequent bleeding episodes are likely.  The bleed was from the uterus streching so much at this crucial point in the pregnancy (when the bottom of the uterus stretches so much).  The PP is still there and another episode is likely.

2.  I still have complete Placental Previa and my cervix is starting to change as the pregnancy progresses.  This is something I knew to be aware of, but was hoping that it wouldn't be an issue until at least 36 weeks or so.  Again, as the cervix continues to change (and the PP continues to overlie it) another bleeding episode is likely.

3. I do not have complete Placental Previa and the bleed is from another part of the uterus (still undergoing tons of stretching) where the placenta has pulled away a bit.  Another bleeding episode is likely.  The reason I assume (if bleeding is from another part of the placenta) that my PP is only partial (and not complete) is because the blood would have to have a means of escaping the uterus.  With complete PP it would be trapped in the uterus, so there must be an opening where the placenta isn't covering the cervix which is allowing blood out.  Again, not complete PP (which is an improvement) but still, another bleeding episode possible as the uterus contines to grow.

4.  I did have complete Placental Previa and the bleed is from the uterus expanding enough that it has pulled the lobe of placental off the cervix (thus the bleeding) and the placenta no longer fully covers the cervix.  Another bleeding episode possible, but the risk is severly diminished (I like this option).

For what its worth, in my non medical opinion, I'm not sure if knowledge of which possible scenerio it is would matter in the big picture.  The placenta is still sure to be low lying thus still a good probability of further bleeding so our diligence still remains.  Management of the pregnancy may not change no matter where we sit with the placenta's position.  Thus, an ultrasound may be simply redundant (especially since I'm scheduled to have one on Tuesday anyway and they'll know a lot more then after giving things just a few more days to settle).

An earlier ultrasound may give me peace of mind a few days early, or allow me to continue being ever viligent (and stressed) for another 3 days (probably not their biggest concern so my feelings are irrelevant).  OR, (and this is where I worry) they are planning on keeping me here till Tueday's scheduled ultrasound - yikes.

Still, our trip here has had some useful medical interactions in the event that we do have another bleeding episode, the next being a bit more severe than this one.

The evening I arrived at BC Women's, they gave me a shot of steriods (betamethasone) the help mature Payton's lungs in the (UNLIKELY right??) event that she is born prematurely.  Typically 4 days after the administration of the 1st injection (a total of 2 injections 24 hrs apart) is when you start to see maximum benefits of the steriods and studies show that these benefits last up to 2 weeks.

Studies also suggest that steriods after 34 weeks aren't effective so we're right in the right ball park to utilize these steriods in the unlikley (right??) event that Payton arrives too early.  While the steriods certainly won't cure her lung problem, it would definitly be an improvement on the lungs she does have compared to if we didn't get the steriods.

The other upside of us being here is we're now going to be a familar face :).  We've started what will (hopefully) be many days (meaning Payton will survive) at BC Women's & Childrens and what better time to start endearing the hospital staff with my wit and charms then now, when stress levels aren't too high and I'm not having to focus on other tasks at hand.  It also allows us to be better known for later, when delivery becomes more likely so that we can be a bit more streamlined in the process (both in Squamish and here).

In Squamish, where we initiated our medical journey, it was a bit like pulling teeth trying to get the nurses to understand the dire need to get me processed and down to Women's hospital.  CDH (even spelling it out 'Diaphragmatic Hernia') doesn't compute with a lot of people, even medical ones, and it wasn't until they were on the phone with the peri from Women's that they started to get their butts in gear to get me transported.  Apparently a "we need her here asap" from a Peri is enough to get the ball rolling and there was talk about an air transport but I think the fact that the bleeding had already slowed was enough to justify the ground transport with sirens blaring.

I would have been happy (stressed but happy) to have by-passed Squamish's hospital all together and just driven down, but we were given explicite instructions from Women's hospital to NOT do that - many warnings in fact. 

So alas, we went the proper channels, knowing that there would be a few hiccups in the road and just happy and relieve that it appears like this experience has allowed for more of a dry run.

The other upside is that I may have found a good fit doctor in Squamish.  A husband and wife set of doctors who told us that IVF babies are near and dear to their hearts and I was invited (hernia and all) to look into utilizing them as a family doctor.  As much as I love my family doctor in Vancouver, with Payton's future and medical reliance uncertain, its clear we need a family doctor close to home and one that (if we end up in the ER in Squamish) knows her history (and her records are local) instead of the blank stares of the unknown severity that CDH too often brings.

Alas, many positives to this recent event though I have to admit, I'm at the point where I want/need to come home. 

Here's my whine:

I miss Olivia.  I have banned her from the hospital this time around because we're at such a crucial stage of wanting to keep Payton safe, and lets face it, Olivia is rough on my belly.  Her precious little mind has no concept of how fragile this pregnancy is (both the CDH and PP) and when she tries to kneed my belly (hey, maybe she'll be a baker growing up) because its fun and it feels neat, she has no idea that its not a good thing.  At this point, I feel its important to let my belly rest as much as possible to allow any tears to heal properly before they're subjected to her strong little arms again (even being as diligent as possible she has the ability to catch me off guard, kneeding away).

I can't envision Olivia in the hospital NOT crawling on me..so we're treating it as if Mommy has taken a few days out of town (true) where we're not accessible to each other (not so true).  Still, I miss her and I've known ever since we learned about CDH, that Olivia was going to be my emotional lifeline in many of the struggles we're facing.  Not having access to that lifeline is tough - such a precious little girl to have so much power over making me feel wonderful.

So, in a nut shell, here I sit, at 4:45 am (I actually got a decent sleep last night) wondering if I'll be checking out today, or if today will be another repeat of yesterday, just hanging around waiting.  Waiting for doctors who have no intention (because there is no need) of doing anything, waiting for more bleeding, or waiting for the mundane to happen (or not happen??).

So we do what we tell ourselves to do:  "Just keep swimming...".