The first twenty-four

I’ve survived my first twenty-four hours in the hospital.  Great news!  Baby has behaved quite well.  I’m strapped into fetal monitoring bands pretty much twenty-four-seven.  I unhook myself to shower, grab some water, go for a quick walk.  I can take a longer break if I want, though I recognize that I am here for a purpose- monitor the baby.  The longer I’m off, there is technically more of a chance we could miss something (the whole reason I’m here).  So I’m tending to follow the rules.

We haven’t had any monitoring since 27 weeks and so it was hard for me to imagine what the baby would do.  If you put any pregnant woman on these monitors all day long, it’s quite common to see small dips in the baby’s heart rate and when that happens, as long as its not frequent or severe, baby is fine.   The dips usually resolve and baby goes on his/her merry way.  With no fluid, we would expect those dips to be more common.  They often happen when the baby squishes the umbilical cord with some movement or position change.  Most babies have lots of fluid to cushion and prevent compression of the cord.  My baby of course does not have that cushion.  But the first full day has gone well! No dips (at least that I’ve seen) and no one has come rushing into my room in response to the baby’s heart rate- all good signs.  I figured this weekend would be quite telling- either completely boring because baby has no dips or very exciting with nurses and doctors rushing in to help fix the heart rate.  I was hoping for boring and so far so good.

Though, since things are going so well, I almost feel a little guilty being here.  Baby is so good and I’m healthy, which of course makes me wonder if clinically we’ve done the right thing?  Should I be home, more active, preparing? Should I be working?  Should I not be worrying about it?

However, the truth is we would not have know how good this baby is until we did this- monitor monitor monitor.  And this great heart rate can change in an instance. If the baby’s heart rate drops and won’t come up despite all our tricks, best thing to do is deliver the baby- which here they can do in essentially minutes.

And frankly, some people might advise to deliver the baby just in case as 34 weeks- to prevent even the risk of that distress and emergent delivery.  We (those of us in obstetrics) often deliver people at 34 weeks for low fluid- but that ‘s usually for other reasons.  Most oligohydramnios is because either the water is broken or the placenta isn’t working.  When the water is broken, we wait until 34 weeks, then deliver because at that point the risk of infection is higher than the risk of prematurity.  With poor placental function, the risk of stillbirth is higher than the risk of prematurity.  So it makes sense in the common cases to deliver at 34 weeks.  My water’s not broken and my placenta is functioning fine.  And the risks of prematurity on my baby’s specific case is very high in our mind.  So we want those extra weeks, if baby can tolerate them, to grow the lungs and grow the kidneys.   But we also feel that if the baby had to be delivered due to distress,  at this point s/he has a reasonable chance of…. Surviving?…. of breathing?….. of doing something.

So really, it just feels weird to me to be so healthy myself, but in the hospital.  Something to really wrap my head around.  This is what we do for our children, right?  I rarely need vital signs. I need no IV.  I’m just here to grow the baby.  It’s all about the baby.  Brings me back to my post-CVS mantra- Stay Baby Stay.

Now that I have no agenda, I feel so much movement.  It’s true- being busy at work, I couldn’t tell if the baby was moving or not, so in the few minutes I might have to sit and be present with the baby, there might be nothing.  Which would of course get my anxiety going- has the baby died?  And I’d just have to wait.  Here, I know my baby is fine.  That burden of that anxiety has lifted.  Now I have my new challenges: adjust to hospital life, tethered within a few feet of a monitor; adjust to an open ended schedule (very un-like me.  I’m busy- it’s what I do best); adjust to sedentary life (with some yoga and hand weights exceptions); adjust to the idea of a baby that I will meet soon, in whatever health state s/he may be in.

I can’t believe I have something I can finally plan and hope for- I think I’m going to have a live baby.

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