Lucille Amelia Mekkelson has been born! Baby and mom are doing well. pictures to follow soon.

Delivery Delayed

Delivery of the Littlest Warrior has been delayed because the NICU is busy dealing with an emergency twins delivery. A new time of 2pm has been scheduled so we are now just nervously twiddling thumbs. Stay tuned! - Erik

Having a baby... TOMORROW!!!

Big news people!!!  I had my 3-week growth ultrasound today and the LW gained 1 lb 3 oz.  We're very happy that she's gaining weight!  Her new estimated weight is 4 lbs, 11 oz, so hopefully in reality she's at least 5 lbs.  However, this new estimate puts her in the 4th percentile on the growth chart, whereas she was in the 9th percentile 3 weeks ago.  Also, they noticed a part of distended bowel that is starting to sneak back into the hole.  They don't want the hole to start compressing the bowel.  So... since I'm only 3 days away from full term, they decided that it's GO TIME!!!  My C-section (because she's still breech) is scheduled for tomorrow at 8 am!

We're equal parts nervous and excited.  We finally get to meet this little diva tomorrow!  So many questions running through my head... what will she look like?  How much will she weigh?  What condition will her intestines be in?  Will she need a breathing tube?  When will we finally be able to hold her?  And of course, the biggie: HOW LONG UNTIL WE CAN TAKE HER HOME???  Actually, these questions have been running through my head since January 5, 2012, the day we found out about the gastroschisis.  I can't believe that tomorrow we will finally start to get some answers.  It has been such a long road, and I know the hardest part is still to come, but I'm so ready to meet my daughter and do this thing!!!

Erik will be updating the blog and Facebook as soon as he can.  THANK YOU from the bottom of our hearts for your prayers and positive mojo!  We are so humbled and thankful to have you all cheering us on.  Stay tuned!

36 WEEKS!

All about baby…

• Average baby weighs about 6 lbs and is about 18.5 inches long
• Baby continues to add fat and put on weight
• Baby is starting to shed lanugo (a layer of downy hair that covers the body) and the vernix caseosa (a waxy substance all over the body that protects the baby’s skin from the amniotic fluid)
• At the end of this week, baby is no longer considered preterm!!

All about me…

Total time in hospital: 5 weeks, 3 days
Total Weight Gain: 37 lbs
Bellybutton: Still a hybrid innie/outtie
Stretchmarks: Just noticed my first few… and I was so close!
Baby position: Frank breech
Sleep: Still decent
Symptoms: BH contractions, fatigue, shortness of breath, pelvic pressure
Food Cravings: Ice cream, chocolate
High Point of the Week: Start of the NBA Finals!  If you know me, you know I’m a big basketball fan.  If you have to be in the hospital, playoffs season is a good time to be there.
Low Point of the Week: Can’t think of one… this was a pretty mellow week.
One Thing I Miss About Home: Nesting and baby prepping. I was enjoying putting the nursery together before I was admitted to the hospital.  But we’ll still have time to wrap things up while the LW is in the NICU.
What I’m Reading: The Glass Castle
What I’m Looking Forward to: Wednesday’s 3-week growth ultrasound
Next Milestone: 5 days until the LW is full term!!  Two weeks until delivery day!!!!

36 Weeks

In-room artwork, courtesy of Erik

Bowel Distension - Part 2

I talked to my perinatologist today about the bowel distension we noticed at yesterday’s ultrasound.  He was aware of the big segment I saw.  They first noticed it a couple weeks ago, and I remember one doctor saying something about it.  He said it will continue to get larger as the baby grows and the intestines grow.  Regardless, he still thinks that cooking the LW to 38 weeks is more important.  He reminded me again that the current medical wisdom is that extra-abdominal bowel distension is not an accurate indicator of future complications.  This is the case no matter how little or how much distension you see on the ultrasound (i.e., there’s not a cut-off amount).  Some babies with distension do end up having GI complications, but others don’t.  But we know for sure that lung maturity and gestational age are related to better outcomes.  So his opinion is that no amount of bowel distension is worth taking the baby before she’s full term, if we can get her there.  I’m glad that we’re still on the same course and that nothing has changed, but I’m also glad that I said something and can rest easier! 

I’ll have my next growth ultrasound on Wednesday.  Unlike bowel distension, this is something that could influence their decision on when to deliver me.  As you may remember from my last growth ultrasound, if she hasn’t grown at all within the past 3 weeks they could decide to deliver me now.  My belly has grown and she feels bigger to me, so I believe in my heart that she has grown, but who knows how the measurements will pan out.  So keep your fingers crossed that they work out in our favor! 

Finally, I had my AFI checked again today.  Long story short, my perinatologist wants to change my schedule a bit so that a nurse down here can do it rather than sending me upstairs to the ultrasound department each time.  Today they measured me at 7.2 compared to 5.8 yesterday.  Just goes to show how variable it can be depending on the technician and what they can see that day. 

AFI Update & Extra-Abdominal Bowel Distension

My AFI was 5.8 today compared to 6.8 on Monday.  The umbilical cord Doppler was still good.  The LW is still doing great on the monitor.  So everything is pretty much the same, but as expected, they are noticing more bowel distension as I get closer to term.  There is one segment in particular that looks really swollen.  Even I noticed it on the ultrasound and it was so big that I couldn’t even tell that it was intestine.  The doctors have seen this segment before, and they continue to say that when it comes to giving the LW the best head start she can get, gestational age is more important than extra-abdominal bowel distension.  See my previous post on this subject.  I also found a published study in the Journal of Pediatric Surgery that supports what the doctors are telling me.  The study identified four factors that were statistically relevant to length of stay in the NICU: 

1. Gestational age
2. If a silo is needed (compared to primary closure)
3. If GI complications occur (like atresia, perforation, or resection)
4. If other, non-GI anomalies are present

The study found that intestinal distension seen on prenatal ultrasounds is not an accurate predictor of length of stay in the NICU.  Some subjects with dilated bowel had GI complications, but others did not.  They concluded that distension produces many false positive predictions of adverse outcome, and does not reliably predict GI complications or the need for a silo.  However, the absence of bowel distension did reliably predict less complex cases and shorter NICU stays.  So basically, if you don’t see distension you know you’re in pretty good shape.  But if you do see it, it doesn’t necessarily mean anything.  You could still have a quick and easy run in the NICU with no complications, or you could end up having a more complicated case.

 

Despite what I’m being told and what I’m reading, I’m still having a weird gut reaction to this large segment of swollen bowel.  So I expressed my concerns to my ob/gyn when she came in today to check on me.  She has been my biggest advocate through all of this.  She comes to see me every day she’s in the office, she calls me on her days off if I have questions, and she reviews every one of the LW’s monitoring strips with a fine-toothed comb.  Like me, she is extra cautious about everything and always takes the most conservative approach.  But most importantly, she listens to all of my concerns and never brushes me off, and she always makes sure that I get answers.  If she can’t answer my questions she makes sure that the perinatologists do.  I told her that I know they generally don’t think that bowel distension is a reason to deliver me early, but now that I’m almost 36 weeks, is there a point where too much is too much?  Because this particular segment looked really big to me.  I told her that I wanted my primary perinatologist to look at the photos of the swollen bowel from today’s ultrasound and confirm that waiting to deliver me is still the best option.  So she is going to call him to review the photos together and he is going to stop by or call me tomorrow to discuss.  I’m proud of myself for listening to my instincts and voicing my concerns.  You can’t have that nagging feeling in the back of your mind when you’re in a situation like this.  I’m sure I will feel better after talking to him tomorrow. 

AFI and D-Day Update

Today’s ultrasound went well!  My AFI was 6.8, up from 4.6 last Thursday.  The umbilical cord Doppler was also good.  She’s still doing great on the monitor – no changes there. 

The technician also pointed out that the LW has some chubby cheeks, although they were hard for me to see because she always has her hands up by her face.   Even though this wasn't a full growth ultrasound, I know she’s growing because I’m getting bigger (and more uncomfortable).  And it's music to my ears to hear that she’s fattening up!  The bigger and stronger she can be, the better.    

Now for the exciting part… we have a likely birthday for the LW!!  My C-section has been scheduled for Monday, July 2.  That’s 21 days, folks!  21 DAYS.  Of course, it could be less than that if the LW decides to come early, and we all know that she likes to call the shots around here.  If she happens to turn into a head-down position, I would be induced that day rather than scheduled for a C-section.  But things are getting really cramped in there, and it’s harder for her to turn with low amniotic fluid, so I have a strong feeling that she’ll stay where she is.  

I’ll be 38 weeks and 2 days on July 2, 1 week and 5 days shy of my actual due date.  Almost all gastroschisis babies are born early, either on their own or by doctor’s orders.  Because the intestines get more and more irritated the longer they are exposed to the amniotic fluid, they like to get the babies out and on the road to recovery as soon as they reach full lung maturity, which is usually at 38 weeks.  (In case you’re wondering, I will not be getting an amnio to confirm lung maturity because they think it is too risky given the low fluid levels and the exposed bowel.)  So my doctors all agree that 38 weeks is an ideal time to deliver.  Let’s just hope that the LW concurs!