A New Plan

I feel like parenting gives me many opportunities to try to explain to my sweet daughter how things don't always seem "fair."

"I know it doesn't seem fair, but you may not have 18 gummy bears a day from Angel's gummy bear jar."

"I know it doesn't seem fair, but you must wear clothes when we leave the house."

"I know it doesn't seem fair, but you have to brush your teeth twice a day."

One of the great parts of parenting is how you can often hear lessons prescribed for you in your own parenting voice.  Last week, I heard Piercy Joye's mom whisper in my ear and say,

"I know it doesn't seem fair, but you've been diagnosed with preeclampsia again this pregnancy, only this time much earlier. I know it doesn't seem fair, but we need to create a new plan for when this baby can arrive in order to keep you both safe.  I know it doesn't seem fair, but you will very likely not get to experience that ideal birth plan you created two years ago. I know it doesn't seem fair. I'm so sorry, but it will be okay."

The last week feels like a whirlwind. In the interest of shedding light on a relatively unknown complication of pregnancy, I've written a long post about my experiences with preeclampsia... Read on if you're interested, and if not, you'll have to know my feelings are NOT hurt!

I had a regular 28-week OB check-up a week and a day ago, to test my blood for glucose intolerance (gestational diabetes: which I do not, by the way, have! Yahoo!).  When I mentioned to my obstetrician's PA that I'd been having nagging daily headaches, she wrote me a script for a muscle relaxer and sent me on a trip to pick up the dreaded orange jug.

Do you know which one I'm talking about, ladies?

I did.  This one liter plastic orange jug is an old "friend" of mine. Last pregnancy I had to do two 24-hour urine collections.  One was prescribed after I was admitted to the Labor and Delivery unit around 35-36 weeks following a major blood pressure acceleration (160s/90s). I don't know the actual results of that urinalysis, but it wasn't showing that there was a problem so major that I'd need to seek induction.  The second urinalysis was ordered routinely two weeks after the first and showed significant enough protein concentration in my urine that my doctor scheduled my induction the day after the test results were available.

The results of that second test confirmed our suspicions of what was a likely outcome: I had developed preeclampsia, and due to the serious nature of this condition and its ability to go from bad to fatal (for mother and/or baby) very quickly, I would need to deliver right away.  Piercy was 38.5 weeks gestation at the time, and because she was term, there were no major complications anticipated with going for an "early" induction.

I was pretty certain that I had a good chance of developing pre-e with my first pregnancy.  I had a few major risk factors: my mother had pre-e with my older brother (her first), I have a history of migraine headaches, and I'd been developing serious vision changes and headaches beginning in the third trimester.

What I truly did not think would happen is that I would develop this condition again in a subsequent pregnancy.  I sort of figured I'd done "my time," had my own crazy, non-ideal birthing experience, and I would be able to move on to uneventful pregnancies in the future with a birth that included going into labor naturally, and possibly trying again for a relatively unmedicated labor.  Many stats claim that once you have preeclampsia, you're finished! No mas! Onward, Mama, to the birth plan of your dreams!

You can imagine that I was a little disheartened when the Physician's Assistant merely ordered the urine collection.

Piercy and I went to turn in my jugs (nasty) on Monday and have my blood drawn to check for another, dramatically more serious although similar condition called HELLP syndrome (H -- hemolysis, the breakdown of red blood cells; EL -- elevated liver enzymes; LP -- low platelet count).

Then my obstetrician's PA left a message on Tuesday asking me to call her on the cell phone.

Uh-oh.

The verdict was in: mild pre-eclampsia.   As my kidneys are now struggling to function properly, I had spilled 301 mg of protein/24 hours.  Ironically, the cut-off for a pre-eclampsia diagnosis is 300 mg.  Thankfully my blood pressure is still low-normal, but due to my history and current headaches, I am now being monitored weekly for changes in addition to the twice-daily blood pressure checks I am taking on my own at home.

I will likely be delivered as soon as I am 37 weeks pregnant (December 14), to ensure that our baby and I both remain in good health.  Hopefully that will mean I will be able to be successfully induced. If my condition worsens drastically between now and then, the baby could be delivered via Cesarean section if and when that time comes.

"I know it's not fair, but..."

I'm currently on a very modified version of bed rest (toddler-parent-modified-bed-rest). We may have a baby prior to 37 weeks and have to stay in the NICU. We will most probably not be moved into our house by the time the baby comes. I may have to have a Cesarean section. We will be bringing a baby home to my Grandmother's house, not our own house. We most likely won't have a Christmas tree this year (sweet Angel is a Jehovah's Witness and doesn't exactly celebrate Christmas).

There are many things that are not ideal about this news, but this news is our reality, and we plan on doing whatever it takes to bring home a healthy baby and healthy mommy. Even if it's not fair, or fun, or according to the plan we made.

In the interim, we've had so many friends and family step up to help us. We've had folks offer to drop off food so that I don't have to cook, and grandparents take Piercy while I get good rest in. (Yes, we are accepting meals! No, we aren't picky eaters, and my condition does not require a low-sodium diet). These people will get us through, and our Baby Dos will know how the village helped him/her make it into this world healthily!

Thank you, everyone.