Fetal Blood Sampling

So, our procedure was originally scheduled for 8/8, and then 2 weeks before was changed to 8/4. Then the time on 8/4 was changed twice until finally they changed it back to 8/8 because of a problem getting the donor platelets ready and washed in time for our procedure. To say it was frustrating is an understatement. Before the sample, I received 2 steroid shots (and got all the lovely side effects from them), had a double IVIG treatment, and gave tons of bloodwork. To say I was over getting stuck with needles is also an understatement... but I still had one more needle to go. The big one. The one that was going through my stomach and into my baby girl. To say I was anxious was the biggest understatement of all.

Because of our history, I made sure all of our hospital bags were packed, and the laundry was done, and there were plenty of groceries for the girls. Then I tried my best to sleep, which was pointless because my anxiety continued to get the best of me, pretty much making it impossible to get to sleep or stay asleep. 8am came quick, but I had been up... so I showered, Aaron got ready, and we got the girls downstairs where NaNa (Aaron's mom ) was waiting for them.  My mom was also there because she was coming to the hospital with us. You know what they say, no matter how old you get, sometimes you just need your Mom. The girls love our moms, so they were so excited. I was having all of the emotions when saying good-bye to them, thinking it might be the last time it was just my 2 girls. I hugged them extra tight and they gave the best hugs, and kisses back to me and baby sister. At that point, I really thought that I'd be introducing them to their sister the next time we were all together.

We arrived at the hospital around 9:45am which is when we were told to be there but we had to then wait another hour in the waiting room--which was not good for that anxiety I was telling you about. I kept thinking something was wrong with the platelets or the anesthesia or the OR was double booked. Finally they brought us back, I got changed, they put in my IV, took more bloodwork, attached my heart rate monitors, took my blood pressure, and then we waited. The sonographer and my doctor came in to do an initial assessment of baby girl's size and position. She was measured to be around 5.5 pounds and not in the best position for the procedure. They also checked her for bleeds and everything looked good in that area which was very relieving. They left and said hopefully she will be in a better position once we got to the OR. An anesthesiologist also came in, asked me a bunch of questions, and explained I would only get an epidural if needed. They were going to try using "twilight" and some anxiety medicine on me to see if they could keep me calm throughout the procedure, and not start contracting like last time. It made sense but it just wasn't what I was told or had prepared myself for so I was a little bit upset about the change. So many doctors, nurses, and students were coming in and out of our room, that when it finally died down and we were getting ready to walk back, it felt too quiet. The kind of quiet that left me alone with too many thoughts. Thoughts I didn't want to be left alone with. Thankfully, it didn't last long, Aaron got into his scrubs, we hugged my mom good-bye, and the anesthesiologist and nurses walked us back into the OR.

The Procedure
If you've ever been in an OR, you'll know that it's cold and super bright and can be very intimidating. I got onto the table, and they started draping me, hooking me up to things, and asking questions, and it seemed like everyone was talking all at once and I was feeling very overwhelmed. Aaron was right beside me the whole time, and did a great job keeping me out of my own head. The sonographer started looking at baby girl, and they found that she was actually in a better position than she had been previously. When they are looking at her position they want to see that there is an optimal way to access the large vein that runs through her liver. It's called the intrahepatic vein. That is the vein they need access to in order to retrieve a blood sample that will provide the most accurate platelet reading. With Mackenzie she was not in an optimal position to access that vein so after some maneuvering they went for the umbilical cord. There's actually much more risk involved if you have to puncture the cord, so we were very pleased to hear they wouldn't have to go that route this time.

The sonographer had to switch sides so that my doctor could access the side of my stomach where she could more easily access the vein. After they got themselves all situated, I was given the "twilight" meds, which definitely calmed me down pretty much instantly. I was holding Aaron's hand, and he was telling me what was going on because I didn't want to look. They gave the baby a anesthetic that kind of put her to sleep, so she wouldn't move during the procedure. Because of the meds, I actually drifted off to sleep a few times too, and they had to wake me to tell me I needed to breathe more shallowly because my deep sleep breathing was moving my stomach too much and making it harder to get the needle in a good position. After they started I could tell something was wrong because I could feel the pressure of the needle going in many, many times, prodding around, and puncturing through my uterus, but wasn't hearing any results. I just heard my doctor asking what was going on, and why is this happening. And it hurt, a lot. I was trying not to act like it hurt but I guess I wasn't very good at that because the anesthesiologist gave me more meds, and was Aaron was wiping my tears away for me.  I can't even really describe how it feels, but it's so uncomfortably painful and the whole time you're being told not to move, or breathe too hard, or cough because there's a needle in your baby. It's extremely scary, and a lot of pressure to be put under. 

Aaron told me that every time my doctor put the needle in, they would pull it up and no fluid or blood would be drawn out. It was literally empty over and over again. My doctor and one of the anesthesiologists started to have a little bit of an argument about why it was happening and he suggested a new tactic of approach. My doctor apparently did not think that was plausible, politely corrected him and continued on. At this point we had been in there for over an hour, and I was in a decent amount of pain each time the needle was reinserted, so the anesthesiologist actually called another doctor behind my doctor's back to assist. She reeeeeeealllly didn't like that and dismissed the other doctor immediately, but she did change needles. Talk about awkward...  The matched platelets that they secured for the infusion are only viable for 2 hours once they reach the OR, so the nurse was constantly reminding my doctor of that fact as well.

Finally, right at the 2 hour mark they secured 2 different samples. The first was 93,000 and the second was 102,000!!!!!!!!!! I literally couldn't even believe it when I heard. I must have asked Aaron to repeat it at least 5 times. Mackenzie's sample was only 5,000, so I had prepared myself for that kind of result again. I looked at Aaron and I could tell he was so happy, that just made me feel so happy, and grateful. As happy as we were, it's still not as high as they'd like her platelets to be, so they infused the donor platelets to ensure she would have over 300,000 which is a more "normal" count. They wheeled me into recovery, and Aaron and I just hugged and thanked God that this time around was smoother, and we had better results. As I said I was very happy, but the biggest feeling I had was relief. Relieved that she was alive and healthy, relieved that I was alive and healthy, and relieved that it was over. Aaron went to get my poor Mom who had been waiting over 2 hours for a procedure she was told would only be around 30 minutes long. She came back and she was so excited to see that I was okay and to hear that the baby was doing well also. I was really excited to see her as well, and get a big hug- the kind only your Mom can give you.

Recovery
I stayed in recovery for around 3.5 hours while they monitored the baby to make sure she was waking up from the anesthesia given to her, and they monitored the mild contractions I was having. Once the contractions slowed down, the cramping I was having subsided, and I was able to show I could eat and not vomit, and use the bathroom they said I could go home to rest. My doctor came by to clear me, and told me I better take it easy. She knows I never do and was very adamant that I let Aaron help me, and that I lay down. If I have any cramping or contractions I would need to come back, but she said she felt confident that everything was completely fine. I was worried about my placenta, but my doctor said that my placenta was untouched during the procedure, and looked very healthy. I'm still worried about it of course, but I don't think that will ever go away. 

We scheduled our C-section for Thursday, August 17th and while discussing that with our doctor I asked about a possible NICU stay as well. She said it most likely won't be necessary, and that I get to room-in with my baby. That's something I've never gotten to do, and the feelings of joy I had in that moment were overwhelming. As long as everything goes smoothly, I'll get to hold my baby girl, free of monitors and just be normal. Maybe that seems silly to some, but I can't wait. 

We went home, and the girls were so happy to see us which was just icing on the cake. They were squealing and running around like crazy. I told them their baby sister was doing really well and they would get to meet her very soon. Something I didn't expect was how Isabelle reacted when I showed her the needle punctures on my belly. She became very upset, and the look on her face was devastating. Her feelings of empathy for me, and baby sister overwhelmed her and she did not really know how to handle it. We reassured her that Mommy was okay, and baby sister was okay too. I told her that it was just sore like a boo-boo, and she eventually was okay. She kissed my belly, and gave me a giant hug. Her kind heart, deep feelings, and sweetness never cease to amaze me. 

Today I've been on bed rest, with minimal activity. I'm very sore on the right side of my belly where the needles went in, I've been battling a headache, and I'm just overall exhausted. But the girls have been great, Aaron's been amazing, and our close friends and family have been lovely. The love and support I've felt over the past few days has lifted me up when I was feeling down, held me there when I wanted to fall, and helped me get through a challenging time. I'm so grateful for you all. Thank you for being so wonderful.

One more infusion. One more week. We can't wait to meet her!!!!!

 

Updates! Double Treatments, FBS & C-Sections-- Oh My!

I've been meaning to write this post for a few weeks now, but we have been so busy!!  Since I last updated you all, we've been on all sorts of summer adventures including the beach, carnivals, pool days, zoo fun, and lots of outside play time at the park. I've never been this pregnant in the summer, so these adventures are a lot more exhausting than I expected them to be.  My waddle is in full force, and my Mom's pool and all places with air conditioning are my best friends.  Props to all you Mommas who have experienced your third trimester in the Summer.  It's definitely easier to be full-on pregnant in the Winter, in my opinion.

 

We also had a small sprinkle with close friends and family, and their generosity and excitement for our little girl really touched our hearts. Sometimes with your 3rd baby, it can feel like people aren't as excited for your family, or kind of forget that you even are pregnant.  We are equally excited for this baby girl as we have been for our first two, so it was really nice to celebrate her pending arrival with others who are just as excited for us. Something that hit me harder than I thought it would was the absence of my Grandma. She loved my girls so much, and would have loved that I was having another girl.  Not having her at the gender reveal to cry tears of joy that it was a girl, or at our sprinkle to share in our excitement was something that I had to quietly deal with.  It just breaks my heart that this little girl in my belly will never know the unconditional love of my Grandma. I know she is looking down, happy as can be for us, bragging to all her friends up there... and I can take comfort in that.  She is and always will be our girls' guardian angel.

Well, after finally adjusting to my single dose IVIG treatments and feeling as though my side effects were low, and finally feeling like we were in a good rhythm, they DOUBLED them. YAY (that's a sarcastic YAY)!!! This is a different plan from my pregnancy with Mackenzie, but since her platelet counts were so low with single dose IVIG, the thinking is that doubling the dose of IVIG will hopefully protect this baby's platelets more effectively. The fact is, they don't know if it will work, and in fact they still don't know why the single dose didn't work for Mackenzie's platelet count.  So, it's kind of just, let's try this and see what happens, which is super scary.  As long as it prevents brain/belly bleeds it is considered by all a success, so while high platelet counts are great, no bleeds is the ultimate goal!

The double treatments were a pain in the butt to get approved, and still weren't approved the Friday before my first Sunday infusion. The home-infusion center I work with was having a really hard time getting confirmation from the doctor assigned to my case.  The doctor listed on the orders was not my doctor, so after lots of back and forth between everyone I had to call my doctor, and she took care of it for us.  Then we ran into another issue because the pharmacist from the home-infusion company told me that I couldn't have both bags of IVIG in one day, which was in direct conflict with what my doctor had told me.  I was told to try it in one day and see how I felt and if I could not handle it, they would split it into 2 days.  So the run-around of phone calls began again, until finally they agreed to send me both bags of my medicine with a stern warning from the pharmacist that I could have severe side effects, including a fluid overload which could cause thrombocytopenia.  So, that was comforting.

 

The actual infusion itself is really long, anywhere from 10-12 hours depending on the vein used. We really love our nurse, so while the length of the infusion is annoying she is so sweet and fun to be around so that makes things better. For my first double infusion she got the girls a bubble machine to pass some of the time, and the girls LOVED it.  She is always willing to go outside, or play with the girls or clean up their messes and I'm so grateful for her.  It has been increasingly more difficult to get a good vein at this point after over 20 infusions. My veins are flattening out, changing shape, and rolling away.  The past few infusions I was stuck multiple times, usually the 3rd time being the charm. By the time we find a good, plump vein it's usually in an uncomfortable spot that kinks a lot, or hurts throughout the infusion.  I just suck it up and try my best not to complain because there isn't usually another option and we need to get the infusion started.  I've also had my IV/vein blown out accidentally (thanks Aaron!), or they start to leak and then my IV needs to be changed in the middle of an infusion also. I only have 2 more infusions, so here's to hoping my veins will cooperate. 

 The side effects have me back at square one, where I pretty much feel like crap from Sunday-Wednesday.  My headaches are barely manageable during the 24 hours following the infusion, and try to linger for multiple days.  I'm getting flu-like symptoms for at least a day, sometimes two and all of this is in addition to the normal aches and pains of being 8.5 months pregnant. Even with all of that I still really enjoy being pregnant.  It will never, ever get old to feel life moving inside of you. It's such an amazing thing to experience.

I know I've said it before, but I really try my best not to let it affect my life as much as I can.  I try my best not to complain, I still go outside, go to the pool, and play monsters and hide and seek with my girls.  They understand that Mommy's medicine for the baby makes me feel sick, and they are so sweet about it-- especially Izzie. She is always telling me "It's okay Mommy... you're okay," accompanied by lots of cuddles and kisses.  And thank God for Aaron, because he makes sure the girls are quiet so I can rest or plays with them when I just can't.  He is the best Daddy, and husband and I definitely could not make it through all of this without him. But when I'm feeling exhausted, or sick I also feel guilty for not being the best I can be for the girls, and even more guilty that I may be upsetting them because I'm different than normal Mommy. So for the most part, I just push through because I don't want to miss out on making memories with them, and I don't want them to feel that I don't want to play with them.

 

So up next for us is our Fetal Blood Sampling this Friday. It's the same procedure that I had with Mackenzie to check her platelet count, and it was literally the worst experience of my life.  I ended up having extreme back labor contractions throughout the procedure, and it brought on real labor and then a placenta abruption, followed by an emergency C-section for which I was knocked out. So to say that I'm anxious for this time around is an extreme understatement. We are taking some extra precautions this time around, including an epidural for me in case I start contracting again. I am also getting steroid shots beforehand to help mature baby girl's lungs.  I'll be observed and monitored closely after the procedure with an option to stay the night just to be safe.  During the procedure, my doctor will insert a very long needle into the baby's main vein that runs through the liver, and extract a blood sample. The sample will literally be run over to the lab and the platelet results will be ready pretty much instantly.  During the platelet reading, the needle will stay in my stomach, in the baby's vein and matched platelets will be on hand to infuse in case her platelet count is low. If her platelet count is normal, then I continue with home IVIG treatments until my planned C-section in 2 weeks.  If the platelets are low, I will reschedule a C-section for within 1 week because that's about how long the matched platelets would last in baby girl's blood after an infusion.  Whatever the outcome of the sampling is, we are just praying that our baby girl is born healthy, with NO BLEEDS, however/whenever that happens.

As always, we feel so blessed to have so many people supporting our family, and following our journey.  We appreciate all the thoughts, well wishes, and prayers that are said for us. Thank you all from the bottom of our hearts. I will try to update the blog again after our procedure on Friday.