Monday, December 1, 2008

Information or Misinformation?

The more monitoring these kids get, the more convinced I am that the tests are really inconclusive or quite possibly, inaccurate. I was originally scheduled only for an NST and a cervical check U/S today, so we didn't expect to see the babies. However, Apple's heart rate looked flat on the strip today. She wasn't having decelerations or anything bad like that, but she wasn't showing accelerations either.  Banana had a bunch of accelerations where his heart rate would jump up for short periods of time.  This is a sign that he is healthy and happy in my ute.

Because Apple wasn't quite as reactive, the doctor decided we'd better do a BPP (biophysical profile) to check her out. And while we were in there, the sonographer did one for Banana as well. Here's what it showed:

Miss Apple:
  • Moving around great
  • Practice breathing
  • Heart rate fine
  • Fluid looked pretty good (one pocket at 5cm)
  • Blood flow through cord okay from what I gathered (although they didn't really say)
  • Weighs about 4 pounds 7 ounces, at the 18th percentile on the growth chart
Mr. Banana:
  • Good movement
  • Practice breathing
  • Heart rate fine
  • Fluid looked good (I think I saw a 6cm measurement on the screen when she was measuring a pocket)
  • Blood flow through cord okay (again, they didn't say otherwise)
  • Weighs about 4 pounds 9 ounces, at the 25th percentile on growth chart
  • His testicles have descended!  (yes, Daddy is proud)
So if today's measurements AND last Wednesday's measurements are to be believed, Apple grew a whole pound in 5 days and Banana didn't grow at all.  Not likely.  The doctor said it is possible that Apple could have had a growth spurt and grew about half a pound in that time, but not really a whole pound.   It could be that the measurements on Wednesday were a little stingy while today's where on the generous side.  They were done by different people using different U/S machines, so it is really difficult to truly know what has happened.  It is also possible that Banana didn't grow much as they can grow in spurts and then have short periods where they don't grow much at all.  Last Wednesday the babies had a growth difference of 24% and today they are considered to not really have any difference.  So who knows what to make of any of it?  This is why they don't generally do growth scans any closer than two weeks apart.

Because Apple's BPP looked good, they aren't concerned about her non-reactive NST.  They generally look for accelerations on the NST to show that the baby's heart rate increases with activity, so it is an indication that the baby is moving around.  Healthy babies move a lot.  However, some babies move around a lot, but their heart rate stays steady and doesn't increase.  This is just fine too, but when seen only on an NST, there is no reassurance that the baby is active enough.  You can't rely on kick counts with twins because it is often difficult to tell which twin is moving.  So the BPP is a better indication.  We have another NST scheduled for Thursday and if we run into the same problem, they will do another BPP.  If that does happen, we might skip the NST's altogether and just do BPP's twice a week.  I would much rather have ultrasounds anyway instead of the NST's where I'm hooked up to the monitors.

So what does all of this mean?  As of today, they didn't see anything concerning, but who knows how accurate the measurements are.  At least they are both moving around a lot and have better fluid levels.  The OB did say if the peri wanted to delivery early based on what they are seeing now, she would question the suggestion and argue against it.  This is my main concern-that we will be pushed to make a decision based on misinformation.  It is just difficult to tell which information is good and which is not.  As of today, we are keeping everything the same unless something with me changes (less fetal movement or worse contractions).  At the next appointment on Thursday, I'll be 34 weeks, which is another milestone.

The OB said today that they may not want me to go past 36 weeks (or maybe 37) with the fluid and discordant growth issues.  December 18 is 36 weeks, so place your bets now!

As far as mom goes (meaning me, of course), everything is going well.  Blood pressure is still low and I'm not showing any signs of pre-eclampsia.  My weight gain has continued slow and steady (up about 31 or 32 pounds now).  My belly now measures 40cm.  And I haven't had much swelling.  I do have a bit of swelling in my lower abdomen which the OB said was normal.  She also commented on how little I complain, which my mom and I both thought was funny.  I told the OB she is lucky she isn't at home with me!

My stretch marks continue to itch like mad.  I've tried lotion, cocoa butter, medicated lotion and bio oil, none of which seems to do anything for the itch.  The OB told me to try hydracortisone cream or bena.dryl cream (or even oral be.nadryl), so we'll see if that does anything.  I have my doubts.  Here's my take on the scientific equation:  Skin stretching to ridiculous dimensions in short period of time + dry climate + winter + little limbs constantly poking out = many loud exclamations of "someonemakethisitchgoawayfortheloveofgod!!!!"

I also have some new pains that have popped up in the last couple of days.  The nail on my big right toe somehow seems to be bruised, although I don't remember stubbing it or hitting it on anything (which in no way means that I didn't actually stub it or hit it and just can't recall).  The more annoying pain is in a couple of fingers on my left hand.  Any type of movement that requires the fingers to bend is painful.  The OB said it is likely fluid retention in the joints and that even a tiny amount of fluid can produce pain and stiffness.  She said she would assume it is pregnancy related unless it doesn't go away after the pregnancy.  If it continues to get worse, I might have to start dictating my posts B or my mom!  (just add it to the hundreds of other things they do for me every day).  Other than that, I'm just as uncomfortable as ever and getting antsy every so often.  Still having trouble getting comfortable on the couch or in bed and still having some lovely pelvic pain every time I move.  Nothing new there.

I'm definitely carrying lower now.  Baby B was lower on the ultrasound today and one of the nurses commented on how low the babies are.  This really isn't any indication of when I'll go into labor, so it doesn't really matter.  Although I'm trying not to sit up too much because my belly rests on my thighs which is a really uncomfortable feeling.  Weird.  I'm not supposed to be sitting up anyway, but sometimes a girl's gotta cheat.

In other household news, B bought a ceiling fan/light fixture for the nursery this week and it will be installed sometime next week.  Good thing as there currently isn't a light in the room.  We continue to get other little odds and ends done for baby stuff.  The christmukah tree is officially up and decorated (with the help of my parents and B, while I sat on the couch and put hooks into ornaments).  We got a good 8 inches or so of snow over the weekend, so it really started to feel like winter.  Although it is 50 degrees today and melting quickly.  We also got a cabinet guy out last weekend to give us an estimate for doing a built in for the tv niche in the family room.  We've been wanting to do this for 2 years now (since we moved into this house), and it feels great to have that finally in the works.  It should be ready for installation the week of December 15th though, so we might need to postpone a bit depending on what these babies decide to do.

That's all for now.  We did get two U/S pictures from today, so I'll post later once we get them scanned.

Forgot to mention, my cervix measured 2.7cm today.  On Wed. the peri got two different measurements at 2.5 and 3.0, but she documented the 3.0 in my chart.  So, on paper, it has shortened a tad since Wednesday.


momofonefornow said...

Go Apple!!!

It makes me giggle that you call it a christmukah tree. That's awesome. I am betting on 35 weeks and 3 days. No real reason. I guess we'll see how it goes.

Maryanne said...

YAh!!!! WHat a great appointment!! It is so frustrating how different tests can be from one clinician to the next and one day to another-usually they are looking for trends and I say my friend the trend looks GOOD!

Kristina said...

My nurse told me that all the monitoring and all the BPPs in the world don't actually improve birth outcomes - they just increase the c-section rates. If every pregnant woman got monitored as much as you, they'd see all sorts of decels and flat periods and low movement and low fluid. Everyone would be in danger of early delivery. I think babies are just not as cooperative in there as people think. Anyway, congratulations on the good news for today - I hope they continue to thrive for at least another couple weeks :)

s.e. said...

Inconclusive results must be maddening after we are trained to rely on numbers. It seems like only good news though!

I was amazed at your video and think you have all the right in the world to complain your way through the next couple weeks. You can appreciate it all later.

And thanks for your recent comments. I truly appreciate it.

Jules said...

December 18th would be a wonderful day for the wee ones to be born. It's a week before Christmas exactly and it's my birthday! lol

Hang in there :)

Rebecca said...

I agree with all depends on who does the tests and what day it is and if they've had lunch or not...okay, that went too far, but REALLY!!!

The swelling is the worst...what about an Aveeno oatmeal bath? The water will help with the swelling and the oatmeal will/should help with the itching.

Keep up the good incubating!!!

Rhonda said...

Inconclusiveness or noncomparable visits aside, it sounds like this one was very positive. I am happy to hear that Apple is appearing to be of similar size with Banana. You sound like you are doing well, too!

i have my next appt Thurs, no U/S, but it will be nice to hear a heartbeat again!


PJ said...

Well they sound like they are chugging along!

A girl's DEFINITELY gotta cheat once and a while!

Ms. J said...

It all sounds s ocnfusing?! But we do have news that Apple is growing and gaining, so we'll take it! Whatever you've been doing, keep it up (including those feet, as best you can). It's definitely working!

How's Hubby's nesting going? I recall that he was frantically rushing around completing projects recently.

Are you still taking your baths?

Duck said...

So I know nothing about what any of this stuff means, but it does sound awfully interesting and good, they sound like they're growing well, and hopefully they stay put for a while longer...
let's see can I bet on 36weeks 1 day..

Jen said...

I go with Kristi's advice, as she's gone through all this... But my two cents, sounds like everything is going good. How big do they want the babies to be at birth? Is there a magical number?

And I've got an appointment Thursday too, Littleton office in the afternoon. Where's yours?

Amanda said...

I recently blogged about how a different u/s technician will give you completely different results. It seems like it would just be so much easier if they'd stick you with one technician throughout the pregnancy. At least it would be less stressful.

It sounds like things are going well, though! I hope both the kiddies keep up the good growing. Just a few more weeks!

Katie said...

all in all it sounds like things are going well! I'm betting you get to 36 weeks based on how things are going.

I had some house construction going on when my daughter was 6-10 weeks old....and would recommend getting any work done now, rather than later....too many stories from my house about contractors accidentally interrupting nursing sessions. ugh.

JJ said...

First, I loved watching that video! TOO cool!
Sounds like Apple is doing really well! Your kiddos are troopers, as is their mommy=)

Rebecca said...

Ummm...that sucks that it's not responding to anything...have you tried the ice packs? Always nice in December...I know, but it may help the itching a little bit.