Wednesday, March 09, 2016

An IUGR Pregnancy

Intrauterine Growth Restriction.

There are a lot of fancy and scary definitions out there, but let me just lay it out for you:

The baby isn't growing at a healthy pace. It's small, too small. It's not getting the nutrients it needs, it often isn't getting the oxygen or blood flow that it needs. It's restricted in all sense of the word.

I personally feel, "uncertainty," best defines an IUGR pregnancy. No one was ever sure about anything. From why growth had stalled to what to do about it.

After the diagnosis, I was very closely monitored. Twice-a-week I was sent for a biophysical profile ultrasounds and dopplers and every second week they'd add on an anatomical one. You know the long ultrasound you get at 20 weeks? Yeah, every two weeks. After each ultrasound I'd walk down the hallway to my OB's office and wait for his decision.

Let me explain. Every time we went to the hospital for these ultrasounds, we went with the knowledge that our baby could be born that day. That means twice-a-week I grabbed my hospital bag and baby's, made sure my parents were aware so they could come and pick up our toddler, M had to let work know that the baby may be coming today so he may not be in tomorrow and I had to mentally prepare myself that today could be the day this baby came into the world. Over a month early.

Twice a week.

So, I'd go through the ultrasound, beg the technician to tell me if there was any growth, anything promising whatsoever and then walk down that hallway to await the decision.

So many times I saw the struggle painted on my OB's face. The flow is looking okay, not great but okay. There's no significant growth from 72 hours ago. MCA, dopplers, cord flow - all of these were terms I had learned and terms, whose numbers that day, were determining factors in our story.

And it always ended the same way.

"Let's wait."

So we'd get back in the car, call everyone and let them know that baby was staying in a little longer (at least another 72 hours) and we'd try to calm down from the adrenaline and go home.

After taking off so many days, M couldn't make it to one appointment so my Mom came with me. I remember her asking why all this talk of induction and why they couldn't just wait and let the baby come naturally.

In all the chaos I had never thought to ask.

And that's when the OB we saw that day explained why. Because IUGR babies have a difficult time handling labour. That the rate of still birth was higher (for many reasons, from the condition not being detected, from the baby not being delivered soon enough or from stress during delivery, which is why they had decided on a c-section etc).

This new knowledge plagued me. Now I didn't know if I wanted to insist on them delivering our baby immediately or if every day we waited, maybe the baby would grow. If we could just make it to 37 weeks, outside of the "premature" time frame it could mean one less fight for our baby. But could the baby make it in there, not growing? Not thriving?

Susanne Remic said it best. "From the moment you're told your baby is not growing well, you feel a little like a ticking time bomb." 

I'd stare at the OB's face every appointment as he contemplated the facts before him. The confusion and struggle was clear as day. It wasn't until that appointment that I understood this was essentially a life or death decision. What was better, an IUGR 32-weeker or an IUGR baby left in-utero until 37 weeks, potentially not getting what it needed?

I'd ask what I could do. "Take it easy and keep eating and come in the second you feel something isn't right."

I never wanted to leave. What if I missed something that wasn't right. The kicks were never strong to begin with, I rarely felt movement. I had enough guilt that my body wasn't helping my baby to grow sufficiently that the added responsibility of being sent home for 72 hours at a time was overwhelming. 

The goal was 37 weeks. If we could just get to 37 weeks we'd be out of the premature time frame. At 36 weeks I went into labour. It was like my body just wouldn't get on the same page. Induction had been pushed off to 37 weeks but baby was having none of that, apparently.

We headed to the hospital where a nurse, unfamiliar with the situation, excitedly informed us, "you'll be having a baby tonight!" M and I tried to make the most of our first outing since the birth of Y, 15 months earlier, and tried to laugh through the craziness. 13 hours later contractions significantly slowed down and after even more ultrasounds, I was sent home and told not to go too far since delivery was imminent. 

I spent that week like the ones before. Two doctor's appointments, more BPPs and dopplers. More waiting. More worrying. 

I made Shavuos, (which happened to be a 3-day-Chag) and headed into the holiday hoping for rest, quiet and minimal drama. 

At 37 weeks 1 day, 3 hours before Shavous was over, I was on my way to the hospital.

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