No Baby Today

This morning Boston had flipped and was head down! Yay! So no baby today, but we are scheduled to go in for an induction on Monday night, meaning that he will likely have a birthday of Tuesday, February 3, 2009!

More Than A Feeling...

The new song on the playlist is Boston's "More than a feeling." I decided to not put it on the playlist until we were close to delivery...and it looks like we are. This song is on my "Greatest Hits" list (although Boston's name is unrelated to my interest in the band). As Boston has gotten bigger and bigger and his movements stronger and stronger, I have come to realize that soon he will be "more than a feeling." We are about to meet our little man - and I am so excited.

Tomorrow morning we need prayers -- I have my regular NST at 8:30 and then at 9:00 we are going to be facing some decisions. On Monday during my office visit it was discovered that Boston had flipped from his previous head down position to a head up/face up breech position. He has so much fluid to move around in that it allows him to turn when most babies would not be able to. At 9:00 tomorrow I have what Lynn called a "position check." If he is still in breech, then Lynn said that we will "talk." This "talk" will focus on the decision of whether to try and turn him manually into a head-down position and then most likely induce right then. I'm not sure what my options will be if he is head down or if he refuses to turn. I know that if I go into labor while he is breech then I will almost definitely have to have a c-section. The risks of cord prolapse are even higher when the baby is in breech and most doctors just don't try vaginal breech delivery any more -- the risks are just to high.

We will try to update as fast as we can tomorrow -- but be expecting some news :)

Caden's Cubs for Clark

We were blessed by the Carlson family with the opportunity to take Clark to create a special Build-a-Bear in anticipation of Boston’s birth. The Carlson’s set up this project called “Caden’s Cubs” to honor their son Caden who was stillborn last summer. To read more about the project, check out the January 5, 2009 entry on their blog, http://thecarlsoncrew.blogspot.com/2009/01/special-announcement.html

Clark, Brian and I had a great time on Saturday building his bear. Clark and I had previously done a “scouting mission” just the two of us earlier in the week when it was less busy in order to make sure Clark had the necessary time to pick out what he wanted. I took each bear, dog, cat, turtle and other animal off the shelf and handed it to him. He shook his head almost every time, rejecting them one by one. I knew we had found his bear when he reached out excitedly and said “Heart, Heart.” He had chosen “Champ,” a champion fur kids. It was fitting, because part of the purchase of Champ goes towards the Bear Hugs Foundation which makes grants to causes that support children’s health.

Clark next picked out a sound for Champ. He decided on the “Roaaar.”

Clark’s favorite part was watching Champ get stuffed and getting to put the heart inside. He had hearts in both fists and wanted Mom and Dad to kiss them before they went inside.

Dad helped pick out some cool clothes and sneakers.

Because the store was so crowded (it was Saturday afternoon), we took Clark to get a pretzel and dress Champ where it was quieter.

Since we have brought Champ home, Clark has gone to Champ’s house several times to get him out, give him a kiss, and then put him back. It was great to have this special time to spend with Clark, in what will probably be our last family outing before Boston’s arrival. Our family is about to be changed forever and it was wonderful to have this memory to share. Thanks to the Carlson family for allowing us to honor Caden and Boston in this special way.

Waiting PATIENTLY

I have been waiting, but not patiently, for Boston to be born. In Latin, the root word of patience "pati" means “to suffer.” The Greek word “hupomone,” which is often translated as “patience” in the New Testament, means “cheerful or hopeful endurance.” That is my aim for the rest of this pregnancy. As I wrote in the November 13 entry, Dr. Blowey wants Boston to stay in utero as long as possible because my kidneys keep him healthy and allow him to grow without putting any strain on his little body. If there is not a significant medical reason for him to come, then just we should wait on him. I didn’t realize at the time how tempting an elective induction would be. With his size and all of his extra fluid, I am SO uncomfortable. Noticeably uncomfortable. Uncomfortable to the point of pain and tears.

I read in Ecclesiastes 7:8 today that “Finishing is better than starting; patience is better than pride.” It made me realize that as much as I am eager to start Boston’s life, it is better to finish this pregnancy with a strong and valiant spirit, with “cheerful and hopeful endurance.” Many verses in the Old Testament talk about waiting patiently. Psalm 40:1 says “I waited patiently for the Lord to help me and he turned to me and heard my cry.” Psalm 27:14 says “Wait patiently for the Lord. Be brave and courageous. Yes, wait patiently for the Lord.”

This is definitely an area where prayer would be appreciated. I want to be filled with the calm and peaceful assurance that God has determined all the days of Boston’s life, including the day he is to born. In the first chapter of Colossians, Paul is outlining all the prayers that he has for the church in Colossae. He closes that section of the chapter with this message: “We also pray that you will be strengthened with all his glorious power so you will have all the endurance and patience you need. May you be filled with joy, always thanking the Father.” That is my prayer: that I will be strengthened with all of God’s glorious power so I will have all the endurance and patience I need.

Volunteering/How Can You Help?

We have received several inquiries and offers of help and because we want and appreciate the offers and will need your help, I wanted to provide more information about what we need and when.

This whole pregnancy has been filled with unexpected events and as much as we have tried to plan ahead of time, there are still many things that are uncertain. The traditional, typical needs of a family with a new baby will not be our needs; we will not be the family at home with a healthy baby, although we hope that someday we can get to that point. I will provide as much information as we have now, with the understanding that we will update the info as it comes available and as our needs change.

What we know we can use:
· Gas cards – we will have to make trips back and forth to St. Luke’s and Children’s Mercy several times a day and the gas will add up.

· Non-perishable food and snacks - for at least the first week we will be in the NICU, so easily portable food that we can take with us will be appreciated. Things like Progresso Soup, dried fruit and nuts, packets of instant oatmeal, etc. would be appreciated. Also, apparently Children’s Mercy has one of the best cafeterias around, so money for a hot meal there would also be appreciated.

· Frozen casseroles/dinners – we are not sure when we will be at home, but are planning on spending one meal a day (probably dinner) at home as a family. Food that can go from freezer to oven would be appreciated. We even bought a full-size freezer to put in our garage for this very purpose.

· Clark care/play dates - Brian’s parents are going to try and come up for at least part of that first week to stay with Clark, but if we have to be in the hospital for longer than a week then we could use some help in watching Clark so Brian can be at the hospital too. Also, even if we get to come home, it is likely that Boston will be more susceptible to infection and thus not able to have a lot of visitors or leave the house. I am sure Clark will not like being cooped up and so play dates would be appreciated.

· Rides to the hospital – this is a “we hope not” request, but if Sarah has to have a c-section then she will not be able to drive for a couple of weeks. Because she wants to spend a lot of time with Boston, we would appreciate having some people to call on for rides.

· Gifts – because we don’t know when we will get to use any clothes or diapers, we are asking people to hold off on these gifts for now. I looked online for ideas and several websites suggested: books to read to baby, books and music for Mom and Dad to get through long bedside vigils, toys for the older siblings, photo frames to put by baby’s warmer in the NICU, movie tickets (for a break for Mom and Dad), gift cards to Wal-Mart and Target for necessities, etc.

· Congratulations – we plan on celebrating Boston’s birth with all of our hearts and invite you to join us. He is our little boy and we are going to shower him with love and affection from the moment he is born. Cards, emails, balloons, flowers, etc., will all be appreciated as you join us in celebrating Boston’s arrival.

· Prayer - once Boston arrives I am anticipating having an abundance of prayer request and praise reports to pass along. We will keep the blog updated with the specific prayer needs that we have and would love for you to target your prayers in kind.


A few more things:

Updates – we know that you will want to know how Boston is doing and how we are dealing with things, but we do not anticipate being able to make, take, or return many phone calls, especially since cell phones are not allowed in the NICU. We will try to update the blog regularly and will rely on you to check it if you want information. Please understand that we appreciate and acknowledge your interest, but have been told we will not likely have the time to respond personally to every call or email.

Visitors – we rely on you for support and comfort. We have been told that parents are divided on the issue of visitors in the NICU. We know the NICU has strict rules on who can visit and when and that some parents are overwhelmed by visitors. When we have a better idea of what is going on we will let you know. Also, we know that anyone who visits needs to be very healthy, so keep that in mind.

Homecoming – we are hoping that our homecoming will be as soon as possible. We were told that coming home with a new baby is cause for celebration and a time for renewed interest from others, a time for gifts and dinner, visits and help.

Paranoia – we were also advised to let people know that we may be overprotective of Boston if he has to spend much time in the hospital. In case we are cautious of other people holding him, don’t get out much, or decline to attend crowded events, please understand that we are doing so with Boston’s health in mind and hopefully it will pass as he grows in strength and health.

If you are willing to help with Clark care, rides, or meals once we get home, please email us at ihearttheprestons@gmail.com and we will contact you when we know more.

Donations and gifts can be mailed to us or dropped off at 14630 W. 85th Terrace, Lenexa, KS 66215. Please specify what you would like it to be used for, unless it is food, in which case we can figure it out on our own :).

We can't tell you how much we appreciate all of your prayer and support. It is what gets us through.

Baby Alcatraz Part 2: St. Luke's is in lockdown

Ashley Bates, the NICU coordinator at St. Luke's (who I love), called this morning to let me know that the NICU at St. Luke's is also in lock down to everyone except parents (which is stricter than Mercy). I told her that she did not have a very fun job today calling all these moms, but that I was okay because we expected that Boston would room in with me at St. Luke's and that we would be transferred to Mercy pretty quickly anyway. However, I wanted to give everyone a heads up in case Boston has to be in the NICU and not with me in my room.

The waiting is the hardest part…

Monday morning I had the whole enchilada of testing – NST, Ultrasound, and Office Visit. The NST was uneventful: I had virtually no contractions while I was hooked up, Boston slept through the whole thing, and my blood pressure was normal. All good things. Boston would get zapped with the stimulator, do what he needed to do, and then promptly fall back asleep. I told Julie, the RN, that he was taking after his dad, who is nearly impossible to rouse when he is sleeping.

I am a big fan of Tom Petty and the Heartbreakers. I bought their greatest hits when I was high school and spent many a day singing along to their lyrics. Often those songs will come to mind, as one did this morning. It’s the chorus to “The Waiting” by Tom Petty (sing it with me):

The waiting is the hardest part
Every day you see one more card
You take it on faith, you take it to the heart
The waiting is the hardest part

That pretty much sums up how I feel right now. Boston could come at any time within the next three weeks. We don't know when, and there is no way to know. I have trouble making plans beyond today because I don't know if I will be able to keep them. We just have to wait -- take it on faith and take it to the heart.

The ultrasound revealed five noteworthy things:

1) Our prayers for Boston's growth have been answered in abundance!!! Yay God!!! If he does have any sort of congenital nephrosis, his size will give him a great head start on the growth that is needed for him to reach transplant size. Right now on the ultrasound he is measuring 8 pounds 5 ounces, give or take a pound. The fact that he is somewhere between 7 and 9 pounds makes me soooo happy! Trust me, I can feel how big he is; he is definitely taking up a lot of room in there.

Because of his size, the docs think he could come any time. He is head down and in position. They have scheduled another growth scan for three weeks, if I am still pregnant then. If during that scan he measures, say, 10, 10 and a half pounds, they are going to punch his ticket and induce. This gave me at least some measure of comfort to know that there is an end date in sight, even if it is still three weeks away.

2) Boston's amniotic fluid level is high. We have been praying "that the level of his amniotic fluid will stay normal in order to allow his lungs to develop and to reassure us that he does not have complications." That prayer was answered as his level stayed normal/high normal throughout the pregnancy; however, he has moved out of the "high normal" range into the "high" range. Normal levels are between 5 and 25; Boston's is 34.11. The sonographer called it his "swimming pool." High levels of amniotic fluid occur in about 1% of pregnancies and while it is not harmful to either Boston or I, it could indicate an underlying problem, such as a congenital defect or block in his gastrointestinal tract. High levels of fluid happen because he is producing a lot of fluid, or not swallowing enough fluid, or a combination of both. The complications I have experienced so far include discomfort for me, because he and his fluid are taking up so much space and squishing everything, and uterine contractions (ouch!). High levels of fluid also indicate that labor could happen soon -- I am basically a water balloon that could pop any time. The doc told me to expect him any time and to keep extra towels in my office and car. High levels of fluid also increase my risk for an emergency c-section, if the placenta ruptures or the cord enters the birth canal before Boston's head does.

3) The doc spotted a fluid-filled cyst in front of his tailbone. Boston has gotten so big now that it is hard to see anything clearly on the ultrasound, but the doc thought she saw something in front of his tailbone. She did a thorough check to make sure that his back and spine were closed, and she was reassured that they were, but still saw the cyst. This is not something they have seen before. We discussed the possibilities of what it could be: nothing, part of his intestine that has dropped down, or a block in his rectum. This finding doesn't change our plan for labor and delivery, but we added a pelvic sonogram to the list of tests that Boston will have once he is born. He also will not be able to eat until they can rule out a block in his rectum.

4) The ventricle in his brain was still enlarged: anything over 1 cm is large and his was 1.2. Because it has been consistently just a bit over 1 cm throughout the pregnancy, we were already planning on doing an ultrasound of his head.

5) Otherwise, Boston looked great. We got to see his chubby cheeks and all the fat he has put on, his big head of hair and his hands and feet. His kidneys looked normal, but to remind everyone, that doesn't mean he doesn't have kidney problems. Boston's AFP level was 65 times too high, and 98% of babies with an AFP over 10 are born with abnormalities. That percentage increases as the level increases. From a medical article: "the difficulty in confirming congenital nephrosis before the baby is born is the lack of ultrasound findings. Although bright and slightly enlarged kidneys have been described, in most the kidneys appear normal, the amount of amniotic fluid is normal, and a large placenta, which may occur, does not appear until late in the pregnancy." Basically, what the article says is that if you have an extremely high AFP and everything else looks fine, you can't rule out congenital nephrosis until the baby is born.

These statistics encourage me to put my faith in God. They tell me that medically, logically, it is likely that Boston will not be born okay. Because the odds are against him, and his chances by the world's standards are not good, it makes me realize how important God's intervention is. We cannot do this without Him. This is too big for us; we cannot do it on our own. God will have to heal Boston.

That's the nice thing about waiting -- it gives you more time to pray :)

Tour de NICU

This week I met with the neonatologists from St. Luke’s and Children’s Mercy, on Tuesday and Wednesday, respectively, . I also got to tour the Neonatal Intensive Care Units (NICUs) and talk with the coordinators about the NICU experience, visitation, etc. It was very informative and not as altogether unpleasant as I had been expecting.

St. Luke’s: I met with John Callenbach from the neonatology department and he outlined Boston’s initial plan of care. Because we do not anticipate any problems with delivery, he said I should be able to deliver in a normal room, as opposed to an operating room where there would need to be ventilators, more staff, etc. Once Boston is born, he will be immediately admitted to the NICU, although this is more of a paperwork thing than a location thing. Provided there are no imminent threats to his health, he should be able to “room in,” i.e., stay with me, any time he is not having tests done.

Pierson Syndrome is virtually impossible to diagnosis in the first couple of days because Boston’s kidneys won’t have kicked in yet and a lot of his numbers will reflect my physiology and not his. It also means that if he does have the syndrome, we are hoping to get to spend a couple of days with him before he gets seriously sick.

In the first couple of days, Dr. Callenbach anticipates monitoring his blood and urine for protein, doing an eye exam and an ultrasound of his head and watching his growth, eating patterns, and for any sign of swelling.

We do not plan on being at St. Luke’s for more than a couple of days. I hope that Boston can stay there until I am discharged from the hospital, which will be after 48 hours, or 96 hours if I have to have a C-section.

The visitation policy at St. Luke’s is extremely lenient on the mother-baby side and provided everything is going okay, the first couple of days will also be prime visitor time for those of you who want to meet Boston because once he is at Children’s Mercy, it is pretty much Baby Alcatraz and only two people can be by Boston’s side at a time and that includes parents, so if Brian and I are both there, no one else can be (more on Baby Alcatraz below).

Children’s Mercy: After our first couple of days at St. Luke’s, Boston will be transferred to Children’s Mercy for at least a week. We were hoping that if everything was going well that we would be able to go straight home from St. Luke’s with follow up at Mercy, but during my Wednesday meeting with Dr. Kilbride (neonatologist a.k.a. baby doctor) and Dr. Van de Voorde (nephrologist, a.k.a. kidney doctor), they told me that they wanted Boston to come to Mercy A.S.A.P. They said that it wasn’t safe for him to go home because even if he looked like he was absolutely perfect, he could deteriorate quickly, so it was necessary to keep him under close supervision for at least a week. They seemed kind of on-board with waiting until I got discharged from St. Luke’s, but they didn’t want a lot of testing done until he was transferred to Mercy. If he gets sent to Mercy right away, then I will have to get a day pass to go visit him there, not something I want to be doing so soon after he is born.

Once he is at Children’s Mercy, they will continue to do the same blood and urine testing and monitoring. They will also do renal function tests and likely an MRI and a test to look for other eye defects. If necessary, his treatments could include protein infusions, nutritional supplements, a drug to reduce any swelling, and antibiotics.

Our best case scenario, if he is doing absolutely perfect, is to get to go home from the hospital after a week or so. It is not uncommon for babies with mild nephrosis to stay for weeks and the more serious babies stay for months before going home, and some never go home at all.

So we are preparing for Children’s Mercy to be our “home away from home” for a while. I called it “Baby Alcatraz” because of their strict, albeit necessary, visitation policy. Only 2 visitors are allowed at the bedside, including parents, which means if I am there (and I plan to be there a lot), only one other person can be there with me. I can’t have both my parents there at the same time, and if Brian is there with me, then no one else can be there. However, I am sure I will welcome the company and be more than excited to share Boston with the world; I just want to warn everyone that this will be on a one-at-a-time basis.

The thing that upsets me the most about the visitation policy is that right now the NICU is on “Sibling Lockdown” due to flu season, which means Clark can’t visit at all. I am working through the sorrow of knowing that once Boston is admitted to Children’s Mercy and until the ban is lifted or he can go home, we will not be able to be together as a family. We will try and cram as much “family time” into the first couple of days at St. Luke’s as possible. I know that this will not be very long (if we get out in a week) but the ban may not lift until March, and if we are there long-term, then it will be very strange to not have Brian, Clark, Boston and I all together.

The NICU at Mercy is very open – the babies line the walls rather than being in their own rooms. So every few feet there is a baby with a couple of chairs in front of it. I plan on camping out in one of those chairs and becoming very well known to the staff. I can have water while I sit next to Boston, but no food. Breastfeeding moms get four meal vouchers a day to use at the cafeteria, which is directly below the NICU. They also provide “nap rooms” and showers to use during the day. Even though we are only going to be (for sure) there for about a week, I am reading about parents and the NICU, how much time to spend there, how to schedule the day, etc. I am planning on being home in the evenings with Clark from at least 5-8 pm, so we can maintain our usual schedule, and I am planning on sleeping at home, and the rest of it we will just figure out. There are no cell phones allowed in the NICU, so I will have to take regular breaks to get messages and send updates. There is a computer for parents’ use in the NICU, so I will be able to update the blog from the hospital (yay!)

I can’t wait to meet this little guy! Even though the beginning of his life will be unconventional, I feel better having a plan and knowing what to expect in the event of the unexpected. Let me know if you have questions; there is probably something I left out.

Update on NSTs

My NST this morning was not as complication-free as my previous ones have been. I was having contractions throughout the testing, although some of them were mini-contractions that Julie just called "irritability."

Boston wasn't reacting the way he should -- although he was moving around a lot, we weren't seeing the same good accelerations in his heart rate that we had seen in the past.

After 45 minutes on the monitor (as opposed to the usual 20), Julie took my results to be analyzed by Dr. Lu. This was a first, as they are usually clear cut enough for Julie to release me on her own. Dr. Lu gave me permission to leave, but asked about whether I was feeling the contractions and to be extra-vigilant about baby-movements.

The plan right now is for me to come back in for regularly scheduled testing on Thursday.

The Importance of Being Earnest

I am a go-getter, an information seeker. I like to know things for myself firsthand. As a result, I have done a lot of my own research on Boston's condition. Some may call this overkill, but for me, I feel it is necessary to make sure that I am doing everything I can to be a good mom for Boston.

I received a benefit from my overzealous pursuit of information last week when I found out that Boston's kidneys had been "bright" again on his November ultrasound, a fact that the doctor's failed to tell us. I requested copies of my ultrasound reports to send to the doctor's at Children's Mercy and as I was reviewing them, I saw that on his November ultrasound, the doctor had reported that his kidneys were large and "mildly echogeneic." Echogeneic means that there are more sound waves (echos) in that area, resulting in the area looking bright. I was shocked when I read this, because I always ask lots of questions during our ultrasounds and the impression that I got from the doctor was that everything was fine during our November ultrasound.

We have had another sonogram since then, and the ultrasound report from that sonogram reported that Boston's kidneys looked normal.

The two things I took away from this experience were:

1) We have thought that Boston's kidneys looked normal since his September sonogram; now we know that is not true: they were bright in November.

2) I need to make sure that the doctors are giving me all of the information, even if that means reviewing my chart after every visit.

Blog Updates

I have been researching ways to best notify people on blog updates, and have decided to do two things:

First, there is now a link on the right hand side called "Subscribe to Baby Boston's Marathon." This will allow you to add Baby Boston's Marathon to your homepage and see in an instant if there have been updates. I use this method to stay up-to-date on the blogs that I follow and can check all ten of them at once.

Second, for those who are interested, I am willing to send out an email notifying you that I have updated the blog. Send me an email at ihearttheprestons@gmail.com if you would like to be added to the email notification list.

If anyone has other ideas on how to notify readers about blog updates, I would love to hear them.

Thanks!

NSTs -- Non-stop testing

I went in this morning for my fifth non-stress test (NSTs). For four out of five of the tests I have been with Nurse Julie -- who is great. She asks me questions about Clark and my family and we pass the 20 minutes in relative uneventfulness. Boston has a tendency to fall asleep during these tests -- probably because I am reclining and giving him plenty of room to relax. I don't blame him -- if the tests were longer I would probably fall asleep too -- after all, it is 7:30 in the morning. For every NST except the first one we have had to use the fetal movement stimulator, which is a handheld buzzer that Julie presses against my abdomen. It is basically a baby alarm clock and gets Boston to jump and hopefully wake up and move around so we can record the necessary heart accelerations. We have not had any problems with the testing -- his heart responds effectively every time he moves; it's just the getting him to move that is the problem. Because of this, we have a tendency to go beyond the minimum 20 minutes into the 30 minute range.

This morning I also had an office visit with Lynne, the nurse practitioner. I was happy to report that I was experiencing some relief from such bad heartburn and that I had no issues to report other than the run-of-the mill pregnancy woes. She measured my abdomen and said I was right on track. She also used a portable ultrasound machine to check out Boston's position and fluid level. That was really cool. The picture on the machine was grainy, but she was able to find out essential information in just a couple of minutes, like the fact that he had plenty of fluid surrounding him and that he was almost head down, but not quite. If you painted a clock on me, with 12 at my head, he would be between 7 and 8.

I have another NST on Thursday, and two more next week, and then a growth scan on the 19th. Those are my favorite, because it is basically a 45 minute show all about Boston. I will keep everyone updated on the testing -- and hopefully there won't be too much more before Boston arrives!