I have been hesitating to publish pregnancy updates lately because all in all, this fourth baby has caused me very few issues (unlike his brothers!), and I didn’t really want to bore anyone with posts about random pregnancy things that most everyone deals with. But a few weeks ago, things changed up a little bit, and now here we are at 32 weeks, and I’m about to go be admitted to the hospital because of complications.
It all started around 28 weeks, when most women will have their Glucose Tolerance Test to check them for gestational diabetes. Though I have suffered through the test in previous pregnancies, this time I flat out refused to do it, knowing that the only outcome would be me vomiting copiously all over myself and the floor because I am just physically unable to tolerate that amount of liquid glucose in such a short time. My doctor graciously understood and told me that we would simply track my blood sugars for a little while and go from there.
Of course, within the first few days, it was evident that my sugars were too high. My doctor put me on a daily dose of Metformin to try and help it out, but after another several days (and a serious bout of digestive distress!), my sugars were still too high. I was also having some really bad lows, which were even more concerning. My doctor opted to have me take the Metformin twice a day instead of putting my on insulin (thankfully!) because she was worried about creating further lows. But once again, after a week on the double dose, my levels were still too high, and the medication was upped to three times a day.
I’ve been on a higher dose of the Metformin now for a couple of weeks, and my sugars still aren’t really being controlled, even with diet and medication. I’ve seen an Endocrinologist for help, but right now, there is still concern. My doctor’s most recent communication is that if my sugars don’t improve before next week, she’s going to have to put me on insulin at meal time. This is a scary idea to me, but I keep thinking that whatever is best for the baby is okay by me.
She also has me coming in once a week for 2 liters of IV fluids to help me stay hydrated and to help me eat more, as my weight was not going up AT ALL and occasionally goes way down. Since I was overweight to start, this wasn’t concerning to me, but she felt that getting some fluids in me might help me to eat more at home and put on some pounds.
Up until this week, the diabetes has been the only really worrying part of this pregnancy. I had expected a lot more drama based on my issues in previous pregnancies, but thankfully nothing really major has been happening. But because of the diabetes, my doctor had decided to book me in for twice-weekly non-stress tests as well as weekly ultrasounds (on top of weekly IV fluids). Tuesday was my first NST. They hooked me up to the monitors to watch baby’s movements and heart rate. They are looking for a base heart rate and then accelerations of 15 BPM for at least 15 seconds. They want this to happen twice (at least) in 20 minutes. They will keep you on the monitors for up to 45 minutes to get it, though.
If they don’t get what they want, they start doing “interventions,” which basically involve pushing, prodding, and jiggling your belly, as well as using a sort of buzzer or other devices to try and freak the baby out and get him to move. Sometimes they make you eat or drink to try and excite him. If none of this works, it’s considered a “failed” NST. They refer to it as a “Non-Reactive NST.”
This is what happened to me during my very first NST.
“Never fear!” My intrepid nurse was on it. “I’m going to talk to your doctor and see what she wants to do.”
It turned out that a failed NST leads directly to a Biophysical Profile (BPP), which is basically an ultrasound where they have a checklist of things they need to see the baby do within 30 minutes.
For reference, my second son, Daniel, was born through emergency induction several weeks early due to failed BPPs, so I have some experience with the seriousness of these tests.
As luck would have it, they were able to get me in immediately so we did the BPP right away. Unfortunately, even with more interventions and trying every trick in the book, baby’s heartbeat was still decelerating more than accelerating, and he wasn’t moving very much. His fluid levels were okay (which is good as I was hooked up to an IV during the whole process!), but the only movements were very small finger curls and not much else.
After about twenty minutes, I played some 80s music to my belly, which got him dancing quite a bit, and we were able to check that off. But he still wasn’t breathing or hiccuping, which was needed to check off his diaphragm movements. After 30 minutes, the tech declared he’d failed the BPP.
My heart sank.
So… they decided I would have to go back in 24 hours for another NST and BPP, just to make sure it wasn’t a fluke. My nurse just kept saying, “I’m sure he will pass tomorrow,” and reminded me to eat and drink well before coming in.
The next morning, two days ago, I went in again, this time bringing the husband along with me. He’s my good luck charm and always has the luck of the devil, and I figured with him there, there’d be no way we would fail. But after nearly 40 minutes on the monitors, our baby boy had failed his second NST. It was slightly better than the first, in that he’d had a couple times where his heart had accelerated by ten beats for ten seconds, but it didn’t meet the standard “15 by 15” they were needing.
Off we marched for our second Biophysical Profile, and I was generally pretty hopeful and positive. In fact, this time around, he was moving a little more, and he had one small bout of moving his diaphragm, but it was only for a second, and it needed to be a full 30 seconds to count. This time, they proclaimed that the BPP was “borderline.” I guess that is better than an outright failure, right?
Given my only experience with two failed BPPs resulted in Daniel’s immediate emergency induction, I was on edge waiting for them to decide what to do. Fortunately, there was a Maternal Fetal Medicine specialist on hand who made the decision to try one more time, this time 48 hours later – today.
This morning, I got up and headed in for an early appointment. My usual nurse wasn’t administering the NST, and instead a younger nurse was taking charge. She got the leads on me and immediately started reassuring me how good he was looking on the monitors. She said his baseline heart-rate was 145 bpm, and she used one of the buzzers a little too excitedly and got his heart rate to raise to 160 for the requisite 15 seconds. She kept telling me that he was passing, and when 20 minutes was almost up, she went out to grab my usual nurse and let her know that things were going great.
When my normal nurse came in, she was so excited for me, but I was a little nervous since what the first nurse was telling me wasn’t tallying with what I was seeing on the monitors. Sure enough, when my nurse looked more closely, she revealed that the acceleration hadn’t counted because the original baseline heart rate had changed to 150 before that stimulation, and therefore he still hadn’t met the criteria. She tried the stim again, but baby boy just wasn’t moving or cooperating. Time was up, and the NST was once again declared “non-reactive.”
I guess I should have been more disappointed, but I had kind of expected it, and I was still hopeful that he’d pass the BPP.
We went into the ultrasound room, and I hopped up for another exhausting round of trying to get him cooperating. But it was a full 20 minutes before we could even get the slightest movements from him. By the 30 minute limit, he’d barely hit his movements and still hadn’t done his breathing, and once again he had failed.
I knew that this would probably mean I’d be headed for the hospital. My nurse called up my doctor, who went to meet with the Maternal Fetal Medicine team, and I sat in the waiting room for around 45 minutes waiting for the result. Eventually the nurse came out to tell me that they were still waiting on confirmation but that the plan as of now would be for me to go home and wait for a phone call. At that point, I’d be heading in to the hospital for 2 -3 days. They want to give me steroid injections to mature baby boy’s lungs in anticipation of a possible early birth, and then they would have to monitor my blood sugars (steroids can screw that all up) and keep doing NSTs and ultrasounds to make sure baby was doing okay.
And that’s where I’m at right now. We’re all just waiting for the call to come through, and then we’ll head in to the hospital. I asked if I should pack a bag for the baby, but my nurse told me not to do it quite yet. So I’m taking that as a good sign. But really, they don’t give you the steroid injections unless they think there’s a decent chance you may deliver within the next 7 days, so… who knows?
For now, we’re keeping positive and trying to be brave. I know things will be okay, even if he has to come early. But I’m keeping legs and fingers crossed that he stays inside. All good wishes and prayers are appreciated.