This morning, after breakfast and all the fun blood sugar tests, etc, one of my favorite nurses (whose c-section is scheduled about a week before my cerclage removal) began the monitoring. Maya goes on. No problem. Bobby goes on. The monitor is flashing 70s. Low 70s. Mid 70s. Sometimes we get the 140s. Rarely the surge up to 170s. Mostly 70s. Now, sometimes the monitor flashes 70s and I can clearly count 140s-150s. The monitor isnt equipped to deal with abnormal HBs; it can only pick up what it hears, so sometimes it misses a lighter sound or, God forbid, it gets confused by hiccups. Always a fun time. But this morning, I couldnt hear a light beat. Just a slow, 70s HB. My nurse heard it too. We were both silent and then she said "This is different." I said "Yes; I"m not sure if it is good or bad." "Neither am I", she said as she pushed the nurse call button and asked the desk to send the CRNP in. She came and listened for a bit before getting the ultrasound machine. Sure enough, put him on and he's in the 130s-140s when they timed him (they still have to do it by hand for an average since the u/s machine gives you detailed stats when you select a specific range but not a long term range). But on the monitor he does NOT sound that way. So, the Resident, Dr K, is called in. She listens and she, too, cannot pick up a missing beat, yet she sees the beats on the u/s. So she calls Dr Bailey and Dr R, the MFM who is on for today (and incidentally is the BOSS; she is the Dept Head for all the hospitals in this network). They ask her to perform a BioPhysical Profile (BPP).
As you may remember, Bobby had a BPP performed last week. At this age, he is eligible for 8 points. There are 4 categories: amniotic fluid, tone, movement, and breathing. (At 28w, the twins are eligible for 10 points with a 5th category, the NST which will look for reactivity). Each category scores 2 points or 0 points. At this point, 8 is normal; 6 is okay; 4 and below are abnormal. Babies that score well typically have a positive 7 day outlook. Last week, Bobby scored an 8. So, today starts and the doctor comments that his amniotic fluid looked good and he was moving a lot, so 4 points right away. Then he starts moving his hands and sucking his thumb and flexing his legs; 2 more points for tone. And then the waiting. Because of his movements and placement, it took her forever (it seemed like) to get a good view of his diaphram, but finally, 2 points for breathing. Thank God. He scored 8/8 again. So, she said that this was good news and she would let the doctors know. That the HB charting in the 70s wasnt good (if it was indeed that low- even she admitted the machine could be wrong since his irregular beats could be throwing it off) but that, on u/s, he looked fine. That she would call Dr B and Dr R and pass on the results, but that Dr R wanted to come and talk to me later in the day.
I spent the morning in tears. I was on the monitor for almost 2 hours as they decided what to do (i.e. from the start of the monitor to the doc coming in to my doc and MFM being called and everyone deciding what to do). All I could hear was a slow HB and I kept thinking: Is this it? Is this how my son dies and I cant do a damn thing to stop it? You have to understand, it sounded bad. I mean, I can deal with seeing a 7o when I can count a 140bpm. I realize the machine is dumb and isnt a person. But seeing a 70 and counting a 70. It makes your stomach churn. Then, seeing him on ultrasound and seeing his heart beating irregularly but at a normal rate. It's a low then high then low then high pattern. Up, down, up, down. Which way??? As I lay in bed, listening, crying, all I could say, over and over again, was "I give this to you, Lord." I couldnt breathe and I was terrified and this was the only thought that came out of my head. I couldnt pray. I couldnt do anything. Except those words. And while I still cried, I started to feel both babies moving, as though they were saying, "Mommy, we are okay." The HBs were charting the same, Maya in the 150s and Bobby still sounding/looking like 70s, but they were moving and okay.
I felt better after the BPP because he scored so well and he looked fine. And so then, it was just waiting. At around 4:30, Dr R came in. I'd been told that she was blunt and straight forward, and to prepare myself. But that is what I prefer. Dont sugar coat it; I want the truth. I read and am well aware of how bad things can go; the last thing I need is someone trying to placate me.
So, she begins by telling me what a low heartrate in a baby shows. Anyone who has read up on bradycardia knows that a low heartrate isnt good, but there is something about an expert telling you that it means oxygen depravation that sends chills down your spine. But after we finish the primer on low fetal heartrate, she says, "but we know that isnt your baby's problem." Because they see movement and his BPP was excellent, because they know his cord isnt compressed, because he has hiccups (often) and is his breathing looks good, this isnt why his heartrate is showing low. It could be a machine malfunction due to the arrythymia or the machine could be halfcounting without showing a sign of that. Today, because no one could hear the added beat and it sounded like 70s, she said that the u/s was a better interpretation and that showed a normal heartbeat with an abnormal rythym- no different than before. She then did her own ultrasound and, amazing of all amazing, saw nothing. His heart was beating normally. Yes, the arrythymia was still there, but no surging, just a normal heartbeat with an irregular pattern. She even went so far as to say that the babies looked so similar she had a hard time telling them apart! (I told her to find the penis and she'd have no problem telling them apart, LOL). She said that, at this point, in her expert opinion, we are stable and that the moment that changes and he shows distress, they will deliver. That she feels they can catch whatever might come up because we are being monitored so frequently.
It was a relief. And then, tonight, while the monitor showed 70s, the nurse, Peter, and I all counted 140s-150s. He had the hiccups, which made the monitoring a fun time as well (and made counting a little challenge!) but overall, his HB stayed in the 140s-150s. It was so reassuring. And, of course, the movement. They are practicing their acrobats right now.
So, it's been a long day. I am so tired. Every day it seems is full of being pulled this way and that. One day of good monitoring followed by bad monitoring. It's just so hard sometimes. I tell myself nine and half more weeks (not even!) and then they will be here full term, safe, healthy... I just have to stay focused on that. I know I will miss feeling them inside terribly, but I will be grateful for the lack of worrying about monitors and nurses in here several times an hour sometimes and pokes and prods and wondering if there is fetal distress. That stuff, I wont miss one single bit.
Thanks for those prayers. They are keeping these two safe in the womb and giving their mama gray hair. But, after all, dark hair with a few streaks is pretty darn chic...