1st Weekly Appointment

Today was our first weekly appointment since finding out about baby Hawke's lack of growth last week. All week long I had been worried about the possibilities of what could potentially happen, and was letting my mind run wild- which is never a good thing. Surprisingly the week  went by fast and it was Thursday again and I was ready to check on our boy. 

I went into this appointment with an idea of what to expect: weekly appointments including new measurements, BPP's and NST's. And at the slightest indication that he wasn't growing, I would be whisked off to deliver him. I had this crazy idea in my mind of us not having time to go back home to get anything, being admitted right away, Hawkins being born before I could fully understand what was even happening, and a whole emergency scene you'd see in a movie. For a week that's exactly what was in my head. 

As a result of that... I was majorly nesting. I organized and cleaned out the most random of things. The laundry room being one of them. As well as our closet with clothes to donate, Harlow's closet to mark, store in bins and organize, as well as gather keepsakes, that over the course of her first year, had accumulated in many different spots in her room. 

Because Hawkins' room hasn't been started yet, I went ahead and organized all of his things in Harlow's closet as well, that way things are washed, folded and organized in a proper spot if he should happen to come anyday now. 

Needless to say, for one week, my mind and body was thinking Hawkins would have an awful appointment today and I would be in the hospital delivering him as we speak. 

Because of that, it's no surprise on the car ride down to UAB this afternoon, I was incredibly nauseous. Which turned into sweaty palms, and me turning up the a/c. Which then lead to my heart beating fast and eventual tears which seemed to flood up out of nowhere. What in the world was happening to me? Why was I in the middle of a panic attack while driving to a normal appointment in which case I would see my baby and see how he was doing? 

When I'm in a moment like that, scene after scene pops into my head like different versions of a horrible movie. In one scene, I'm alone in the ultrasound room with Harlow and they see he has fallen below the 5th percentile and they have me call Adam to come down there because they need to deliver him via c-section immediately. The next scene is us standing in the nicu, unable to hold our little boy while he fights to hang on to life. The next scene is Hawkins not making it and I'm looking at Adam saying how are we suppose to get through this again? 

I had to stop myself there because I was going too far. Why was I driving to my appointment, and these are the things that pop into my head? 

Sometimes, I feel like I have it all together, and even when I don't, I can pretend really well. And others... It's an embarrassingly emotional meltdown robed in a frantic panic. 

This didn't stop in the car... Even when Adam took a break from work to talk me off the ledge of my breakdown while driving down to my appointment. This carried on into the doctors office. 

I go through the motions of check in- the usual pee in a cup, blood pressure and weight check. The numbers catch my eye... Was I reading this correctly?? It was saying I lost 4 pounds since my visit 1 week earlier. 

Now, as I've posted before, I kept seeing the same range of numbers throughout my entire pregnancy. It wasn't until last appointment I finally convinced someone to take me seriously and look at my chart to tell me how my weight gain was. In which case it revealed my weight was exactly the same as my first prenatal visit. Only I was 31 weeks. Sure enough, Hawkins was having a growth issue, which we wouldn't have caught (at least this early) if I hadn't pushed for someone to look into my lack of weight gain. Now, here I am a week later and I'm weighing 4 pounds less than last week?!? 

Cue: anxiety. 

If Hawke is already measuring 5 weeks behind and here I am losing 4 whole pounds, what could this be meaning for him?! I couldn't wait to see the doctor and ask, and more importantly, get an ultrasound and measure my little guy! 

The doctor walks in. And it's someone I've never met before. A younger, middle eastern woman who introduces herself and says she's a fellow. 

Okay. There it is. A fellow. I'm all for medical students learning and doing their fellowship and getting hands on experience. But when I've just been told 1 week earlier, that my baby has IUGR, I've gotten 2 rounds of steroids, don't know exactly what to expect, and had a nervous breakdown in the car, I'm not really looking for a fellow to walk in and act like they know everything they're talking about. 

It also didn't sit well with me when she was giving me the standard treatment:

"Any fluid leaking? Any cramping or contractions?"

I tell her no and her response is, "okay great, so everything's going good."

Uhh... Have you even read my chart? I had a panic attack on the dang car ride over here, I've already cried once today, and you're going to give me the standard treatment like everything is going 'normally' in my pregnancy? 

I decide to look past it, and ask about my weight being 4 pounds less... Which wasn't a good idea, considering it showed me even more how she had no clue what she was talking about. She really tried to give me the 'every pregnancy is different... You'll probably gain it all here in these last weeks' line. She expanded and went even further into her 'figuring out' my lack of weight gain.

"What was your pre pregnancy weight?"

Well, I guess exactly what I weighed at last appointment... Harlow was 8 months old when we conceived, I hadn't lost all my baby weight and I don't pay attention to the scale. So my pre pregnancy weight was what was recorded at my first prenatal appointment... Which was exactly what I weighed last week, giving me a 0 weight gain. 

"Okay... Well... What was your weight... With her?" And she points to Harlow.

Well, I got pregnant with her 6 weeks after I had my daughter Lyla... So I'm not sure what that 'pre pregnancy weight' would be. 

"Oh, the one with the issues?" 

Alright. This chick has officially lost me. Really... Referring to my daughter who passed away as the one with the issues? Right then I stopped her quest of heroically figuring out the mystery to my lack of weight gain and shut down the entire conversation. She was about ready to walk out the door as she said, 'okay we'll see you in a week', when feeling mad, emotional, and confised I stopped her.

I felt pressed for time and like I needed to hurry and think of all the things I wanted to ask because my appointment was about to be over. I asked if during the BPP test/ultrasound, if they would be measuring him. I've been worried and wanted to know if he's grown any, especially after seeing that I lost 4 pounds. That's when she told me no, they wouldn't measure again for 3 weeks. 

Feeling fragile and frustrated with this 'fellow' already, I was on the verge of tears and asked if Dr. Davis was there and that I'd like to speak with him and sent her out of the room. 

I started sobbing the minute the door closed behind her. 

Dr. Davis came in and felt so bad. He explained to me that with the error of ultrasound, that comparing measurements between last appointment and this appointment, just 1 week's time,  it would be impossible to accurately measure and draw any conclusions from it. They want to wait another week, and will measure him again at the appointment next Thursday and compare them from there to see if he's had any progress or not. In the meantime, the major thing is doing the BPP's to make sure he is happy and feeling good and not experiencing any distress. Obviously it sound better when Dr. Davis explains it.

Words can't begin to describe how much I love this doctor. He is so genuine and sincere. The look on his face when he talks about Hawke, is the same look that he had talking about Lyla, when we were scared and first sent to UAB to figure out what was wrong with her. I feel okay and safe when he's keeping an eye on things. I didn't see him much during Harlow's pregnancy- thankfully because his expertise wasn't needed. So it's been both difficult and comforting, to be seeing him again regarding Hawkins.

Some of the similarities feel strange to me. Sort of a déjà vu, but also very different. Between Lyla's small abdomen and Hawke's small abdomen. Delivering her at 32 weeks and being 32 weeks with him now. Her positioning in my belly and his- I delivered her bottom first, and he's in that exact position now. It's both comforting- thinking about her and being taken back to that time with her- as well as painfully difficult. I'd like to think some of that is all contributing to this anxiety I have regarding Hawkins and his health. I know what can happen. And I've heard a lot of these things and have had a lot of these questions before. Walking such a similar, yet so different path, can be emotionally hard. 

We ended the appointment with the BPP test/ultrasound... Which went great! The techs have to wait and watch the baby to do all of their 'tricks' for the test and it can sometimes last up to 30 min just waiting for them to do everything. Hawkins did them all within like 3 minutes! Our boy is little, but a fighter nontheless. Just like all of our babies :) 

For the next week, we just sit and wait. 

Little Hawke

Mothers intuition is always right. I'm finding this concept to be more and more true as I become a mother time and time again. When I was pregnant with Lyla, I had a feeling something was off or wrong but never shared it with anyone. So when we went for her anatomy scan at 20 weeks and found out her abdomen was measuring ridiculously small and they didn't know what to make of it, I wasn't shocked. My worst nightmare had come true. I knew something was wrong, and there it was. Heartbreaking still, despite having had a feeling. 

My pregnancy with Harlow was as perfect as it could be and was a pretty boring and uneventful pregnancy- which I welcomed with open arms. Although I had some anxiety throughout my pregnancy, purely fear based, I knew at the end of the day, everything was going to be okay and she was going to get here healthy and safe. Heck, I knew she was a girl and her name would be Harlow after my first ultrasound at 6 weeks with her :)!

Getting pregnant with our 3rd, made me more anxious than before and I had no idea why. Why would I be anxious, when we've already had a successful and healthy pregnancy following the passing of our first born? Shouldn't that have given me the confidence I needed to know that not every baby I had was going to die? Wasn't she our 'rainbow', giving us hope for the future? 

I couldn't tell in the beginning, if my anxiety and fear that something was 'off' or 'wrong' was really just guilt manifesting. I was so busy and preoccupied with my sweet, high needs 8 month old, that I really hadn't had the time to dedicate my full attention to him. And yes, once again, I knew it was a him :). I felt like something was going to be wrong this time. I couldn't have 2 healthy living babies in a row could I? That would be too good to be true. Despite trying to take the time to focus just on him, I pushed my feelings to the side and kept on being a mom to Harlow. 

While I was pregnant with her, I knew she was going to be okay, so I declined any and all testing and decided to just watch her via ultrasound and depend on that to tell me if something would be cause for alarm. This 3rd time around, I opted for all the testing without a second thought. The 1st trimester screening, the 2 blood tests, the NT scan, you name it, I did it. I wanted to know. 

When discussing my feelings with Adam regarding why I suddenly wanted all the testing, I told him I didn't know if it was just guilt for not giving him too much thought or this nagging feeling I had that something was wrong. But I really wanted to do it. After all, the worst that could happen would be that we would know sooner if something was amiss. We had to wait all the way until 20 weeks to discover our little Lyla was sick. At least with this testing we'd have an idea if anything was remotely wrong and we could begin focusing on him and our time with him- just as we were blessed to do with Lyla. Adam said okay, whatever would make me feel better, and he was okay with us doing the testing this time around. 

Every appointment, ultrasound, and test result that came back was normal. Although I was thrilled and so happy to know for sure that he was healthy, I couldn't help but beat myself up over the fact that I really thought something was wrong. I had officially lost it and my anxiety that had creeped its way into my life with Harlow's arrival- my constant need to make sure she's safe- had started to take over my life and now the life of this precious boy that was completely healthy. I really needed to get a handle on things. 

Flash forward to yesterday morning. It's a regular checkup that I had been looking forward to after being in California for nearly 3 weeks seeing all my family and friends. I had already been put on appointments every two weeks and it had been 3 weeks since my previous one. I was ready to see my boy! Which we have officially named: Hawkins Soren Epperson. 

I had been having some gnarly cramping and pains off and on for about a month and although I had asked before  about them, I got the usual response of it being typical during pregnancy. Along with asking those questions, I asked my doctor about my weight gain. I was now 31 weeks and 2 days and I felt like I kept seeing the same range of numbers on the scale at every appointment. I'm not one to weigh myself. Ever. It's just not something I pay attention to. I try my best to eat healthy and judge any 'weight gain' by how my clothes fit. I choose to not watch numbers on the scale. During pregnancy however, it's imperative. I had no idea what my starting weight was exactly or if I had gained anything, but I felt like I kept seeing the same thing at every appointment. I had asked about my weight gain at a previous appointment but we had moved onto talking about something else before she could go into the computer and look at my log of weight checks. So I never got that question answered. 

Here we are, about a month later and I decide to ask her again. She tells me she believes it's fine (my fundus height is measuring normal), and that I will probably start gaining weight now that I'm in my 3rd trimester. She informs me I'll most likely get an ultrasound at the next appointment or the one following that- one month from now. Before she leaves, I ask one more time for her to please check the numbers for me because I'd really like to know. I know I'm probably bugging her about my weight but I'm honestly worried and concerned and have been feeling like something is wrong. She goes ahead and leaves the room to check for me so she can ease my mind. 

When she comes back, she lowers her head and says, "well.... Your weight has fluctuated a little bit, but you weigh exactly as much as you did when you first came in for your first prenatal visit... I'm going to order an ultrasound so we can check on his growth." There it was. I knew it. I knew something was wrong and it was about to be confirmed. Why was I having to be the one to monitor my weight gain, I'm not sure, but I knew I needed to be persistent until someone looked into it. I had gained 0 pounds this pregnancy and I was 31 weeks and 2 days. 

Worried, but relieved I was getting his measurements checked, I walked to the ultrasound room. While she was doing the ultrasound, the tech wasn't telling me anything, but I could watch on the bottom corner of the screen how much each thing was measuring, so it was nice that I could track for myself what I was seeing. The first thing she measured was his leg (femur) and it was measuring about 1 week behind. Okay, not bad at all and totally common. She moves to his head and that is measuring 1 week behind as well. Again, not too bad and pretty common. I began to think again about how this anxiety is starting to get the best of me and I need to just relax and trust that he is okay. She moved the wand around and found his abdominal cavity.... Which was measuring 5 weeks behind. Did I see that correctly? Over a month behind? I knew it. I knew something was not going to be measuring on track. She kept her eye on his abdomen for awhile and explained that she was trying to see signs of practice breaths and his diaphragm moving- which he was not able to do. 

She put the calculations into the computer and I waited with the gel still on my belly while feeding Harlow some graham crackers in her stroller. She left the room and when the door opened again it was dr Davis. He sat down and said , "well, this little guy is measuring small. His head circumference and femur seem to be behind, but nothing too alarming. However his abdomen is extremely small, being 5 weeks behind. That is cause for concern." He paused a bit. And then continued, "I don't know why he is growing like this... But it seems to me like a case of IUGR and most likely an insufficient placenta that isn't delivering all the nutrients like it should  be." 

There I was, flashing back to this same moment just 2.5 years before. We were sent to UAB for the target ultrasound where dr Davis, the head MFM doctor at UAB sat down with us to discuss her abnormally small abdomen. He talked about IUGR with us regarding her condition as well, because her abdomen was measuring significantly smaller than the rest of her body... Just like I was now hearing about Hawkins. I started to feel a little sick, and couldn't believe I was having this same conversation. 

He doesn't have a chromosomal condition or any other markers... His heartbeat and heart in general are great, he passed all testing in the beginning and the rest if his body is small, but growing together. It's just his abdomen that is measuring extremely small.

Before Lyla's amnio confirmed triploidy, I researched a lot about IUGR and hoped and prayed that that's what it would turn out to be. So I had an idea of what was going on and what we were dealing with, and it most certainly wasn't an issue of being incompatible with life, like Lyla's diagnosis. 

Because he showed no signs of breathing or trying to take practice breaths, they hooked me up to monitors to do a NST and check on a few other things. After 20 minutes of being very creative with entertaining a 15 month old with monitors attached to me, it was over and I waited in the waiting room to call Adam. 

There, dr Davis caught up with me and we went over the diagnosis and what this means so far right now. 

Hawkins is diagnosed with IUGR (intrauterine growth restriction). This diagnosis comes from his measurements and his very small sized abdomen, which is typical of babies with IUGR. During the ultrasound, a BPP (biophysical profile) was also performed and tested him in many areas, like breathing, amniotic fluid levels, tone and responsiveness. He was very responsive for being 31 weeks and reacted well to stimuli, so that's a good sign. However he was not breathing and amniotic fluid was low. 

I asked dr Davis what the plan was, now that we know he is an IUGR baby and is extremely small...Measuring just 2pounds and 10ounces. He said the plan is to wait and watch him. I will now have an appointment every week, with an ultrasound everytime for measurements and BPP tests. If he doesn't pass the BPP's they will also add in some NST's as well. If he continues to grow, they will keep him in the womb, as it is still the safest place for him. However, if he stops growing all together, or falls even more behind, they will want to deliver him as soon as possible, as he will fair better outside the womb at that point. Right now, he is in the 6th percentile. If he falls behind even just a little bit, it will put him at the 5th percentile or lower, which would cause them to want to deliver him. Because of the possibility of him coming soon/early, they gave me a steroid shot to help develop his lungs so he can try to make some breathing motions. 

We went back this morning for the follow up BPP and he passed! That steroid shot seemed to work :) I got an additional steroid shot before we left the hospital this morning as well. 

It looks like our Little Hawke is already a fighter and may be making his appearance early, and will be very small. IUGR babies tend to stay smaller than their peers for quite some time, but eventually they do end up catching up! 

So here we have a waiting game and lots of hoping, praying and monitoring to see what he does. We are praying he continues to grow and will stay inside as long as possible to give him the best chance outside the womb. However the doctors are trying to prepare him for delivery if they have to.