The process has begun

Today at 4pm we went to the hospital for my first pill. The aim of this pill is to remove the placenta from the uterus, which takes two nights and one day.

We were shown our hospital room - I made a few pictures but haven't found out yet how to post these with my new blogger app on my phone. It just looks like a small hotel room with a queen size bed (a wooden frame!), a lazy granny chair and an ensuite bathroom with shower.

We spent the compulsory hour after taking the pill in our room, and as I was fine when the hour was over we went home again. I can expect symptoms ranging from nothing at all to cramping to severe abdominal pain, in which case I have to return to the hospital of course. Up to this point I'm just hungry all the time!

Kickstarting labour

This is how the next couple of days will look like:

• Tomorrow evening we'll go to the hospital here in Nelson, where I get the first of a series of pills. I have to stay there for 1 hour, so that they can check that there are no side-effects, as this pill apparently can make you feel sick.
  
• If everything goes well, then after that hour we can go home again, where we'll spend the night and the following day, doing nothing much.
• Then on Friday morning 8am we're expected back in the hospital, with a bag. I'll get an internal exam, and another dose of this hormone mixture (?), but now vaginally applied. Over the course of the morning I'll get a couple more pills to be taken orally, 4x the dose of the first one.
• At the same time contractions should begin and if everything goes well then early Friday afternoon the delivery side of things should be over. It might happen that the placenta doesn't want to come out, if that's the case they need to remove it surgically.
• We can stay at the hospital for as long as we like. If things drag on until the evening we can stay for the night, but most people opt to go home as soon as possible.
  
• We'll be there with the three of us: DH, myself and our midwife. Specialists are around in case there are complications. Pain relief is available, as much as I like as there is no baby to take into account.
  
• There is a separate area in the maternity ward for 'people like us', a bit like a hotel room with double bed, bit of a living area.
• I was really not looking forward to this part, but now that I know what I can expect I am starting to get quite curious actually.
  

Get your tissues out for the next part:

• do we want to hold the baby after delivery? Take pictures? We'll decide in the moment I think, that's fairly unthinkable at the moment.
• Then in Wton they want to research the baby and the placenta to find out the cause for all of this - why was the placenta not functioning? We'd like to know that too. So after the delivery everything will be sent off.
• We are required by law to register the baby and bury/cremate him, as he is over 20 weeks old. Another hurdle to get through at some stage. This freaked us out a bit as we don't want to make it bigger than it is really. But now we sort of have to. Then I found out that you can choose your own private place and bury the baby yourself without doing it through a funeral service with coffee and cake, which made this prospect a lot nicer. This is not our first priority, so more about that when the time is ripe.
  

My god, hear what we are talking about, it's sometimes ridiculous and we do laugh between the tissue moments too! It's not all drama.

The baby died

This morning the midwife came by for a routine visit, and after measuring blood pressure etc. she tried to find baby's heartbeat but was unable to locate it. Could have been nothing, but as baby's movements in the last two weeks were very few and sporadic, we all thought that this could be the end of it.

She arranged a scan for this afternoon, and as DH was in Wton for work I went with DH's mom. It became immediately clear that there was no movement or heartbeat and that baby was gone. Baby passing away is quite the shock as this is the end of the road we took almost 7 months ago, but it came not totally unexpected at the same time, and it possibly saves us from a truckload of trouble and very difficult decisions, so there's also quite some relief.

DH is arranging flights to get back from Wton tonight, so that we can have a conversation tomorrow with our midwife on the next steps, which will be labour and delivery to get the baby out. That'll be quite a painful process I imagine, literally and emotionally. Luckily that'll happen here in Nelson at the hospital, no need to go to Wton anymore. After that we'll start with a clean slate, and hopefully take that holiday we were planning to take as I think we could use it.

Still a mixed bag

Sorry for the delay in reporting the results of our scan yesterday, but I had some technical blog problems...

So we went to Wton for yet another scan and came back with mixed results. On a positive note baby has grown, especially his tummy this time. He has now an estimated weight of about 340 grams; he put on 80 grams in the last two weeks. And he is still alive.

But all this growth doesn't change the situation that he is way too small and that he's having a hard time in there. His organs can start deteriorating any time now if they haven't already, as he is conserving energy for his brains which can cause damage to his kidneys and liver to start with.

There is nothing that can be done at this stage, so we'll wait and see for another two weeks. If he then is close to 500 grams they'd like to get him out, although that is still open for discussion as the lead obstetrician doesn't think he'll survive the next two weeks, and if he does then he'll very likely won't survive after delivery.

So we''ll be back in Wellington in a fortnight, with a bag this time in case we decide to take the baby out if he's close to 500 grams. And that will be done through c-section, because there is no way they'll let these fragile babies go through the stress of labour and delivery. But it could also be that we then wait and see for another week, or two.

Nothing to report

We know, we have been quiet over the past week... But that's because we have visitors, work, and gorgeous weather to keep us entertained. Although it's actually drizzling now. Very good for the garden, as October was the driest October month ever. As you can see, nothing to report...

Check-up

Our midwife swung by yesterday for a catch-up and a check-up. Blood pressure was good (no white coat syndrome this time) and no protein in urine. Also the sample that had been sent to the lab 2 weeks ago was clear of protein too.

Pfew.

Again I was totally convinced that baby had died in utero as I hadn't felt him move for a day and just only now and then the day before. But the midwife found the heartbeat straight away, still a feisty 150bpm. And last night and this morning he was really wild, having a jolly good time keeping me awake.

Doing the maths

Folks who follow our other blog may remember a little incident with DH's kidneys when we were applying for our resident's visa a while ago. We had to undergo some medical check-ups and one of the things they checked was our urine.
Well, DH's results at the time came back abnormal, he was suffering from 'kidney failure', we were told by the Dr. That was the strangest thing ever: DH wasn't aware at all that he had troubles with his kidneys, the whole family got stressed, and besides that these results brought our stay in NZ in jeopardy.
These things always happen in the festive season, so in the middle of the X-mas holidays while we had friends staying with us he had to collect his urine in a huge container, can't remember if it was for 48 hours or a whole week :-)

Anyway, we got his results on a sheet of paper and as we are good with numbers and formulas (DH) and quite good at finding evidence from research on all sorts of things (me), combining these lovely skills you'll get us questioning medical results. In the case of DH's 'kidney failure' we found out that some moron had made a mistake with the very complicated formula and that DH never could have had these results. Only from the age of 86 years would it be possible. So no kidney failure for DH!

Now I'm going to translate this to our pregnancy - no miracle stories, I'm sorry, but still....
Again we found a mistake in the latest scan measurements, which has consequences for the use of the formula to estimate baby's weight, and which means the difference between showing a total standstill in growth or some growth, which in turn may mean the difference between actively interfering in the pregnancy or applying a 'wait and see' policy.

Interesting is some research into the formulas they use to estimate baby's weight. There are numerous formulas in use, and they all result in a different outcome. The perfect formula hasn't been found yet. We checked a few of those formulas with the measurements from our scans, taking the error out, and the most pessimistic formula tells us that baby is currently weighing 240 grams, and the one we like most is the formula saying that baby is 320 grams. The one they used at the hospital and has the measurement error in it says baby currently weighs 200 grams.

Estimating baby's weight is interesting, but also prone to inaccuracy as those formulas are based on average babies at the end of a normal pregnancy, so what we also did was plotting all our scan results thus far on fetal growth percentile charts. That makes visible whether there has been growth at all, and how baby is doing compared to the general average. See below for a chart related to the diameter of baby's head.

What we achieve with this? Hmm, not much really, but we feel a lot better informed, the picture is a bit less gloomy than it was, and it emphasised our decision to 'wait and see'. You never know.
And our midwife will slam the hospital around the ears because of the measurement error :-)

What the error was? Inaccurate use of cm's instead of mm's. Which made the circumference of the head 17.3 mm instead of 173 mm and thus a lot smaller than the diameter of the head, which was 50mm. And that is impossible.