a little down time

Virginia and I are enjoying a little R+R in Maryland this week.  Last week was our final week with our Nanny and Virginia does not start daycare until next Monday so we decided to take a week to regroup and prepare for avoid all of the upcoming change.  

Its really hard to believe that this photo was from our first day with Sarah and Lilah from last Summer.

And this is a photo from our last day with them last Thursday.  These little nuggets have grown so much and learned so much from eachother and Sarah has been the most nurturing and creative caregiver.  It was quite sad to see this chapter end, but we are so thankful for the great year that we had.

Our trip to Maryland hasn't all been R+R:

Virginia screamed the whole length of the New Jersey turnpike on our way down.

Every other word out of her mouth is "no".

She has dumped all of the water out of the dog bowls twice. 

She has refused naps.

She ran away from me at the mall, clearing the nordstrom shoe section along the way.  

But all that is forgotten when we play outside in jammies and have tea parties with miniature stuffed animals.  This gal is quite sassy and funny.

scale

I have always had a hard time depicting just how small Virginia was, but lately I have had a hard time remembering it myself.  "Impossibly small" is what comes to mind.   Much of this post is just a reminder for me.  A reminder of how far she has come.  A reminder that so much is possible.  A reminder that every ounce of heartbreak and worry is rewarded ten fold in our joyful little girl.  

I didn't have the foresight to put anything next to her for scale in those early days.  I remember being utterly shocked by her size but even more amazed that she was so tiny, but so perfect.  Every detail was there - just so tiny.  

 Her blood pressure cuff was smaller than a standard size bandaid.

 My wedding ring fit over her ankle.

The first time I held Virginia her head nestled between my breasts and he feet touched just above my belly button.

Her diaper was smaller than a playing card.

That lamb is a beanie baby (!)

At 2 months old she fit in her tiny stocking.

At 2 months old they swaddled our "warm baby" in a pillow case folded in half

10 weeks old being held "like a baby" for the first time.

 feeling "huge" to us at 11 weeks.

scenes around toddler town

We have been busy playing hard, laughing harder, and smiling bigger. 

 Just soaking up all that summer and toddlerdom has to offer!  

love

Intuition is power

With all of the talk about viability and  end of life decisions, I can't help but continue to return to intuition.  As I have said before, we had a long time to prepare for Virginia's early birth.  We had the time to research and the time to ask the "right" questions.  We had the time to pour through the statistics.  We received some really harsh and unsympathetic counseling and some really caring and factual counseling as well.  In the end every decision was our decision and our hearts and our intuition played a key role in making those informed decisions.

At the risk of sounding more than a little hokey, there was a lot of intuition and luck that saved our child.  It is something that is often undervalued in the obstetrics and neonatal world.  It is something that many first time mothers and first time parents brush to the side because they don't want to seem foolish.  I believe in all things good medicine - preventative care, the best specialists, vaccinations & medications, but I also believe in trusting my gut, knowing my body, and acknowledging that "feeling."

My intuition is what alerted my doctors that my pregnancy and my baby were in great danger.  There was no bleeding, no discharge, and no time-able contractions, but there were a few braxton hicks contractions and a feeling that something may not be right.  Sure, I could have walked away from the ultrasound feeling foolish and like an alarmist but instead we realized that I was silently and painlessly dilating at 21 weeks.

Counseling, research and intuition is what we relied upon when talking about resuscitation.  At 22 weeks the neonatologists asked us to choose the gestation for resuscitation.  That statement grossly oversimplifies the conversations which included options for comfort care, survival and disability statistics,  and delivery & resuscitation scenarios.   We chose a date based on that information and our own intuition.  I knew my due date was off by as many as 4 days in the bad direction.  I knew we had to take this into consideration.  We would later find out that at 650 grams, Virginia was most likely born at 24weeks 3days or so rather than the 25weeks 0days on her official stats.  In the micropreemie world hours can make a difference.  A half of a week is like changing the book.

5 days prior to delivery (at 24 weeks 2 days officially and 23 weeks 5 days in my head) I was transferred to labor and delivery because delivery seemed immanent.  At that time we consented to the c-section and asked for resuscitation using all medical options.  We did not even entertain the idea of letting her "declare" herself in the delivery room.  That decision was not made just with intuition alone but with knowledge of the potential outcomes, the confidence in our doctors, and the faith that we were making the right decision.   Upon delivery she was blue, she did not cry, and she had no drive to breathe, but she was kicking.   Her neonatologist that day gave us the statistics for her survival if she made it through the first 24 hours and then again if she made it through the first 72 hours.  After day three he was quite frank with me.  He said bluntly "I was not very impressed with your daughter at delivery, but she has been pretty impressive since then."  I immediately understood and was both relieved that she had crossed some majorly scary days and that we also did not let her "declare" herself in her first moments.

None of this is to say that intuition is everything.  I've followed my gut and have been wrong, but I have never regretted it.  The only regrets I have had on this journey have been the times that I didn't trust my instinct and that I didn't speak up for myself or for Virginia.

If I could amend my letter to doctors, nurses, sonographers, anesthesiologists, therapists, etc  I would plead with them to not only appease it but also encourage their patients to trust their gut and to listen to that "feeling."  Intuition can be a powerful thing.  Knowledge is power, but it is not derived from statistics alone.

mom confessions

Mom confessions volume 5 (or is it 6... 1st confession- Im too lazy to go back and check).  I apologize in advance, these ones are all over the place.  Kinda like my head these days.

I am SO sick of my kid throwing food.  I know that there are some additional  things I can do to work on this but those things are just as annoying as the food throwing. 

I bought fold over ruffle socks to disguise V's SMOs for those days that I just don't feel like inviting questions or looks.  

I need a date night with my Husband.  It's been at least 4 or 5 months.  

I haven't been to a movie theater in 2 years or a gym in 2 months... thank god for netflix and bootcamp.

Im not ready for summer to end and am scared of the cabin fever that will take over our house this winter.

I am terrified of Ginny going into daycare - biggest fears are her getting RSV or pneumonia and her biting other kids.

I love watching what people pin on pinterest more that I like looking for stuff to pin.   Same reason that I don't hide oversharers on facebook.  

Suprisingly I have SO much more patience with Virginia on the days that I am home with her all day than the few hours that I see her on work days.  

Best Best Best part of my day is the "MAMA!" I get when I walk through the door at night.  It totally makes up for the crocodile tears that I still get every morning.  

Lastly, who needs to go to the zoo when you have a petco down the street?

Transabdominal Cerclage Q & A

Lately there has been alot of traffic to the blog and questions here (and in real life) regarding the transabdominal cerclage.   Im going to host a little Q & A below to answer the most commonly asked questions.

Prior posts on my TAC experience can be found here and here.

How did you find out about the TAC?

During Bedrest with Virginia.   I had a lot of time to do a lot of research and happened upon it when researching rescue cerclages.  No one was willing to give me a cerclage with Virginia given the late gestation and complete effacement.

Why not go for a TVC (transvaginal cerclage)?

Personally, I just feel that the stakes are too high.  I had rapid cervical changes, major funneling, and aside from some sporadic braxton hicks contractions I had NO idea that anything was happening.  I feel the TAC gives me the best chance to carry to term and the best chance to avoid bedrest.

Who did your procedure?

Dr. George Davis in New Jersey.  He performs hundreds of these each year and placed 9 other TACs the week I had my surgery.  http://www.abbyloopers.org/ is the best resource for looking for other providers and general info regarding the TAC.

Did they operate through your prior incision?

Nope :(   My c-section incision was too low. 

What type of anesthesia did you have?

I was intubated and under general anesthesia.  My understanding is that spinal anesthesia is only used for patients getting their TAC during pregnancy

How was recovery?

I had the open (not laproscopic) TAC and recovery went really well  considering that it was an open abdominal procedure.  I had minimal bleeding and really the focus of my recovery was resting my abdominal muscles.  I was was driving after 10 days, I was able to pick up Virginia towards the end of week 2 and I was up to full workouts by week 5-6 and back to ab exercises 2-3 weeks after that.  

Can you feel the TAC?

Nope.  Early in my recovery I had some twinge like pain that I assume was at or near the TAC but nothing since then.

Will you need IVF for a future pregnancy?

I have actually even been asked this by 2 physicians ... yikes!  No, the TAC is tight enough to prevent dilation but it is not locked and sealed ;)  My doctor indicated there is some evidence of fertility issues in some women after the procedure but it is relatively uncommon.  

Could you still deliver prematurely?

Yes.  I don't plan to though :)  According to Dr. Davis, this procedure essentially takes the cervix out of the picture.  It is a so called "cure" for cervical incompetence.  What it doesn't prevent though is preterm labor or any of the other possible reasons for a premature birth.  We feel confident that we have eliminated my largest risk factor.  I will be followed very closely and cautiously for preterm labor, especially considering that I had a classical (vertical) c-section which increases the risk for uterine rupture.  

Will you have to have another c-section?

Yes, but I would need one anyways due to my previous classical incision.  The TAC stays in place and is not intended to be removed.

Any other questions?  Feel free to comment and Ill answer them there :)