Friday, July 5, 2013

The difference of a due date

As you see from yesterday's post, days matter in the life of a micropreemie.  A year ago today, though, I still hoped for a full-term baby.  But things weren't looking good.

I was in bed rest in the hospital, and the contractions had started to return.  It was July 5, 2012.  I was 21 weeks past my last cycle, and trying to figure out how early I could have this baby and have him live.  I suddenly became very concerned about days.  There was talk about letting me go home tomorrow to do bed rest at home, if I could get the contractions back under control.  In preparation for that, the nurse came in and was going through my discharge record with me.  She said I was 21 weeks and 3 days along, due November 12.  This was as dated by the first trimester ultrasound, and every ultrasound since.  21 weeks and 3 days, due November 12.  But according to my last menstrual cycle I was 21 weeks and 5 days.

A few weeks earlier when the second trimester ultrasound had revealed the same date as my first trimester ultrasound, I'd asked them to use the later due date, November 12.  At that point all was well in my pregnancy.  I wanted my charts changed so that I wouldn't feel like inducing early. It was sort of a mental game. I hate pitocin. I had planned to have this baby via vaginal birth after a terrible experience and c-section with my second child, and I'd wanted to have the time for this baby to come drug-free and in his own time.

That was before I learned that "his own time" seemed to be far too soon.  In the past week, on bed rest fighting to stay pregnant, I'd changed my mind about the best due date for this baby.  "Could you state my due date as November 10 instead?  That's my due date by my last menstrual cycle."  And, since they were so close, just like that, I went from 21 weeks and 3 days to 21 weeks and 5 days pregnant.  Seems small, I know, but I was playing a different mental game this time.

Turns out those two days would matter.  When I went into labor a few weeks later, on July 15, I was in the 23 week range by the November 10 date, and the 22 week range by the November 12 date.  Changing the date didn't make him more viable, but it made him more likely to be considered potentially viable in the minds of doctors and nurses. And in my mind, too.  Only one doctor would have considered resuscitating a 22 weeker.  All were willing to resuscitate a 23 weeker.

Lesson Learned: If you are not yet to 24 weeks, go by the EARLIEST due date allowed. Don't switch to the later one until you're well into your last trimester.  It might not matter, but you never know.


Today, July 5, 2013 is a beautiful day. Perfect weather. I'll probably go for a run once I've had a chance to pump. There's a cool breeze and a warm sun. My sister and her friend dropped by on their way through town. We all sat out on a blanket near the lake and enjoyed sandwiches for dinner. Despite being extraordinarily tired from a long day (his post-op visit was today) Jonathan showed off his rolling skills on the blanket, and the girls got as close to the water as they possibly could without getting in trouble. They found a turtle, and Ella is sure she counted 42 ducks.  While he was a bit tired for it all, Jonathan even managed to sit up for a few seconds by himself.

Our worries today are primarily food related. "I don't get it," Steve said to me over the phone at lunch time, "He's a human, humans like to eat.  Why doesn't he like to eat?!?"

The last time Jonathan was weighed, we saw that he was starting to fall even further off the growth chart.  He's already less than 2% for his adjusted age, less than 0.1% for his actual age, and yet he doesn't seem able to get from 13 to 14 pounds -- even if we give him three months to do it.  He's not losing weight, not yet, but his rate of growth is no longer tracking with the growth curves.

So we try to feed him. Whatever he wants, whenever he wants.  He's okay with teething biscuits and oatmeal and fruit and veggies -- as long as he is feeding himself.  Problem is, he's too uncoordinated. And today, even though we gave him ample time to play with the food himself, he wanted only to stare at the spoon in his hand.  We count the ounces of breast milk.  We add extra calories through formula. We sneak food in him whenever we can via a feeding tube in his tummy, but he is still so very small.  His feet just this past month became bigger than the prints we have of his sister on the day she was born.  And then they are only barely bigger.

"Maybe he's tired. Or teething?" I suggested over the phone. It seemed possible. With our other kids, I'd just let them be. No biggy if they don't want to eat. With Jonathan it's a guessing game.  Feed him -- but if you over feed him that's really bad, he'll make you regret it -- or don't feed him until he tells you he's hungry. He'll tell us, but then maybe we've waited too long and lost precious time to sneak in extra calories.

Mostly we just sneak the calories through the g-tube.  Tonight I did that after he fell asleep.  Only two extra ounces.  But it didn't sit well, so fifteen minutes later he woke up crying.  As I sat in the rocking chair rocking him back to sleep, I watched the light on the canopy of maple leaves outside. He is little, but he is full of spirit. He is the happiest, most content child we've ever had -- and we've had some content children.  (Eleanor alone is responsible for a half a dozen more babies being born around a year after she was -- "false advertising" she was. "They don't all come this cute or this well behaved" I should have put across her chest on a onesie to protect all the unsuspecting graduate students.) Jonathan is even more easy going.  And his smile lights up a room.  His cute shy way of burying his head when you say his name -- it's endearing.  He's cute. And easily portable.

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