Well, we’re 31 weeks along now, three-quarters of the way!, (actually a bit more as I’ve noted below), well into viability, and actually facing the realization that we might soon be holding a baby. LittleFoot is growing, as evidenced by my belly really popping in the last few weeks. And for the moment, things are in a peaceful place, though getting a bit more uncomfortable with the extra set of growing elbows and knees on my insides. And I think I yawn-peed a little the other day (yes, kegels… I know.).

Before I begin the details of this update, I’d like to take a moment to express just how amazing my team of doctors, midwife, nurses, technicians, and staff are. We are both constantly feeling very well cared for, closely watched, and like they have our back. We feel treated like real people as well as comfortable in the notion that they are figuring out the best way for all of us to bring Little Foot into the world. A serious debt of gratitude to the Stanford medical crew for their care. They have been exceptional.

On to our Risk Factor Update:

Age (40)

Yep, I rounded the big 4 – 0 since our last post. And with that came a wild party attended by everyone I know and love with lots of hugs and general debauchery. Just kidding (thanks, COVID). I spent my birthday teaching and writing a quiz for my students. Wild times. But we did get delicious bbq (which gave me heartburn but was totally worth it), and Brian lovingly indulged my one birthday necessity – a Baskin Robbins silly monster ice cream cake (mint chip ice cream and chocolate cake for those needing to know) complete with extra hot fudge sauce.

Ah, but what about the pregnancy? Right, the real point of being here. Well, I did have a brief glucose scare. I didn’t pass my first glucose screening testing for possible gestational diabetes. So I had to go back for a 3 hour fasting glucose screening – a total of 12+ hours without food but including shotgunning one disgustingly sweet beverage. Seriously, I thought Hawaiian Punch flavoring died with the 90’s. Thankfully, Brian was with me for support (and in case I got sick or passed out – I didn’t – as was forewarned about this test) and my blood tests came back normal, so I think I’m in the clear now for gestational diabetes. I’ve also since learned that my diet is not one of the primary contributing factors to this condition (thank god. I’m addicted to Whole Foods brown butter chocolate chip cookies… and vanilla ice cream… and did I mention the birthday ice cream cake?). 

Congenital Heart Anomaly

So, I might have mentioned to my OB that I’d had a couple spells of wooziness since my last visit. Not dizziness, not fainting or light-headedness, but slight wooziness… like that in between stage of a drug rise where you think you might be feeling it a tiny bit, but it definitely hasn’t hit yet (not how I actually described it to my OB). Things are just slightly off. And while I thought she had told me I might expect a few of these as my blood volume increased, apparently the nature of the context around mine – seemingly out of the blue – warranted a little bit of concern. So I spent ten days as the proud wearer of a Zio patch, a round-the-clock heart monitor (yes, I could still take showers while wearing it). We’ll see if anything scary pops up. For now, we wait because, despite being pregnant and time being a bit more of the essence, it still takes 2-3 weeks to get results through the proper channels.

Pulmonary Valve Insufficiency

My second trimester echo and ekg showed normal pregnancy related changes, and all looked good! I’m scheduled again for another one at 33 weeks. Fingers crossed for no surprises.

In the meantime, I’ve been feeling quite good cardiac-wise. Of course, I’m a bit more winded going up stairs, and I have definitely slowed down and fatigue more quickly on our hikes. I may not have mentioned our hikes before this… Hmm, well, hiking is my main source of exercise and outdoor medicine as well as one of Brian and my favorite ways of spending time together (you probably already know that). It has been for a few years now, and we’d like to keep doing it as long as possible. I really had no clue if I’d be able to continue it at this point in the pregnancy. But we are still getting out about 3 times a week for hiking in the nearby hills. And it’s felt wonderful. Lots of short stops on the uphills, more frequent water breaks, and I could mark up a map of all the quality pee spots along our trails (and some not-so-quality spots – nothing like a Little Foot bouncing on the bladder to necessitate my own marking of half the trees on our hikes), but hey, we’ll definitely do what we have to to enjoy this part of nature before a long break for birth healing and a who-knows-how-extreme fire season.

Unicornuate Uterus

I didn’t have to have my cervix sewn shut. Yay! No more trans-vaginal ultrasounds. Yay! My uterus is still stretching to accommodate LittleFoot’s growth. Yay!

I’m now getting growth ultrasounds every four weeks, and it’s so exciting! In the last one, LittleFoot was in a full pike position with her legs up over her head and was holding on to her feet. We were glowing and giggling for days over that.

Additionally, next week we begin non-stress tests to monitor Little Foot’s heart rate and movement. From what I’ve read, this involves putting a monitoring belt around me for about 30 min and watching her heart rate during rest and movement. Apparently, her heart rate is supposed to increase with movement, and if it doesn’t, that could be a sign that she is not getting enough oxygen, indicating insufficient blood flow through the placenta. This is a risk that I possess in part due to being the bearer of only one artery connecting to the uterus. In a full uterus, there are arteries connecting from both sides of the body.

In the meantime, we have been monitoring her movements at home, and she is a squirmer! I think we’ve identified a few distinct movements including, kicking, hiccups, and flip-turns of the uterin side wall.

And some of my favorite moments so far are watching Brian feel and react to her movements. “Woah!” “Was that her?!” “Does that keep you up at night?!” “That was huge!”

Birthing

Since writing you last, I have had several more people exploring my vagina than, I think, at any previous time in my life. And the conclusion they came to was that I could possibly be okay giving birth vaginally. There is nothing really preventative toward that route. But I also might not be okay. It was a gray area, as all areas seem to be. And if I ended up needing a cesarean in the middle of birthing, it would be bad news to have to do that as an emergency procedure given the possible complications that might have to be dealt with upon opening me up. But, in the end, the doctors left it as our decision as to how we wanted to construct our initial birth plan.

The long and short of it is that we have decided to go the safe route and schedule a C-birth. (A neighbor friend of ours shared that term as a way of honoring C-sections as birth, rather than just surgery, and I love it. So, we’re trying to adjust our language). Upon consulting with my OB, she decided it would be safest all around to schedule it at 37 weeks – full term but on the early end (thus, we are well more than 3/4 of the way!). This means that Little Foot’s latest possible birthday will be June 29th. Of course, Little Foot may decide to come before then. But if not, mark your calendars! June 29th will be the day!… and send some extra love to Brian who will be our birthing coach throughout the surgery and support crew post birth and while I’m healing (not that we will be alone in this… we are blessed with a wonderful support network… but he’s still the one in it 24/7 with me).

Additionally, we will be relocated closer to the hospital for the two weeks prior due to continued risk of premature labor as we near the zeroeth hour. A rather cush service offered by Stanford for those of us living far enough away from the hospital that a long, in-labor commute would be, well, unfortunate at the least. So, team Westlander is now preparing not only for all things baby and a C-birth, but also for a lovely two week family vacay in beautiful, sunny, Palo Alto, CA… possibly even at the Ronald McDonald house… stay tuned for further details.

So, I’ve been wanting to tell you so many things about the backstory of our becoming-parents journey. So many pieces partially written and not quite ready. So instead, an update on where we are and what we’re expecting (aside from, perhaps, the obvious).

The very general and bestest of all news is that Little Foot is doing great! The doctor said, “She looks gorgeous.” Pfft. We new that. But seriously, that is a direct quote after viewing her anatomy ultrasound images and finding no signs of anomalies. Yay!

We are 21+ weeks along, and she is growing per the charts and moving all around (though I can’t feel her yet… or can I? Was that her? Or was that gas?… it’s hard to tell). She is decidedly not cooperative during ultrasounds, either turning away from the wand or curling up into a ball and taking a nap. Hmm… How early do these personality traits begin?

And now, let’s check in with the risk factors so far:

Age (still 39)

Honestly, the other risk factors seem so much greater that I still don’t know the specifics of this one. I think I’m at higher risk for pre-eclampsia (I’m taking aspirin), gestational diabetes (I’m still eating dessert), and a few others. But I couldn’t tell you much about it. So let’s move on.

Congential Heart Anomaly

Good news on that front! Little Foot had a fetal heart echo a couple weeks ago, and her heart is way more normal than mine was. There were no signs of major anomalies! (always possible that minor ones come up that can’t be imaged that early)

Brian and I are honestly stunned at every piece of good news we get (we keep waiting for the other shoe to drop), and this was no exception. Also, Brian actually got to join me for this ultrasound due to it being performed at a children’s hospital (they have a 1-guest policy during COVID). If I hadn’t mentioned earlier, he is not allowed at any other appointments including ultrasounds due to COVID precautions. So it was tear-jerkingly wonderful to be able to hold his hand while we both watched Little Foot duck and weave trying to avoid the ultrasound wand.

Pulmonary Valve Insufficiency

My first trimester echo and ekg showed no changes. So we are still holding okay there. No news is good news in that department! Next appointment later this week.

Unicornuate Uterus

Additional good news in this area too! and a bit more detail… My uterus seems to be holding well so far! Due to the unicornuate uterus, we are concerned about it not being able to stretch enough to allow Little Foot all the growth and roominess a fetus tends to expect from its temporary Yotel. We are deeply concerned I will go into early or pre-term labor as my unicorn reaches its maximum stretch.

To track for warning signs of weakness in the area and potential early labor, I get to have my cervix measured via ultrasound every two weeks to check for shortening. Shortening of the cervix can be indicative of me not being able to hold her much longer without intervention. Intervention? Yes, specifically in the form of a tiny operation called a cervical cerclage… in laymen’s terms, sewing my cervix shut.

So, every two weeks from week 16 – 24, I get a transvaginal ultrasound to measure the length of my cervix. Trans-whatinal? Oh yes, you read that right. For those who don’t know what a transvaginal ultrasound is, I’ll give you a minute to sound it out slowly and Google it yourself. For those thinking, “Is that through the….???” Yes, yes it is. With a comfort level somewhere between an awkward sexual experience and a papsmear, these are no treat. But they’re not the worst, either (The cerclage itself sounds much more uncomfortable.). And so far my cervix has been holding at a healthy length. Yay! I am one more transvaginal ultrasound away from not needing to have my cervix sewn shut. Apparently, once you are far enough along – have reached viability – it is considered riskier to bring a needle and thread near your very important sac of fluid than to adopt other methods of preventing pre-term labor. So fingers crossed for continued cervical length for now!

Additionally, the blessing of having an ultrasound every two weeks is that they also do an abdominal ultrasound to check out Little Foot. So I get to see her developing much more frequently than with a low-risk pregnancy. And it’s been so fascinating. From seeing her bones fill in, to facial features developing, to her moving around and kicking. That part is a real treat!

Birthing

Not on the original list of risk factors, giving birth is a risk factor that I was unaware of being one (’cause we needed one more). Okay, yes, birthing carries risks and is risky for anyone going through it. But a few weeks ago my OB specifically mentioned that she was not yet sure how I would be giving birth, “because you’re a little bit complicated.” Huh? I thought my options were pretty limited in that area.

But she’s right. I’m a little bit complicated in structure and placement of my birth-giving and other nearby organs. I just hadn’t anticipated actually giving birth (in much the same way I hadn’t anticipated getting pregnant), so I hadn’t thought through how my own medical history played into its complications. The short of it is that, in addition to the other anomalies I listed previously, I was born with the end of my colon not connecting where it was supposed to. I had a colostomy for the first year of life until the anomaly (and later the colostomy) were repaired in 1982. But nothing repaired is structured exactly as if it had developed normally. So I’m “a little bit complicted” down there.

Meaning, giving birth vaginally, while ideal if I’m fit for it, comes with possibly higher potential for wreacking havoc on some delicate handiwork from the 80’s that I do not want havoc wreacked on. Additionally, my OB specifically commented that, “the baby might not fit.” Hmm… that whole natural birth thing is sounding more and more unappealing.

On the other hand, having a cesearean brings with it the concern that my doctor may accidentally puncture or cut through my colon (oh yipee), and so would require a colo-rectal surgeon to be on hand during the procedure in case I find myself in the unfortunate position of needing both my uterus and colon sewn back together. Not to mention whatever infection risk comes with opening one’s excrement tunnel during a c-section.

To this end, I have an appointment this week with a specialty group of doctors to further explore the mysteries of my down-there’s and what kinds of birthing are possible.

And that about sums it up for my end of things at the moment. But you must also be wondering about our other team member. What has Brian been up to through the growing of Little Foot and numerous doctors’ appts that COVID prevents us both attending? He has been almost single-handedly holding up the entire rest of our lives. He cooks (really, far more than I think he wants to), does all dishes all the time, cares for the pup (because the smell of her food is atrocious), cares for me in the most loving and encouraging way (seriously, he’s unbelievably sweet… he even cheers me on when I take a nap… which I’m taking a lot of these days), attends all my appts with me via Facetime (video call), and spends (seriously) no less than 2 hours a week on the phone with insurance companies because my medical insurance is, to put it mildly, “a little bit complicated.” This is all in addition to doing his own things and taking on some time-consuming roles in our community. So, he’s basically the behind-the-scenes hero of this story. Many cheers for my amazing partner in all things!

And our ongoing cheer for Little Foot’s journey: Go, Little Foot, go! Grow, Little Foot, grow!

Today is a day for rejoicing. Despite the craziness that ensued in our capital and Capitol last week, it was a week of good news in the Westlander household. Today, I am 13 weeks pregnant, and last week we had our first ultrasound that showed something that actually looked like a baby! 

The ultrasound took measurements that are predictors of possible chromosomal abnormalities and initial developmental anomalies. And those measurements came back at the lowest risk for said abnormalities and anomalies. Yay! 

Combine that info with blood test results (with close to 99% accuracy) we got a couple days ago revealing that we are low risk for chromosomal abnormalities (Down’s Syndrome, Trisomy 13, Trisomy 18, and a couple others), as well as the Democrats taking the senate (thank you, Georgia!), and you’ve got some serious celebrating going on here!

Dry celebrating. I had half a chocolate chip cookie and milk. And it was spectacular… especially the milk. I have been loving milk, lately.

I’ve been wanting to share about our pregnancy for weeks now, and I just hadn’t had the energy to write about it. Continued good news and seeing our little one wiggle around on the ultrasound has definitely given me a perk and the motivation to share.

But the real reason I’d like to write about this is to put out into the world our story of a high risk pregnancy. However it goes, wherever it ends, my hope is that anyone else with similar conditions might find some companionship in our journey, and that we might find some connection and comfort in sharing with you, too. 

Of course, I am starting to share on the cusp of entering my second trimester. So you already know the first trimester went mostly okay – fingers still crossed every day. But I’d like to share with you our story of fertility, or infertility, or whatever you want to call it, and actually getting pregnant. And I’d like to continue to share this journey as it evolves – all sharing subject to energy and life allowing for it, of course.

So I’ll start in the middle, with where we’re at, with what we know and what we’re facing. And we’ll go from there.

So, let’s begin with the present facts and risk factors:

1. Facts
   1. I’m pregnant. Holy f***ing s**t. We did not think that could happen.
   2. I’m 13 weeks pregnant. Still amazed every day that progress is happening.
   3. We now know (as of last week) that our little one is low risk for the major chromosomal abnormalities.
   4. The sex is female (and we’ll be using she/her until she/her has an opinion on gender)
   5. We currently refer to her as Little Foot, and I will continue to call her Little Foot in these posts.
2. Risk Factors
   1. Age: I’m 39 years old and will be 40 at the time of birth (hoping we make it that far). This puts me at increased risk for things I haven’t done much research on yet (except for the genetic ones)
   2. Congenital heart anomaly: My own heart anomaly (Tetralogy of Fallot, repaired in 1983) puts Little Foot at slightly increased risk for having a congenital heart anomaly of her own.
   3. Pulmonary valve insufficiency: I am presently in need of an artificial pulmonary valve. I was in the process of moving toward that procedure when I found out I’m pregnant. That is a story I will try to share with you soon. But for now, the procedure is on hold (it was not an emergency). However, there is a small chance I may need the procedure during the pregnancy.
   4. Unicornuate uterus: I have half a uterus – the right half. The left did not develop. This comes with a few risks of its own: early term or pre term labor due to my uterus just not being able to stretch enough, miscarriage due to lack of blood supply feeding the placenta (from my understanding, this is due to having only one artery connected to the uterus where there are normally two), and the need for a cesarean among them.

Really, it’s this last risk factor, the unicornuate uterus, that will be the one that keeps me up at night (us? probably not… Brian’s an amazing sleeper). Not currently, as Little Foot has yet to exceed 3” in size. But eventually, when I don’t know from one day to the next whether my body will continue to support her, I will probably worry. 

So, sharing this journey with you as best we can will help, I hope, with the continual practice of letting go of processes and outcomes we cannot control. 

And for today, let’s get back to rejoicing and to hoping – for Little Foot and our journey, for vaccines, for Georgia, for our nation.