Non-stress tests, NICUs, and neonatologists, Oh my.

Today was a long day. After dropping off Nicholas at Paula's house and Blake off at preschool, Jason and I went for another non-stress test. Like last week, I could feel the occasional kicking, but the test was still considered "not reactive". If I understand correctly, the heart rate should be going up a bit with each movement, and it wasn't. Since I was already scheduled to have an ultrasound later in the day, Dr. Brazus told me to make sure and tell them that the NST was not reactive. Dr. Brazus decided against checking me to see if I was any more dilated because she didn't want to take the chance of anything happening prematurely. Even though I am technically 35 weeks along today, because of the extra fluid I am measuring 38 cm and extra fluid can lead to premature contractions. She, like Dr. Hiett, thinks I will deliver before my scheduled delivery date of 4-14-09.

From there, Jason and I went to St. Vincent Women's Hospital for our tour of the NICU with Rosie Groves, the fetal care coordinator. The NICU is located on the 2nd and 3rd floors. There's no difference in the floors other than the 3rd floor has about twice as many beds. There can be 4 people at the bedside at a time, visitation is 24/7 with some restrictions on children. Rosie will mail me the details of that. They have lactation rooms on each floor with all the equipment I'll need to pump and freeze breast milk. They also have a family lounge with tv, computer, Wifi, fridge, showers, lockers. We went into a classroom there at the hospital to meet with Dr. BenSaad, one of the 18 or 20 neonatologists. He was very kind, very informative. During the delivery, a neonatologist, a nurse, and a respiratory therapist will be in the room with us. If the baby comes out crying, no problem. We will be able to hold the baby and spend some time with her. If she's not crying, they will give her a breathing tube. They will also (regardless of the breathing status) put a tube down into her stomach to clean it out, since she will be unable to pass or digest anything that's built up in her stomach. All this will be done in our room (assuming no complications arise). The baby will be on an IV at the beginning. After the surgery, she will have a tube feeding in addition to the IV to start trial feedings. We will be able to hold the baby as long as there's no breathing tube and in most cases, the babies don't have the breathing issues. I felt really good about all that I learned, all that I saw. Finding a balance of how much time to spend with the baby and how much time to be home with my boys will be difficult, but just knowing that I can call the nurses any time day or night and that the neonatologists check in with me daily is great peace of mind.

After leaving the NICU, we drove back to St. Vincent Carmel for our appointment with Maternal Fetal Medicine. The ultrasound was not only for a growth scan, but also because our NST was not reactive. The baby is currently measuring 4 lbs, 9 oz which is a pretty good size. Still lots of fluid--no surprise. Julie, the ultrasound tech did a great job in explaining what they look for following a non-reactive NST. There are 4 things like breathing (which is technically not breathing, but movement of the diaphram like in breathing), tone, muscle movement, and something else I can't remember. Each of the 4 things counts for 2 points and therefore, we want to score an 8. We scored a 6 because they couldn't monitor the breathing movement. With a score of 6, we have to return for another scan tomorrow at 11 a.m. If we score another 6 it could mean another follow up scan or possibly another amniocentesis to see if the lungs are fully developed. If a baby scores 2 or 4 they would most likely have the person deliver that day. Yikes. Praying for 8!