Happy Birthday!

We welcome with so much love and joy, Peter Vikram Sieminski

Born at 10:25pm on September 19, 2016

Weighing in at 6lbs 14ozs and 18 inches long

We’re so proud of our 36-weeker. He didn’t have to go to the NICU and is happy and healthy in the well baby nursery. So many blessings!

Nora is coming to the hospital later today to meet her brother ūüôā Here we go………

36 Weeks, Cholestasis & Induction

Yesterday I hit 36 weeks. Holy cow I feel so lucky to have made it this far.

While yesterday was a huge milestone, today is even bigger. It’s our last day hanging out with Nora before BBS arrives because…..I’m being induced tomorrow :0

A few weeks ago we scheduled my cerclage removal for tomorrow,¬†Monday, the 19th. I’ll be 36 and 2 when the stitch comes out. But my doctors were torn on when I’d actually go into labor. My OB thought I’d go that day, while my MFM thought I’d go a few days later.

We don’t need to guess anymore because they decided as a team to induce me after the cerclage is removed (assuming I don’t go into labor only own). That’s nearly 14 weeks (3 1/2 months) of bed rest for BBS and I. Wow!

You might be wondering why they’d induce after I’ve¬†come this far. Late last week it was confirmed that I developed¬†cholestasis of pregnancy. ¬†About 10 days ago my entire body started itching like crazy. At first it was mainly my hands and feet, but then it spread everywhere. 4 benadryls + an ambien couldn’t make me fall asleep through the itching. It was horrible.¬†I called my OB’s night nurse and told her my symptoms. The next day my doctor sent me for lab work to test my liver function and bile acid. The results came in confirming the condition, UGH. Below is a quick overview of what Cholestasis is.

According to What to Expect:

Cholestasis is a liver disorder that most often occurs late in pregnancy, typically during the third trimester. While it ¬†occurs in just one to two pregnancies in 1,000, it can cause complications in your newborn ‚ÄĒ which is why it‚Äôs important to recognize the symptoms and talk to your doctor if you think it might be affecting you. Fortunately, early diagnosis and active management by your doctor can help ensure you and your baby have a safe and healthy pregnancy and delivery.

A quick biology lesson: Bile, excreted by the liver and stored in the gallbladder, helps your body break down fats into fatty acids that your intestines can absorb. Cholestasis is a condition that slows down the normal flow of bile into the gallbladder, causing a buildup of bile acids in the liver ‚ÄĒ which in turn spills into the bloodstream, causing intense itching. Possible causes include:

Hormonal changes that occur during pregnancy (especially in the third trimester): Extra estrogen can increase cholesterol levels in bile and decrease gallbladder contractions.

Gestational diabetes: This disease is often associated with a higher risk of cholestasis.

Genetic disposition: If an immediate family member has had cholestasis during pregnancy, be sure to tell your doctor.

Gallstones: A collection of small stone masses in the gallbladder caused by imbalances of bile (pregnant women are also more at risk of gallstones due to increased estrogen levels) can also be the cause.

With regular prenatal care and monitoring, your baby will likely not be affected during pregnancy and after delivery. Studies have found little increased risk to babies when their mothers have only mild cholestasis and low amounts of bile acids. However, in cases when maternal bile acids are higher, cholestasis can increase baby’s risk of a low birth weight, a slightly lower¬†Apgar score, lung immaturity and¬†preterm delivery¬†‚ÄĒ which is why early diagnosis and treatment are so important. In extremely rare cases, stillbirth is a risk, though it may be prevented if¬†labor is induced¬†before week 38.

I can’t believe I’ve managed to add more goddamn¬†lemons to my pile. But there you have it. Because this condition can put BBS at risk, we’re opting to induce at 36 and 2. In a perfect world, we’d wait until 37, but BBS’s non stress tests have been a mixed bag. So we’re choosing to be safe than sorry.

So this is it my friends. I thank you from the bottom of my heart for all of your love and support on this journey. Please send your continued good vibes my way – pray for an uncomplicated delivery and that BBS makes his debut healthy and happy.

I’ll post more once he’s born. But please be patient with me. Even though I’m being induced, he might not arrive until Tuesday. And even then, we’re going to want some family time to process this whole journey. If BBS goes to the NICU I expect that we’ll be quite busy with that – but I’ll do my best to post updates here for you all.

With all my love and thanks!

I heart how Maisey’s lurking in the corner of this pic. Haha

And on the 53rd Day…

I went home.

After 7 1/2 weeks on hospital bedrest, I’m heading home. BBS is still safe ‘n sound in utero. So my doctors are letting me take this party back to my own bed. I’ll still be on strict bed rest at home, but at least I’ll be home.

I’m so happy that I’ll get to see Nora on a daily basis. She only came to visit me on the weekends because I felt it was important for her to maintain her routine and have stability during the week. I wanted her to go to the park and run around outside everyday, not come to the hospital and sit couped up in my room. The upside to all this craziness is that Paul and Nora have enjoyed an incredibly special two months together. Their bond has been cemented and then covered with tar for good measure! And, extra little bonus, Paul can now do a mean ponytail ūüėČ

But truly, not seeing Nora regularly was the absolute hardest thing  for me to deal with. I had to emotionally shut down during the week in order to cope with her absence. Thankfully BBS is an extremely active kiddo. So his kicks, punches and rolls served as a reminder of WHY I’m sacrificing. His life and health far outweigh my own ache and long for Nora.

Whenever I feel down about this process, I force myself to refocus by recalling how far I’ve come. When I was first admitted, my doctors fully prepared Paul and I to lose BBS. Upon admission, Dr. Katz gave me three choices (1) do nothing and allow my body to finish delivering BBS and he would pass away, (2) take medicine to purposefully end the pregnancy and try to get pregnant again at a later date or (3) do everything medically possible to save BBS knowing there are zero guarantees. I was alone at the hospital when given these choices because Paul and Nora were still making their way up. For me, the conversation was surreal but not scary. I think I may have even laughed at the first 2 choices (perhaps a nervous habit? or maybe a sign of how naive I was about how bad my situation was?). Number 3 is what I chose on June 14th and I continue to choose today. No brainer.

Perhaps one day I’ll blog about the insanely tough conversations we’ve had with the neonatologists and about the stats of my ever shortening, basically non-existent cervix. But not today. Today I focus on the next stage of the fight. I’m not to the finish line yet.

I have very mixed emotions about leaving. Mentally, I like knowing that the doctors and nurses can spring into action within seconds should anything go down. But I have to remind myself that I’ve been super vigilant thus far and I’ll continue to be equally, if not more so, at home. Emotionally, I lose a bit of confidence every time someone says something like “What?!! You’re going home? Are you sure that’s a good idea? Whose decision was it? Well, don’t overdo it at home.”

Ummm, thanks for basically saying you have zero confidence in me. It’s insulting and undermining. I’m the one who has fought every second of every day for the past 53 days to keep my child alive and safe. I’m the one who lays in bed all day long. I have constant heartburn because I eat my meals laying down. I have the beginning of bed soars on my thighs because I lay all day. I worry every.single.time I get up to go to the bathroom. Trust me, it’s me who knows more than you what’s at stake here. I realize that you say these things out of concern, but you’re effectively saddling me with your own fears. Please stop putting me in the position of comforting and reassuring you.

The reality is that I will go into labor one day. Whether that happens tonight (on the very night I arrive home) or one month from now is irrelevant because it won’t be my fault. It won’t be because I walked to the bathroom in my home instead of festering in the hospital and walking to the bathroom there. It won’t be because Nora jumped onto the bed to read a book or snuggle with me (newsflash she does all of that when she visits the hospital). It won’t be because I walked into the kitchen to get a water refill. It won’t be because I did or didn’t do anything.

Next steps/milestones: Tomorrow I’ll hit 30 weeks which is a HUGE accomplishment and something I plan to celebrate with Paul, Nora, Maisey and BBS. I’ll have an ultrasound Wednesday the 10th. They’ll measure the baby and check the cerclage. Dr. Katz will look at the results and determine if I can stay at home or if I need to come back in.

Sorry I went so deep with this post, apparently I had a lot of pent up emotion…

Final spin on the monitors before being discharged 

 

Premature Baby 101


To mark my 6 week anniversary at the hospital (gah!), I thought we’d do another “class time with Andrea”. It’s been awhile since I’ve dropped some wisdom on you! hahaha

In all seriousness, I wanted to pass along some information about micro preemie’s. I suspect some of you out there have found yourself thinking “Man, she’s so lucky. She gets to sit around all day and watch TV while nurses wait on her hand and foot. It’s like a vacation!”

Let me tell you, far from it.

To start, completely losing your independence sucks. I feel like I’m annoying everyone when I need more water, a fork, a napkin, or my reading glasses. I feel like a burden asking to have my humidifier refilled twice a day, asking for someone to come into my room to pick up the colored pencil I dropped on the floor, or asking for someone to get my mid morning snack out of the fridge (turns out diabetics need to eat constantly….).

Laying in bed 23.5 hours a day is difficult on the body. I’ve lost muscle tone and mass. I’ve developed gestational diabetes (I’m blaming lack of exercise/movement), and I’m just really sore in general. As the baby grows, the weight of my belly makes laying really difficult.

Trust me, I’d rather be at home, taking care of Nora, Paul and Maisey. I’d rather be having a normal, uneventful pregnancy. I’d rather be reveling in the fact that this is the last time I’ll be pregnant – and stuffing my face with ice cream!

Instead, I lie here for BBS and do the only thing I can to help him. I remain as calm and stress free as possible. I keep weight off my cervix in hopes that the cerclage will continue to hold. I track my daily contractions like a watchdog. I’ve learned all the lingo there is to know in the perinatology world. I keep an open dialogue with my doctors and nurses. I try to push out of my mind the terrifying information about preemies that I’m about to share with you.

Once you understand what micro preemies have to face, you’ll understand why I haven’t written about this until now. I was admitted at 22 weeks and 3 days when BBS wasn’t viable outside the womb. If he had been born in the first week and a half of my stay here, doctors wouldn’t have tried to resuscitate¬†him. Let that sink in for a second….that’s extremely painful to think about.

End of day, I just want the best life possible for BBS. But¬†I can’t control what’s ultimately going to happen. As the person who’s growing this life, I feel guilty that my body isn’t doing a better job. But, I try to focus on the fact that he’s safe right now and we’ve gotten to 28 weeks and 3 days together!

The information below was gathered from https://penut-trial.org/node/1

Prematurity is defined as a birth that occurs before 37 completed weeks of gestation. It is associated with about one-third of all infant deaths in the United States and accounts for approximately 45 percent of children with cerebral palsy, 35 percent of children with vision impairment, and 25 percent of children with cognitive or hearing impairment.

Approximately 50,000 infants per year (961 per week) are born at less than 28 weeks of gestation in the US.

The risk for problems associated with prematurity increase with decreasing gestational age and birth weight. The most immature infants (those born before 28 weeks of gestation) have the highest mortality rate, and if they survive, are at the greatest risk for long-term problems.

The chronic medical and neurodevelopmental problems of children born prematurely often require additional health care and educational services.

 

 

Birth at 23 Weeks of Gestation

What happens at birth If full resuscitation is chosen, at birth the doctors will dry and warm the baby, and then check the heart rate, breathing, oxygen levels, and movement. A breathing tube may be placed to help the baby breathe. Some babies will receive a medicine called surfactant in the delivery room. This helps keep the lungs expanded so the baby can breathe.

It is important to realize that even with the medical team’s best efforts to resuscitate the baby, he/she may not survive to be admitted to the NICU.

Long term medical issues. Some complications of being born early can last throughout life, but usually problems are most severe early on. After going home, most former 23 weekers (85%) require special medical care for at least a couple of years. Rehospitalization for medical problems is common in the first two years of life.

Survival

In the US, of 100 babies born at 23 weeks gestation, an average of 70 will die (black figures), and 30 will live to go home (blue figures).

 

 

Neurodevelopment

Babies born early are at high risk for developmental disabilities like cerebral palsy (CP), learning disabilities or mental retardation, hearing, and vision problems. Bleeding in the brain while in the NICU increases these risks, but problems can also occur in the absence of bleeding. The baby may have one or more of these problems.

Developmental outcomes for the 30 survivors at 11 years of age are shown by the colored figures

  • ¬†Severe Disability (23%)
  • ¬†Moderate Disability (26%)
  • ¬†Mild Disability (39%)
  • ¬†No Disability (13%)

 

Definitions:
Severe Disability: Likely to be dependent on caregivers, may be unable to walk or control muscles, very low IQ, deafness, or blindness.

Moderate Disability: Reasonable independence likely, spastic muscles, but can walk with help, low IQ, hearing loss corrected with hearing aid, or impaired vision without blindness.

Mild Disability: Learning disabilities, mild impairments such as need for glasses. Autism and ADHD are more common in premature babies.

Vision: Most will have normal vision, but 25% will need glasses, and about 8% will be blind.

Hearing: Most will hear normally, but (7%) will have severe hearing loss in one or both ears.

Breathing: Many need extra oxygen when they go home. Sometimes, a breathing machine is needed. Most babies get better with time, but breathing problems such as asthma are common.

Birth at 24 Weeks of Gestation

Long term medical issues. After going home, most former 24 weekers (75%) require special medical care for at least a couple of years. Rehospitalization for medical problems is common in the first two years of life.

Survival

In the US, of 100 babies born at 24 weeks gestation, an average of 37 will die (black figures), and 63 will live to go home (blue figures).

Neurodevelopment

Babies born early are at high risk for developmental disabilities like cerebral palsy (spastic muscles), learning disabilities or mental retardation, hearing and vision problems. Bleeding in the brain while in the NICU increases these risks, but problems can also occur in the absence of bleeding. The baby may have one or more of these problems.

Developmental outcomes for the 63 survivors at 11 years of age are shown by the colored figures

  • ¬†Severe Disability (21%)
  • ¬†Moderate Disability (33%)
  • ¬†Mild Disability (30%)
  • ¬†No Disability (16%)

 

Birth at 25 Weeks of Gestation

Long term medical issues. After going home, most former 25 weekers (75%) require special medical care for at least a couple of years. Rehospitalization for medical problems is common in the first two years of life.

Survival

In the US, of 100 babies born at 25 weeks gestation, an average of 25 will die (black figures), and 75 will live to go home (blue figures).

Neurodevelopment

Babies born early are at high risk for developmental disabilities like cerebral palsy and learning disabilities or mental retardation. Bleeding in the brain while in the NICU increases this risk, but problems can also occur in the absence of bleeding. The baby may have one or more of these problems.

Developmental outcomes for the 75 survivors at 11 years of age are shown by the colored figures

  • ¬†Severe Disability (11%)
  • ¬†Moderate Disability (28%)
  • ¬†Mild Disability (44%)
  • ¬†No Disability (17%)

Birth at 26 Weeks of Gestation

Long term medical issues.

After going home, many infants born at 26 weeks of gestation require special medical care for at least a couple of years (50%). Rehospitalization for medical problems is common in the Ô¨Ārst two years.

Survival

In the US, of 100 babies born at 26 weeks gestation, an average of 14 will die (black Ô¨Āgures), and 86 will live to go home (blue Ô¨Āgures).

Neurodevelopment

Babies born early are at high risk for developmental disabilities like cerebral palsy and learning disabilities or mental retardation. Bleeding in the brain while in the NICU increases this risk, but problems can also occur in the absence of bleeding. The baby may have one or more of these problems.

Developmental outcomes for the 86 survivors at 11 years of age are shown by the colored figures

  • ¬†Severe Disability (10%)
  • ¬†Moderate Disability (34%)
  • ¬†Mild Disability (33%)
  • ¬†No Disability (23%)

Birth at 27 Weeks of Gestation

Long term medical issues.

After going home, many former 27 week preemies (35%) require special medical care for at least a couple of years. Rehospitalization for medical problems is common in the Ô¨Ārst two years of life.

Survival

In the US, of 100 babies born at 27 weeks gestation, an average of 12 will die (black Ô¨Āgures), and 88 will live to go home (blue Ô¨Āgures).

Neurodevelopment

Babies born early are at high risk for developmental disabilities like cerebral palsy, learning disabilities or mental retardation, hearing and vision problems. Bleeding in the brain while in the NICU increases these risks, but problems can also occur in the absence of bleeding. The baby may have one or more of these problems.

Developmental outcomes for the 88 survivors are shown by the colored figures

  • ¬†Severe Disability (10%)
  • ¬†Moderate Disability (10%)
  • Mild Disability (35%)
  • ¬†No Disability (45%)

 

Birth at 28 Weeks of Gestation

Long term medical issues

After going home, many former 28 weekers¬†(30%) require special medical care for at least a couple of years. Rehospitalization for medical problems is common in the Ô¨Ārst two years of life.

Survival

In the US, of 100 babies born at 28 weeks gestation, an average of 8 will die (black figures), and 92 will live to go home (blue figures).

Neurodevelopment

Babies born early are at high risk for developmental disabilities like cerebral palsy (CP), learning disabilities or mental retardation, vision and hearing problems. Bleeding in the brain while in the NICU increases this risk, but problems can also occur in the absence of bleeding. The baby may have one or more of these problems.

Developmental outcomes for the 92 survivors are shown by the colored figures

  • ¬†Severe Disability (10%)
  • ¬†Moderate Disability (10%)
  • ¬†Mild Disability (35%)
  • ¬†No Disability (45%)

 

Definitions:
Severe Disability: Likely to be dependent on caregivers, may be unable to walk or control muscles, very low IQ, deafness, or blindness.

Moderate Disability: Reasonable independence likely, spastic muscles, but can walk with help, low IQ, hearing loss corrected with hearing aid, or impaired vision without blindness.

Mild Disability: Learning disabilities, mild impairments such as need for glasses. Autism and ADHD are more common in premature babies.

Vision: Most will have normal vision, but 25% will need glasses, and 1% to 2% will be blind.

Hearing: Most will hear normally, but about 3% will have severe hearing loss in one or both ears.

Breathing: Some babies will need extra oxygen or a breathing machine when they go home. Most babies get better with time, but breathing problems such as asthma are common.

As you can see, BBS’ odds of surviving, and surviving without too many long term problems was dramatically increased since I was first admitted. Hopefully he won’t have a birthday anytime soon…..

 

Day 24 – 25 Weeks 5 days

Hey everyone,

Just wanted to do a quick update for you.¬†We were supposed to leave on our babymoon tomorrow – oh well – guess we’ll take a raincheck on that one!

I’m on Day 24 of my incarceration, errr, I mean, hospital bed rest stint. In all seriousness, I do, at times, feel like a prisoner, though its arguable that prisoners have more freedoms than I at the moment ūüôā But, when I start to feel that way, I just remind myself that this is all for my son. And, of course, he’s worth it.

Everything with my body, the cerclage and baby are holding stable. I do fetal monitoring and contraction monitoring 3 times a day. So far I’m not really having any contractions to speak of. The few I have are not painful, so are likely just Braxton Hicks – which are normal at this point in a pregnancy. ¬†Baby boy is super active and recently moved from breech to head down (though he can easily move back to breech since it’s still really early). I get my amniotic fluid levels checked twice a week, and so far so good on that front. I get an ultrasound to check the cerclage every two weeks — my next one in July 13th.

My doctors are becoming cautiously optimistic. ¬†While we still talk in terms of days, not weeks. They each (my OB and my high risk surgeon) have said they’re hopeful I get to 28 weeks and beyond. ¬†My surgeon went so far as to say that he’ll be going on vacation in late August for 2 weeks and ‘I’m not to have the baby while he’s gone’. If I behave, he said he’d remove the cerclage on September 15th. That, ladies and gentleman, is TEN WEEKS from today. Holy goddamn hell. Thats a long way away. But my due date is October 15th, so to hold this guy in until September 15th would be awesome!

So that’s the update for you. Here are a few of my upcoming mini-milestones (in case you wondered about the inner workings of my brain):

  • Make it to my in-room massage on 7/7 (that’s today, yay, I made it!)
  • Make it to the RHONJ premiere on 7/10
  • Make it to the Flipping Out premiere on 7/13
  • Book another in-room massage for next week and make it to that
  • Make it until week 27 (7/16) when my OB gets back from vacation
  • Make it to my 41st birthday (7/17) b/c mama’s hoping for a damn good present this year ūüôā

So those are the goals for the next little while — you can see I’m trying to keep it light and simple! Stay tuned for a post on tips n’ tricks to surviving a prolonged hospital stay. Figure I might as well pass along some things I’ve learned along the way…

xoxo

 

 

 

 

6.29.16 – 24 Weeks, 4 Days

Huge hugs and kisses to all of you for the many, many messages of love and support. Your thoughts and prayers are working!

As I write this I’m listening to the baby’s heart beat glub glub on the monitor. It’s the best sound ever.¬†I get fetal monitoring and contraction monitoring every four hours throughout the day. I’m on the monitors for an hour session each time. It’s a great activity that takes up four hours of my day and I just love hearing his little body moving around and his strong heart thumping away. Yay!

This morning I had an ultrasound done to check the stability of my cerclage and all looks good. The doctors were very happy with the way everything looked. They’ll check it again in a few weeks.

Our game plan remains unchanged. I’ll¬†stay¬†on hospital bed rest for the foreseeable future and will just cross fingers and toes that my body keeps responding to inactivity.

Onward and upward.

xoxo

6.14.2016 – Seriously?

When life keeps giving you lemons, I’m here to tell you, you WILL get sick of making lemonade.

Two weeks ago I went to see my OB because I’d been spotting for about 24 hours. I was 22 weeks and 3 days pregnant. She did an exam and told me that she could feel my membranes. She said I have an incompetent cervix and I needed to immediately go to the hospital where I’d be admitted for at least a couple of days.

She told me that she was going to call a high risk surgeon to meet me and she was hoping he’d be able to place a “rescue”cerclage in my cervix. There wasn’t a whole lot of certainty in her voice though. She was really unsure whether anything could be done.¬†She was very factual and calm, but I could tell baby boy and I were in deep shit.

So I hopped a cab (faster than uber or an ambulance) over to CPMC California. The nurses in triage were expecting me (I started having major PTSD flashbacks of the adria leak and my trip to the ER for the antidote….)

Long story short, I was having emergency surgery within an hour and a half. I was 3cm dilated and the surgeon could see baby boy’s feet coming out through the membranes (which were bulging out of my cervix). ¬†Thank heavens the doctor was able to get the bag back into my cervix without rupturing it and there was enough cervix left to work with to insert a cerclage.

I’m not going to lie to any of you. The outlook those first 72¬†hours was really, really grim, but my body pulled through, and, far as anyone can tell, the baby is none the wiser (though he did get a good healthy dose of narco post-op and a 4-day-round-the-clock-dose of antibiotics via IV to my body).

So now I’m on indefinite bed rest at the hospital. Since I was asymptomatic when all of this started (save a little spotting) my doctors are hesitant to breathe a sigh of relief.¬†We’re forced to take everything day by day and pray for the best.

It’s been 14 days since I arrived here. It’s been incredibly hard not to see Nora, Maisey and Paul all the time. It’s been a major test of character to have to surrender 100% control of everything in my life. From caring for my child, to my own body. I have to be strong every day and remember that I’m a mere vessel. Here to incubate the newest member of our family. It’s not an easy job at all. I was in a lot of physical pain early on. Now I’m in a lot of emotional pain. But when I focus on one day at a time, that helps.

This past Saturday I hit 24 weeks in my pregnancy, which is a huge milestone. Should baby boy arrive at this point, there are life saving measures that can be taken. That was not the case when I first arrived at 22 weeks.

So we are grateful for every small victory and we’ll keep pushing on. There are so many more details to the story, but the above is the gist. We’d appreciate it if you could keep us all in your prayers and hold space for us. We’ve got a long, long road ahead and hope that it’s drama free.

xoxo,

Andrea