Reckoning.

by Alexa on June 11, 2012

My amnio is tomorrow morning—Tuesday, eight a.m. Full interpretation of the three different measures of maturity (L/S ratio, PG, DSL—they are not bothering with the rapid test) will take four or five hours. If the results show mature lungs, I am to report to the hospital Wednesday morning at 9:30 for an 11:30 C-section, and by noon Twyla will be BORN and SAFE(r) and FREE, FREE AT LAST.

If the results do NOT show mature lungs, well, there are several possible next steps, but most of them result in about another week of waiting, while my heart pounds and my brain drips discreetly out one ear.

To say I am nervous about the results of the amnio would be something of an understatement. These tests of maturity are designed to predict whether babies will have respiratory distress syndrome if delivered, and because there is an understandable desire to err on the side of caution when it comes to respiratory distress, they are designed to have a very high predictive value for maturity. In other words, if the test says “mature,” the chances of the lungs actually being IMmature is very, very small. The flip side of this is that, by erring on the side of caution in order not to miss a pair of immature lungs, a result that says “immature” is not terribly reliable. Lots of babies test immature when actually their breathing is just SWELL, thank you very much. I don’t have the exact numbers in front of me, but I think female 37-weekers (girls mature about a week-ish earlier than boys in this respect) have a substantially less than 5% chance of lung immaturity, but only TEST as mature at a rate of 70-80%.
Another factor is my extra fluid—all measures of lung maturity tend to be lower with polyhydramnios, but not necessarily due to actual functional immaturity. My doctor warned me that she sees a lot of immature results with polyhydramnios, and has sometimes delivered these babies right after the test for some other reason (the amnio starts labor, for instance) only to find that their lungs are functionally very mature.
I also have gestational diabetes, which is legitimately associated with delayed lung maturity, at least in insulin-dependent cases. Mine is diet controlled and I have had no abnormal blood sugar readings, so theoretically I should be fine. However, to account for the increased risk of respiratory distress syndrome among the babies of diabetic mothers, the lab requires diabetic mothers to have higher/better results than the babies of non-diabetic mothers in order to get the official “mature” designation.
The deck seems to be stacked against me, a bit.

BUT! The increased umbilical doppler resistance that is my primary medical indication for early delivery tends to lead to accelerated lung maturity (presumably because the baby figures that it had better get itself together in a hurry MAYDAY, MAYDAY) so I do have that in my favor. Plus Twyla is a girl, and as I mentioned, girls are often Fast. And I will be 37 weeks—many babies have mature lung tests even at 36, I am told. Also, on ultrasound, Twyla’s fluid was full of revolting schmutz (I guess it is bits of vernix? Whatever it is looked unsanitary, and she is going to need to be hosed down after birth, for sure), the presence of which doesn’t tell us anything definitive, but the lack of which is definitely associated with immature results. So, it could happen! Right? I could get a call tomorrow afternoon saying that everything is go for delivery on Wednesday? Of course I could! Please?

If you wouldn’t mind, could you send very emphatic mature lung—or mature TESTING lung—thoughts in my/Twyla’s/the laboratory at the University of Minnesota’s general direction? These thoughts should be as fervent as you can make them, and additionally you might feel free to direct some mental focus at the lab people interpreting the slides and the doctor reviewing the results and just generally toward everyone deciding to go ahead with delivery on Wednesday. I may actually go to the cathedral and light a candle, as is my (bizarre, I know, given my atheism) custom in dire situations, but you needn’t go that far. A murmured (or silent!) expletive, a chicken bone rattled surreptitiously under your desk—anything at all would be gratefully accepted.

I will also accept anecdotal tales of Lung Maturity Testing Results You Have Known. Searching the Internet is more infuriating than helpful in this case, because every time someone asks about this on a message board or similar, do you know what people do instead of ANSWERING THE QUESTION? They make snotty remarks wondering why the woman is delivering early in the first place, implying that the reason is probably golf/schedule/ignorance related, and making it clear that THEY, PERSONALLY, would never endanger their baby in this way—but then, that’s just the kind of Mother They Are. (Honestly, I would like to hang some of these women with sustainably sourced hemp nooses, really I would, and I say that as someone who falls on the crunchier end of the parenting spectrum.)

The point is, please think of us tomorrow. And now, here are some pictures from well over a week ago that already no longer accurately represent my vastness, including one of Simone forcing me to chase her, outdoors, in public, which I assure you was a memorable spectacle to witness, as I was essentially swathed in a parachute-sized bolt of fabric. (At least Scott thought it deserved memorializing, because he had his phone camera out in record time, though I imagine it was hard to keep it steady with all that laughing.) Unfortunately most of the chase pictures were faintly obscene, but this one isn’t so bad, while still giving a sense of the Heffalump-y quality of my pursuit.

35weeksMaxi

Godzilla
Until tomorrow…

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