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Reckoning.

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…

65 comments

  1. Erin says:

    I also had polyhydramnios due to baby’s esophageal atresia; when the doctors were doing one of my amnioreductions, they said he (he!) was on the cusp of maturity at 35 weeks. So I’m thinking very good positive thoughts for you two. Also, I read your book a few months ago and enjoyed it so-you are a fabulous writer.

  2. sharon says:

    Everything crossed, all deities appealed to, candles lit – and as a side bet that the amnio triggers labour if all else fails.

    Twla, your adoring public awaits ;-)

  3. heather... says:

    I have EVERYTHING crossed for you. My tale of Lung Maturity Testing Results is a direct observation of my 36 weeker, who came out at six pounds and still hasn’t stopped screaming, almost two and a half years later. Really, send earplugs.

    I have you in my heart and mind. So much love coming to you!

  4. Cara says:

    Since I’m a prayer and not a candle lighter, prayers said, breath figuratively held and lots of good thoughts headed your way. Come onTwyla!

  5. Mijke says:

    Sending every possible positive vibe your way today (and tomorrow, of course)!

    I have never had any lung maturity tests done. But: with our twins my water broke at 32 weeks and they were born 14 hours later, no time for the steroids to help their lungs mature. They only needed a day of C-PAP and a shot of surfactant they were off! Not fully mature yet, but they were close. They say twins usually mature sooner for the same reason they mentioned it in regards to your increased umbilical doppler resistance: twins have to share their resources and space, so they better make sure they are ready to come out before there’s none left of either. If my twins were almost ready at 32 weeks, Twyla should be rocking that test at 37, right?

    Also: my youngest (kind-of-triplet with our twins, if it weren’t for the fact he spent 2 years immersed in liquid nitrogen before he finally became a part of our family) was born at 36 weeks and his breathing was excellent! Him being a boy, and boys always being way behind girls (in- AND outside of a uterus, for as long as they both shall live, right?), that counts as something, right? Again: Twyla will be rocking her test at 37 weeks!

    And if all else fails: I will be sending voodoo-thoughts to all your lab technicians and doctors, making them misinterpret any and all negative results regarding lung maturity. Twyla is coming out tomorrow!!!!

    Wow. Tomorrow…

  6. Veronica says:

    Sending all of my very strongest mature lung test results you way. I’ll also be crossing everything, waving my hands vaguely in the air and hoping like mad that Wednesday is a GO for you.

  7. Rebeccah says:

    Will be saying all sorts of non-religous prayers for you tomorrow. (And may I add that Simone and you are both *gorgeous*?) You’re almost there, mama …

  8. Tammie says:

    Thinking of you. I can’t wait to see pictures of Twyla! I know it’s so, so hard when you’re waiting and worried, but this will all be behind you as soon as tomorrow! And you’ll be holding her!
    Hang in there. xo

  9. Noelle says:

    Prayers sent to you and Twyla, Alexa. You look beautiful in the pictures. I hope you have something fun to distract you while you wait for the test results.

  10. Sara says:

    Congratulations!! My youngest was born at 36 weeks, with a set of fully mature lungs. And he’s a boy. We didnt’ have the test because we didn’t know he was going to be early, but there you have it. Mature lungs at 36 weeks. No NICU stay needed. :) I’m so happy for you. I’ll wave some chicken bones under my desk today for you, per your instructions.

  11. geohde says:

    Dude,

    got nothing for you, and I’m an O+G type. We don’t do them here because if we think we are worried enough to deliver, then we deliver and deal with it, regardless. Also we sure as hell don’t do them at term although we do think about a dose of steroids for cold c-sections before 39 weeks. Perhaps we just hate our paediatricians and like them to suffer?

    Good luck.

    g

  12. Losh says:

    Good thoughts, crossed fingers and any other good luck charm I can muster, coming your way! I think you look gorgeous by the way!

  13. Jessica says:

    I had an amnio to check for lung maturity on a 37 week girl and never got to hear the results as the amnio itself put me into labor. Sending positive and very mature vibes your way!

  14. Given the time zone differences, you are likely having or have had your amnio by now. Regardless, I was sending good thoughts up and out as I was reading your post so I hope that counts for something.

    Pulling for you and Twyla and overjoyed that you are in the final hours (or days or week) of your miraculous (in so many ways and not meant to be a religious judgment) pregnancy.

    I hope that mine goes as ‘normally’ (of course I also hope that by putting this out there I haven’t just jinxed myself).

  15. MJ says:

    No chicken bones here, but sending my good Presbyterian prayers your way, and to all of your doctors and lab people, for a successful outcome. (Hmm, the last was perhaps an unfortunate choice of word.) How wonderful to have brought her this far in utero – now we just need to get you two to the finish line.

  16. Molly says:

    Oh, just sending you all kinds of good, happy, stars-aligned, meet-your-baby-tomorrow thoughts!

    You rock that maxi dress, by the way!

  17. Patti B. says:

    Emphatic, fervent thoughts coming your way!! BTW, you and your bolt of fabric and your oldest daughter are completely adorable :) Good great luck! (And I share this sensitively; but I delivered identical twins (girls) at 36.5 weeks by emergency c-section; while *bonus* under general anesthesia; and the incision left Twin A with 12 stitches across her shoulder…ALLLLL that to say that they both were on room air since the second they were born. It will be all good :)

  18. Susan says:

    I had an amnio with my son at about 35.5 weeks. His lungs weren’t mature, but they were absolutely fine when he was delivered at 36.5 weeks. I was induced early because of suspected intra-uterine growth retardation and because of my low fluid levels. I ended up with a C-section. He was 5.5 pounds, skinny–having had no time to plump up–but healthy. So it seems to have been a false alarm. He is now almost 17, over 6 feet tall, and still growing.

    Thinking of you today.

  19. Cathy says:

    Hoping and praying. I can’t imagine how exhausted you must be, emotionally and otherwise. Happier forms of exhaustion are on their way.

  20. Laura says:

    Sending prayers and good thoughts, lovebug! My twin girls were born at 33 weeks, 5 days because of pre-eclampsia and HELPP, and their lungs were mature. Okay, we did get to have the steroid shots first, but still!! They never had trouble breathing and they came home after 13 days in the NICU, at 4 1/2 lbs. each. Never an illness or any kind of a problem until they went to daycare at 7 months– then it was virus-o-rama, but that’s another post! They are sassy 2 1/2 years olds now, and they rarely stop yelling!
    I’m praying that by the time you read this, you are packing up for your safe and healthy delivery of Twyla tomorrow!

  21. Raquel says:

    Sending tons of good thoughts to all involved tomorrow. I don’t have any data on lung maturity test results, but my daughter was born at precisely 37 weeks (well, that’s assuming these counts are actually precise – a big assumption IMHO) and she was fine. Lung maturity wasn’t even discussed. I know you have several other complicating factors that I did not have, but girls are tough :-)

  22. Emily says:

    Another early bird baby mama (does that even make sense? I don’t know) here! Baby was born at 37 weeks with fully mature lungs. He started screaming from day one and kept it up for much of the first few months of his life! He likes to delve back into it, now and again, just to keep us on our toes. Sending good thoughts your way!

  23. Jenn H. says:

    I shall send all the positive vibes I can muster your way tomorrow. That’s a helluva lot, too. :) You look lovely, as always!

  24. Renee says:

    My only anecdotal story of 37-weeker lung maturity comes from having delivered a son three days shy of 37 weeks who had quite mature lungs, thanks so much. He was covered in an alarming amount of disturbingly cheesy vernix as opposed to his 38 week and three days delivered older brother. I had preeclampsia with the first that nearly went undiagnosed because of the diagnosis guidelines and my super-low baseline blood pressure. 128/75 sounds perfectly lovely for a pregnant woman unless you take into account that said pregnant woman’s baseline blood pressure at the start of pregnancy was 90/40. And that she has put on 11 pounds of edema in two days because her kidneys are threatening revolt. So, hyper-vigilant the second time around led to earlier intervention, which led to earlier delivery with absolutely no lung maturity issues. We didn’t even test for it.

    • Dr Spouse says:

      Our 36+6 baby was a good breather apart from when he was in the expired car seat we were loaned. I’m really surprised that they are even suspicious that a 37 week baby would not be ready as I thought they were considered fully cooked at 37 weeks – everyone has gone on and on about how if he had waited one more day he would have been considered full term.

      (No idea about the vernix as we only met him at 3 days old, and labour was possibly brought on by semi-accidental external factors)

  25. erin says:

    Good luck! I am at the University RIGHT NOW (work) and will look over at the hospital on my walk in a few moments, to send some good vibes. My month old niece was born at UMMC at 37 weeks, and while she was/is a little peanut, she is JUST FINE.

  26. Dr Spouse says:

    PS I didn’t mean that last comment to be a reply to a comment, just a regular comment. And I’m thinking that you may be out of the test shortly? already?

  27. Leslie says:

    My son was born right at 37 weeks (his idea), and we had no issues with his lungs. He did have jaundice, but a few days in the lights cleared that right up. Hoping everything goes your way today and tomorrow!

  28. tash says:

    Hoping the wait is already over and the MATURE results in hand. (C’mon Twyla, throw us a bone, here.) (Not literally, please.) I don’t pray, but will do my usual pleading stare into the computer where I’m sure it gets sucked into the interwebs and becomes a powerful force.

    We can haz updates?

  29. KP says:

    Oh, you are one of those TOTALLY ADORABLE pregnant women, aren’t you? You look fabulous! :)

    Sending good thoughts (ok, fine, probably prayers, except I’m shit at praying so I usually just think a whole jumble of “PLEASE! Twyla! lung maturity! Birth! Soon!” and hope it means something to God/whoever is running The Universe) for lung maturity and a go-ahead for your C-section (or for the amnio to start things off – as long as it ends in a healthy you and healthy Twyla, it’s all good to me).

    • KP says:

      Wait! Holy shit. I just realized that if today’s amnio starts labor and Twyla is born TODAY, we will share a birthday. No pressure or anything, but I can *guarantee* you that people born on June 12 are extra awesome.

  30. Stephanie says:

    Sending you good vibes and lots of lung maturity thoughts. I gave birth to my first at 37 weeks via a scheduled c-section. No lung maturity testing required. I had complete placenta previa so my doctor decided if I got to 37 weeks we were going to call it close enough and sign her eviction notice. And you know what? She was fine, prefect, no nicu time, no observation. Wishing the same for you!!!

  31. Leah says:

    I’m not on Twitter, but I follow your tweets via the sidebar on this page. So I saw the KICK ASS news about Twyla’s lovely, mature lungs. Go Twyla! Can’t wait to hear about her safe arrival tomorrow. Sending thousands of happy, positive thoughts your way, Alexa!!

  32. Sara says:

    Sending strong wishes for both mature lungs and tests that show them!
    I managed to avoid a 37-week amnio by going into labor the night before I was supposed to have the amnio. Maybe there’s another out for you . . .
    Best wishes.

  33. Ariel says:

    I also had polyhydramnios, and I would amuse myself in the wee small hours of the morning googling the subject. I coudn’t sleep, because the pressure of all that water in my uterus (I measured at 39 cm with no discernible reason for 10 weeks. WTF???) made my lower limbs look like balloons. And they REFUSED to even consider an earlier c-section, even though I was miserable, and had the beginnings of pre-eclampsia (I didn’t have protein in my urine, but check for every other symptom. my BP was 3!! degrees lower than the ‘uh-oh” level.) and didn’t they care that the placenta could come unattached at any moment???? BUT. At 37 weeks, they did the breathing testy thingy, and she was FINE. Even though they made me wait until 39 weeks. And then, when I was on the table, water was pouring out of me during the procedure (I could hear it splashing onto the floor! AWESOME!) and the Dr. said “I’ve never seen this much amniotic fluid in my life!” so I told him “I KNOW!”
    Anyway, I laugh at it now, my baby is 11 months and healthy, and they never could figure out why I had so much stinking amniotic fluid, but EVERYTHING WILL BE FINE FOR YOU TOO! HUGS!

  34. Ariel says:

    Oh, and also, I had an ultrasound every week, and they said that all that stuff floating around is normal, they can just see it better now with the better equipment…But she’s coming anyway! Yeah!

  35. smark says:

    Go baby go! One day, when she’s a teenager, you’ll be able to tell her she was officially mature right from the beginning.

  36. S says:

    Popped in to see if Twyla had arrived, and I see from the twitter feed you include in your sidebar that she has. (I’m not on Twitter.)

    Congratulations! Hope she, you and all your family are doing well. :-)

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