What a happy week! Transfusion #1 finally happened and it couldn't have gone better! I want to remember as many details as possible so I apologize in advance for this post being quite wordy. Hopefully it's not too hard to follow!
Once again our week began on Monday with an MCA scan and NST. I felt so much better going into this appointment than I did going into last week's appointments. Rather than making assumptions about what his level would be on Monday, I just prayed that the Sonographer would be able to get an accurate measurement so we could make the best decision for Austin's health. I was confident going into our appointment and felt we would know exactly how to proceed depending on what number we saw.
We learned pretty quickly that Austin was in need of a transfusion and there would be no more putting it off. The level came back at 66 which clearly put him in "A".
Logan and I weren't too surprised or worried about where things stood at this point because we just felt blessed to have avoided it this long and we had been prepared for a transfusion for awhile so we were ready to move ahead. The doctor on service on Monday was great and helped us feel extra confident about the transfusion as well. When she walked in and said: "Well, I think it's time." Logan and I both knew she was right and didn't hesitate at all. She explained that Austin's pericardial effusion (fluid around this heart) was a bit more pronounced so that also confirmed that he needed the blood. He passed his NST on Monday with flying colors so it was nice knowing he was still doing well from that standpoint.
We were asked to be at the hospital at 9:00am on Tuesday in order to prepare for a 10:00am transfusion. We were taken back right away and over the next hour and fifteen minutes we had a lot of nurses and doctors coming in and out prepping for the procedure. I changed into my lovely hospital garb, had an IV placed, was given an antibiotic (in case of infection from the needle), and then we did our best to patiently wait as they got everything set up. In the room were three doctors, two nurses, a medical assistant, two lab techs, and Logan. One doctor was responsible for monitoring Austin's heart rate and guiding the other doctor into the correct place by watching on the u/s machine, the second doctor was responsible for actually infusing the blood and the third doctor had the main job of getting the needle into the artery that connects the placenta to the umbilical cord. They started by telling me to choose a position for my arms and then to leave them there for the rest of the time. That was hard for me! I also wasn't allowed to lift my head off the pillow, take deep breaths, or do anything else really. I prayed with all my might I wouldn't have to sneeze! Haha. Putting the needle in didn't pinch too much because they gave me a local anesthetic but once they got it in my skin, penetrating the uterus was painful! Rather than a sharp pain it was more of a dull, throbbing ache. There was quite a bit of resistance getting into the uterus so I could feel the jerking as she pushed it further in and Logan said he could see her getting stopped and then pushing harder. As soon as she got the needle in I didn't feel much the rest of the time. Sometimes getting the needle into the artery can be difficult but fortunately she was able to get right in within a couple of minutes. This is when having my placenta on the front side of my uterus is a HUGE blessing. Austin's elbow and knee were on either side of the cord so she had to get the needle right between them and she did a great job! They warned us before that the needle can accidentally poke the baby so if that happened it wouldn't cause any problems but he would feel it and move away. How sad is that?! Thankfully Austin wasn't poked. In order to make sure Austin didn't kick the needle and knock it out they had to give him a paralytic which was my least favorite part. I know it was necessary but I still don't like the thought of it. We were assured that it would wear off after a couple hours and he would be just fine.
As soon as the needle was in the artery, a blood sample was drawn and taken to the lab right away so they would know exactly what his blood count was so they could give him the correct amount of blood. As they waited for the lab to call with the results, they began the infusion at a slow rate and were constantly checking Austin's heart rate to make sure he was handling it okay. They said it's a good thing I was 31 weeks at the time because smaller babies (around 25 weeks) can't handle very much blood at once. The lab called within a few minutes with the results. **Quick background info: Babies are typically given a blood transfusion for anything below a hemoglobin of 8, which is roughly a hematocrit of 24. The doctors expected his hemoglobin to be right around that or slightly higher.** When they hung up the phone and said he had a hematocrit of 15.4 (hemoglobin of 4.9) I couldn't contain myself and loudly said: "15.4?!" One of the doctors was like: "Yeah, we heard." I don't think he liked that I was so alarmed but I couldn't help myself. Our poor baby needed blood in a bad way! A different doctor even confirmed with me afterwards that they were very surprised he was so anemic. There's no worry about his low blood levels causing damage or anything but we're all just very glad we did the transfusion when we did. Because of how low Austin's hemoglobin was, he needed 90 CCs of blood so they would infuse 10 or 15 CCs and then check his heart rate before continuing. Fortunately they were able to get all 90 in and he handled it beautifully. As soon as they finished the infusion, they took another small sample in order to get his hemoglobin once the blood was in and it came back MUCH better at 14.8 (hematocrit of 44). At this point they pulled the needles out and we were finished! The doctors told us multiple times that everything went extremely well and we could tell they were pleased with the results.After the transfusion we were taken down to Labor and Delivery where they monitored Austin for the next few hours. His paralytic started wearing off pretty quick and it was such a relief to feel him kick again! His heart rate was strong the entire time so after a few hours we were free to go home!
They wanted me to go back on Thursday (yesterday) for another NST to make sure he was still doing well but we didn't have to do an MCA. Austin's heart rate typically hangs out around 130 during most of the NSTs so in order to "pass", he has to raise his heart rate up into the 150s at least two times for ten seconds each time during a 30 minute period. If he seems to be sleeping and his heart rate never raises, they'll put a little buzzer/noise maker thing on my stomach in order to get his heart rate to go up. So much for non-stress test, right? Haha. During yesterday's NST he was nice and comfy and his heart rate wasn't going up like they wanted so they buzzed him and he was NOT happy. For about 10 minutes he hung out in the mid 160s and was moving a bunch, clearly trying to get comfortable again. Once he settled back down to his baseline of 130 they gave him a "pass" and all was well!
We've been told to anticipate the next transfusion happening on or around Monday, May 4th. We feel incredibly blessed that the transfusion went so well and it brings us such peace knowing Austin now has the blood he needs. Isn't it amazing what they are able to do these days? We always talk about what a miracle it is that this is even possible! Austin hadn't stopped moving the last couple weeks but I'm amazed at how much stronger his movements have been the last few days since his transfusion! I'm sure he feels SO much better and has tons more energy now. I vividly remember how tired Eli looked when his blood level got too low and Austin's was way lower than Eli's ever was. We have felt such relief the last few days knowing he probably feels so much better!
The majority of my posts lately have been about Austin, as they should be, but I don't want to forget how I'm feeling through all of this. Physically I have no complaints at all. I'm able to eat anything I want, I have a decent amount of energy, I'm not too uncomfortable, and aside from using the bathroom one time each night, I sleep great! Emotionally I'm doing pretty well but I do worry about Austin so that can stress me out a bit. Knowing we've made it this far brings me a lot of comfort because I know he would be okay if he was born today but I still hope we can make it another month or so! The next transfusion, which will happen around 33.5 weeks, will be our last one and then we'll start discussing an induction date for a few weeks after that. I can't believe it's getting so close!
Weight: 144.2 (This week: -.4 | Total: +23.4)
32 weeks down, 5 (hopefully!) to go!