{ Becoming Hospital Pros }

Dear Lainie-bug,

You and I are becoming quite proficient at ultrasounds, consultation rooms, and waiting for doctors. Quite proficient. Yesterday we spent almost five hours at the university hospital getting a nonstress test, another complete fetal ultrasound {your fifth!!}, consulting with a neonatologist and an OB/GYN, and getting a tour of the labor & delivery unit. Daddy joined us partway through the ultrasound, since he had some important meetings at work in the morning.

You passed the nonstress test with flying colors. They wanted to see your heart rate increase by at least 20 beats per minute, for 15 seconds, two different times during the 20-minute test--and you had increases of at least 30 beats per minute, for over 20 seconds, at least six different times--I lost count! Way to go!

Your ultrasound looked really good, too. Amniotic fluid levels are normal--that's one of the main ways they gauge whether or not you're doing well inside me. I know that ultrasound assessments of fetal size are notoriously inaccurate, but you measure on the petite side--estimated at 5 pounds, 10 ounces. I need to fatten you up! {Convenient...there are brownies and caramel ice cream in the kitchen.} The only thing that was different at this ultrasound was that the doctors are now not completely sure that you have a diaphragmatic hernia. There is now a question of whether or not it may be a diaphragmatic eventration. Here's the difference: With a hernia, there is a hole in the diaphragm, and abdominal organs move up through the hole into the chest. With an eventration, part of the diaphragm is thin and abnormal and forms a pouch or pocket that pushes up into the chest. So the main difference is that in an eventration, there is still tissue separating the abdominal and chest cavities, whereas in a hernia abdominal organs are pushed up through a small hole. Either way, the lungs are still compressed and don't develop normally, because the abdominal organs {whether or not they are contained within a pocket of diaphragmatic tissue} are taking up chest space. The doctor said that an eventration is slightly less serious and has slightly better outcomes, but it's still the same basic problem. You will still need surgery and special care after your birth. Once you're born, they will be able to image your chest more precisely to determine whether it's a hernia or an eventration.

I really like the NICU doctor who talked to us. He reminds me of a skinny old grandpa; he's been a doctor for over 40 years! When we asked if we can hold you after you're born, he basically said, "Be assertive! Tell them you've been told it's a small hernia and that you can hold her. Don't ask if you can hold her. Tell them you've been told she may not need aggressive respiratory support and that you want to hold her." That made us smile and feel better!

We also got a little tour of the labor and delivery unit. I'll be honest, Lainie Rae: It's not my first choice of where I'd like to give birth. I'm very glad that you will be so well taken care of, and that whatever may be needed to give you a safe, healthy start to life outside the womb is available there. But it's not the nicest L&D I've seen...and I've seen a few!

And I must say, you are a funny girl. You are almost always pretty mellow, not moving much unless I have been lying very still for awhile. At about 4am yesterday morning, you spent a good half hour thumping and tapping every few seconds. It was very methodical: Right elbow...two seconds...left foot...two seconds...right fist...two seconds...right foot...two seconds. On and on and on! You've never done that during the night before...maybe you were excited about the cheese stick I had just eaten. {Yes, sometimes I wake up hungry in the night.} But a few hours later, as you have with every single ultrasound in the past six weeks, you stubbornly refused to move to give them a better view of your chest. And after we left the hospital, you stretched and thumped and swirled your legs regularly for the rest of the day. Maybe you don't like being the center of attention!

Well, Little Miss, we have mounds of laundry and errands to take care of today, so we'd better get busy!

Love you always,
Mama