All is well with both the baby and me. My blood pressure was 124/70, proper weight gain and measurements etc. The baby's heart rate was a little higher--152-156 she said, but it was a different nurse, so who knows if they all count the same way.

My mom, wise in all things, especially when and how to expand your worry list, asked me last week if I'd stay on the heparin all the way through delivery. "Wouldn't it be dangerous to enter surgery while on blood thinner?" she wondered. As always, Mom was right. I asked Dr. Kennedy about the heparin schedule and she said I would not be on it at delivery, but just one day off will be enough time off to return to normal for surgery. So I just won't take it the day before the C-section is scheduled. She's not sure whether I'll need it after, but doesn't think so. She thinks continuing the
baby aspirin will be enough, but reserves the right to change her mind.

Just so it doesn't seem like I'm coasting through problem free, I will admit to some lower back/leg pain on the right side that makes walking--my primary form of exercise--less comfortable. Dr. Kennedy smiled and nodded knowingly when I told her about it--just another one of the things I didn't get far enough to experience last time, she said. She said the baby's position probably is putting pressure on my sciatic nerve(s?) and it could continue or the baby could move, relieving the pressure. She offered to send me to physical therapy if I want it, but we'll see. It's not debilitating, just sort of a stiff feeling. Definitely contributes to the "pregnancy waddle" or maybe it's vice versa. Once I get going and loosen up a bit it's better. I can still make it all the way home from work, though I didn't hesitate when John found me on my walk this evening and stopped to pick me up!

Today's blood pressure: 110/70
Baby's heartrate: 146
No additional news means a boring update: all is well.

John gave his first heparin injection tonight. He's been dreading it for weeks, knowing that as I approached the third trimester (!) I'd have to stop using my abdomen as an injection site. Because of the bruising the shots cause, it's important to vary the site as much as possible. The other two options are thigh and upper arm. I've been alternating between thigh and abdomen, but now must switch to alternate between thigh and arm. Giving the shot requires pinching up the skin and then sticking the needle in. Logistically, it's impossible to do this for myself on my arm since it's a two-handed process. John did very well, though I don't think he believed me when I said it didn't hurt. I suppose I'm used to needle sticks by now. He'll be used to it too after another 13-14 weeks.

Today I started my weekly OB appointments. At this point in most pregnancies the check-ups are still every four weeks, but my checkered history calls for more careful monitoring. As of today though, everything is fine. The baby's heartrate was 144, which is about where it's been all along. My blood pressure was fine at 120/73 and all signs point to continued health for both of us. Dr. Kennedy keeps saying she just knows everything will be fine this time. Sometimes I wonder if she says that to reassure herself or me. Probably a little of both. It can't be easy to have two people's lives in your hands.

On Thursday I went for the 23-week ultrasound that is part of the study I wrote about in early September. This was to measure the bloodflow through the uterine arteries where signs of constriction could point to oncoming preeclampsia. The right side was completely normal and the left slightly elevated pressure, but not enough to warrant any concern. Dr. R. who is running the study took one look and declared, "You will not be having a baby in the next few weeks." Music to my ears! She can't rule out later-onset preeclampsia, but she believes that if it were coming soon there would have been visible constriction in one or both arteries. In fact, she's the doctor who did the ultrasound the day before Will was born. She remembered that when she first spoke with me about the study three weeks ago and flipped back in my chart to look at her notes from that test. Sure enough, one of the arteries was described as "kinked" which doesn't mean that bloodflow was completely cut of, but severely restricted. The next part of the study will be a repeat ultrasound at 28 weeks and we'll hope that the only thing that has changed in the picture is the size of the baby!

Haiku for the working mom-to-be:

Friday afternoon.
Exhausted, hungry. Tough choice:
Nap or dinner first?

Tonight the nap won out followed by a dinner in which the primary menu selection criterion was: how soon will it be ready?

An ultrasound today shows everything is as it should be. Their measurements line up exactly with a baby at 19 weeks and 6 days, which is right where we are--tomorrow marks the halfway point, 20 weeks. The baby was not in a "posing" mood, the technician said, so we didn't get a good full-body picture. John and I agreed that about the only thing that was recognizable were the feet--our first set of footprints! The baby's legs were extended but the upper body was curled up, including a hand/arm covering his/her face (no, we did not find out the gender!) Will always kept his hands by his face, too. The NICU nurses told us it was comforting for him. I think in the case of his brother or sister, it's probably a space issue at this point. Their estimate is that the baby weighs about 12 oz. right now. So tiny, yet Will was not much bigger than that at birth.

I found out today about a preeclampsia study being done at the university, and when I said I would be interested in participating, they paged the doctor who is running the study to come meet with me. There's not a large window of opportunity to get people enrolled because the study requires a special extra ultrasound at 23 weeks to measure bloodflow through the uterine arteries. There is some research that says this can be predictive of oncoming preeclampsia, but not enough to mandate this test for all pregnant women or even all high-risk pregnant women. There's still nothing they can do to prevent it, but one step at a time I guess. I'm willing to do anything I can to add to the pool of knowledge. At some point there MUST be a treatment or cure.

In the last few days, maybe a week or so, I've started to feel the baby moving. I'd forgotten how subtle it is at first, remembering mostly Will's persistent kicks (punches? head-butts?) of objection the week I was sick before he was born. But at first it's a mere flutter. You have to be pretty still and quiet to even recognize it. It's a nice reminder that all is as it should be. They told me at the doctor's office that I could come in whenever I wanted to if I just needed the reassurance of hearing the heartbeat. I haven't done that, but have considered it a few times when the four weeks between appointments seems to stretch forever. Now maybe when I feel that anxiety I'll be better off finding some quiet and waiting for the baby to reassure me.

Last week we got to visit some friends in the hospital after their baby was born. When they called to ask if we could bring them a piece of camera/computer equipment they'd forgotten I didn't even think twice about saying we'd be right over and that we'd bring dinner to spare them the hospital fare. A few months ago I might have hesitated or even said we'd have to meet at the door. It was weird being back up on the 6th floor, but also very comforting to see what a real Mother/Baby room looks like--mom, dad, AND baby. A rolling bassinet at the foot of the bed. No worries or fear. Something we hope to experience for ourselves in January.

Update from today's 16-week appointment: all is as it should be. The baby's heart is beating at about 150 beats per minute; my blood pressure is normal, 114/70 (I think...should have written it down.) My heparin dose is increasing, and next month I'll have an ultrasound. Starting in October (24 weeks) my appointments will be weekly. Until then, high alert for anything that seems possibly, maybe, slightly unexpected or out of the ordinary. They say they won't get tired of hearing from me no matter how many times I call. I hope I won't be putting that to the test.

Welcome to the Kenyon family blog. It's been up since Memorial Day, but we're just now sharing it. We plan to use it, as the header notes, to share family news and random musings, and the first bit of news, as you can see if you read from the bottom, is that we're expecting another baby in January. I've been bursting to tell people all summer, but John has calmly played the voice of reason in this little drama, reminding me that even under the best circumstances it's best to wait at least until the end of the first trimester before sharing the news. And if you've come from our other blog, you certainly understand the many reasons this pregnancy can't be classified as routine.

I have the best doctor and a great medical facility practically in our backyard, so whatever is needed to keep us healthy will be done. Right now, other than a good diet and balance of rest and exercise, that consists of giving myself injections of heparin twice a day and taking a daily low-dose aspirin to keep my blood thin (clotting may have been a factor in my previous preeclampsia and HELLP syndrome) and having regular pre-natal check-ups every four weeks. The frequency of those checks will likely increase earlier than in most pregnancies. For those of you keeping track at home, I'm now 14 weeks along. I try to concentrate on each day, each week, and not let myself think too far ahead. There are just too many "what ifs."

Yesterday was a weird day. I woke up too early after being up late at a wedding and could not get back to sleep no matter how hard I tried. So I got up, but then spent the whole morning on the verge of an emotional meltdown. It finally happened shortly after noon when John asked if I wanted to go with him to the Jazz Fest downtown to hear a band we enjoy, led by a friend of a friend from Cedar Falls. I burst into tears and sobbed, "I don't know what's wrong with me. I don't know why I can't get my emotions under control today!" John calmly replied, "Maybe because you're pregnant?" Oh yeah.

I think most men freak out or are at least squirmy uncomfortable at the sight of any woman's tears, especially those of their wife. But around here, tears have not been uncommon these last few months, so maybe he was relieved that there was no reason--no new or renewed pain triggering the outburst.

It's not that I ever forget that I'm pregnant, but I don't always focus on the enormous complexity of all that's going on physically. When I was pregnant with Will I was obsessed with the What to Expect When You're Expecting book and read and re-read it constantly to know what was going on at every moment. Now I know that there's no way to know what to expect next week or next month so I try to focus on each day. There's really no book for a pregnancy like this and I'm not sure I'd want to read it anyway. Maybe it's better not to know what's ahead. Maybe this is yet another test of my ability to give up my need to control and plan every last detail and just let myself be swept along. I guess that includes letting the tears flow where they may.

Today's ultrasound showed a tiny but perfect beginning of a life, complete with a heartbeat of 153 beats per minute. It also showed that I'm not quite as far along as we originally guessed. Today I am seven weeks and three days. That led to an adjustment in the estimated due date. Based on the ultrasound, the due date is January 26, 2006, exactly a year since our family and friends joined us to remember Will and celebrate his short life. At first I misremembered and thought it was the anniversary of his death. I got stuck on the 26th which is tied to both his birth (10/26/2004) and his death (via the memorial service) but he actually died on Jan. 22. Regardless, it seems to be an intricately woven plot laid out before us and could be the most beautiful or the cruelest twist of fate ever. I'm leaning toward seeing the beauty--Will up there orchestrating things to mitigate our pain as we continue to face life without him.

As we've already established though, I definitely won't make it all the way to the due date. The C-section will be scheduled two to three weeks before that to avoid the chance of going into labor.

So now I'm supposed to start the heparin shots. I tried to get the prescription filled this afternoon, but after waiting more than 40 minutes I finally left Walgreens and planned to go back later. I didn't get a chance though so it will have to be tomorrow. This particular prescription seemed to flummox them on several levels. I guess it's not a common regimen, especially for long term use as I plan. Maybe they'll get used to it after a couple of refills. I hope to find out.

On Wednesday, I saw my OB for what was originally scheduled to be an appointment to discuss some bloodwork I had back in April to test for a few different things that may have contributed to my developing HELLP Syndrome. These tests were supposed to help us know whether it was too dangerous for me to be pregnant again.

I had called the day before the appointment to let them know that we'd learned over the weekend that I am in fact already pregnant. Dr. Kennedy's cheerful greeting immediately let me know that all was fine, or at least manageable. She certainly would have been more somber if she was coming in to tell us that the tests showed continuing the pregnancy would be too dangerous to my health to consider. So the news is that everything they tested was within normal range except for anticardiolipin antibodies, which are slightly elevated. I don't know what those are, so apologies to anyone who might have come across this page while searching that particular term. Given that all the other levels were normal, this particular elevation does not indicate anything specific, she said. In fact, it would not be of concern at all except for my medical history. So she said she would recommend a daily low-dose baby aspirin and probably heparin shots during the pregnancy. That is, heparin shots that I will give myself twice a day. Yikes!

Not much time to absorb all this. This treatment is preventative, not curative. That is, if we're going to do it at all, we must start ASAP because it wouldn't help once things get going down the wrong path. So needless to say, though I am less than thrilled about nine months of twice-daily needles, I am willing to do whatever it takes to ensure that this baby is born healthy and as close to term as possible.

In addition to all this, I will be monitored closely throughout the pregnancy with more frequent scheduled appointments and nearly every ache and twinge requiring a "rule out" office visit. We will not have any repeats of last October when I was home for a week with searing abdominal pain, vomiting and diarrhea and we all assumed it was a lingering stomach bug, all the while I was getting sicker and sicker with HELLP. So I will be the Pregnant Hypochondriac and wear the label proudly.

The next step is an ultrasound a week from Monday to determine for certain that this is a viable pregnancy. I won't start the heparin until then. So it won't actually be nine months of twice-daily shots. I should be about eight weeks by then so it will really only be about seven and a half months left. Plus Dr. Kennedy pointed out that since I had a "classical" Cesarean section with Will, meaning I can not labor in future pregnancies, a C-section will be scheduled at 37 or 38 weeks. So there. Less than seven months of twice-daily shots. I feel Pollyanna lurking in the background and the glass will be perpetually half full.

A new part of our journey begins. After a few weeks of uncertainty and, on some level, denial, a home pregnancy test confirmed last night that Will's brother or sister is on the way. It's a long road ahead with more than the usual emotions given what we've been through. We're lucky to have such a wide circle of family and friends to care for us and support us along the way.