the rest of the story

in some of my previous posts i've eluded to some back-stories that i promised to expand on. so finally i'm making good, here are those missing parts of our pregnancy and birth story:

at our 20-week anatomy ultrasound (when we found out the baby's gender) in october 2008 the doctors also discovered that marianne's left kidney was dilated (read: retaining urine) slightly more than normal. sometimes some organs develop ahead of others so they scheduled a follow-up ultrasound eight weeks later to see whether it would self-correct. at the follow-up in early January the left kidney was even more dilated - medically referred to as hydronephrosis - and not expected to "normalize" by/before birth. we were scheduled for periodic ultrasounds for the remainder of pregnancy to track the progress of the dilation. 

the ultrasound doctors referred us to a urology specialist at The Children's Hospital, a renowned facility, for a prenatal consult and postnatal care. after studying our ultrasound records, the urologist speculated the cause of the hydronephrosis was most likely either a uretero pelvic junction obstruction (an immaturely developed muscle in the "funnel" where the ureter exits the kidney) or reflux (backward flow of urine from the bladder to the kidney). he said we wouldn't know for sure until they could do tests on marianne a few weeks after birth.

in the last month of pregnancy we were having ultrasounds every week. the last two ultrasounds showed a progression in the dilation  of the left kidney and borderline high amniotic fluid levels (which can press on the placenta and decrease blood flow to baby). given these factors, our doctors recommended inducing labor in my 39th week so we could start treating marianne's kidneys. even though i wanted to do what was best for her health, i wasn't exactly thrilled at the prospect of inducing...it just didn't feel right. whether it was foresight or letting go of my hopes for the spontaneous onset of labor, either way i had a hard time coming to terms with it.

we went in at 8:45pm on tuesday, march 17 to get the induction underway. the drug they were starting me on (cytotek) is usually a slow start to the labor process. it's a 4-hour dose and most women receive 2 or more doses to achieve a ripe enough cervix to begin pitocin - the drug that really sets the contractions in motion. when they administered the first dose of cytotek at 10pm, i was only 1cm dilated and 60% effaced. within two hours i was dilated to 3cm and 80% effaced and contractions were coming one after another, lasting about a minute each. this kind of progression of labor from cytotek is virtually unheard of - at least in my doctor's experience. this would have been good news except marianne wasn't responding well to the contractions. her heart rate was dipping and spiking in patterns that weren't favorable. over the next hour or so they tried a few things to get her to stabilize but to no avail. at about 1:30am they told us they were taking me to the o.r. for a caesarean birth and they didn't mess around. they gave jerry a "blue suit" to wear and wheeled me off. i was hurting, nervous, scared and mad.

the anesthesiologist was administering the spinal block as waves of contractions kept coming, meanwhile doctors were counting instruments and nurses were preparing the warmer. it wasn't long after the drugs set in when jerry was called in and moments later, at 1:50am, they asked him if he wanted to stand up to see them pull her out. so at least one of us got to see her entrance into this world - i will forever miss having that memory but i will never forget hearing her meek little whimper within seconds of birth. tears streamed down my face and i knew from that moment forward i would never again be mad about the c-section. all i cared is that we had our baby girl.

marianne had her first urology tests on april 8. she had a renal ultrasound to look for the UPJ obstruction and a VCUG (involving a catheter and a radioactive dye) to test for reflux. the VCUG proved that reflux is not occurring but the renal ultrasound showed that there is hydronephrosis in both kidneys (Grade 3 in the left and Grade 1 in the right - Grade 4 being the most severe case). her urologist said he's positive the hydronephrosis is due to obstructions but he also told us that kids (even with the most severe grades) will often outgrow it. she's been wetting diapers normally but he wants to do one more test to check for any loss of function so that he can determine whether corrective surgery is necessary or if we can watch to see if her kidneys develop and outgrow it.

we're going in to radiology tomorrow morning for the Mag 3 test - involving a dye injected via IV and again with the catheter. hopefully we'll be able to consult with the urologist in the next few days for his prognosis. if it's surgery - he has explained the minimally invasive procedure, that has a 98% success rate, which would be general anesthesia, a 2cm incision, reforming the UPJ and an overnight stay in the hospital. if it's a wait-and-see outcome we will be taking her in for periodic ultrasounds to track progression.

and now you know the rest of the story (as we know it so far).

i love this photo - it gives me a giggle every time i see it!