Frank Orval Pierce Garcia joined the outside world on Thursday August 26.
His birth blew all our expectations out of the water – beginning with the surprise discovery that the placenta was no longer over my cervix (as we prepared to head to OR when my preeclampsia developed severe features) and continuing on through a surprise rotation to breech (as we started an epidural for the surprise vaginal delivery attempt).
Frank was born at 36 weeks exactly, weighed 5 lbs on the dot, and has not needed a NICU stay. Thus far, my c-section and preeclampsia recovery has been uncomplicated. We both expect to return home tomorrow.
God has been gracious to us again and again and again – and we praise him for this newest evidence of grace.
Last year, recognizing that while we were at low risk for death or serious illness from COVID-19 you might not be, our family masked up, socially distanced, and got our vaccines.
My children have masked every time they’ve been in public since the CDC started recommending it (which means Daniel and I have also masked whenever our children have been in public, even during the brief period that CDC dropped the recommendation for masking for vaccinated individuals). My children missed a year of Sunday school (their primary interaction with other children) so their mother could continue to teach Sunday school without putting others at risk.
We did this not because we are particularly vulnerable to COVID but because the grandparents of my Sunday school students, the person who stands behind me at the grocery store, and the fellow taking my money at the McDonald’s drive-through might be.
This year, though, as Delta ramps up, filling our local hospitals once again and as lowered mitigation practices have started “respiratory season” months early (really months late since we basically skipped it last fall and winter), I feel particularly vulnerable.
Because this year, my family is at risk.
While preeclampsia is the immediate concern for me and baby, preeclampsia isn’t the only thing going on. I have complete placenta previa, which means that baby’s placenta completely covers my cervix. If my cervix starts to dilate and the placenta begins to detach early, baby could die. I could bleed out. It’s not a pretty possibility. This is why we’ll be delivering early, via c-section, no matter what happens with the preeclampsia.
But even if there’s no cervical dilation, no placental detatchment prior to our c-section, we’re not out of the woods yet. We are grateful that ultrasounds show no evidence of accreta – abnormal embedding of the placenta into my uterus. But even without any ultrasound evidence, there is still a significant risk, given my history of two prior sections and the presence of complete previa, that the placenta won’t detach cleanly and I’ll need an emergency hysterectomy and lots of transfused blood.
This year, given placenta previa and the risk of accreta, it matters to my family that our hospital is adequately staffed and equipped to handle desperate situations. We might well be that desperate situation.
But say God graciously grants us reprieve from early labor, from accreta, from hemorrhage. We’re still having a preemie. No ifs, ands, or buts about it. This baby will be born before term. We’re going to try to get as close to term as safely possible, but “safely possible” is no later than 37 weeks, 5 days.
And, as we know from past experience, preemies are particularly susceptible to respiratory viruses. In fact, we were strongly encouraged to distance our preemies by keeping them away from all crowds (including grocery stores and church) and all other children until they were a year of age because of their risk for rehospitalization if infected by RSV (the “respiratory season” currently going on that we skipped last year is largely RSV).
But our baby won’t be able to stay away from all other children – he’s blessed with four big siblings. Instead, our children will likely have to spend a second year in a row isolated from other people – last year, to protect those others, this year to protect their baby brother or sister.
And should baby end up getting sick and ending up back in the hospital? It matters to our family that the hospital be adequately staffed and equipped to handle that situation.
Which means that this year, it matters to us personally that we as a society get COVID under control.
Maybe it doesn’t matter to you personally. You consider the risk to yourself to be fairly low. But if you get COVID and spread it and community levels stay high, my children face another year of isolation. If you get it and spread it and our hospitals stay full, I and our new baby may be unable to get the care we might need.
So please, even if you won’t do it for you, will you do it for us? Will you consider laying down some of your rights to help us? Get vaccinated if you haven’t already been. Wear a mask when you’re around other people, especially if you’re unvaccinated or your community has high levels of transmission. Choose not to go out at all if you’re sick.
As our first year of “official” school, 2020-2021 was an interesting one.
We started slow, working our way up to the “main event” (which turned out to be a great start to the school year) … but then we tapered back as the year continued. We got pregnant at the beginning of the calendar year and first trimester exhaustion is a real thing :-) “Reading time” and Tirzah Mae’s core subjects remained consistent, but singing time, calendar time, and activity times were sporadic at best.
Nevertheless, I’m considering 2020-2021 to be a successful first year of “official” homeschooling. For the year, we all completed:
Literature – Poetry
Nursery rhymes and songs from What Your Kindergartener Needs to Know
Nursery rhymes and songs from What Your Preschooler Needs to Know
The 20th Century Children’s Poetry Treasury edited by Jack Prelutsky
Nursery Rhyme Classics illustrated by Kate Greenaway
The Usborne Children’s Songbook illustrated by Stephen Cartwright
A Zooful of Animals selected by William Cole
Seasons by Charlotte Zolotow
Yummy: Eating Through a Day edited by Lee Bennett Hopkins
Literature – Stories and Folk Tales
Stories from What Your Kindergartener Needs to Know
Stories from What Your Preschooler Needs to Know
Aesop’s Fables illustrated by Jerry Pinkney
The Blue Fairy Book edited by Andrew Lang (continuing into the 2021-2022 school year)
Literature – Chapter Book Read-Alouds
Mr. Popper’s Penguins by Florence and Richard Atwater
The Boxcar Children by Gertrude Chandler Warner
Mrs. Piggle-Wiggle by Betsy MacDonald
Betsy-Tacy by Maud Hart Lovelace
The Toys Go Out by Emily Jenkins
Charlotte’s Web by E.B. White
The Wonderful Wizard of Oz by L. Frank Baum
My Father’s Dragon by Ruth Stiles Gannett
Matilda by Roald Dahl
A Cricket in Times Square by George Seldon
The Chocolate Touch by Patrick Skene Calling
Plus a number of audiobooks (that everyone listened to) and individual read-alouds (that I did with each child) that I didn’t record as official “school”
Social studies selections from What Your Kindergartener Needs to Know
Social studies selections from What Your Preschooler Needs to Know
Tapestry of Grace, Year 1, Unit 1 (After one quarter, I decided I’d rather us get a broad narrative overview of history with just Story of the World without adding in supplemental readings – we’ll do Tapestry of Grace as our second go-through once more of the children are school age)
Story of the World, volume 1: Ancient Times (continuing into 2021-2022 school year)
Science selections from What Your Kindergartener Needs to Know
Science selections from What Your Preschooler Needs to Know
Exploring the World of Plants by Penny Raife Durant
From Seed to Plant by Gail Gibbons
Seed to Plant by Kristin Baird Rattini
Seed, Soil, Sun: Earth’s Recipe for Food by Cris Peterson
Took a seed hunting hike – collected seeds from our yard on sticky wristbands
Did celery experiments in plain water, sugar water, and dyed water
Sprouted beans to see if cotelydon changes size
Sprouted 4 different kinds of seeds to explore which sprouted first
Sprouted avocado seeds and inspected regularly with magnifying glass
Planted and grew radishes, lettuce, spinach, and beets from seed to harvest
Observed and drew spring plants in the yard
Watched about a bazillion documentaries about dinosaurs (unplanned “interruption” to my planned science programming)
Halfway through the year, I switched to having each child have a “cooking day” with mama, where they helped with meal preparation. All have shown progress with measuring skills, knife skills, stove safety skills, and mixing and spreading. They are improving in ability to crack eggs without making a huge mess.
All three of the “big kids” have made great strides in representational drawing and scissor skills. While we haven’t done a lot of formal projects, we continue to do the occasional process art and explore color mixing whenever we have opportunity.
The children spent lots of time outside (and inside) running, climbing, swinging on swings, dancing, and building things.
Tirzah Mae’s hand-stitching is becoming increasingly small and even. She is able to hand sew a straight seam.
Tirzah Mae Kindergarten
For Tirzah Mae’s kindergarten language arts, she did about half of the American Language Series K phonics and reading program (consonants, short vowel words, inital and final consonant blends, and consonant di/trigraphs.) She used homemade worksheets to learn proper letter formation for all the lowercase and uppercase letters.
For math, we continued on with Shiller Math Kit 1 until I accidentally borrowed a kindergarten math workbook from the library (thinking it was a “train the teacher” type book). Tirzah Mae immediately fell in love with the workbook and begged to do it instead of her regular math. (Sigh!) So she completed a kindergarten math workbook from Creative Teaching Press to round out her kindergarten math experience.
Overall, it was a good year. Morning time has definitely been a wonderful part of our routine – the regular inclusion of nursery rhymes and folk stories helps me be confident that the preschoolers are getting what they need in the language arts department even if I’m not doing specific “preschool” work with them.
Kindergarten work with Tirzah Mae was more challenging than I expected – despite being highly motivated to write (the stories have already filled literally dozens of notebooks), Tirzah Mae would much rather be moving than sitting still – and having to “do school” with mama while the younger children were playing rankled. I also see now that I tried too hard in the past year to get through a lesson a day instead of emphasizing focused, diligent work for a shorter period of time. As a result, both Tirzah Mae and I were prone to boom and bust cycles where we’d do a lesson a day for several days and then wear out and not do anything for several days only to start again with a fresh burst of motivation later (I know, not a great way to do skill work!) Nevertheless, looking over the skills Tirzah Mae has attained in the past year, I am confident that she is right in line with where she should be at the end of kindergarten.
When you’ve been a mother to preemies and had your fair share of complicated pregnancies, all sorts of numbers take on new significance.
For me, 29 weeks and 6 days is when I was hospitalized for preeclampsia with Tirzah Mae.
33 weeks, 6 days. When I was hospitalized with Louis.
32 weeks, 1 day. When Tirzah Mae was born.
34 weeks, 3 days. When Louis was born.
And today is 35 weeks. Baby #5 will be our oldest preemie yet.
Then there are the days from diagnosis to delivery.
8 days of hospitalized bedrest from diagnosis to delivery with Tirzah Mae.
4 days of hospitalized bedrest from diagnosis to delivery with Louis.
14 days now from diagnosis with Baby #5, still at home and still pregnant.
It’s encouraging to remember the numbers, to compare then and now.
It’s discouraging to consider the immediate future. We want baby and I to stay healthy, ideally for baby to stay in my womb for 19 more days. But 19 more days of waiting feels daunting. Sometimes just one more hour of waiting feels daunting.
“Rest” is exhausting when there’s the constant looming thought that the next blood pressure measurement might be the one that ends it all.
“Rest” is exhausting when you’re considering what to make for lunch and trying to balance time on your feet and kids’ complaints and whether the increased fluid retention from whatever sodium-filled convenience food you finally decide on will overwhelm your already fragile ability to cope.
“Rest” is exhausting when you want nothing more than to be present with your children but quickly feel overstimulated by the inevitable noise and movement and squabbling that four children competing for mama’s attention brings.
So here we are in the interim – looking back to celebrate two extra weeks with baby in the womb, two extra weeks at home with our already-born children.
And here we are in the interim, terrified at the hubris of scheduling a c-section for three weeks away, frightened at the prospect of (at any given moment) delivering within hours, worried that we haven’t the strength to continue this “rest” for three more weeks.
And here, while we’re in the interim, would you pray for us? Would you praise God for two weeks at home, for 35 weeks in the womb? And would you pray that we would experience true rest, the peace that passes understanding, for the rest of this pregnancy, whether that’s three more hours or three more weeks?
I’ve had a lot of questions in the past several days, so I thought I’d try to give a brief summary of preeclampsia for those who are interested.
Preeclampsia has two major diagnostic criterion – high blood pressure combined with protein in the urine after 20 weeks of pregnancy. For a diagnosis of preeclampsia, there need to be two measurements of blood pressure at least four hours apart where either the top (systolic) or bottom (diastolic) numbers are greater than 140/90. There are several other warning signs that preeclampsia might be on its way or present (large weight gains in the course of a day or week, lots of swelling in legs, intractable headaches, visual disturbances, severe pain in the upper right side of the belly) but those are not diagnostic like blood pressure and urine protein.
When I went for my prenatal appointment this past week, I wanted to talk with my doctor about preeclampsia because my morning blood pressures had been rising and because I had some of those other warning signs – I was gaining 2-6 lbs of fluid daily (although mostly losing it overnight), had developed pretty severe carpal tunnel (caused by fluid retention in my wrists), and was having painful swelling in my legs and feet as each day progressed.
In light of this, we did labs (including a test for urine protein) despite my blood pressure falling under the 140/90 threshold for a diagnosis of preeclampsia. I had protein spilling into my urine – and, at my appointment the next day, my blood pressure was over the line. This is when we arranged for me to have 24 hours of monitoring in hospital. Note that I didn’t yet have an official diagnosis of preeclampsia because I hadn’t had two blood pressures (taken at least four hours apart) “over the line”.
While hospitalized, I received a couple of steroid shots that will help mature baby’s lungs in case early delivery is required. Otherwise, I sat or laid around in bed between blood pressure checks, which occurred every 2 hours.
Of the 18 blood pressure checks I had in the hospital, five were at or above the 140/90 line that fits the diagnostic criterion for preeclampsia – the rest were in what, in non-pregnant folks, we call the pre-hypertensive range (top number between 120 and 140, bottom number between 80 and 90.) Prehypertensive blood pressures aren’t normal or healthy – they’re a sign to start taking care – but they’re not a sign of imminent danger either. If you showed up at your doctor’s office routinely with pre-hypertensive blood pressures, your doctor probably wouldn’t start you on medicine, but they might schedule you an appointment with a dietitian who can help you develop eating habits that are known to be helpful with managing blood pressure (both the Dash diet and the Mediterranean-style diet have good evidence for blood pressure control). Your doctor would likely also encourage regular physical activity and, if indicated, weight loss.
Given that my blood pressures were right there on the line during my hospitalization, I returned home yesterday afternoon. I will continue at home with outpatient monitoring at present.
As far as monitoring goes, there are three main potential indicators that I need to head back to the hospital and/or have the baby right away.
First, baby could stop growing or be in distress because of what’s going on with me. To make sure this isn’t the case, we will do weekly biophysical profiles which use ultrasound to measure baby’s growth, activity, and amniotic fluid.
Second, my blood pressure could rise to severe levels – greater than 160/110. I will continue to monitor my blood pressure at home at least once daily and I will go into the doctor twice a week to have in-office monitoring. (Louis had to be delivered at 34 weeks, 3 days when my blood pressure rose persistently into the severe range.)
Finally, other organs in my body could be affected (additional kidney problems, liver problems, blood cell abnormalities) which would be an indication for delivery – Tirzah Mae was born at 32 weeks, 1 day when my liver enzymes and blood cells indicated multiple organ involvement. I will have weekly labs to monitor for this last potential indication for delivery.
But, unlike during my pregnancies with Tirzah Mae or Louis, we have caught the preeclampsia while the majority of my blood pressures are NOT in the preeclamptic range. This makes outpatient monitoring a possibility and makes our likelihood of delaying delivery until the c-section we were otherwise planning for 36-37 weeks much higher than it was with either of our first two children.
So we are feeling fairly optimistic about the prospect of staying pregnant longer and maybe even avoiding a NICU stay this time around.
We do appreciate your ongoing prayers – we know things can still change pretty rapidly in this game and that we need to be ready for anything. We also want our children to be able to enjoy as normal a life as possible while we wait for the new baby to arrive while at the same time not hastening baby’s arrival – so we will need lots of wisdom as to what I should and should not be doing and how to truly love and wisely parent all five of our little ones as we wait.
Daniel could also use additional prayer as much of the added burden of parenting, meal preparation, and homemaking falls on him – and all this in the midst of a fairly busy season at his day job.
I got to looking at my old blood pressures to give an idea of the differences between my first twenty four hours of hospitalization with each case of preeclampsia.
Total BP readings
Normal BP readings (<120/80)
Pre-hypertensive BP readings (120-139/80-89)
Preeclampsia BP readings (140-159/90-109)
Severe preeclampsia BP readings (>160/110)
A few notes: I had a lot more blood pressures taken with the first two pregnancies because each high blood pressure generally triggered a follow up after I’d had a chance to sit quietly for a while, in hopes that it would come down a little with extra rest. With Tirzah Mae, I was on IV magnesium sulfate for the first 24 hours of hospitalization to prevent seizures and lower blood pressure. Even with this intervention and no movement whatsoever, my blood pressure was still above the line (orange or red) 70% of the time. Contrast this with this pregnancy, where I received no medication and had no enforced restrictions (although I did mostly sit or lie down when I wasn’t getting up to use the restroom) and had blood pressures below the line (yellow or green) >70% of the time. The one “severe” blood pressure this time around was from when I was telling an animated story while my blood pressure was being taken (that’s a no-no – you’re not supposed to talk while your blood pressure is being taken.) A second pressure taken 5 minutes later when I wasn’t talking was at the low end of the hypertensive range.
Of course, I should add the caveat that I am not a medical doctor and cannot diagnose or treat any disease. I speak as a mother who has experienced preeclampsia three times, twice with severe features necessitating preterm delivery. If you have or suspect that you have preeclampsia, please contact your maternity provider so an individualized treatment plan can be made that takes into account your unique medical considerations.
“We specialize in pregnancy complications,” I tell the nurse with a laugh. And, truly, it often feels we do. Preeclampsia, transverse presentation, preemies, post-dates, prolapse, miscarriage, shoulder dystocia. We’ve done them all.
And with this pregnancy, we have complete previa and now preeclampsia again.
Yes, that’s right. I am back in the hospital at 33 weeks and a day, nursing a sore bottom from the corticosteroid shot meant to mature baby’s lungs in case we need to deliver in the next couple of weeks. Lord willing, no severe features of the preeclampsia will reveal themselves and I’ll head home after my second shot tomorrow.
It can be such a glib phrase. Or it can be a profound one. I probably use it glibly plenty – but not when it comes to having babies.
If there’s anything specializing in pregnancy complications has taught me, it’s that God gives and takes away, he chooses and he chooses best. And he is present every step of the way.
He is present when sperm meets egg, when embryo implants, when placenta forms. He is present and working when preeclampsia is written into the vasculature of the developing placenta. Or when the placenta develops right on top of the cervix.
God was present and working when I started bleeding and our fourth baby was lost just five weeks after conception – and God was present and working when I started bleeding early on with this pregnancy and our baby survived.
God was present and working and willing when we discovered complete previa on the “routine” 20ish week ultrasound I’d declined with all my other pregnancies (providential, wouldn’t you say, that I chose not to decline this time, when it matters so much that I not go into labor or deliver vaginally?)
God was present and working and willing each time that the external signs made clear the preeclampsia that had been latent from the beginning.
None of this has ever been hidden from his sight. None of this has been outside his hand.
Someone recently pointed out to Daniel that this is a part of Adam’s curse, this perpetual pain in childbirth. And so it is. But it is also God’s blessing on us fallen creatures.
For here, in the many pains of childbearing – pains we have felt most acutely – here we also experience his presence, his providence, his hand. Here we see that he is not content to let us lean on our own understanding, not willing to let us labor under delusions of our own control, not satisfied to let us remain in our fallen insistence on autonomy. Here, he calls us to rely on him, to trust him, to be conformed to his image.
For whatever God may will for the remainder of this pregnancy, I am confident in this: that God is willing and able to complete the good work that he started in us. He is present in this pain for that very purpose.
Dose 2 of Pfizer is in my arm – a couple more weeks and I’ll be protected.
I’m thrilled that preliminary reports suggest that in addition to virtually eliminating the risk of severe COVID in vaccinated individuals, the currently available vaccines also reduce the risk of infection at all (and therefore spreading.)
Given that it doesn’t eliminate risk of infection, I’ll still be masking up when in the presence of potentially unvaccinated individuals – but this extra layer of protection is more than welcome and I look forward to the increased confidence it can give us in small groups of individuals whose health status/vaccination status is known. And, of course, I am hopeful that others will join the ranks of vaccinated so we can break the chain of transmission sufficiently to keep icky variants from gaining a foothold here in the US.
If you live or work in Sedgwick County, Kansas, the mass vaccination site at the old Central Library (so nice to visit my old digs again!) is very efficiently run and has had open appointments for anyone over 16 for a couple of weeks now. If you’re somewhere else, check with your local health department and get your vaccination scheduled – together, we can beat this!
Sometimes, I just want to take a snapshot of this moment in time, so I can remember the ordinary not-so-noteworthy things that nevertheless make life as a parent of young children so delightful.
Like how Shiloh is taking her tentative first steps – three to five at a time, but only when she thinks no one is watching.
Like how Beth-Ellen gave me dozens of pretend gifts for my birthday and then carefully gathered together all the pretend wrapping paper and took it to papa to be shredded and composted.
Like how Louis has suddenly decided that drawing is a thing and is busily creating books full of animals, complete with captions, when only a week ago he didn’t even bother trying to be representational with his artwork.
Like how Tirzah Mae found a math workbook and raced through half of it in less than a day’s time.