Monday, March 16, 2009

Noah's Irregular Heartbeat

Let me first of all say, for friends and family near and far, that Noah is fine. He is happily growing away and making is mom gain at least a pound and a half a week-- which is welcome after her earlier lack of weight gain. However, we did have a little scare, that I am even reluctant to call a scare in retrospect, although at the time, my new mother's heart was aflutter with nerves, which is very similar to what my little baby Noah's heart was up to about three weeks ago at my regular prenatal appointment. Everything was decidedly routine until it came time to listen to Noah's heart.

Dr. Ambur found it easily-- he has been laying head down and butt out for the past several weeks, but after she found it, both she and I heard something unusual. "I think I need to go get a new Doppler. It might be the battery that is making it sound strange." Noah's heart, although good and strong sounded odd to me even still when Dr. Ambur came back with the new Doppler and listened with a much more serious face than usually when she heard his heart.

She told us that she heard an irregularity in it, which is exactly what I heard when I listened. Every fourth beat or so Noah's heart would beat an extra beat-- "bum, bum bum, bah bum," it would go. I immediately began to fear that something was terribly wrong wit my sweet little baby, but Dr. Ambur told us that it was likely something far more common called a PAC-- "Premature Atrial Contraction," which is found commonly in fetuses in the third trimester.

Typically babies with PACs outgrow them in the womb, or shortly after birth. Dr. Ambur advised that we wait and listen in a week, at an appointment between my regular bi-weekly appointments. The addition of a new appointment told me more than anything that if this wasn't PACs it could be something serious, but I told myself to not worry and to relax over the next week to encourage Noah to have a regular heartbeat (one possible cause of PACs is stress.)



I spent the next 7 days thinking calming thoughts to my baby, avoiding sugar and caffeine and researching everything I could find about PACs and irregular heartbeats in pre-born babies. I found out good things about their commonness-- about 15% of babies have PACs. I heard from women in the May What to Expect When You Are Expecting (WTEWYE) message board-- their experience ranged from experiencing just what I was and waiting to see if their baby was okay, to having gone through it in past pregnancies. Some babies simply outgrew it, and others had fetal EKGs and other heart monitoring tests just shortly after birth. One woman's doctor even had her baby placed in the NICU for 3 days shortly after birth simply as a precaution.



I also asked my good friend and wonderful doctor Sara if she knew anything about PAC, and said that although she didn't she would ask a friend of hers who was a pediatric cardiologist what she knew. The answers I got were very soothing, and I really appreciated getting an answer from someone who, I am sure, is often deluged by more medical questions than she would like.



Finally, the next week arrived and my next appointment. Jim and I waited nervously-- he kept insisting that it would totally be gone, or at least much improved, and thankfully-- he was right. This time Noah's heart still had some irregular beats, but it was every 12 or so, rather than every 4 beats. This improvement seemed to confirm that he really was outgrowing it, and Dr. Ambur was content to wait until the next week when my regular appointment was scheduled to hear how he was doing. If it wasn't gone at that point we would proceed with an ultrasound of Noah's heart and possible other monitoring and tests.



Once again we waited through the week until Friday arrived. I dropped Jim off at work (we are still sharing a vehicle) and began to drive home until time for my appointment. Driving down University, I came to its intersection with Broadway, and saw that the light was red. I moved my foot off the gas and was abut to brake when the light turned green, so I simply proceeded on in my path. As I got to the intersection I saw on my left a large semi barrelling at me, as I slammed on my brakes, he made a left turn to drive in front of me.



Immediately my little one began to punch and kick as never before. I was unsure if he was responding to my adrenaline or if it was from being squished by the seat belt, but he definitely had strong opinions about the idiot driver who I now was forced to follow most of the way toward home. I had read of placental abruption in cases of car accidents and knew that it is generally advised that if a pregnant woman is in a car accident she goes to the hospital right away, but I had not been in an actual car accident, so I contented myself with laying down and doing kick counts and then asking about it at my appointment.

I asked Dr. Ambur about seat belt placement and was surprised when she said, "Well, we can throw you up on the fetal monitor for a while, and it will give us a nice long chance to see is heartbeat." I was secretly delighted. I got to hear my little boy's heart for 20 minutes, not just for the few seconds that Dr. Ambur could manage to wrangle him to lay still for the Doppler? The fetal monitor is commonly used in non-stress tests for overdue or at-risk pregnancies. Once I was all set up on the couch, I knew that his heart was SO MUCH improved. I do not think that I heard any irregularities, and his heart reacted just as it should when he would kick or punch, or squirm. It would speed up, and then gradually slow as he stilled.

"The primary goal of the test is to measure the heart rate of the fetus in response to its own movements. Healthy babies will respond with an increased heart rate during times of movement, and the heart rate will decrease at rest. The concept behind a non-stress test is that adequate oxygen is required for fetal activity and heart rate to be within normal ranges. When oxygen levels are low, the fetus may not respond normally."

For those of you who don't know-- a fetal monitor has 2 straps that go around the pregnant woman's abdomen- one to hear the heart, and one to monitor for contractions. There is also a Jeapordy-esque toggle to hold that I was directed to push each time I felt the baby move, which was quite often. I now wish I had one at home, so that I could listen to him all of the time. I never thought that I would be thankful for a semi almost hitting me, but without it we would have had a much shorter time to listen to our boy's heart.

Surprisingly, it sounds as if most women don't share my affection for this procedure. When I told Dr. Ambur that I really appreciated getting to hear him for so long, she told me that most moms can't wait to be done with the monitor. Maybe if I was overdue (a common reason to conduct a stress test) I would feel differently. If I were a week overdue I think everything would annoy me, but for now I am content that my little boy is growing well, and that his heart is healthy (although I am still a worry-wort at times) and that he will stay put for the remaining 6 weeks as he should.

After we all listened to the regular bump, bump, bump till we were satisfied of its normalcy we were told the blessed news that Dr. Ambur tought that it would be advisable that we could go back to regular 2 week appointments, at least for a few more weeks until I am down to weekly appointments and srreenings for dialation and effacement. Eekk!

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