We’d had a nice Saturday, with two visits from Erin and Sam, a visit from Sharon, nice weather, and plenty of time sitting outside by the ship canal, watching the boats go by. I was preparing for a nice and relaxing Saturday evening. We usually do my evening NST around 8pm, so I picked out a movie that I planned to watch during and after the NST.

Sometimes, it can be hard to find both heartbeats to do the NST, given that the babies can still move around a lot. The nurse was having trouble finding both heartbeats, so she called the doctor to bring over the ultrasound. Usually this results in a resident coming in with the ultrasound machine. In this case, I got lucky with two residents and a fellow (These people seem so YOUNG! I guess I am getting old). When the doctors found Baby A on the ultrasound, her heartbeat was very low — in the 80s. 140-150 is normal. It rebounded quickly.

Before I knew it, a nurse inserted an IV and started pumping me full of magnesium (which helps with neurological protection for preeemies), and the doctor gave me a briefing on the risks of a c-section. “Are we sure?” I wondered, skeptical if this was worth delivering over.

Sometime around this point I started sobbing. 25 week babies were not the plan. The plan is to be here for a long, boring stay. This was the first time I really came to terms with the relative risks and tradeoffs of being here in the hospital this early — I could lose one or both of these babies tonight, or this could be the beginning chapter of My Children with Severe Disabilities. “Come on babies, fight!” I kept repeating to myself.

By the way, magnesium makes you feel hot, flushed, and terrible.

Despite the heartbeat improvement, the c-section preparations continued. The anesthesiologist came in to discuss my medical history, I got a dedicated labor & delivery nurse instead of the typical antepartum nurse, and my doctors made calls down to the NICU. I called Erin sometime during this window to tell him what was going on and that he may need to come down. He was home alone with Sam, so he made some arrangements in case he needed to come in. It was hard to go through this alone.

Baby A’s heart rate continued to stay in the normal range for the next hour or so, but they wanted to keep me on the monitors (and the magnesium) all night to make sure it was just a blip. Monitoring these small babies for large chunks of time is difficult — it requires frequent nurse interventions and sometimes additional ultrasounds to find the heartbeats again. The nurse also had to check my vital signs and reflexes every 2 hours to make sure the magnesium wasn’t killing me. They gave me sleeping pills so I could sort of sleep through it, but with the frequent interruptions and the stress of having almost delivered these babies, it was hard to sleep. At around 5:30 am, since everything still looked good, they let me off the magnesium and monitors.

In the end, it was a false alarm.

The interesting thing is that we saw a similar blip on my NST last night, which just resulted in staying on the monitors for an extra 30 minutes. Again, blips are common this early. It makes me wonder if the Saturday night blip was only escalated quickly because the doctors happened to be in the room to see it. This is the strip from last night, and you can see a stretch of time where the babies were coming on and off the monitors. And then you see the dip. The dip was followed by over an hour of normal.

But here’s the thing: dips can happen at any time, when babies are on the monitor or not. When a doctor is in the room or not. I’m off of the monitor for ~22 hours a day, so it’s more likely that dips are happening when no one is watching. We are mostly just looking for patterns in these early weeks, but it can be hard to see the patterns in a small sample of unreliable data.

My reflections on this false alarm are mixed. On one hand, I’m grateful to be in good care with frequent monitoring. On the other hand, I see the gaps in this plan — the 22 hours a day without any monitoring, the difficulty in deciphering between a blip and a pattern when the data is so spotty, the reality that sometimes extensive medical monitoring can lead to unnecessary and detrimental interventions. It makes me wonder if it would have been better to stay home for a few more weeks. We’re almost at 26 weeks where we reach a new stepping stone of preemie outcomes, so it’s not like I’m suggesting I go home now. It just makes me think more about the choice of when to come here, how beneficial this really is (some recent studies on it say “meh” and I can see why) and whether or not I have much say in decisions now that I’m here.

It also makes me think about the tradeoff of modern medicine. If we’re looking for issues, we’re more likely to find them and intervene. Sometimes intervention is good and necessary. But sometimes it is not. The line between the two choices — deliver or not — can be hazy, and the decision needs to be made relatively quickly. There’s a chain of command and more steps that go into such decisions here, so I don’t know that I was actually that close to delivery. The magnesium and extended monitoring precaution is common if they see anything suspicious, just in case. But how close were we?

This false alarm makes me hope that everyone involved in this process—the nurses, residents, attending OB, MFM, Erin and me—makes the right decisions. It makes me hope that the distributed cognition of the group doesn’t get messed up. And most of all, it makes me really hope we can hang on for at least a few more weeks.