Day 14: Back on Track

We are happy to report that Vivienne is back on the conventional ventilator and is doing well. As I mentioned in the previous post, her unplanned extubation last night resulted in her needing the oscillator vent. Thankfully, she rebounded quickly and was back on the conventional vent by 10:30 this morning. Viv looked very comfortable all day and her vitals looked great. Mom and dad are hoping that she continues to have a restful and uneventful night. No more surprises!

A few other notes from today include a significant drop in her Dopamine dosage (down to 7, which is a reduction by half since yesterday morning). The doctors are very pleased with this development and hope to wean that to 2 or 3 before surgery. Speaking of surgery, we were told to expect to be on the schedule sometime in the next 3 to 7 days. Obviously this can change but Vivienne is really taking big steps forward, so we're confident that surgery is coming soon.

Other items of note: I had the pleasure of changing a dirty diaper today (no sarcasm; I really do enjoy it). Dave and I also got to assist with a bedding change. This was fun because we got to lift Viv up while the nurse swapped out the blankets.

Hopefully there are no surprises tonight, and Viv can continue to take steps in the right direction.

Setback

UPDATE: It turns out that the re-intubation was the cause of everything last night. Her breathing tube got clogged with blood/gunk thanks to a coughing fit during re-taping. Viv just wasn't able to recover on the conventional vent, so they put her back on the oscillator. The good news is that she's right back where she was, and they are going to try the conventional again today (but with more sedation).

Well, in true CDH fashion our highs have once again become lows. Vivienne started having trouble on the conventional vent last night and was having difficulty expelling CO2. Her breathing tube also become displaced and she had to be re-intubed. She is currently back on the oscillator. The good news is that she's stable. We're obviously disappointed, but this is just how these things go sometimes. We'll post a full update this evening.

Day 13: See Ya Later, Oscillator!

Vivienne was a real rockstar today. She handled all of her weans and took some major steps forward, the biggest being the switch from the oscillator to the conventional ventilator. This is a big deal for a few reasons. First and foremost, it moves her much closer to her repair surgery. Second, the conventional ventilator is a more comfortable machine. There are no vibrations and noise, the tubing is less rigid, and it allows for less sedation. Viv was so alert after the switch. She was looking all around and really studying our faces. It was almost like meeting her again for the first time.

The second big step today involved weaning her blood pressure medication. Her Dopamine level dropped from 14 to 10. This also bodes well for surgery. Additionally, Viv's oxygen support was down to 29 when we left today which is the lowest it has ever been.

The only hiccup today came during care. Something really upset her (we don't know what), and it sent her into a fit. Her heart rate spiked to over 200, and she was heaving/gagging. Luckily it didn't last too long, and I was able to help calm her and bring her heart rate down. Hopefully we will have less of these episodes now that she's on the conventional vent.

Here's a short video of Viv enjoying her new set-up. Compared to yesterday's video it's easy to see why mom, dad, and Vivienne are excited for the change.

We're excited to hear what the doctors have to say during rounds tomorrow and are hopeful that surgery is just around the corner.

Day 12: Eyes Wide Open

Another good day for Viv! As you can see, our sweet girl had her eyes open for a few minutes which was great fun for mom and dad. She has been pretty sedated since her birth, so it's very exciting when she is more alert (as long as she's in a good mood). Apparently, she had her eyes open for the nurse this morning as well. She even took a pacifier for a short time. Exciting stuff!

Here's a short video of Viv enjoying a few drops of breastmilk. Sorry it's so dark and that the orientation isn't landscape - with all of the excitement I forgot to turn my phone the right way. The video also picks up the sounds of the NICU - the constant whirring of the ventilator, the beeping of the monitors, and a few crying neighbors.

Finally, we have a surgery update to share. Our surgeon has been briefed on Vivienne's current condition, and it has been decided to postpone surgery for now. The goal is to continue to wean her blood pressure medication and to transition from the oscillator to the conventional ventilator prior to surgery. We don't really have a timeline since everything will depend on how Viv is coping/adjusting, but she's making great progress and is definitely on the right track. She will let us all know when she is ready.

Day 11: Getting Better is Hard Work

Today was another step forward for Vivienne, as they were able to chip away at her oxygen level, oscillator setting, and Dopamine. Unfortunately, whenever they do this it leads to some discomfort. Once Viv demonstrates that she can handle it they wean her more and she goes through the same process all over again. The purpose of this is to get her ready for surgery as quickly and safely as possible, but it isn't fun for Vivienne or for us to watch.

The highlight of our day at the hospital was a few minutes when Viv had her eyes open and was looking at us. By the time we thought to get out the phone and take a picture the moment had passed, unfortunately, so no pics today.

The other highlight of our day was getting out in the city again for a little while. We picked up some new clothes for me and then met friends for dinner. It feels good for us to get outside of the Ronald McDonald House/CHOP bubble every now and then and Philadelphia has a lot to offer.

Still no word one way or the other on Vivienne's repair surgery, but we're hoping her surgeon will be encouraged by her progress. It would be wonderful to reach that milestone soon so Viv can truly begin to recover.

Day 10: All About Oxygen

Another positive and uneventful day is in the books. The main goal today was weaning Viv's oxygen support. When we arrived this morning her oxygen tank was set in the low 50s, and it was down in the mid 30s by the time we left this evening. She tolerated the decrease pretty well and only really had significant episodes during care. The good news is that she is able to recover faster than she used to. Though Viv's numbers were stable for most of the day, she did seem to be a bit uncomfortable. She tried to cry several times and seemed to be coughing/gaging (possibly due to the breathing tube or the build-up of mucus since she can't swallow). It's extremely difficult to watch her struggle and not be able to do much. My heart breaks every time her little face scrunches up. We are definitely looking forward to getting past this stage and hope that the repair surgery can happen sooner rather than later.

In other news, today was my original due date and would have been Viv's birthday if I had needed the induction. I can't say I'm disappointed that I missed out on another 9+ days of pregnancy.

Dave and I took a break from the NICU to check out the Franklin Institute with some Ronald McDonald House friends. It was a nice break from the hospital routine, and we hope to continue to enjoy more of what Philly has to offer in the coming weeks.

That's all for now. Hopefully Viv has a good weekend so she can impress her surgeon on Monday.

Day 9: More of the Same

We're happy to report that Vivienne had another great day! Her slow but steady progress is wonderful for her (and for us!), but it doesn't result in very exciting blog posts. Viv's oxygen support was under 50 today and her ventilator settings were reduced based on an encouraging X-ray that showed more of her good lung had opened up. The team did decide to increase her morphine a bit to make her more comfortable. Other than that it was a very uneventful day. Her vitals looked great and her blood gases continue to be encouraging. She also tolerated a lot of NICU noise and commotion and generally maintained her composure during routine care and a follow-up echocardiogram. It's weird having a baby that can't cry, and it's sad when it's apparent that she's trying. Luckily those moments are rare since they keep her pretty comfortable and sedated. Dave was able to get in some quality hand-holding time when she was receiving care, and I think it helped her cope with being poked, prodded, and moved.

This has been a great week so far. Viv's surgeon returns from vacation soon and will determine if she's ready for surgery. Hopefully the repair can happen sometime next week, but we're all comfortable waiting until she is ready.

Day 8: Officially One Week Old!

It's been a week since Vivienne's birth! Time seems to simultaneously fly and stand still in the NICU. The lack of windows and the Groundhog Day-like monotony makes it easy to forget the date and lose track of time. Viv is doing great. She had another uneventful day, which is exactly what we want and what she needs. Her vitals looked really good all day and her blood gasses continue to improve. Dave and I decided to leave the hospital a bit early and were able to take a glorious two hour nap. We're still adjusting to our new schedule, and it felt great to recharge the batteries a bit.

It feels good to have week one under our belt. We still have a long way to go of course, but we're getting into a groove. Every day with Viv is truly a gift, and we are in awe of her strength. She's one tough cookie.

On to week two!

Day 7: Baby Steps and Special Moments

Today was a great day. Vivienne seemed very comfortable and her vitals only seemed to dip during periods of overstimulation. The team is trying to wean her Dopamine (blood pressure medication) and oxygen support, and progress was made on both fronts. All of Vivienne's nurses have been wonderful, but today's nurse was particularly helpful and really took the time to explain a lot of the "medical stuff." She was also very tuned in to Vivienne's needs and encouraged Dave and I to participate in care. As a result of her reassurance and confidence, we felt more comfortable interacting with Viv. Stimulation isn't beneficial for CDH babies, but she seemed to be tolerating interference a bit better today. Dave and I were able to participate in care and helped to calm her with our touch (mainly applied to the top of her head). I also couldn't resist planting a few kisses there as well. The highlight for me came when I placed my finger in Viv's hand and she grabbed on. I tried to pull away a few minutes later (Dave was trying to get me to adhere to our pumping schedule), and she tightened her grip. These little moments are so special to us. We're hopeful that our sweet girl has another restful night and that she continues to take small steps forward tomorrow.

Action shot of the nurses lifting Viv up during care to wipe down her back and inspect the skin for signs of irritation. 

Viv took advantage of some extra room to stretch her legs. 

Holding hands.

Day 6: Uneventful

Vivienne had a good day. We arrived at the hospital before 8:00am and were able to catch rounds. The doctors decided to bump up a few of her medications to make her more comfortable. They also determined that her chest tube was a bit too deep, which was causing a part of her right lung to collapse. Obviously a baby with severe pulmonary hypertension needs every bit of lung to be functioning, so they made the necessary adjustments. These changes resulted in a much happier baby (and happier parents). Viv's blood gasses continue to look good, and we'll be anxious to see if they attempt to wean her a bit overnight. She has some work to do if she wants to stay on the surgeon's calendar.

That's pretty much it for today. We are in the thick of the NICU monotony - a tweak of a setting here, a change in dosage there, etc. Every day is essentially an experiment and there really is a lot of trial and error. Ultimately this is a marathon not sprint, and we're fine chugging along at Vivienne's pace.

Day 5: Slow and Steady

Vivienne had a better day today, but she did take a few small steps backward with her medications and oxygen support. As I've mentioned previously, it isn't uncommon for CDH babies to take one step forward and then two steps back, so this really isn't all that surprising. The important thing is that she isn't careening toward a cliff; she's just adjusting to her new environment. The doctors want to see how much she can do, but they aren't going to push her too hard. Ultimately, Vivienne is the one in charge. She will determine when she's ready for the conventional ventilator and when she's ready for her repair surgery. Slow and steady is the name of the game. Hopefully Viv will have a restful night and be ready to take a few steps forward tomorrow.

One item of note involves Vivienne's heart. She has had three echocardiograms since yesterday morning. Her heart is fine - no abnormalities or function issues - but the cardiology team did recommend a medication to keep her Patent Ductus Arteriosus (PDA) from closing. All babies have an opening called the ductus arteriosus between two major blood vessels leading from the heart. This opening closes shortly after birth since it's unnecessary once the lungs begin to function outside of the womb. Viv's PDA was beginning to close (as it should), but cardiology recommended that we keep it open for now to assist with her pulmonary hypertension. Essentially, the PDA will serve as a "pop-off" valve to relieve pressure placed on the right ventricle due to hypertension. Without that release, the pressure would cause the right ventricle to weaken and become very sick. The PDA should close once the medication is stopped; however, there is a very small chance surgery may be required to seal off the valve.

That's pretty much it for today. Sorry for the lack of pictures, but Viv was very sedated and covered up today. They really wanted to stimulate her as little as possible so she could remain calm. It's very difficult not being able to interact with her, and we are looking forward to the day when we can act more like parents and less like observers.

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Day 4: Little Miss Grumpy

We got back late from the hospital tonight so this is going to be a short post. Viv is still doing fine, but she didn't really take any major steps forward today. Since she has been doing so well they were weaning her from various treatments and she started to experience a little difficulty late this afternoon. She was pretty agitated all day. They switched her pain medication to morphine and she received a blood transfusion to resolve low hemoglobin levels. The rest of her settings didn't really change much today.



"Why can't they just leave me be?!"

The good news of the day was that mommy got to change a diaper and Viv's urine output continues to be adequate, so no more catheter for now. We're hoping for a restful night tonight, for Viv and for us.

Being a Milkman

 

A few posts back Allison described the meeting with the lactation consultant, Diane, and how the CHOP philosophy is for dads to do most of the work related to milk production, other than the actual pumping. Diane spent as much time talking to me as she did talking to Allison and she gave me a sheet with ten duties that were my responsibility to carry out. The idea is to take some of the pressure off of moms related to milk production specifically and just in general. 

 

Our lives now revolve around pumping, so it makes sense that we'd both be engaged in the process. We pump for 15 minutes every two and a half hours. The goal is to pump eight times each day and to go 2-3 hours between pumps. Sleep and everything else that we do gets scheduled around when we pump, although if we want to pump a little early or are running a little late we have half an hour of built-in buffer on either side. Because Viv isn't actually consuming the milk yet we don't have to wake up in the middle of the night to pump as long as we do a late pump around 11:30-midnight and an early pump around 6-6:30am.

 

Vivienne can't digest food yet so most of the milk gets put into vials that I label and number and give the hospital to freeze. Once she can consume the milk they will unfreeze it and feed it to her (through a tube, at least initially) in the order in which it was pumped. In addition to the vials that are stored, we periodically set aside a small amount of milk that we or the nurses swab onto the inside of her cheeks, her tongue and around her lips. Her body absorbs some of the milk and it also acts as a force shield keeping out viruses and infections.

 

Diane said that in the first week we shouldn't pay attention to the amount of milk being produced and just to make sure that we pump regularly, even if nothing is coming out. The first day, Allison produced 11 milliliters over six pumps (one of my tasks is to keep the pumping log, including measuring the volume from each pump). The second day was 87 mL over nine pumps and yesterday she made 232 mL over eight pumps. The long-term goal is to produce between 500-1000 mL per day. Although it seems like Allison is well on her way to meeting that, Diane said that things could start great and then trail off. We're trying not to get too overconfident but I have to admit that I've been bragging (probably more than I should) to the nurses about Allison's production. I was also joking with Allison (again, probably more than I should) that she had the best breasts in the SDU. 

 

I take my role as milkman very seriously. We set the pumping schedule together but it is my job to keep track of it. Remembering to pump isn't hard but fitting the rest of our day in around the pumping schedule can be a challenge. On Day 2 I put the pump pieces into the wash basin, capped and labeled the bottles and filled out the log but forgot to wash, rinse and lay the pieces out to dry before going down to drop off the milk and visit my daughter. When I returned the nurse had completed my task but explained to me that I'm not supposed to just leave the pieces soaking. I tried to explain that I knew this and had simply forgotten but after that, whenever she saw me doing something milk-related she took it upon herself to give me pointers. This delighted Allison, who had observed earlier that I was becoming a dictator about our pumping schedule as well as a bit overconfident about my mastery of the milkman duties.

 

That's probably enough on pumping, at least for now. Although we appreciate the great care that Viv is receiving, it is a bit frustrating to not be able to do more for her ourselves. Being a participant in the milk-making tasks and giving Viv oral care has been a great way for me to feel more like an active dad and less like just an observer.



Day 3: More Good News

Our little Viv is continuing to impress and amaze. She has remained stable and is being weaned off of medications and oxygen. Her ventilator settings have also been reduced. I was present during morning rounds and was amazed to hear the doctors mention that they wanted to move her to the conventional ventilator within the next few days. I was also able to view her chest X-ray and was blown away to see the difference in her left and right lungs. Her right lung seems to be a pretty decent size, but her left lung is so tiny. If her right lung is a big plump grape, then her left lung is a shriveled up raisin. This isn't surprising of course, but it's encouraging to see how well she is coping with so little lung tissue.

The best news of the day came from the surgeon. She is very pleased with Viv's progress and wants to tentatively schedule the repair surgery for March 30. The surgeon also said that barring a major set-back like an infection, it is extremely unlikely that our sweet baby girl will need to go on ECMO. I couldn't help but shed a few happy tears as I digested this news. We are trying to stay level-headed and grounded in reality, but Viv is making it difficult by being so damn awesome. She's still very sick and the situation can deterioate at any time, but so far everything has fallen into "best case scenario" territory.  

So, now we continue to look forward and hope for uneventful days with slow and steady progress. We were discharged from the hospital today and are back at the Ronald McDonald House. It's difficult being away from Viv, but our new routine of commuting to and from the NICU begins tomorrow. 

And now for today's milestones and a few pictures!

-Her ventilator was weaned down several times.

-She is using minimal oxygen support.
-Her blood gases are perfect.

-Her heart rate is steady.

-Her Dopamine levels have been reduced to 9mg.

-Her catheter has been removed and she is producing urine.

One of the nurse technicians made Vivienne this beautiful name plate.

Just chillin'. 

My sweet gift basket from the Special Delivery Unit. 

Day 2: A Good Day

Greetings from CHOP! As you know, Vivienne hit a bit of a rough patch last night. The doctors described her as "kind of stable" and ECMO was being discussed. Well, we are happy to report that our little fighter turned things around and ended up having a great day. I'll go into the particulars soon, but first it's important to stress that while a good day is awesome, it's just that: a day. CDH babies are very sensitive, and their situation can change on a dime. That being said, we will happily put today in the "win" column. Now for some specifics:

-Viv started the day with a mysterious fever, but her temperature is now perfect.
-Her oxygen support has been weaned from 100 yesterday to 40 today.
-Her heart rate dropped from 200 beats per minute at the peak of her distress to an average of about 120 beats per minute.
-The setting on the oscillator ventilator has been reduced, meaning she's taking on a bit more of the work.
-Her blood gases have been excellent and consistent.
-Her blood pressure has improved and is holding steady, and her dosage of Dopamine has been reduced from 16mg to 12mg.

The only "set-back" she had today was her inability to pass urine. Her bladder was full, but she was having trouble expelling the urine, so they ended up placing a catheter. The nurse wasn't concerned and noted that a lot of CDH babies need a catheter at some point.

So, all in all it was a great day. Hopefully we stay on track tomorrow.

And now it's time for pictures!

Viv's sensors make her look a bit like ET. "Viv phone home!"

All of Viv's equipment.

Daddy providing oral care. Check out all of her hair!

First family photo! 

Vivienne is here!

Vivienne Eleanor looking at her daddy. Notice how small her abdomen is compared to her chest - this is because of the location of her organs.

Vivienne Eleanor is here! My contractions last night never really went away and became full on labor at about 2:30am. At 3:45 I decided to wake-up my happily sleeping husband. My pain was intensifying, and I was getting jealous of his slumber. We called the doctor around 5:30 and were at the hospital by 6:00. A quick check revealed that I was 7-8 centimeters dilated and 100% effaced - quite the change from the 2 centimeters dilated and 80% effaced that I was during our trip a few hours earlier.

I labored drug-free (!) for the next 4 hours, bringing our sweet daughter into the world at 10:05am. It was the hardest and simultaneously most rewarding thing I've ever done. Dave immediately cut the cord, and Viv was passed through to the adjacent room where a team of doctors and nurses were waiting. Her personality was on full display as she tried to bite the breathing tube while being intubated. Despite having extremely high CO2 levels, she punched and kicked furiously and had to be restrained. She's a fighter - just as mom and dad predicted.

Despite her feistiness, the truth is that Viv is facing an uphill battle. Her lungs are very small, and while she did enjoy a honeymoon period for most of the day, reality was setting in by evening. The first few days for a CDH baby are a true roller coaster ride. They tend to start off strong and then take several steps backward. This is where we are now. She's hanging in there and fighting hard, but it's likely that she will need ECMO (heart and lung bypass) very soon. This isn't a certainty, but a CDH baby with a severe defect rarely escapes this machine. Regardless, there's nothing we can do but listen to her doctors and hope that she first adapts and then eventually makes steady progress.

She looks so tiny in a sea of tubes and machinery.

They keep her face covered to prevent over-stimulation. 

Please send positive thoughts and prayers for our daughter. She is embarking on a difficult journey, and her situation is very fluid. We are very grateful to be at CHOP and are hopeful that her fighting spirit will carry her through the difficult days ahead.

P.S. - We still don't know her key stats like length and weight - those things weren't top priorities after she was born. We'll let you all know as soon as we get the info.

P.P.S. - Mom and dad are doing well. We're exhausted and nervous of course but are above all thrilled to have Vivienne here! We will try to provide daily updates to keep our readers informed of her condition. Thanks for all of the prayers and well-wishes!

Crazy Day

Early this morning I awoke to mild contractions. They weren't strong, but they were consistent. After very little sleep, I quickly got ready for the day and furiously put in four hours of work, paying special attention to last minute details - just in case. We headed to our appointment with some anticipation since I was going to be checked for signs of progress (I'll spare you all of the details). In a nutshell, Vivienne continues to ace her biophysical profile test, and my body is getting ready for labor. No induction please, little miss Viv!

After the prenatal visit we met with a lactation consultant to learn all about breast pumps. You may think this appointment was mainly for mom, but Dave ended up receiving a lengthy list of instructions. The CHOP dads are known as the "milk men." Mom is in charge of supply; Dad is responsible for everything else (cleaning parts, labeling bottles, storage, and delivery). It's nice to know that Dave will be suffering with me every 2-3 hours, 24 hours a day. Did I say suffering? I meant supporting of course. Seriously though, the power of breast milk is pretty amazing. Your body is able to tell what your baby needs and adjusts the composition of the milk accordingly. It also acts as a vaccine, immunizing your baby from disease and helps the GI tract to function properly. Vivienne won't be able to receive any feeds until after her repair surgery, but Dave and I will be able to participate in what is called oral care. This is where a swab is saturated with my milk and rubbed throughout the inside of the baby's mouth. It's a very important activity with many benefits.

Finally, we checked in with the psychologist to round out our visit. Our anxiety levels have been rising as Vivienne's due date approaches. This isn't unexpected, and it's good that we can get a mental tune-up when we need it.

I started to feel very uncomfortable on the way back from CHOP. The "check" I mentioned earlier was very unpleasant, and it sent me into 4+ hours of regular and intense contractions. After we hit the four hour mark, we decided to call the hospital, which then turned into a late night visit. Of course as soon as we got in the car my contractions seemed to taper off a bit, but we pressed on anyway. At the very least we saw it as an opportunity to become more familiar with the route to the hospital and a chance to learn how to navigate the late night security/elevator procedure. We arrived at the Special Delivery Unit and entered the triage room where I got into a gown and was hooked up to monitors. The good news is that Vivienne was handling the contractions like a champ. The bad news is that I had to get yet another "check" (though this one was much less traumatic, thank goodness). We stayed for about an hour and then made the quick journey back to Camden. I'm still having contractions now, but they are much more manageable. Hopefully, a good night's sleep is in the cards.

We have another appointment scheduled for next Tuesday, but we're hoping we won't need it. As always, we will update the blog with any news.

Greetings from Camden, NJ

We got the call from the Ronald McDonald House last Wednesday around 5pm, and by 8:30 we had made our way there from King of Prussia and checked in. The room is pretty nice and spacious and despite the presence of many children things are surprisingly quiet. Camden is not the loveliest of places, but it is very convenient to Philadelphia and to CHOP. There is a public transport hub right across the street, and yesterday we took the train in to visit some friends who live in the city.

We had a successful 37 week appointment today. Everything is progressing just fine and the doctor said that going into labor is no longer a concern since Viv is fully developed. Even though we're hoping for labor to occur naturally, we did schedule an induction for the evening of March 26. We're hoping that Viv takes matters into her own hands though and moves the timeline up.

After another routine appointment, we received a reality check during a tour of the delivery room and the adjacent room where a team of doctors will immediately intubate and try to stabilize Viv. It's moments like these when we remember just how abnormal our situation is. We also met with the neonatologist, who walked us through some not-so-pleasant things we already knew about Viv's condition and then answered some questions that we (mostly Allison) had. It's hard to hear about all the things that can go wrong, but we also understand that this is the reality of the situation. Vivienne's defect is severe, and there's no point in sugarcoating it. It's the doctors' job to keep us informed, and it's our job to be prepared for a variety of outcomes.

There has been so much work to do getting to this point and so many little milestones to meet that we always had some minor task or benchmark to keep us occupied. Now we're nearing the end of the pregnancy, and it's unsettling and scary to know that this phase is coming to a close. Soon it will be all up to Vivienne and her tiny lungs, and all we will be able to do is love her and hope she's able to beat the odds.

Relocation

We relocated to the greater Philadelphia area on Sunday and are chillin' at the Best Western in lovely King of Prussia. Allison's sister, Lauren, hosted us Sunday night, we worked there on Monday and arrived here Monday night. This morning we drove into Philadelphia for another doctor's appointment. The traffic wasn't great but the trip was much better than having to commute from Hyattsville!

The appointment went well. Viv scored a perfect 8 out of 8 on her "test," meaning she isn't showing any signs of distress. She's growing like a weed and is now an estimated five pounds, seven ounces. Allison's vitals look good as well.

In other good news, it looks like a room at the Ronald McDonald House will be opening up later this week. This is great for our sanity and our wallet.

Overall, we're excited to be nearing the end of this part of our journey and are looking forward to meeting our daughter in a few weeks!