Wednesday, October 31, 2012

Happy Halloweening

Meet Elmo's Halloween pumpkin doppelganger, Hellmo:
Jackson went trick or treating as....Jackson:
We weren't in the dress-up mood today. Though we did learn that his favorite dress-up item at school is a fancy handbag he likes to carry around. His murse. He does like to accessorize.


Tuesday, October 30, 2012

Triage is the Ninth Circle of Hell

No labor today. No baby out yet. Nothing interesting at 37 weeks. And yet I got to spend 2.5 hours in triage at the hospital just for giggles, I guess.

The NST at my 37-week appointment was fine except for some little blips every so often -- the test was reactive (which is good, it means his heart rate accelerated appropriately with movement) but every now and again, about 5-6 times within 20 min, there was a little downward spike of deceleration. One or two of those and no big deal, but 5-6 and my OB wanted me to be monitored for a while near L&D ("just in case") and have a biophysical profile. So, off to triage. Baby is good after all. His heart rate was fine without any additional "variations," and he passed the BPP with flying colors. The blips at the OB's office may have been from his position -- maybe leaning on the cord or something. So that was that. I got to lay on the super-uncomfortable gurney for over 2 hours and listen to the loud nursing staff jibber jabber at the desk and hear the first-time mom next to me who was SURE she was in labor get sent home 0 cm dilated and then listen to a worried first-time mom who was just discharged last week for possible preeclampsia and was right back in for hypertension. My first half hour was spent worrying about whether I'd be having a C-section tonight, or at least getting induced suddenly, and then after the midwife came in and reassured me that the monitoring and BPP looked fine, I just wanted off that stiff cot and to get home. Around 4pm, I finally got to go. In all this mess, there was never an internal check to see if I was dilated or effaced, but I know we'll do all that next week anyway. And since the baby's room STILL isn't done, I'll take the time. I have acupuncture tomorrow and a prenatal massage on Thursday. Let's encourage this the relaxing way, shall we?

And then I arrived home to find my dog had shat in her crate. She has to be crated when we're gone for more than a few minutes. With me working from home, now not working at home, she rarely needs to be in the crate. But. In the past month she has shat in there 3 times. She was weird around the time I was ready to birth Jackson, so I'm convinced it's behavioral in the same way. Although she's getting old (8 years now), so who knows. So I let her outside and dragged her crate out there to start cleaning it out. I called KB to complain about the shit-stained crate and remarked offhandedly that I hoped the high winds hadn't blown the fence gate open. Dunh dunh dunh. I suddenly decided to go check and discovered the creaky old gate swinging in the goddamned breeze. And no dog. So 15 minutes of pacing up and down the street with a fistful of treats and a leash later, I hopped in my car and started driving around -- and called KB to unintentionally pile onto his stress a little more. (My asshole neighbor across the street -- who doesn't work and is always home and spies on all the neighbors and knows what time I come and go every day -- as usual didn't even open her front door to ask if I needed help. This is the third dog escape, and she's been home during all 3, and she never offers help. And I saw her walking by her front window so I know she knows. Asshole.) AND THEN. Thankfully. I got a call from a neighbor around the block who captured my refugee dog and called the number on the tag. Relief. That the day didn't get any worse. Although it's not over. Sheesh.

Back to my regularly scheduled kvetching about the pains of full-term pregnancy and hoping we get spontaneous labor in the next 13 days. Rain and barometer changes and a full moon this week. Hell yeah.


Sunday, October 28, 2012

What the What

Almost a full 24 hours now of contractions somewhere between Braxton Hicks and the "real" ones I remember from early Stage 1 labor. This is no fun. I tried timing some last night but they're all over the place and I fell asleep in my effort, so I guess whatever they are, they aren't very organized yet. Haven't lost the plug and no signs of amniotic leak. Just annoying random contractions.

And I just made a list of things I planned to do this week, not the least of which is finish the baby's nursery (move in furniture and hang pictures). Crikey. Guess I'd better make Monday a hustle day. I haven't even carved a pumpkin yet. Add that to Monday's list. (I wanted to be ambitious and carve a Bert and an Ernie because obviously, but maybe just a Cookie Monster will do.)

We'll find out if these are real contractions on Tuesday, since they'll show up on the NST monitor. Really, I need to make it until Tuesday so we're not considered "pre-term." Not that they'd stop it, and not that my 6+lb baby wouldn't be just fine, but you know, "high risk" yada yada yada. Although my favorite OB is on call tomorrow. Hmmm. Silver lining. We'll see, won't we?

Pregnancy blows for me, from start to end. The finish line is so close and I am hitting the wall. Bam.


Wednesday, October 24, 2012

For the Love of OBs and Therapists

Lest anyone think my OB practice is a bunch of pushy surgeons, I should clarify a few things. Things I realized in therapy today. (Last sesh until after the baby. And then right back on the couch with a baby at my teat to deal with the likely postpartum anxiety. It's how I roll.)

It's clear to me now that my OBs weren't dwelling on the what-if scenarios because they don't expect them to happen. Scheduling the induction for 39 weeks was a placeholder move, in case we mutually decide it's the right thing to do (ACOG does recommend 39-week delivery via induction for gestational diabetes to minimize ongoing risks to mom and baby). Given my history of A) early labor during the 38th week and B) uncomplicated vaginal delivery of an 8-lb baby, my OBs are actually quite optimistic that a second labor, even if it's a big baby, will be both timely and fine. And as for C-section (which ACOG does suggest should be offered for babies expected to be in excess of 9-10 lbs), I have been absolutely reassured that I can labor through the ol' vag and that again, my history is encouraging since we know I can easily deliver a baby this way. If this was my first L&D they would be a bit more concerned, but this philly has produced results.

So my big realization was that *I* was the one blowing this out of proportion due to anxiety. Not that I don't deserve more info, which I am now getting having spoken up to request it, but my OBs really are just expecting a straightforward labor for me and were acting accordingly. If any of the what-if scenarios manifest, I'm sure (in the absence of recent conversations) they would give me the same non-pressured talk about options. It's just not my personality or in my comfort zone to wait and see and find out *then* what the options are. I need to know *now*. So now I do. Keep calm and carry on.

My OB practice is great, and I'm happy with them despite the recent hiccup (which was exacerbated by an idiotic scheduling nurse -- her, I could do without). After years of trying to conceive and a total of 4 IVF cycles followed by difficult (to differing degrees) pregnancies, I've not had the cajones to even consider a home birth, and wouldn't have been a candidate for either pregnancy anyway (hypertension during delivery with Jackson and gestational diabetes with this baby -- no midwife practice in this area would touch me with a 10-foot pole). And birthing centers are out for the same reason -- they only take low-risk pregnancy/L&D presentation. All of which is moot as I am perfectly content to have a hospital birth. I don't want my recent outbursts to stoke any anti-hospital/anti-OB fires or to suggest that a midwife or homebirth approach would be any better -- for me, it surely wouldn't. The same miscommunication could occur with any internist over even the most mundane medical issue, but because this is about having a baby, it's emotionally charged. I amped it up in my overly analytical way and let the stress of recent complications make it a much bigger problem in my mind than it was in the OBs'. Lesson learned, sometimes it's really not you, it's me.

But it does not escape me that this is my last one -- last pregnancy, last birth -- and I want to remember it well, not with remorse or panic over hastily made decisions or traumatic responses to complications. I have limited control over birth, as is true for any delivering mom (the tiny tyrant calls the shots, more or less), but I want to strive for the best possible experience. So these recent conversations with my OBs have at least led us to that request, laid out bare, so they understand that this is special. I fought as hard for this baby as I did for Jackson, and have suffered through a hard pregnancy at least as much (and here at the end, a bit more) and want the conclusion of it to be something I can remember fondly (just as I remember Jackson's birth).

Acupuncture and prenatal massage are next week. Same practitioners I saw the same week when pregnant with Jackson, and then went into labor less than a week later. Bang a gong, get it on.


Monday, October 22, 2012

Deep Sigh

I got a call from the OB office's coordinating nurse today, a voicemail that truncated mid-message but included enough info to let me know that she had A) miscommunicated to my preferred OB (the one I wanted to move induction up by one mere day to have on call) that I instead wanted to move it BACK and regretted to inform me that B) her hands were tied with regard to C) hospital policy D) yada yada yada. I called back with the intent of bitching her ear off over this stupidity. And that I did. I told her I'm tired of being told different things by different people due to poor communication and wished to only speak to physicians about these things from now on, since it's their clinical judgement and diagnoses driving all of this. Also, I may have mentioned something about losing my shit if I hear "hands tied" or "hospital policy" one more time. ("Say 'what' again...") So she had my favorite OB, who happened to be on call today, call me to chat. And chat we did. All the things I was saving for a diatribe at my appointment tomorrow, I explained to her. I asked for some clarity around these "hospital policies" and to know what exactly was on the table as a recommendation, based on what criteria, and what might end up being considered emergent if it comes down to it. She filled in the picture nicely. I do not have to have an induction if I really don't want one, as it's not even indicated for macrosomia (giant-ass baby). It's indicated for gestational diabetes, but if I really don't want it we can just increase the monitoring past 39 weeks and play it by ear. It's not that I am opposed to induction in and of itself, it's more about the fact that a near-majority of inductions end in C-section. So you get to labor for however long and then have surgery anyway. Worst of both worlds. I asked her if C-section would at any point be strongly recommended or otherwise considered necessary for safe delivery due to macrosomia or the GD, and she said that if the next ultrasound (done in 2 weeks at an appointment with her) shows that baby will likely be >9 lbs, she would offer a C-section but that I would not ever be coerced into having one. Whichever doctor is on call when I deliver would simply keep me informed of pros and cons with a vaginal delivery versus a C-section, and if we encountered difficulty with the baby dropping or maneuvering through labor we would make decisions in real time based on whether I wanted to keep trying to labor or throw in the towel. Then, the $60,000 question: would the OBs be willing to start doing internal exams and stripping/sweeping membranes at 37 weeks to get things going al la natural? Yes. Apparently it's even ACOG guidelines to "encourage" spontaneous labor to avoid intervention.

So. Whew.

(On the one hand, I feel like I might be a total drama queen about this shit, and I don't mean/want to be. On the other hand, it's all very new and undesirable and after a second pregnancy-cum-gauntlet, I just want a straightforward birth for this baby. It just can't be too much to ask. Right?)

36-week Appointment Follow-up: My OB was unusually helpful today. Guess my chart has an asterisk now. Ha. He confirmed baby is head down, fluid levels look good, NST and heart rate look great. Given my last labor, we're still optimistic spontaneous labor will happen within the next several weeks. And if not, when the 39-week induction date rolls around in 3 weeks (!) we can decide what to do based on NSTs, ultrasound, and what my cervix is up to. If it's starting to dilate but without signs of labor, induction will be a consideration, since it will probably work if my body is already starting to prepare. On the other hand, I could continue with NSTs and ultrasounds for up to another week to see if it progresses on its own to start labor or break water. I'm hoping we'll go ahead and do an internal check next week to annoy my cervix enough to think about getting started...


Friday, October 19, 2012

Swell Season

It has begun. The Cankling. Being on my feet for any extended period of time past, say, I dunno, 15 minutes results in lower extremity swelling. Awesome. (At least *knocks on all hard surfaces that even resemble wood* there has been no upper extremity problem, like the painful neuropathy/numbness I had last time, that lingered for weeks postpartum.)

I'm also pretty amazed this baby has so much apparent room, being a mutant giant and all, to move around as much as he does. He shifts position constantly. And it feels horribly uncomfortable. I've tried to reason with him, have tried complaining to him, and have tried poking and pushing back on his wee giant parts from the outside, all to no avail. He's got the moves like Jagger.

My 36-week appointment is Tuesday and I'm going to initiate a frank discussion with the doctor about several things. 1) It needs to be noted in my chart that I have a medical education, am not a layperson, and do not want to be approached like I'm in the lowest common denominator and/or have a third grade education. I want facts, medically accurate information, options, and respect. There's a variation between doctors in the practice as to how I am spoken to and how much information, requested or volunteered, I receive. I'm also sick of hearing about "hospital policy" when what I want to know is about clinical judgement. When everything was fine, this was not an issue. Whilst shit is hitting the fan, this needs to be fixed. Especially in time for L&D. 2) I want to know if they'll support me in an effort beginning at 37 weeks to do whatever we can to kickstart labor for a spontaneous L&D experience, in the form of weekly (or more often, I don't care) internal checks and, if possible, membrane sweeping. This promotes release of prostaglandins that encourage the cervix to ripen and, to use a medical term, get busy. I can't imagine why they would be opposed to this approach, but you never know. I am interested in anything, medically validated or wives' tales, that helps us avoid the need for pharmacological or surgical intervention. I chose this practice in the first place for their minimum-intervention philosophy and statistics, but it feels like at the first sign of complication, that gets checked at the door. Imma get it back. (The OB I'm seeing at my 37-week appointment seems like she would be on board with my request, but I'm not 100% sure. The OB I'm seeing at my 38-week appointment with follow-up ultrasound, my favorite OB in the practice, I think would be. She gets my concerns.)

Maybe I'm committed. Or just stubborn. Or should be committed. No matter.


Tuesday, October 16, 2012

When Bigger is Not Better

Baby boy is nearly a man. He's estimated by ultrasound measurements to weigh >6 lbs at 35 weeks. Although this method is error-prone, it's all that's available and his extrapolated weight by 39 weeks is between 8-9 lbs. Where 9 lbs is the cut-off for converting the induction plan to a C-section, because big babies get stuck in vaginal deliveries and injuries all around can hypothetically ensue. So. I have another ultrasound in 3 weeks (the week before the scheduled induction) to recheck his estimated weight, and a decision may be made then. Or not. Nobody seems able to say. That's perhaps the worst part. Second only to the fact that the doctor on call the day of my scheduled induction is one of my least favorite in the practice -- she's not awful or anything, I just am very lukewarm toward her and vice versa (plus some info from a friend about the doctor's Catholicism and its impact on patient care leaves me unsettled as a secular person/patient) -- and my attempt to have the scheduling nurse move the induction up by one day, so I can have my absolute favorite doctor in the practice deliver my baby the day before, was met with the Great Wall of Hospital Policy. They simply won't schedule anything a minute before 39 weeks without an amniocentesis to confirm lung maturity is what I'm told. I had a meltdown on the phone with this nurse, explaining that the Great Hospital Policy is protecting their liability with regard to a procedure (induction) I don't even want and certainly don't want to have my least favorite doctor perform. This is not an elective procedure after all, it's being mandated for medical reasons. She offered to move it back, which would allow more time for baby to gain more weight and almost certainly require a C-section, another Great Policy (as I know several moms who've safely delivered 9+ lbs babies) that exposes me to increased risk in order to further minimize hospital liability. What choices am I permitted regarding my pregnant body and my baby in this actuarial calculation? Did the election happen already and the GOP (win or lose) plant a flag in my vagina? Her final offer was to leave a note on the (favorite) doctor's desk to follow up with me. Super. I expect little at this point. It seems the best way to not be massively disappointed.

My greatest aspiration now is for an early labor. I'll be full-term by Halloween, in 2 weeks, and will start doing any voodoo suggested to promote labor in the hopes that he will come spontaneously between 37-38 weeks, before he can be declared too big to birth. Bug bucks, no whammies.

Fucking diabetes. My body is spectacular at failing me and now this baby, too.


Tuesday, October 9, 2012

Three Down and Three-to-Five to Go

Or, One Down and 3.6 to Go. Find out what and why here unless you're already a music nerd like me.

Third NST was fine. Baby boy is a champ. The practice OB I saw today answered all my lingering questions about what GD means to my labor options and the L&D process itself. Here's what I know:
  • Growth scan is scheduled for next week (35 weeks) to see if the extrapolated size of the baby will be >9 lbs by 39 weeks. If so, C-section. If not, plain ol' vag delivery.
  • After the scan we'll schedule induction (or C-section if warranted) for 39 weeks. Hopefully I'll go into spontaneous labor before that, but we won't go past 39 weeks due to GD.
  • The hospital now uses wireless monitors so I will be FREE! to wander the halls and move around to deal with contractions. Except if/when I get an epidural, after which I will have to stay in bed (but I'll try to at least switch positions, sit on the side, etc. to keep labor moving).
  • I'll get my blood sugar tested frequently during active labor and if it's high, will get IV insulin to keep it in the normal range. This minimizes the risk of the baby having hypoglycemia.
  • Gloriously, all GD interventions and monitoring will cease 100% for me immediately after delivery. I will have to do another glucose tolerance test at my 6-week postpartum visit to confirm that the diabetes is cured (amen), but getting the baby out is the cure.
  • Even if the baby has low blood sugar at birth, they won't send him to the NICU for monitoring (assuming everything else is fine as well). The treatment would be to breastfeed right away (which I already plan to do) and if that doesn't work, he'd need a small amount of formula. Whatever it takes, I'm just glad to know he won't have to leave our room.
It's good to have a plan. Now I just have to keep on truckin' for 3-5 weeks. I think I can, I think I can...


Tuesday, October 2, 2012

Two for Two

The second NST went just fine today, with baby boy cooperating admirably. We also confirmed he's head-down, which I could tell mostly by the head-butting of my bladder and the butt-butting of my ribs. But good to know for certain. There will be a growth scan some time in the next several weeks.

My blood glucose values have been mostly fine, with a few excursions above normal (but not by much). The more common issue has been low values, necessitating a bigger and more urgent snack when I feel crappy (I can tell before even checking that it's going to be too low). I have to do a better job of planning morning snacks especially, to avoid the hypoglycemic response that can in turn prompt a surge in blood sugar afterward. So damn complicated. But only for a few more (4? 5?) weeks.

I finally worked out the details of Operation Toddler Watch, for when we have to go to the hospital to wrap up Operation Get This Baby Outta Me. One of Jackson's teachers is available on any weekday to pick him up in my car (because of the carseat) and feed him dinner and put him to bed, then wait patiently for KB to come relieve her of her duties. She can stay overnight the first night if needed. Score. We have another babysitter who can come over on a weekend, and can also stay the night if needed. (Our plan, assuming an uneventful delivery, is for KB to spend evenings/nights/early mornings at home after the first night to keep Jackson in his routine as much as possible). And a neighbor offered to come over if we have to scoot in the middle of night. So. Whew. I was having a mini-freak-out earlier this week about the nuclear option, which would be KB staying with Jackson during all non-school hours and possibly leaving me to birth a baby BY MYSELF. It's been our misfortune thus far that KB has not been able to attend a single OB appointment (even the anatomy scan), so the prospect of L&D being a solo visit just walloped me. Plus, what if something goes wrong? What if it turns into emergency surgery? Or would I labor all alone in the L&D room while the nurses are out chit-chatting at the nurses' station? If the baby has to spend time in the NICU for low blood sugar who would go with him and then follow him to my room? Gah. Mindfuck. But we seem to have it worked out now, so hopefully this plan sticks and everything goes according to it.

My maternity leave starts in 4 weeks. Hell yeah.