Posts tagged ‘Pregnancy #1’

Happy Due Date To Me

Today is little boy’s due date, and I’m so pleased to have refused to give that information out to the general public. Nonetheless, the midwives certainly know. I’m not particularly looking forward to this afternoon’s appointment, since they have been keen on my “not going post-dates” due to the giant baby syndrome.

After my last week’s appointment, the midwives and my acupuncturist (the latter based on an analysis of my pulse) figured the baby would be here pretty soon. But then I caught the cold of doom (like, #5 of this pregnancy?) and basically lay on the couch coughing for several days. I asked baby to stay in until I could breathe, eat and sleep again, and he has obliged. While I’m still snotty and coughing, my energy is just now returning, to the point where I think I could handle labour and birth.

I kind of wish we had never heard of the giant baby thing, because I’m pretty happy to keep lumbering along, knitting, marvelling at my spectacular stretch marks, and doing little jobs around the house until baby decides he’s ready to join us. And basically, that’s how I feel. For what intuition is worth, I feel like baby is fine too. He’s doing lots of dancing and wriggling in there.

My belly, looking all pretty after henna at my awesome Blessingway at 37 weeks.

My plan for today’s appointment is to accept another stretch and sweep (#3! Woohoo!), but not the “labour cocktail” they will offer. The latter is an unholy purging brew containing castor oil, cohosh, and other deliciousness. I’m not afraid of pooping for hours, but I am kind of afraid of what happens if it makes me really really ill (like it sometimes does, I believe) and then I start labour weakened and dehydrated. That sounds like a terrible plan.

But I do also want to note, at this special juncture, a bit of the mindfuck that is late pregnancy, especially when your caregivers want the baby out (which is not in any way unique to me. In fact my caregivers are so damn awesome and chill compared to the norm, I count my blessings all the time). On the one hand, babies come when they are ready. You should just chill out and let them arrive. But on the other hand, maybe your own fears and anxieties are keeping the baby in! I’m not looking forward to labour enough. I’m not doing enough squats, walking, sex, pelvic tilts, or yoga. When I think that there will be a baby here pretty soon, I still feel like “holy shit, really? are we ready?” instead of “come to us, baby, just as I envision you in daily meditations”.

I am, at least, eating enough pineapple. Nobody could accuse me of less.

Braindump: 36 Weeks, Homebirth and Potential Restrictions

Today was my 36-week midwife appointment (2 days early), and it seemed like all the restrictions came out of the shadows.

I’m most disappointed to learn that provincial policy applies an arbitrary time limit to cervical dilation. Once 3 cm dilation is reached, after 4 hours with no further progress, “consultation with a physician” (i.e. hospital transfer) is mandatory. Having read about homebirth (in the US context) as having the advantage of avoiding arbitrary hospital time limits, I am pretty disappointed to that this rule will be applied to me labouring at home, however unlikely the scenario.

The midwife’s response to my dismay was basically that if I had been labouring for 4 hours with no progress, I’d be asking to go to the hospital anyways. In certain contexts, that makes good sense. However, I can think of 3 births during which the mom’s body took a several-hour break at 6-8cm dilation to allow her to have a rest or nap before transition and pushing. So a pause in dilation isn’t necessarily pathological or even uncomfortable! The midwife also mentioned the purpose of this policy in limiting professional liability. Anyways, there is no point in arguing about it, because midwives are bound by these rules too. I’m still thinking about whether there’s anything I can do to try and protect myself, such as declining frequent cervical checks.

Image

St. Anne, a Catholic version of the crone goddess, and patron saint of childbirth. I love the idea of her, but do wonder why she is always so creepy looking in paintings. Also, why does the baby Jesus look like a balding miniature bodybuilder?

I also have an exciting new documented risk factor to contend with, because our baby is presumed giant. Oh, didn’t I tell you? Our last ultrasound at 34 weeks – which showed his kidneys are PERFECTLY FINE, fuck yeah – also resulted in a new diagnosis of “fetal macrosomia”. This means the kid is expected to be really big. Although guesses of fetal size are notoriously inaccurate, his head was estimated in the 99th percentile. Just what every mother wants to hear! We were offered another ultrasound to reassess his size, but have decided against it. Ultrasound exams look for trouble, and every ultrasound so far has brought a new diagnosis to cause stress and threaten required interventions. No, thank you.

Fetal macrosomia is a contra-indication for homebirth. It means that medical care providers will be extra vigilant about the speed of my progress, on the theory that big babies are at risk of cephalo-pelvic disproportion, meaning the head might not fit into the pelvis and therefore couldn’t apply proper dialating pressure to ye olde cervix. According to “Ina May’s Guide to Childbirth”, true cephalo-pelvic disproportion is pretty darn rare, but the concern is often raised with big babies, small women, and small women with big babies. (Hi!)

Another contra-indication for homebirth is my pet fibroid, which was also diagnosed during the last ultrasound. I couldn’t handle a discussion with the midwife today about how much it increases my risk of  postpartum hemmorhage, but will start researching.

Going post-dates would be another risk factor, and while there doesn’t appear to be a hard cut-off at three strikes, it’s clear that the more risk factors I have, the less support there will be for birthing with limited interventions. At an early appointment with a different midwife, I had already raised the question of going post-dates. At that point, with no other apparent risk factors, she had assured me there is no policy on induction or “risking out” of homebirth, but I could merrily go to 43 or 44 weeks. Because of the suspected big baby, however, I am finding myself encouraged to try and have this kid earlier, depending on which midwife at the practice I talk to about it. Hence, starting this weekend, I get more accupuncture, to try and line everything up for delivery. At 38 weeks, the midwives will offer stretch and sweeps, which I haven’t decided yet whether to accept.

The opportunity to birth at home (in the absence of good reasons to go to the hospital) is pretty important to me. The biggest reason is that I feel safer at home, with the fewest strangers around possible, and feeling safe helps mammals give birth. Mostly, that’s psychological, but it’s also partly based on a risk assessment. Despite my documented “risk factors”, I believe this is a low-risk pregnancy and birth, and going to a hospital (again, in the absence of a good medical reason) would actually increase our risk of infection and unnecessary interventions.

Overall, I am feeling relieved to still be clear for a homebirth, although wary and a little defensive about losing the opportunity. I’m also very glad to have an awesome doula lined up to provide non-medical support. I’m fortunate that Z is pretty sensible about all this stuff, although he does think I’m nuts to be upset about being on the clock for cervical dilation. Thank goodness we took a comprehensive childbirth class together, so he is reasonably well informed about best practices and options. One of the lessons from our childbirth classes were that the birth partner is the best advocate and spokesperson for the family. (I’ll be busy, and it’s not the doula’s role.) I still need to think about how to best prepare him to speak on my behalf about issues that might come up.

At 37 weeks (8 days and one midwife appointment from now) I will theoretically be clear for a homebirth at any time this baby feels like showing up. First babies do not tend to be early, and this one has shown absolutely no signs of being in a hurry to arrive, but he may find himself encouraged to depart earlier than he otherwise would have liked by evening primrose oil, acupuncture, and stretch and sweeps. As a general principle, I would prefer to leave my baby alone until he’s ready to be born, or at least until 42 weeks. However, given the risks presented either by actual macrosomia or by decreased support for a low-intervention birth due to presumed macrosomia (I don’t know which stresses me out more) I am feeling conflicted about hurrying him out. Baby, it would be really helpful if you could just be ready to be born on your own steam around 38.5 weeks, OK?

TL:DR – It’s very nearly time to start collecting waterproof sheets, Gravol and secondhand towels. Yay?

33 weeks: Nesting, Exhaustion, All is Well

I have been such a naughty blogger. Haven’t been writing, haven’t been taking belly pictures. Naughty!

Alas, I’ve been kind of knackered. I had three (count’em) colds, one after another, stretching out over two snot-encrusted months. It would appear that I have no immune system at all. I’m also just plain tired. Walking is far, stairs are tall, bags are heavy. One theory is that I may have developed anemia: the midwives have me taking iron supplements for the next few weeks, then a blood test will reveal how I’m doing.

But, really, in the realm of important things, all is well. The kid is enormous (or feels that way to me) and is vigourous, flippy and full of kicks and pokes. He is positioned incorrectly (as indicated by the bony skull pushing into my ribs), but at 33 weeks tomorrow he still has lots of time to turn. I’m going to see an acupuncturist tomorrow to see if she can convince him to get head down. I wonder if that might be more comfortable as well as more conducive to easy birthing, but won’t get my hopes up about comfort.

A random image from Christmas day by the ocean.

After the Christmas holidays, I’m back to work until 39 weeks (or that’s the plan). The very thought of going downtown and working 8.5 hours every day for 6 more weeks is so exhausting that I’m trying to get lots of nesting done in the next few days here. Z is painting the kid’s room, because it had lots of holes in the walls. Today, we did a big shop, picking up all kinds of baby miscellany like a change table topper, diaper bag and swaddling blankets.

Then, the day after tomorrow, we’re going on a road trip to collect hand-me-down clothes from some friends in another city. I’m hopeful that between the clothes their little girls have outgrown, and the stuff we already have, we can be officially set for clothes for the first six months. Then, we just have a few more things to fix and organize in the kid’s room, and we need to put together a functional guest room space in the basement or attic for when grandma comes to visit after he is born.

Just twoish months left! When I feel like an old, old woman huffing and puffing my way down the sidewalk, I remember that one day I will go running again, sleep on my stomach and be strong enough to carry this little kid around all over town.

Some Whine with my Cheese

On the subject of cheese: I have been all about the dairy products lately. I can’t decide whether to count my heightened cheese and milk consumption as a virtuous attempt to meet the insane dietary protein guidelines recommended in my prenatal class, or whether I am just a gluttonous cheese-hound. Because I am definitely that.

I've been eating these little cheeses like they're going out of style.

As threatened, a bit of a whine: I have a cold, which makes me cough all the time, which would make my abdominal muscles sore, if I had any. Instead, coughing torments my poor stretched-out belly, aggravates the round ligaments, and makes my belly button distend outward in the most tragic manner with each cough. And gives me a headache. It’s really very tragic.

This is the tail end of the second trimester, a time when I had hoped we’d be more or less finished renovations and able to settle down, relax and get ready for the baby. Haha! Renovations are certain to extend past the kid’s birthday, and may in fact outlive us all.

Oh well. We are tough and resourceful. We’ll do what we can for now, take a little break when the kid is born, then keep going. Babies don’t need kitchens or living rooms anyways, right? They just need diapers, a place to sleep, and somewhat sane parents so I’m focusing my efforts on that stuff for now.

This is what every mama says at every stage of pregnancy, but I CANNOT BELIEVE there are give-or-take 12 weeks until we will have a kid. Living with us for ever! How can you even prepare for a thing like that? You can’t. It’s insane.

Ginormababy!

I got a copy of my ultrasound records from my midwives so I can bring them to the pediatrician at the end of the month. Reading them for the first time, I have just realized all kinds of neat information I had no idea about.

Because of the pelvicaliectasis shitstorm, we had two ultrasounds with detailed measurements taken three weeks apart, at 19w6d and 22w6d. The kid was measuring a week ahead both times, with an estimated weight in the 95th percentile (1.5 pounds a week ago!)

I have the gestational diabetes test coming up this weekend, so as long as I pass that, I will try not to worry about the giant baby situation. I know it doesn’t predict anything about how big he will be at birth, or what his birth will be like. But it is fascinating all the same.

I also learned from the ultrasound records that I have an anterior placenta (but no evidence of previa, so it’s all groovy). That likely explains why I never felt definitive movements until almost 20 weeks.

Having access to your own medical records is the bomb!

Perspective

Now that life is back to normal and I’m all done hyperventilating, here is the update to our 20-week ultrasound that showed a dialated renal pelvis (fancy medical term: pelvicaliectasis)

After the 20-week ultrasound, we were asked to return in three weeks for a second ultrasound to see if anything had changed. Last week, that ultrasound revealed that the renal pelvis continued to be abnormal.

As at the previous ultrasound, the technician wouldn’t give me any information. So, when he left the room to show the measurements to the doctor and get further instructions, I lept off the examination table and recorded a voice memo of all the measurements and notes that were left visible on the computer screen. For the first few days until they had written up my results and sent them to my midwives, who then delivered them to me by phone, that was all the information I had.

I plugged those measurements into Google and found a few medical journal articles and the like suggesting that this was fairly a mild case of pelvicaliectasis, which might resolve on its own after birth. It could also lead to kidney infections and other no-fun complications in affected newborns who might, at worst, need antibiotics and corrective surgery. Not great news, but not the worst either.

The most awesome medical journal article ever, covering this very topic, is entitled “Mild fetal renal pelvis dilatation: much ado about nothing?” The authors can’t stop making Shakespeare references:

To screen, or not to screen, that is the question:
Whether ’tis nobler in the nephron to suffer
The slings and arrows of outrageous infection,
Or to weight obstruction against a sea of refluxes,
And, by meds or surgery end them?
To flow, to reflux no more,
and by clinical trial to say we end the loin-ache
and thousand p-values that medicine is heir to,
‘tis evidence-based practice devoutly to be wish’d.

Extreme dorkiness aside, assuming that I understand it correctly and it is actually relevant in this case, the article suggests that relatively mild cases of prenatal renal pelvic dialation aren’t necessarily that big a deal. So we felt a little better.

But then!

The hospital’s very sympathetic Medical Genetics people called last Friday to explain that sometimes renal pelvis abnormalities are also markers for a genetic disorder, which can be life-limiting or maybe even “incompatible with life”.

Angst!

On Monday, we were given the option to have an amniocentesis to find out for sure. Amnio is pretty high risk at this point in pregnancy, as it can cause premature labour, which would really, really suck at 23 weeks, as the fetus is just barely, maybe viable. But since the fetus’ risk of a genetic disorder was estimated to be much higher than the risk of an amnio, we decided to go with the test, and at least have our answer.

I didn't look, but believe the needle used for amniocentesis was about this size.

After the needle in the belly, I went on bed rest for 24 hours and restricted movement for another day to reduce the risk of early labour. (Due to cramps that have scared the crap out of me as recently as yesterday, I’m still walking like a really old person and avoiding exercise even more diligently than usual.)

The hospital ordered FISH results, which are an early response to the part of the amnio that tests for the most common genetic disorders, the same ones that babies with pelvicaliectasis are at elevated risk for. They called yesterday to say that the baby does NOT have one of those genetic disorders. ( \Thank you, hospital, because I would have lost my mind spending two weeks waiting for those results. We’ll get the complete results in another 10 days, but since there is no elevated risk for those other disorders, we are not worried.)

So, it’s “only” a kidney problem. Even if the kid ends up with malfunctioning kidneys, infections, and needs surgery as a newborn, he does not have a systemic, life-threatening or life-limiting genetic disorder.

In a month or so, we get to go see a pediatrician who will hopefully have some more information about post-natal prognosis and possible treatment options. But, as the geneticist told me over the phone, whatever it ends up being, it’s just plumbing. It can be fixed with medicine and surgery.

Perspective: hooray!

After a few days of serious anxiety and feeling like maybe we should stop hoping for, looking forward to, and bonding with this kid, we are now back to contentedly considering names, getting ready to build the crib, and buying postpartum cloth pads on the Internet. (OK, maybe that last one is just me.)

The Big Ultrasound (can bite me)

So, 20 weeks. Theoretically half way but I refuse to acknowledge that bullshit. You aren’t even pregnant for the first two weeks, so there’s no way they should count. I would further argue that the following two weeks shouldn’t count either because pretty much everyone spends them in blissful ignorance of conception. I myself recall drinking some beer in week 3 just case I turned out to be pregnant and didn’t get to have any more for a while.

Anyways, at 20 weeks, you get to have the big ultrasound. I slunk out of work early on Wednesday and when to the hospital, where Z and I were harassed by recruiters for medical studies until it was our turn. Then an untalkative technician scanned my belly for awhile pointing out various fetus parts… kidneys, creepy alien eye sockets, a foot, kidneys again, a spine… At one point she left to show something to a doctor, then came back in and kept scanning. And then told us we were all done.

Today the midwives called to say that the report from the hospital notes an appearance “suggestive of an anomaly of the urogenital tract” on one kidney. If I consent, they’d like to scan again in 3 weeks.

And that’s it. The midwife seemed a little surprised that no-one had mentioned anything to us at the hospital. And I’m a little surprised too. This information would be so much less scary if we had ANY IDEA what kind of “suggestion of an anomaly” it is, what it could potentially mean, how common it is, and how often it doesn’t indicate any problem at all.

Dr. Google, drunk as usual, tells me that some fetal kidney abnormalities seen on scans turn out to be fine, others require antibiotic treatment of the newborn, others indicate Down’s syndrome, while the complete absence of kidneys means the kid dies. For once, Dr. Google actually calmed me down because 1) I don’t think the fetus is completely missing kidneys, since the cryptic note from the hospital specified one weird kidney, not two; and 2) somewhere on the internet it says that, if weird kidneys indicate genetic problems like Down’s syndrome, other markers are usually visible as well. We just got one weird kidney.

The other stuff? Antibiotics? Surgery? Everything being fine? We can handle those outcomes.

But I am still definitely going to spend the next three weeks worrying about this until we have more information. And being kind of pissed off that nobody bothered explaining anything to either us or our midwife. They were probably all busy saving lives or something, but it’s still a drag.

Oh, and it’s a boy. It’s what everyone guessed, including me. Whenever I feel a passing twinge of regret that I don’t get to dress this kid in frilly dresses, I just think about shaggy little boy hair, overalls and little checkered shirts with pearlescent buttons.

Based on the genetics involved, the baby is expected to look pretty much like Raggedy Andy.

It’s neat to be able to refer to this kid with a gendered pronoun. Maybe we’ll even come up with a name one of these days.