36 week update

Summer finally arrived in Seattle.  Wednesday was the first day in something like 260+ days that the temperature got above 75 degrees!  We had the darkest summer solstice in 15 years last Sunday!  Needless to say, this CA girl is happy to see the sun!  However, I already notice a huge difference in my body's ability to regulate temperature!  A mere 70 degrees feels like 90 to me.  So, I suppose it's a good thing I'm no longer a CA girl (at least not right now). 

We had our 36+ week check-up today and everything looks good.  I'm now measuring exactly 36 weeks!  Who knows if there is an explanation for this.  One thing I noticed over the last few weeks is that my stomach is rounder whereas before the bulk of it was just below my rib cage before quickly sloping downward.  Perhaps the change in shape contributed to my no longer measuring big.  This could also explain why Tray measured big.  I read that baby's in certain positions will read bigger on an ultrasound machine.  I'll be surprised if I end up with a big baby.  I'm expecting an 8.5 pounder or less.  :)

Tray is head down and starting to settle into my pelvis.  I'm about 1 cm dilated and it's unclear how effaced I am because my cervix is still pointing backward.  Once it comes more midline, our OB can make a better estimate of whether it has started to thin.   I'm still having tons of Braxton-Hicks contractions and menstrual-like cramps.  I'm now taking 3 trips a night to the bathroom (it used to be just one).  I usually wake in the middle of the night to a full bladder and a rock hard stromach in the middle of a contraction.  It's VERY uncomfortable but not painful.  The last couple of nights I've been able to feel Tray's little butt just below the left side of my rib cage.  I wonder what a contraction feels like inside? 

We were able to have a nice long conversation with our OB about our birth plan.  She read through the whole thing and offered a few caveats, but overall it sounds like we're not asking for anything too out of the ordinary.  The one potential issue is if I were to need a c-section.  The hospital's policy is that you can only have 1 guest in the operating room with you.  I've never had to stay in a hospital or have surgery.  I really hate hospitals, always have.  It's important to us that if I can't have skin-to-skin contact with Tray (which I can't in the case of a c-section), Matt take my place.  The problem with this is that I'm then left alone for the remainder of the surgery (the baby comes out in the first 10 minutes; it takes another 30+ to complete the procedure).  I REALLY don't want to be left alone, awake on an operating table with my stomach cut open.  We asked our OB that it be noted in my file we'd like an exception to the rule so that our doula can be present with me if/when Matt leaves my side to be with the baby.  She was sympathetic but ultimately said it's up to the anesthesiologist assigned to us.  They call the shots.

We're looking forward to a nice relaxing weekend starting now!

Week 34 check-up

We went in for our week 34 check-up and guess what?  I'm now measuring "right about where I should be" and I gained 4 pounds in 2 weeks!?  Say what?  Let me get this straight, two weeks ago at my appointmet, I was measuring at least 3 weeks ahead and I'd only gained 2 pounds over the course of the month before.  Now, I put on 4 pounds in half that amount of time and suddenly the size of my belly balances out? 

Ahhhh, this is all so confusing and proof positive that there really is no one size fits all in pregnancy!

Tray: Our potentially larger than average baby

We went in for our ultrasound this morning.  The good news is that Tray is healthy and well-developed with a strong heart rate (153).  The other news is that Tray is apparently quite large.  At 33 weeks, an average baby weighs 4.75 pounds.  They're estimating Tray's weight at 6 pounds, which is the 95th percentile.  Both my measurements and Tray's measurements are average for full-term (37 weeks).  What does this mean?

Our OB is still not alarmed.  She said there's a large margin of error in ultrasound results, especially further along in the pregnancy.  Furthermore, this particular ultrasound company likes to overestimate their results.  Their philosophy is that it's better to overestimate than to underestimate.  Our OB said we needed to take the results "with a grain of salt."  She's relatively confident that Tray will be bigger than average, but there's nothing else to suggest that Tray will be abnormally large. 

I inquired about what her standard procedure is moving forward.  She'll continue to measure my fundal height (as is normal) and she'll do a manual exam of Tray's size in a few weeks.  If Tray seems to be getting even bigger, she might send us in for another ultrasound.  Otherwise, my care will be consistent with a totally normal pregnancy (which, I suppose, it still is).  I asked whether I'll be able to go into labor naturally.  She said "absolutely" and went on to cite a recent study that shows that big babies who endure induced labors do NOT fare better, as was originally thought.  She also said that she and her colleagues would do absolutely everything possible to avoid a c-section and would be diligent about not "throwing in the towel too early."  

My doula had a 10 pound baby and she's a bean pole and a marathoner.  She doesn't want me to worry but suggested that I might ask my OB about practicing some self-induction methods around 37 weeks or so.  We will certainly consider her advice very seriously if I don't happen to go into labor before then. 

There are a lot of things that are really confusing about why I might be having a larger than average baby.  I don't have gestational diabetes (in fact, my OB said my glucose results were "fantastic").  I'm not big and Matt isn't big.  I've gained only 18 pounds overall, apparently 6 of which are baby and another few are extra amniotic fluid, which doesn't leave a lot for me, my uterus, my boobs, etc. (there have been studies that show women who gain a lot of weight in pregnancy have bigger babies).  I was a big baby but that's because I was nearly 3 weeks late.  Brian wasn't a big baby.  Matt wasn't a big baby and neither was Sam.

Big sigh.  Today was hellish but the best part was when we got to see our baby again:

Tray's profile

Tray's little piggy foot

Still Measuring Big

We went in for our regular check-up on Friday and learned that I'm still measuring big (even bigger than last time).  I reached the "magic #" that mandates another ultrasound.  So, this coming week we'll be going back in for our 3rd ultrasound of my pregnancy (the first since week 20) to see what's going on with Tray.  My OB still isn't worried.  I believe she's just being conservative in ordering this ultrasound.  Our doula was with us at Friday's appointment and she also did not seem worried.  Yet it's hard for me to not be worried.  Par for the course, I suppose. 

I'll be sure to post an update when we know more. 

28 week check-up

Friday we went in for our 28 week check-up with our OB.  Everything looks great!  Our OB says I'm doing a "great job" with my weight gain.  Hopefully I do a "great job" with my weight loss too!  :)

My glucose test came back negative, which rules out the possibility that we (Tray and I) could have gestational diabetes.  This was one of the possible explanations for why I was measuring big the last couple of visits.  I'm actually still measuring big (2 weeks ahead of where I should be) but our OB says she isn't worried about it at all.  This is hugely reassuring! 

I asked her why/how I could possibly be measuring big.  I don't feel big.  I don't think I look big.  I've gained exactly the right amount of weight (averaging 1 pound per week since a couple of months ago).  She thinks I'm hiding my pregnancy well, probably as a result of being in good shape with strong stomach muscles.  This may also explain why many people think I'm carrying high:  lower stomach muscles hold up the pregnant belly.  So, the reality is that I'm bigger than I look.  I guess that's better than being smaller than I look...

The other good news we learned at Friday's visit is that I am not anemic!  Evidently, it is very common for pregnant women to be anemic by this stage in their pregnancy.  My iron levels are perfect!  Everyone should thank Matt for this.  He makes sure I eat leafy greens every single day, sometimes multiple times a day, and it's paying off!

28 weeks

Friday's Appt. and Questions to ask the OB

Friday's appointment went well. Tray's heartbeat is still strong and everything looks good. Well, everything except that I'm measuring big. For the second visit in a row, the size of my belly is bigger than it should be. Granted, the OB uses a fabric measuring tape so that measurement is quite crude. If I continue to measure big at next month's appointment, I will have to have another ultrasound. (Side note: With a totally normal pregnancy, the last ultrasound is at 20 weeks! Can you believe that? They don't look at the baby again until s/he is born!)

I know Tray and I just went through a growth spurt so that may explain why I'm measuring big. At our February appointment (19 weeks), I'd only gained a total of 7 pounds, which is under where I should have been. At this appointment (24 weeks), I'd gained a total of 12 pounds (up 5 pounds), which is right around where I should be.

One of the big decisions we recently made was to hire a doula for my labor. A doula is a labor support person for the mother. They offer pain coping techniques including massage, counter-pressure, relaxation exercises, birthing pool, etc. for the duration of the labor. Typically, they also offer support postpartum in the form of home visits and 24 hour phone support for up to 2 months after birth. We met with the doula we eventually hired a couple of weeks ago and Matt and I both really like her. She's a mother of three, a distance runner, a writer, a brand new yogi (like us!), and the former director of the Seattle Midwifery School (which means she's also a midwife, although, she will only act in the capacity of a doula for us). It was very helpful to hear her perspective after assisting at over 300 births!

The hope is that we will labor at home for as long as possible with her assistance. She will bring all of her doula toys (birth ball, birthing pool, rebozo, hot/cold packs, scented oils, etc.) to help us try to meet this goal. (This is, of course, assuming a totally healthy pregnancy and no potential issues.) Ideally, we will birth at home until 6-8 cm of dilation. The hospital is a short 10 minute drive from here, so we will be in a good position to get there sooner if necessary. The ultimate goal is a natural birth, without intervention or drugs but in the hospital with our OB (sounds like an oxymoron in this day and age). This is just a goal and we are well aware of all that lies on the other side of the spectrum. We want to be prepared for all possible outcomes.

At Friday's appointment, we got to have a conversation with our OB about our doula. We were also able to ask our OB several questions our doula brought up during out meeting. First off, our OB is very friendly to the idea of a doula and has worked with doulas in the past (she even gave us a sheet of recommended doulas last time we asked). She's also aware that if we were living in a European or an Asian country, there's a 90% chance we'd be giving birth with a midwife, as OBs are only used for high-risk pregnancies in the vast majority of the world. All and all, our OB is about the best doctor we could ask for right now. The only problem is that she works in a hospital and hospitals follow strict protocols. Let me explain.

Like all of medicine, protocols are developed out of research. Medical research is most often based on the bell curve. Medicine looks at the distribution of a given scenario and a protocol is instituted for the mean (the average) of that distribution (the very top of the curve). So, for example, with a woman in labor, the protocol might be to put her on pitocin (a synthetic version of oxytocin which is what your brain is producing to get your body to start contractions) after ____ hours without natural contractions. The protocol is applied to all women at a certain number of hours (whatever the protocol is), with very little variation. The problem is that variation exists in the real world (as the bell curve proves). On a bell curve, the mean is just the very top of the curve. 50% of people fall on one side of that inflection point and 50% of people fall on the other side of that inflection point (i.e. some women will experience natural contractions much sooner than the average and some women will experience natural contractions much later than the average). But everyone gets treated the same because that's how medicine is able to minimize risk and how hospitals are able to keep up with the demand. Our OB, despite her desire to give us the birth experience she knows we want, will ultimately have to follow the protocol at our hospital, more or less.

In the scenario of a woman without natural contractions, say 8 hours after her water breaks, the hospital will put that woman on pitocin to minimize risk for infection and speed up the labor process. A midwife would let that woman continue to labor at home unless there was some reason for alarm. Pitocin exists for a reason, absolutely, but too often it is applied to nearly every woman who walks though the doors of the labor and delivery ward, before seeing what her body is naturally capable of. However, the real problem with all of the interventions that occur at a hospital during the labor process is that one intervention leads to another, which leads to another, and to another. It can be a very slippery slope. Historically, the ultimate goal of obstetrics was a healthy baby, and protocols were developed in response to that goal. From my perspective, the real goal, however, should be a healthy baby and a healthy mother.

There was an article in the NY Times earlier this week about the c-section rate in the United States. The World Health Organization recommends that the average c-section rate in any country should be no higher than 15%. The c-section rate in the US is now at 32%. One in every 3 women gets a c-section!! Some states are as high as nearly 40%! It used to be that a c-section was only performed as a life saving measure. Now, if I wanted to, I could elect to have a c-section (elective c-sections are probably only a very small percentage of the 32%). I totally see the benefits of a c-section and I can understand why they are performed. But, again, I don't want to be forced to have a c-section because of protocol alone.

The hospital where we will deliver had a c-section rate of 34% in 2008. The flaw in that statistic is that our hospital has one of the best neonatal departments in the state. They see more high risk pregnancies than other hospitals which drive up their total. We asked our OB what her c-section rate is. The last time they measured, as a group (there are 8 female OBs total), they were around 13-15%. We asked our OB how often she delivers her own patients. She's on call one night a week, which means that if I deliver in the middle of the night, I have a 1 in 7 chance that my OB will be the one who delivers our baby (good thing her partners share a similar philosophy!). For daytime deliveries, she's on call 5 days a week (meaning she runs from the office to the hospital (next door) to deliver her patients throughout the day). Overall, she says there's a 60% chance she will deliver our baby. I asked our OB about birthing positions. When a woman gives birth on her back (how most hospitals require a woman to give birth), her pelvis is 33% smaller than if she was squatting or bending over (the baby passes through the pelvis). Our OB says she has delivered babies in all kinds of positions but, typically, once a woman has an epidural, she's required to lay flat so most women give birth lying down. If I'm able to make it through labor to the pushing phase without an epidural, I hope to get into whatever position feels best at that time. Obviously, that position is TBD, but it's nice to know that I may be able to do something other than lay in bed.

The more research we do (books, documentaries, etc.), the more we are glad that we're getting the big picture. We will give birth with an OB in a hospital and that is reassuring in many ways. But we will also have our doula with us and she will know what type of birth we want and she will advocate for us, which becomes especially important when you end up with labor nurses you've never met before and an OB you've never seen because yours is off duty. Also, studies have shown that doulas decrease the likelihood that you will end up with an epidural, a c-section, etc.  Ultimately, we don't know what the labor experience holds for us and, more than anything else, we're trying to prepare for that unknown equipped with as much knowledge as possible.

19 week update -- more details

First, let me say I'm fine and everything with Baby Tray is perfect.

One night in Boston, I woke up in the middle of the night with this intense abdominal pain centered around my belly button.  After it didn't lessen over the course of a few hours, I called the 24 hour nurse help line through Matt's awesome insurance.  They recommended I head to the emergency room.  I wasn't keen on getting up in the middle of the cold, snowy Boston night to ask Matt's parents to drive us to the hospital (although, I know they would have done so happily), so I decided to seek a second opinion.

Our OBs office has a 24 hour message service.  You can call, leave a message and, if it's an urgent matter, one of the OBs from the practice will call back right away.  So, at around 3am east coast time, I had a nice long conversation with an OB (not mine) about my pain.  She said it didn't sound like appendicitis or a gall stone because the pain was NOT centered on one side of my abdomen.  She asked a lot of other questions and eventually said that it was probably just an irritated gall bladder and indigestion.  She recommended I take Tums or Maalox.  I took some Tums and was eventually able to fall back asleep.  I felt okay the next morning.  However, throughout the rest of our time on the east coast, I continued to have the same indigestion issues after meals.

Since returning to Seattle, I'm happy to report that almost all of my morning sickness symptoms are gone!  I have a much healthier appetite and I'm not experiencing any nausea.  I still gag a little in the morning when I first wake up and I absolutely must get something substantial in my belly within about 60 minutes, but I'm honestly like a new person.  I'm not experiencing the same indigestion after meals as previously.  I also have a lot more energy overall.  Hallelujah!  After 3 months straight of feeling like sh*t, I'm glad it appears to be behind me. I sort of feel like I'm coming out of a depression.  For 3 months all I did was come home (maybe go to the gym first), eat, feel sick to my stomach, go to sleep, wake up, feel like crap, repeat.   All of those poor women who are sick all 9 months!  I truly cannot even imagine. 

I've started feeling little tickles from the inside of my belly recently.  It's still sporadic and hard to notice.  At yesterday's ultrasound appointment we were able to see just how much Baby Tray moves around.  I'm glad I don't feel everything just yet.  Both the ultrasound tech and our OB are amazed at how active s/he is!

We think we may have figured out Tray's sex from the appointment.  I'm sure we're wrong.  We've seen all of 2 ultrasounds ever, that hardly makes us experts!! We told the tech we didn't want to find out and she said nothing, but there was one point that we thought we could make out some identifying features!  I'm not saying any more than that because we really don't know and I really want it to be a surprise.

Finally, random story overheard at the ultrasound office yesterday.  As we're waiting in the reception room at the ultrasound office, I hear this woman talking to her partner on her cell phone.  This was the conversation:  "I'm at the ultrasound office.  You're not going to believe this.  {She takes a deep breath}.  They think we're having twins.  They must have missed it the first time. I need you to get here as soon as you can."  The totally wild part is that she looked bigger than me, so it's possible she's like 18+ weeks and just finding out that she's having twins.  What a shock!

19 week ultrasound

Today we went in for what they call the 20 week ultrasound.  I was really nervous going into this appointment because I'd read so much about bad news being delivered at the 20 week ultrasound.  The purpose of this appointment is to really take a lot of time and look over all of baby's parts:  fingers, toes, bones, organs, facial features, etc.  If we had wanted to find out the sex of the baby, this would have been the appointment.  Fortunately, we're still on the same page about wanting to be surprised! 

Here are some photos!

Baby profile at 19 weeks

Baby foot!

Baby sucks thumb!

Huge relief to know everything is perfect with Baby Tray!!

In other news, my morning sickness is almost completely gone!  I still experience the occasional gag in the morning but I'm like a new person otherwise! 

Active Baby!

Yesterday ended one of the most challenging weeks I've had in a very long time!  Work was completely insane, my professional activities were on full throttle, our car broke down and we found out we're looking at $1,000 worth of repairs, and I'm still completely exhausted on a daily basis. Everyone says the morning sickness and exhaustion should go away at the end of the 2nd trimester.  I'm nearly done with my 16th week and still every morning I get that feeling like I shouldn't brush my teeth or else!  For the 3rd month straight, bedtime is no later than 9pm. 

But all of this was made better yesterday when we got to hear our baby's heartbeat!!  Tray's heartbeat is strong and, according to the OB, Tray is a very active baby!  S/he was trying to swim away from the doppler and the OB had to chase her/him across my belly!  The OB says everything sounds great and my bump is exactly where it should be. 

I was surprised to learn that I've only gained 3 pounds overall.  Tell that to my jeans!  We're told that's normal and a lot of women don't put on the majority of their weight until further along in their pregnancy.    Still, it made me wish I had a healthy appetite and wanted to eat.  I'm still at the point when nothing sounds good, and that's especially true later in the day.  Poor Matt asks me if lentil soup sounds good or lamb burgers or some other meal made with all of his love, and I just shake my head.  Nothing sounds good but I'll eat it.

This weekend is going to be dedicated to the nursery.  The to-do list includes:

• putting up a picture molding in the nursery
• buying paint (this is the color we plan to use but in a zero-VOC brand -- it's called Glistening Moonlight)
• designing an Elfa closet for the nursery (and taking advantage of their annual sale!)

And because every post should have a photo, here's a snap of a little pillow case I bought the other day:

Tomorrow

Tomorrow we have a regular check-up appointment with our OB.   It's seems like forever since we were there last.  A couple of weeks ago, I was so anxious and tense about wanting to hear Tray's heartbeat again, I was starting to freak myself out.  I hear this behavior is normal.  I've never been someone who needs a lot of reassurance but bringing a baby on board has definitely left me feeling needy.  I just need to know that everything is okay still! 

In other news, I've agreed to participate in a migraine/preeclampsia  study with Swedish Medical Center (where we will deliver) and the National Institute of Health.  There's no compensation involved but I've known enough women who have been affected by preeclampsia that I figured it's the least I can do.   The study is pretty low-key.  They'll take a sample of my blood on Friday and send me home with a couple written surveys that shouldn't take longer than 15 minutes each.  Around 20 weeks, I'll do a 1 hour phone interview.  There is one requirement of participating that made me hesitate though.  After I deliver, they need a sample of tissue from my placenta.  Luckily, this doesn't actually involve me in anyway since, I will assume, I won't want anything to do with my placenta!  :) 

On an entirely unrelated note, please feel free to comment!  It's fun getting comments.  It makes it seem like I'm not just posting into a black hole.  Also, please take our fun little surveys along the left sidebar. 

Looking forward to tomorrow!

Seeing our baby

We've had 2 ultrasounds so far. The first was at 7 weeks and all we could really see was a blob and in the middle, a very fast heartbeat. Still, it was such a huge relief to know that all was well. You hear so many horror stories about blighted ovums and miscarriages, etc., it's impossible to describe the feeling the first time you see your baby.

Our 2nd ultrasound was at the very end of December. This ultrasound was part of the sequential screen and was performed outside of our regular OBs office. Just prior to this ultrasound, we went in for our regular check-up at which point the OB said she was going to try to find the baby's heartbeat using a doppler. She warned that at this stage (less than 12 weeks), it was a bit of a toss-up whether she would be able to hear the heartbeat. There was a moment when she put the doppler to my belly before she started to explain which heartbeat was mine and which was the baby's (you can hear both) when, once again, my heart sort of stopped in anticipation and fear.

At the sequential screen ultrasound, our baby actually looked like a baby and we could see it moving around. We could even make out tiny hands and feet. All of that and he/she was only 4cm long at the time!