My fundus is now at least 3 cm above my belly button - this is since my visit to the midwife a week ago when my fundus was AT my belly button.
There is a definite baby head at the top, but there's something resembling a baby head about the length of my hand below the definite baby head. Logic says this could be the baby's bum, but:
1. the baby is only supposed to be 5 in long right now, I think (16 wks 3 days), and
2. their heads are so much bigger than their bums at this point that I really don't think it's a bum...
I've considered the possibility that our date are off, but here's the problem with that:
1. I had a definite period that started on Dec 6
2. I was charting my temp and had a definite ovulation spike on Dec 20 (plus my temps before then had been my normal pre-ov temps).
So, I'm now seriously considering the possibility that it's twins. Here's the problem: my midwife is not legally allowed to deliver twins. I desperately don't want to deliver in the hospital, and I'm nervous about using a "traditional birth attendant" (unlicensed midwife). My doula of choice won't attend a birth with a traditional birth attendant and I'm not sure I'm comfortable with that scenario, either. I guess I'm not as ballsy as I had thought.
The option left to me is to play dumb, I guess. My midwife likely won't look for twins and I can refuse an ultrasound if she's bound by the College of Midwives' Scope of Practice regulations to ask for one. Then, assuming all is well, it would be "Oops, it's twins!" when two babies come out. I likely would know before then since I seem to be pretty good at telling what position the baby is in (I knew for sure with Hippo that he was left occipito-something - turns out it was occipitotransverse - which would be why he hadn't yet dropped into my pelvis).
The suspense is driving crazy. What would you do in my position?
Sunday, March 30, 2008
Friday, March 28, 2008
Emotional
I've been feeling very emotional the past few weeks. I cry at news stories at the drop of a hat. I know this is fairly cliche for pregnancy, but being this emotional made it hard the other day for me to make yet another round of calls trying to find a home for Natasha, our lab-pointer mix who nipped my son last week.
Natasha is sweet in the right environment, but she's been on a reign of terror since DH and I married and moved in together two years ago. In the first year, she nearly killed Soulmate (my DH)'s dog, Ceilidh - a much smaller dog than Natasha, several times. Then, DS (let's call him Hippo) came along. With Hippo's arrival, Natasha began pooping in the house with regularity. It's not that she would ask and we would ignore her (though admittedly we sometimes would). She would stand up, look us in the eye, and poop on the floor right in front of us with no warning. Yeah.
When Hippo started to walk, she upped the ante and started peeing on the floor as well. If Hippo comes within 4 feet of her, she growls. We'd been looking for a new home for her since Hippo was 3 mo old. When he started walking, we decided it was time to really, seriously try to rehome Natasha.
We hired a company called Last Chance Dog Rehoming. We paid them $60 for an initial evaluation where we were told we'd receive advice on how to cope with her until she left. The advice: don't let her near the baby. Uh, no shit. Then we paid them $100 to write an ad to be posted on the local pet adoption websites. The ad was a joke. They referred to her horrible home several times in the posting. Now, I'll admit I'm not a great dog mama at this stage in my life - it's all I can do to be an adequate mama to Hippo - but Natasha is fed, taken out, walked on occasion, and has a host of comfy couches to sleep on. She could use more exercise, but she's hardly abused. I emailed and asked them to take out the references to her home life. They did, but they didn't get why I was mad.
Fast forward to last week. Hippo was marauding about the house and I thought I had a handle on the situation, but he got too close to Natasha too fast and she snapped at him. I don't believe she intended to bite him, but her teeth connected with him when she snapped causing a minor scrape. Still, a bite is a bite and I called Last Chance and anyone else I could think of to help us find her a new home with no kids. Last Chance said, "Sorry, we don't have any foster homes right now." Remember we are paying these people and we've offered to pay for food and vet expenses while she's being fostered.
So, I emailed everyone I know again. Soulmate placed ads in the local online marketplaces. I called some more rescues in town. Finally, someone suggested the SPCA. They said that they had the same kind of problem with their dog when their daughter was born and the SPCA was able to find a home for the dog within a day. I called and must've talked to the bitchiest employee there. This is where the emotion comes in. The woman flat out didn't listen to me. She wouldn't let me finish telling her about Natasha and her needs. She just said, "I've heard enough." and told me I was cruel to think of rehoming her and just delaying the inevitable - putting her down. She said that if I "took the easy way out and pawned her off on someone else" that person would end up having to put her down. I lost it and was sobbing at this point. I ended up hanging up on her because the conversation was pointless.
In the mean time, I felt backed up against a wall. I didn't want to put her down, but she'd not safe around my child and I can't have her in my house. I called the vet and told them I was thinking of putting her down. After they established that I had already talked to all the rescues in town, they told me to bring her in for a physical assessment by the doctor. In the meantime, they would see if they could help out at all.
About an hour later I received a call from Last Chance. They had heard that I had an appointment to put Natasha down and were upset by this. I explained the situation - that I was taking Natasha in for a physical assessment and that, yes, I had talked to the receptionist at the vet about putting her down. Miraculously, Last Chance now thought they had a foster home available. I was sobbing throughout this conversation as well. I knew I couldn't put Natasha down myself - I'd have to have Soulmate or his dad take her if it came to that.
Nevertheless, I took Natasha to the vet that afternoon with a lighter heart - hoping that this was the light at the end of the tunnel. The vet found her delightful. We updated her vaccines and he said he understood why we were rehoming her and that he thought we'd find a place. She wasn't a lost cause. While we were there, Last Chance called the vet to make sure we weren't putting her down. They assured the receptionist they would have a foster home within a few days.
That was Tuesday. It's Friday now. I emailed Last Chance Tuesday night to tell them what the vet had said. I haven't heard from them. I emailed them again this morning. We'll see if they get back to me.
I honestly don't know what to do. I feel like I'm stuck at the bottom of a well and yelling. I can see people walking by, but they aren't responding to me. I don't want to put her down, but I feel backed against a wall. No one will take her and I can't keep her. What's left? I can't abandon her to a shelter - she'll be completely unadoptable if she's in a cage all day (I know this about her as she came to me initially as my foster dog years ago). They'll end up having to put her down anyway. It seems less cruel to me to do it while she still lives with us.
The thought makes me sick.
Natasha is sweet in the right environment, but she's been on a reign of terror since DH and I married and moved in together two years ago. In the first year, she nearly killed Soulmate (my DH)'s dog, Ceilidh - a much smaller dog than Natasha, several times. Then, DS (let's call him Hippo) came along. With Hippo's arrival, Natasha began pooping in the house with regularity. It's not that she would ask and we would ignore her (though admittedly we sometimes would). She would stand up, look us in the eye, and poop on the floor right in front of us with no warning. Yeah.
When Hippo started to walk, she upped the ante and started peeing on the floor as well. If Hippo comes within 4 feet of her, she growls. We'd been looking for a new home for her since Hippo was 3 mo old. When he started walking, we decided it was time to really, seriously try to rehome Natasha.
We hired a company called Last Chance Dog Rehoming. We paid them $60 for an initial evaluation where we were told we'd receive advice on how to cope with her until she left. The advice: don't let her near the baby. Uh, no shit. Then we paid them $100 to write an ad to be posted on the local pet adoption websites. The ad was a joke. They referred to her horrible home several times in the posting. Now, I'll admit I'm not a great dog mama at this stage in my life - it's all I can do to be an adequate mama to Hippo - but Natasha is fed, taken out, walked on occasion, and has a host of comfy couches to sleep on. She could use more exercise, but she's hardly abused. I emailed and asked them to take out the references to her home life. They did, but they didn't get why I was mad.
Fast forward to last week. Hippo was marauding about the house and I thought I had a handle on the situation, but he got too close to Natasha too fast and she snapped at him. I don't believe she intended to bite him, but her teeth connected with him when she snapped causing a minor scrape. Still, a bite is a bite and I called Last Chance and anyone else I could think of to help us find her a new home with no kids. Last Chance said, "Sorry, we don't have any foster homes right now." Remember we are paying these people and we've offered to pay for food and vet expenses while she's being fostered.
So, I emailed everyone I know again. Soulmate placed ads in the local online marketplaces. I called some more rescues in town. Finally, someone suggested the SPCA. They said that they had the same kind of problem with their dog when their daughter was born and the SPCA was able to find a home for the dog within a day. I called and must've talked to the bitchiest employee there. This is where the emotion comes in. The woman flat out didn't listen to me. She wouldn't let me finish telling her about Natasha and her needs. She just said, "I've heard enough." and told me I was cruel to think of rehoming her and just delaying the inevitable - putting her down. She said that if I "took the easy way out and pawned her off on someone else" that person would end up having to put her down. I lost it and was sobbing at this point. I ended up hanging up on her because the conversation was pointless.
In the mean time, I felt backed up against a wall. I didn't want to put her down, but she'd not safe around my child and I can't have her in my house. I called the vet and told them I was thinking of putting her down. After they established that I had already talked to all the rescues in town, they told me to bring her in for a physical assessment by the doctor. In the meantime, they would see if they could help out at all.
About an hour later I received a call from Last Chance. They had heard that I had an appointment to put Natasha down and were upset by this. I explained the situation - that I was taking Natasha in for a physical assessment and that, yes, I had talked to the receptionist at the vet about putting her down. Miraculously, Last Chance now thought they had a foster home available. I was sobbing throughout this conversation as well. I knew I couldn't put Natasha down myself - I'd have to have Soulmate or his dad take her if it came to that.
Nevertheless, I took Natasha to the vet that afternoon with a lighter heart - hoping that this was the light at the end of the tunnel. The vet found her delightful. We updated her vaccines and he said he understood why we were rehoming her and that he thought we'd find a place. She wasn't a lost cause. While we were there, Last Chance called the vet to make sure we weren't putting her down. They assured the receptionist they would have a foster home within a few days.
That was Tuesday. It's Friday now. I emailed Last Chance Tuesday night to tell them what the vet had said. I haven't heard from them. I emailed them again this morning. We'll see if they get back to me.
I honestly don't know what to do. I feel like I'm stuck at the bottom of a well and yelling. I can see people walking by, but they aren't responding to me. I don't want to put her down, but I feel backed against a wall. No one will take her and I can't keep her. What's left? I can't abandon her to a shelter - she'll be completely unadoptable if she's in a cage all day (I know this about her as she came to me initially as my foster dog years ago). They'll end up having to put her down anyway. It seems less cruel to me to do it while she still lives with us.
The thought makes me sick.
Changes
So I'm feeling lots of stretching in my lower abdomen these days. It seems baby decided to leave his/her little corner of my uterus (upper left) and settle more in the middle. I can feel her position any time my uterus contracts (Braxton-Hicks-style). Maybe I'll finally start to look pregnant. By this time with DS, I already looked like I had a tidy little baby bump. But that was back when I had some stomach muscles. A few weeks agao my muscles gave up the ghost and stretched out to where they were when I was 6 mo pregnant with DS. Now, it looks like I just had a big lunch because these muscles are all floppy with no baby behind them. Nevertheless, I've had to bust out the maternity tops because they are the only thing that cover my jiggling abdomen. Good times.
In other good news, my fasting blood sugar numbers have gotten WAY better. They were rarely ever above the GD cut-off (5.0-5.3 m/mol) anyway, but now they are fab-u-lous (today's was 3.6 m/mol). I rock. Not sure why the change, but I suspect one of two things:
1. I've always washed my hands before testing, but I've been paying more attention the past few days to specifically scrubbing the sides of my fingers.
2. I started taking my prenatals again after having had the flu for several weeks (they make me somewhat nauseous and I just couldn't handle any more nausea after not eating for 5 days, barely eating for 10, and losing 5 lbs). Along with the prenatals, I'm taking a vitamin protocol recommended by my husband and his TCM colleagues to help regulate blood sugar (cinnamon, calcium magnesium, zinc citrate and chromium something-or-other).
Whatever's going on, I guess it's working.
In other good news, my fasting blood sugar numbers have gotten WAY better. They were rarely ever above the GD cut-off (5.0-5.3 m/mol) anyway, but now they are fab-u-lous (today's was 3.6 m/mol). I rock. Not sure why the change, but I suspect one of two things:
1. I've always washed my hands before testing, but I've been paying more attention the past few days to specifically scrubbing the sides of my fingers.
2. I started taking my prenatals again after having had the flu for several weeks (they make me somewhat nauseous and I just couldn't handle any more nausea after not eating for 5 days, barely eating for 10, and losing 5 lbs). Along with the prenatals, I'm taking a vitamin protocol recommended by my husband and his TCM colleagues to help regulate blood sugar (cinnamon, calcium magnesium, zinc citrate and chromium something-or-other).
Whatever's going on, I guess it's working.
Monday, March 24, 2008
15 wks 4 days - GD, fundus, milk:(
I've mentioned this before, but I've been taking my blood sugar throughout this pregnancy ever since they threw the "gestational diabetes" diagnosis at me retroactively for daring to have a 9.5 lb baby. There was not a shred of lab evidence to support this since I refused the GD screening. A random glucose taken 4 days before my son's birth was 4.0 mmol/l (corresponds to 72 whatever-measurements-they-use-in-the-US). Yeah. I totally had GD. Not. AND I didn't consent to them taking a random blood glucose (and was never asked).
Anyway, I conducted my own little glucose tolerance test today just to see. I woke up at 5 am and there was chocolate cake with frosting leftover from the weekend. So, I had a generous slice and a glass of milk to wash it all down. I even crawled back into bed to wait to take the readings at 1 hr post-cake and 2 hrs post-cake (I've heard that they often make you lie down after taking the regular GTT). I passed with flying colours.
That said, due to the illnesses, I've been eating complete crap and found myself craving leafy greens shortly after my cake escapades this morning. For lunch, I'm proud to say I made salmon salad with chopped cucumber and tomato. It was delicious.
I'm also at the point in pregnancy where my digestion really slows down. I ate a normal-sized grilled cheese and tomato sandwich for supper last night and it took HOURS to digest. It felt like a rock in my stomach all night. So, for my own comfort I really need to watch my portions and make sure I'm getting extra water.
In other news, my fundus is at my navel. I'm only 15 weeks. The midwife didn't seem to flinch at this, but neither did she keep the doppler out after we very quickly found the baby's heartbeat on Thursday (i.e. she didn't try to look for twins). Smart lady. We're refusing ultrasounds unless a very compelling reason comes up (more compelling than possible twins). I got some reassurance from my best friends on the ICAN list that a fundus at the navel this early in a 2nd pregnancy isn't anything to even think twice about.
Sadly, my milk seems to be drying up. Usually I can get it to squirt across the room if I try to express, now, I'm lucky to get one or two big white drops. Eating oatmeal has been recommended to me (did that today) along with Motherlove's Mother's Milk Two for moms nursing while pregnant. DS hasn't yet started to complain, but he's not staying at the boob quite as long as he used to. I'm determined to do what I can to keep my supply. Any suggestions are eagerly appreciated.
Anyway, I conducted my own little glucose tolerance test today just to see. I woke up at 5 am and there was chocolate cake with frosting leftover from the weekend. So, I had a generous slice and a glass of milk to wash it all down. I even crawled back into bed to wait to take the readings at 1 hr post-cake and 2 hrs post-cake (I've heard that they often make you lie down after taking the regular GTT). I passed with flying colours.
That said, due to the illnesses, I've been eating complete crap and found myself craving leafy greens shortly after my cake escapades this morning. For lunch, I'm proud to say I made salmon salad with chopped cucumber and tomato. It was delicious.
I'm also at the point in pregnancy where my digestion really slows down. I ate a normal-sized grilled cheese and tomato sandwich for supper last night and it took HOURS to digest. It felt like a rock in my stomach all night. So, for my own comfort I really need to watch my portions and make sure I'm getting extra water.
In other news, my fundus is at my navel. I'm only 15 weeks. The midwife didn't seem to flinch at this, but neither did she keep the doppler out after we very quickly found the baby's heartbeat on Thursday (i.e. she didn't try to look for twins). Smart lady. We're refusing ultrasounds unless a very compelling reason comes up (more compelling than possible twins). I got some reassurance from my best friends on the ICAN list that a fundus at the navel this early in a 2nd pregnancy isn't anything to even think twice about.
Sadly, my milk seems to be drying up. Usually I can get it to squirt across the room if I try to express, now, I'm lucky to get one or two big white drops. Eating oatmeal has been recommended to me (did that today) along with Motherlove's Mother's Milk Two for moms nursing while pregnant. DS hasn't yet started to complain, but he's not staying at the boob quite as long as he used to. I'm determined to do what I can to keep my supply. Any suggestions are eagerly appreciated.
Monday, March 17, 2008
I'm better, at least
So I didn't fully recover until this past Thursday. I can't recall a time in my life when I've been actively sick for over a week. At least ds didn't get it. DH did and is recovering.
So, my uterus is well on its way toward my belly button. I'm assuming that it's normal for it to grow a little faster in a second pregnancy... The other thing that worries me is that the baby is all on one side near the top of my uterus. I've been able to feel her (no, we don't know the sex) move periodically. At least I know that my placenta is well-away from my scar. But why isn't she taking advantage of her space while she has it?
I see the midwife again this week - my pregnant self lost the appointment slip, so I have to call.
All is well.
So, my uterus is well on its way toward my belly button. I'm assuming that it's normal for it to grow a little faster in a second pregnancy... The other thing that worries me is that the baby is all on one side near the top of my uterus. I've been able to feel her (no, we don't know the sex) move periodically. At least I know that my placenta is well-away from my scar. But why isn't she taking advantage of her space while she has it?
I see the midwife again this week - my pregnant self lost the appointment slip, so I have to call.
All is well.
Sunday, March 9, 2008
The flu that wouldn't leave
It began over a week ago. My poor ds refusing lunch and then throwing up over both of us when I tried to take him out of his carseat. No sooner had he recovered than I succumbed. It wasn't horrible. A day of nausea with only one trip driving the porcelain bus followed by 4-5 days of general fatigue (worse than my usual pregnancy fatigue).
I'm not the kind of person who gets sick. I can count on two fingers the amount of times I've thrown up from illness in the past 15 years.
Yet, on Friday (two days ago - a mere 6 days after my bout with the "flu"), my throat began to tickle. I felt fine otherwise, so I ignored it. Yesterday, I had no appetite and felt achy and exhausted all day. DH played with ds in the afternoon so I could lie down. I spent 1.5 hours dutifully in bed with my eyes closed. No sleep.
I forced myself to eat some chickpea salad when I woke up wondering if I was in desperate need of proper (read: vegetables and protein) food. I did feel better for about 3 hours, but the throat tickle had turned into a full-blown cough and a slight fever.
Last night, I finally managed to fall asleep around 11:30 (I started trying at 10:30). Then, I woke up at 3:30 to pee and I haven't been able to get back to sleep since.
The exacerbating circumstance is this: I've been waking up this early every morning for the past two weeks. If it's not up to pee, it's up from a nightmare of the family-members-losing-limbs variety. In the end of my pregnancy with ds, I would wake up every morning before 5. I didn't set an alarm, it just happened. I didn't have to be up, I just woke up. I would eventually get back to sleep around 6:30-7:00 and sleep as long as I needed. Now, I have a baby who sleeps really well, but often wakes by 8:00. If I can manage to get back to sleep, I'm lucky if I make up 30 minutes.
Ugh.
I just want to sleep. I want sleep to be easy and pleasant. So, now I'm sipping herbal tea with honey and hoping that when I crawl back into bed, sleep comes quickly and completely. I can't take another 6 months of 5 hours/night.
I'm not the kind of person who gets sick. I can count on two fingers the amount of times I've thrown up from illness in the past 15 years.
Yet, on Friday (two days ago - a mere 6 days after my bout with the "flu"), my throat began to tickle. I felt fine otherwise, so I ignored it. Yesterday, I had no appetite and felt achy and exhausted all day. DH played with ds in the afternoon so I could lie down. I spent 1.5 hours dutifully in bed with my eyes closed. No sleep.
I forced myself to eat some chickpea salad when I woke up wondering if I was in desperate need of proper (read: vegetables and protein) food. I did feel better for about 3 hours, but the throat tickle had turned into a full-blown cough and a slight fever.
Last night, I finally managed to fall asleep around 11:30 (I started trying at 10:30). Then, I woke up at 3:30 to pee and I haven't been able to get back to sleep since.
The exacerbating circumstance is this: I've been waking up this early every morning for the past two weeks. If it's not up to pee, it's up from a nightmare of the family-members-losing-limbs variety. In the end of my pregnancy with ds, I would wake up every morning before 5. I didn't set an alarm, it just happened. I didn't have to be up, I just woke up. I would eventually get back to sleep around 6:30-7:00 and sleep as long as I needed. Now, I have a baby who sleeps really well, but often wakes by 8:00. If I can manage to get back to sleep, I'm lucky if I make up 30 minutes.
Ugh.
I just want to sleep. I want sleep to be easy and pleasant. So, now I'm sipping herbal tea with honey and hoping that when I crawl back into bed, sleep comes quickly and completely. I can't take another 6 months of 5 hours/night.
Wednesday, March 5, 2008
Put that in your "big baby" pipe and smoke it!
Doctors love to pull the "big baby" card these days. Frequently, the mother gets pinned with gestational diabetes whether or not she passed the glucose tolerance test (GTT) if her baby is more than about 8.5 lbs. Some doctors even go so far as to recommend a c/s even in first-time moms or moms who've delivered vaginally before if they suspect a "big baby". Here's the fly in that ointment:
J Obstet Gynaecol. 2007 May;27(4):374- 8. Recurrence of fetal macrosomia in
non-diabetic pregnancies.
Walsh CA, Mahony RT, Foley ME, Daly L, O'Herlihy C.
National Maternity Hospital Dublin, Ireland.
Fetal macrosomia (birth weight >/=4,500 g) is known to increase a number of
adverse maternal and perinatal outcomes. Although there is a clear
association between maternal diabetes mellitus and fetal macrosomia, the
majority of macrosomic infants are born to non-diabetic mothers. We wished
to determine the recurrence rate of macrosomia in non-diabetic pregnancy and
to see if a history of multiple prior macrosomic infants confers additional
risk.
A retrospective analysis of 14,461 term, singleton, infants born to
non-diabetic mothers in 1997 and 1998 was performed, using a computerised
hospital database. Among 14,461 term pregnancies, 529 infants (3.7%) were
macrosomic, and the incidence was significantly higher in parous women
(4.6%) compared with nulliparas (2.4%, p < 0.0001).
Over the next 5 years, 164 of these women returned for another delivery.
Women with a history of one macrosomic infant are at significantly increased
risk of another macrosomic infant in a subsequent pregnancy (OR 15.8, 95% CI
11.45 - 21.91, p < 0.0001). For women with two or more macrosomic infants,
the risk is even greater (OR 47.4, 95% CI 19.9 - 112.89, p < 0.0001).
Macrosomia was associated with increased rates of instrumental delivery and
anal sphincter injury regardless of parity, and additionally with increased
rates of caesarean delivery and shoulder dystocia among nulliparas.
Overall, 88% of women who laboured with a macrosomic infant achieved vaginal
delivery.
Hmm. 88% of women achieved vaginal delivery. Sounds perfectly sensible to me and well within the WHO guidelines that c/s is necessary in 10-15% of births.
J Obstet Gynaecol. 2007 May;27(4):374- 8. Recurrence of fetal macrosomia in
non-diabetic pregnancies.
Walsh CA, Mahony RT, Foley ME, Daly L, O'Herlihy C.
National Maternity Hospital Dublin, Ireland.
Fetal macrosomia (birth weight >/=4,500 g) is known to increase a number of
adverse maternal and perinatal outcomes. Although there is a clear
association between maternal diabetes mellitus and fetal macrosomia, the
majority of macrosomic infants are born to non-diabetic mothers. We wished
to determine the recurrence rate of macrosomia in non-diabetic pregnancy and
to see if a history of multiple prior macrosomic infants confers additional
risk.
A retrospective analysis of 14,461 term, singleton, infants born to
non-diabetic mothers in 1997 and 1998 was performed, using a computerised
hospital database. Among 14,461 term pregnancies, 529 infants (3.7%) were
macrosomic, and the incidence was significantly higher in parous women
(4.6%) compared with nulliparas (2.4%, p < 0.0001).
Over the next 5 years, 164 of these women returned for another delivery.
Women with a history of one macrosomic infant are at significantly increased
risk of another macrosomic infant in a subsequent pregnancy (OR 15.8, 95% CI
11.45 - 21.91, p < 0.0001). For women with two or more macrosomic infants,
the risk is even greater (OR 47.4, 95% CI 19.9 - 112.89, p < 0.0001).
Macrosomia was associated with increased rates of instrumental delivery and
anal sphincter injury regardless of parity, and additionally with increased
rates of caesarean delivery and shoulder dystocia among nulliparas.
Overall, 88% of women who laboured with a macrosomic infant achieved vaginal
delivery.
Hmm. 88% of women achieved vaginal delivery. Sounds perfectly sensible to me and well within the WHO guidelines that c/s is necessary in 10-15% of births.
Tuesday, March 4, 2008
One more since I'm on a roll
For my third post of the night: I came across this little study on PubMed entitled "Suspected macrosomia? Better not tell."
Now, I have only seen the abstract (reprinted here for your viewing pleasure) and the study was small, but there's at least one real gem right in the conclusion:
Sadeh-Mestechkin D, Walfisch A, Shachar R, Shoham-Vardi I, Vardi H, Hallak M.
Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel, mestechk@bgu.ac.il.
OBJECTIVE: To evaluate the management policy of delivery in a suspected macrosomic fetus and to describe the outcome of this policy.
STUDY DESIGN: For this prospective observational study we followed the management by reviewing the medical records of 145 women and their infants. The study population included women at term admitted to the obstetrics department with suspected macrosomic infants, as was diagnosed by an obstetrician and/or by fetal sonographic weight estimation of >/=4,000 g. The comparison group (n = 5,943) consisted of all women who gave birth during the data collection period.
RESULTS: Induction of labor and cesarean delivery rates in the macrosomic pregnancies (actual birth weight >4,000 g) of the study group were significantly higher when compared with the macrosomic pregnancies of the comparison group. When comparing the non-macrosomic to the macrosomic pregnancies (actual birth weight 4,000 g) of the study group no significant difference was demonstrated regarding maternal or infant complications. The sensitivity, specificity and positive predictive value of the methods used for detecting macrosomia were 21.6, 98.6 and 43.5%, respectively.
CONCLUSION: Our ability to predict macrosomia is poor. Our management policy of suspected macrosomic pregnancies raises induction of labor and cesarean delivery rates without improving maternal or fetal outcome.
It speaks for itself.
Now, I have only seen the abstract (reprinted here for your viewing pleasure) and the study was small, but there's at least one real gem right in the conclusion:
Sadeh-Mestechkin D, Walfisch A, Shachar R, Shoham-Vardi I, Vardi H, Hallak M.
Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel, mestechk@bgu.ac.il.
OBJECTIVE: To evaluate the management policy of delivery in a suspected macrosomic fetus and to describe the outcome of this policy.
STUDY DESIGN: For this prospective observational study we followed the management by reviewing the medical records of 145 women and their infants. The study population included women at term admitted to the obstetrics department with suspected macrosomic infants, as was diagnosed by an obstetrician and/or by fetal sonographic weight estimation of >/=4,000 g. The comparison group (n = 5,943) consisted of all women who gave birth during the data collection period.
RESULTS: Induction of labor and cesarean delivery rates in the macrosomic pregnancies (actual birth weight >4,000 g) of the study group were significantly higher when compared with the macrosomic pregnancies of the comparison group. When comparing the non-macrosomic to the macrosomic pregnancies (actual birth weight 4,000 g) of the study group no significant difference was demonstrated regarding maternal or infant complications. The sensitivity, specificity and positive predictive value of the methods used for detecting macrosomia were 21.6, 98.6 and 43.5%, respectively.
CONCLUSION: Our ability to predict macrosomia is poor. Our management policy of suspected macrosomic pregnancies raises induction of labor and cesarean delivery rates without improving maternal or fetal outcome.
It speaks for itself.
Finally a heartbeat
It was a beautiful sound. Today, at 12 weeks and 5 days, we heard the heartbeat of our second child. DH teared up and I only didn't because I was trying to keep our first child from biting my nipple.
It's finally real. I've gone through days over the past few weeks where I've thought I really wasn't pregnant - that maybe I was one of those women who convince themselves that they're pregnant until their bodies start to show the signs. Heck, I'm even showing already (more from my muscles' pregnancy recall than the baby, but I'll take what I can get).
So, it's real. I'm here. I told my parents. Dad was a bit of a trip. I may have to only speak to him through my stepmom for the duration of the pregnancy. He doesn't believe I've done my research or that I know what I am choosing. Oh well, I can't let that add to my stress.
Anyway, I'm back.
The real question: how do you have two nursing kids in a family bed without rolling over constantly? I'm contemplating night-weaning ds, but I think I need another month or two (or three).
It's finally real. I've gone through days over the past few weeks where I've thought I really wasn't pregnant - that maybe I was one of those women who convince themselves that they're pregnant until their bodies start to show the signs. Heck, I'm even showing already (more from my muscles' pregnancy recall than the baby, but I'll take what I can get).
So, it's real. I'm here. I told my parents. Dad was a bit of a trip. I may have to only speak to him through my stepmom for the duration of the pregnancy. He doesn't believe I've done my research or that I know what I am choosing. Oh well, I can't let that add to my stress.
Anyway, I'm back.
The real question: how do you have two nursing kids in a family bed without rolling over constantly? I'm contemplating night-weaning ds, but I think I need another month or two (or three).
Why VBAC?
If you're out there and still reading, Liza (who commented on my last post - yay comments!), I'm sorry for being such a loser and not updating my blog. I'm about to write a post about just that. In the mean time, I'll answer your questions.
Re: *knowing* you found the right midwife - I thought I had the right one the first time, too. Turns out she was way too afraid of the OBs at the hospital. She would've shaved me and prepped me for surgery herself if she thought it would make them happy.
Before getting pregnant, I studied VBACs. Seriously. I lived on the ICAN yahoo group and read the research. I learned how to use PubMed so I could find studies/evidence on my own.
Then, I went looking for a midwife. I interviewed 4 and all gave me the feeling that I would end up in the hospital (and probably not progressing due to the stressful environment). They were afraid of failure more than I was. When I met my current midwife, she listened to my story and said, "Oh! So you'll be just like a first time mom giving birth!" That was all I needed to hear. No trying to convince me that I'd end up with high blood pressure again. No telling me that she doesn't attend HBACs because "HBAC moms don't go to the hospital when the midwife tells them to" (all real life things I got from one midwife I interviewed). I grilled her and made sure she knew I'd done my homework. We spent a good 30 minutes after my appointment discussing why the c/s rate is so high in our city.
So, that's how I knew. I also kept/am keeping an open mind. I can change providers at will if I get uncomfortable with her for any reason. I suspect this won't happen because we've already had several frank and honest discussions. I showed her my cards and she showed me hers. Time will tell if we're the right pair.
Now, as for scheduling at 39 weeks. *Most* women will not go into labour on their own by 39 weeks. Often, I've heard of providers telling women they can VBAC as long as they go into labour by their due date (40 weeks). Gee, uh, thanks. I don't have the study to hand, but I do recall reading that most Caucasian women gestate beyond 40 weeks. It's known on the ICAN list as "the old bait and switch". Doc says, "Sure you can have a VBAC! I love VBACs! Then, at 36 weeks, Doc says, "Baby's getting awfully big. You better have an ultrasound before we let you grow this monster any bigger. You better go into labour soon, or baby just won't fit." Then, at 37 weeks, we should use pelvimetry (see ICAN website on CPD for references to why pelvimetry is complete bullshit) to see if your pelvis is big enough."
Bait and switch. Mom ends up with a c/s unless she has some major guts and can outrun this knife-wielding, fear-mongering physician.
But, this doesn't answer your question. Why schedule? Why not wait for labour if you're bound and determined to have a c/s? Baby will be more likely to be fully developed (i.e. lungs will function properly) and there's evidence, I believe, that shows that the oxytocin mom and baby share during labour provide some benefits after birth (you'd have to address that question specifically to the ICAN list).
Why 39 weeks? Are they afraid you'll explode if you gestate to, say, 40 weeks and 5 days?
Ok, I'm one person trying to represent the thousands of women on the ICAN list. I recommend you post your two questions (or at least the one about why 39 weeks?) to the list and watch the replies flood in. Go to Yahoo Groups and search for ICAN. Subscribe. It's like entering a whole other world where the birth process is celebrated - not feared.
My wish for you, dear Liza, dear Liza? That you change midwives - fast. FTP is no reason not to VBAC. There's a TON of preparation you can do to make sure your baby is in the right position, that your uterus is toned, and that you're limber and can move into different positions easily. Beyond that, I wish for you that you will go on to experience a glorious birth in spite of all the naysaying you've heard expressed by your care providers. You CAN do it!
Re: *knowing* you found the right midwife - I thought I had the right one the first time, too. Turns out she was way too afraid of the OBs at the hospital. She would've shaved me and prepped me for surgery herself if she thought it would make them happy.
Before getting pregnant, I studied VBACs. Seriously. I lived on the ICAN yahoo group and read the research. I learned how to use PubMed so I could find studies/evidence on my own.
Then, I went looking for a midwife. I interviewed 4 and all gave me the feeling that I would end up in the hospital (and probably not progressing due to the stressful environment). They were afraid of failure more than I was. When I met my current midwife, she listened to my story and said, "Oh! So you'll be just like a first time mom giving birth!" That was all I needed to hear. No trying to convince me that I'd end up with high blood pressure again. No telling me that she doesn't attend HBACs because "HBAC moms don't go to the hospital when the midwife tells them to" (all real life things I got from one midwife I interviewed). I grilled her and made sure she knew I'd done my homework. We spent a good 30 minutes after my appointment discussing why the c/s rate is so high in our city.
So, that's how I knew. I also kept/am keeping an open mind. I can change providers at will if I get uncomfortable with her for any reason. I suspect this won't happen because we've already had several frank and honest discussions. I showed her my cards and she showed me hers. Time will tell if we're the right pair.
Now, as for scheduling at 39 weeks. *Most* women will not go into labour on their own by 39 weeks. Often, I've heard of providers telling women they can VBAC as long as they go into labour by their due date (40 weeks). Gee, uh, thanks. I don't have the study to hand, but I do recall reading that most Caucasian women gestate beyond 40 weeks. It's known on the ICAN list as "the old bait and switch". Doc says, "Sure you can have a VBAC! I love VBACs! Then, at 36 weeks, Doc says, "Baby's getting awfully big. You better have an ultrasound before we let you grow this monster any bigger. You better go into labour soon, or baby just won't fit." Then, at 37 weeks, we should use pelvimetry (see ICAN website on CPD for references to why pelvimetry is complete bullshit) to see if your pelvis is big enough."
Bait and switch. Mom ends up with a c/s unless she has some major guts and can outrun this knife-wielding, fear-mongering physician.
But, this doesn't answer your question. Why schedule? Why not wait for labour if you're bound and determined to have a c/s? Baby will be more likely to be fully developed (i.e. lungs will function properly) and there's evidence, I believe, that shows that the oxytocin mom and baby share during labour provide some benefits after birth (you'd have to address that question specifically to the ICAN list).
Why 39 weeks? Are they afraid you'll explode if you gestate to, say, 40 weeks and 5 days?
Ok, I'm one person trying to represent the thousands of women on the ICAN list. I recommend you post your two questions (or at least the one about why 39 weeks?) to the list and watch the replies flood in. Go to Yahoo Groups and search for ICAN. Subscribe. It's like entering a whole other world where the birth process is celebrated - not feared.
My wish for you, dear Liza, dear Liza? That you change midwives - fast. FTP is no reason not to VBAC. There's a TON of preparation you can do to make sure your baby is in the right position, that your uterus is toned, and that you're limber and can move into different positions easily. Beyond that, I wish for you that you will go on to experience a glorious birth in spite of all the naysaying you've heard expressed by your care providers. You CAN do it!
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