39w4d – the end of an era

In this case, the end of my gestational career. The scheduler at the hospital asked how I would celebrate my last night of pregnancy, when it hit me. This is the end of something, arriving later than expected.

I could have used the three extra weeks the first time around. But this time, with MDs predicting early deliveries, I found myself walking slowly, stunned, through November, getting bigger. And unlike the first time, beauty and peace came to my face and body the farther I went. People remark on my appearance, kindly. The combination of waddle and sashay is enough to get a measure of amused attention.

Ben came in to see my “biiiiig belly” and hug it, saying, “I can’t wait for you to see you, little one!” My mouth is dry, given that my last beverage was at 4:57am. I’m looking forward to little one too, and a tall cool glass of water.

see you all in a few!

37w4d, or no limits on term

Now what?

After months of hearing about my risk and unlikelihood of making it to term, here we are, term +4. Flirting with 190 lbs, but never quite staying there long enough to close the deal. Keeping true to my typical low blood pressure (a hoot of a revelation for anyone who has experienced my temper).

Little one spends a lot of time in variations of transverse lie – sometimes, she sits upright on the left side. Other times, she rolls over onto her side, a huge bump protruding from my left with no symmetrical match. Then there are those legs, stretching and kicking to the appendix, the right hipbone, and (I’m beginning to think) into my actual right leg.

Ben pats my belly and asks “Little one, when are you coming out?” then tells me “Mommy, she’s not ready yet.” When H starts to show signs of wear, he takes one peek at my profile, and the caring returns.

I walk into Ben’s school and the coffee shop each day to shocked expressions. “What is going on? When is she going to come out?” I’m left with shrugged shoulders, a smile, and a sore back.

On another note: yesterday in our house, we all celebrated the impending arrival of a smart and gifted president, grateful to those who waited in lines in the last month, and those who took on more dangerous challenges in the decades that preceded us.

I remembered ’04, taking Ben in a carrier to the polling place, and crying through Kerry’s concession speech. I swore I would have traded the Sox WS victory for the 04 election. So a few weeks ago while watching Garza pitch circles around the Sox in game 7, I whispered to God – ok, can we make a deal? I won’t complain about the Sox getting knocked out if my guy wins in November. Who knew God was also a broken-hearted feminist red sox fan?

Last night, I started whispering to Little one, patting her and telling her, “It’s ok, you can come out now. You’ll be safe. We have a chance to make a better world, from the bottom and the top. So it’s ok – it’s ok – we’re going to make it better, and we need you to help.”

36w3d

I wasn’t sure I would get this far, but today I’ve equalled my record of days pregnant.

B was born, an emergency cesarean, at 36w3d. After a Thursday night of delightful Jon Stewart and a few minutes of the talentless Colin whoever who left me cursing that he was given a TV show. After the water trickled at 2:30am Friday, then rolled out, a wave no bathtowel could match.  We slowly got our things together; I told one of my staff via IRC that I wouldn’t be making our 7:30 telcon, H lined the passenger seat with lawn bags and towels, and I waddled out in a sundress, the only thing I had left that fit, with a green towel wedged between my legs, as calm as could be.

This time, I understood how remarkable it was that I actually got pregnant – most women with a bicornuate uterus have a 40-45% chance of miscarriage.  As far as conception goes, I’m 2 for 2.

I had no overseas trips, no real business to tend to other than mothering and shepherding little one along to term. That said, a job would have been a welcome distraction from the sickness and unexpected worries of the first and second trimesters, not to mention the disturbing surprise at the top of the third.

Yet here we are. At her last ultrasound exam, I thrilled to hear of a growth spurt. Weightwise, she has managed to climb back up to 50th percentile. Her head is measuring close to her brother’s, otherwise known as the melon on the vine. The neonatologist hugged me, saying “Congratulations! She is just as normal as can be.” I called H and my mother – both times shaking and in tears. I saved my energy to write email to the rest of my family and friends, since I knew I’d just be whimpering with joy and relief if I made another call.

Little one is moving briskly and with impunity – mama feels all sorts of things in parts of her body she didn’t know her uterus could go. I think she likes to kick my appendix, or loop her foot around my hipbone. There’s always something poking down there that isn’t mine.

H calls everyday at noon, just making sure I haven’t gone into labor. Don’t tell him, but I think I’ll be driving myself to the hospital this time, just to make sure we get to the right place.

34w4d

Zen lessons continue unabated in the Little One Prenatal Challenge. This week, it began at my OB’s office. Her assistant said, “We’ve scheduled your delivery – Wednesday 19 November at 1pm.”

My eyes popped. “Are you serious? You’re aware there’s no way I’ll get that far.” (A known uterine abnormality prevented me from even getting to term with Ben; plus, my current profile scared a fellow patron at the coffee shop who thought for sure I would be giving birth at the pick-up counter.)

The assistant agreed. “I know, I agree with you. But this is hospital procedure.”

“So, since the delivery is scheduled on a date that is medically impossible for me to reach, what do I do when my water breaks? How will this be any different than what happened the first time, when I ended up with an emergency C-section at 36w3d?”

The short answer is – it won’t be any different. Except that now I’ve been given conflicting instructions by two staff at the practice, one of which included instructing the physician on-call of my medical conditions, because, I guess, THEY CAN’T BE EXPECTED TO READ A CHART.

So my zen lesson is – of course I could have gone to a midwifery practice. I would have had informed partner-based care throughout the pregnancy, I still would have been sent to the specialist practice for diagnostics, and had a chance for the wonder MD to deliver. I’m preparing an information sheet now to give to H in case I faint or something gets in the way of me explaining my medical condition once we’re at the hospital. But instead of getting really angry, I just shook my head.

Meanwhile, she is rolling and wedging herself into unusual positions. This is a mix of good and bad – good, because she is active: bad because she is pushing the air out of my lungs with different parts of her body I have yet to identify at unexpected times. H does his best to greet me each morning with a spoon, his fingers resting on my belly hoping to pat his daughter to be. He marvels out loud at her strength, and speed of movements. Later if we share a car trip somewhere, he uses both hands to pull me out of his car (the ’99 Honda Accord starts to feel like a low-rider when you’re this size). My waddle gets slower and slower, as the body gives way to the bump.

Food tolerances are almost normal. I can eat many of the things I usually love, if not in the same quantities. Finally, chocolate! Small amounts of fresh grapefruit! These are little pleasures, which are nearly as delightful as the memory of the first glass of water I was allowed to drink after B was born.

The baby bag is nearly packed, and we have a full wardrobe waiting for her entrance. Now as long as the gender predictions hold, we’ll be ready to be fully unprepared all over again.

petite and powerful

This is my new mantra – every morning, as I roll all of my weight onto my elbow in order to sit up, swinging my legs over the edge of the bed. Petite and powerful I whisper with every kick, blurb, roll over. Petite and powerful, she dances 30 minutes after my first glass of orange juice, waves to her future big brother through the opening in my bathrobe, under an expanding belly that looks more like bread dough about to overtake the bowl.

Petite and powerful is what I hoped, silently, on our way to the specialists’ office last Friday afternoon, when H took wrong turn after wrong turn, making me wish we had relied on my car and sense of direction. Petite and powerful I thought, feeling the warm sticky gel on my abdomen, while saying to the 5th tech, “Bicornuate uterus, placenta at the top of the left fundus, very active, though she lost a quadrile in weight last month”. Petite and powerful held her own this month, staying in the 30’s percentilewise, giving her father and mother breathing room – though keeping her mother chained to 120g protein a day.

At this stage of the game, it means she’s about 4 lbs, and that the best signals we have from her are the powerful – her movements are hardly ever delicate. She muscles around just like her brother, looking for space to stretch. She sometimes sends an arm or leg low in my womb, as if she’s going to kick her way out. When she’s quiet for a long stretch, I go back to the fridge for a juice, sip a cup, and wait.

Yesterday, the nurse at my regular OB’s office confirmed my thinking – all I have to do is make it through the next 4 weeks, eating plenty of protein, keeping off my feet, and avoiding stress. To that, I add “petite and powerful”, and feel 1 November coming to meet the both of us, bringing her out to meet the world.

By the way, the love and support we’ve received since my last post has been a godsend. I think it kept both of us growing, supported, and strong. My love and thanks in return.

the incredible shrinking (baby) woman

Just when you think you’ve managed to swim in a new sea and its cycles, a wave comes from behind at lowtide, leaving you gasping.

As an official “high-risk” obstetrics patient, I’ve been put on a regimen of checkups with special features – ultrasound exams every 4 weeks, to check on both baby (presumed by mommy to be fine) and cervix for signs of early labor. From 16 to 28 weeks, Little one’s growth rate has been dropping. I’ve been asking why, and have been advised to increase protein intake, reminded not to smoke (not an issue) and to keep healthy. Measured in percentiles, she’s gone from 78th to 32nd in 12 weeks – a full quartile in the past 4 weeks alone. This was a tear-inducing shock. Not to mention a complete reversal of experience I had with my first, who maintained a 95th percentile size and still is near the top of his development curve four years later.

At the OB’s instructions, I have been protein loading until the cows come home, and even then, I hit them up for a pail of milk. I’ve been feeling bigger, and thought for sure we’d at least maintain her growth rate (90g or protein a day, minimum; dropping the OB-sanctioned coffee and white-knuckling my way through the days of migraine). But the sonographer said 32nd %ile for weight, and I gasped.

“She was 58th at my last exam.”

I had brought a chart I made from the last three ultrasound reports, showing the downward trends. I had noted that the placenta was evaluated at Grade 2 at 20 weeks – about 10 weeks too soon for such a grading. I had a list of questions, and now I had tears to blink back. H held my hand while I looked at the twinkling lights in the ceiling (all ob/gyn practices should consider such features for their examining rooms…)

The MD I had this time, my third in 5 visits, was the one who delivered my son in an emergency c-section, and he must have remembered what we were like – as he showed up with a set of charts for us. He explained that we were still in a safe spot, and went through each of the measurements, explaining to us what he looked for in terms of trendlines and when they saw a red flag. He explained the ratios and relationships they watch closely, and the range of error with ultrasound readings – up to 10% on weight, and even more on percentiles for abdominal circumference.

He told me that maybe the baby was figuring out where she wanted to be – petite and powerful, perhaps, based on her activity level. He told us what would happen if she took a big drop at the next exam, and what the next steps would be, including increased exams to determine if there was a particular issue getting in the way of baby’s growth, and the issue of discussing how early to deliver.

He told us that if there was a problem with the placenta, there would be little we could do to override that, save to keep the same high-protein, high-nutrition diet to get as much to the baby as possible.

He also told me I could come back at any time, regardless of appointment. “Just show up if you’re worried. We’ll take you.” It was kind and reassuring.

But on the way home, I couldn’t help but wonder, “What if what she wanted to be was a brief visitor? What if she decided this wasn’t the time or place for her to arrive?” I’m still wondering.

showing, telling

It’s been a long time since I last posted. 24/7 sickness (as opposed to morning sickness) has kept me from writing much of anything. Added to that has been mild dehydration and bedtime at 7:30pm. But today, at officially 13w, I feel as though I have a little bit of energy. Three consecutive days of sun. Lily of the valley and lilacs perfume the backyard. A medicinal glass of iced coffee (taking the edge of a migraine) and gorgeous birdsong, along with an earlier viewing of little one, swimming and paddling away from the ultrasound transducer is helping with the discomfort and fatigue.

I put on a spring maternity dress and was amazed at how pregnant I look. Dimensionally, I’m close to where I was at 5-6 months. Strangers are starting to be nicer and more courteous in the supermarket, smiling women and people gently getting out of the way of the widening load I’ve managed to become.

missing midwifery

When I found out I was expecting this time, I thought I’d probably have to go to a traditional obstetrics practice; my first birth was premature, and was likely caused by my bicornuate uterus. I figured it would be ok if I chose a women-run practice, that the gaps between it and midwifery care would not be so great. I was wrong.

The loaded language of the modern medical pregnancy is enough to make a woman believe that she is incapable of figuring out how to birth a baby. Except that the body is designed to do just that, before there were ultrasound machines, or quad screens, or obstetrics.

I have felt like mentioning – ok, screaming – this as of late. Instead of being asked to consider different treatments, instead of conversations where the assumption is that the mother knows and is capable of knowing about her body and the process of pregnancy and childbirth, the mother is told what to do. It’s not sitting well.

My nurse knows nothing about vegetarian diets, and actually asked me if I’m getting enough protein. Sigh. I never had these issues with the midwifery practice – they understood that a veggie diet is not a risk for healthy fetal development, and gave me props for my hematocrit levels at the start and the 28 week point.

The other part has been more than a little annoying. From the perspective of the practitioner, I have a name: high risk. I get this name based on nothing in my chart, other than my birthdate. I’m wondering how many women go through this without knowing that they own  the birth. They know what to do, they can trust their instincts, but they would do well with some knowledgeable support. What if more women knew about their bodies, the glorious power of them, their ebb and flow? What if this self-knowledge were as common as knowing one’s shoe size? Midwifes understand the power this knowledge gives; obstetric practices would do well to take heed.

the road ahead (6w2d)

I broke out the journal the Dilettante gave me when I was pregnant with Ben, to try to recall details, other than my famous story of lower abdominal pains while listening to the State of the Union address in Jan ’04.

The symptoms are similar, though some details are making themselves clearer. For example, I do remember falling asleep at about 8pm each night, but I didn’t remember waking up all through the night. I remember the seismic burping, but not any remedy other than passing out of the first trimester. (I think I discovered a solution this time around – ginger tea.) And consistent with the first time, the strain on all buttons, seams and fasteners is on, on, on!

Some things are very different. I’m starting out on the other side of 40, and 5 lbs heavier than I was with Ben.  I’m not working – the camaraderie from a remote office is still better than none at all.

And now, after reading my medical records, I have a concrete, clinical sense of how lucky Ben and I were – that there were so many internal issues that didn’t reveal themselves until later, and that my confidence and good health up until that point were what carried me through challenges. Now I’m much more wary – not so much in terms of diet, but certainly in terms of travel and physical activity. (I won’t be going to Denmark this summer, for example.)

I’m also seeing some changes in medical advice – I’ll be getting prescription vitamins this time around – big doses of folic acid, and a prenatal multi with DHA – something I barely had in my diet the first time around and which has been proven to offset post-partum depression. That can’t be a bad thing to try.

Here’s another thing that’s different – and wonderful. Ben is very excited to be a big brother. We’ve talked a lot about whether what’s growing in Mommy’s womb will stay around long enough to be a baby, or whether it will decide to go. We know it’s the little one’s decision what to do. But Ben hopes it decides to stay.