Friday, August 20, 2010

When it rains, It pours

Chris and I had a good laugh last night.

We just can't believe that this whole pregnancy has gone by SO smoothly - barely a bump in the road - only to have this many issues crop up in the final weeks.

I had my growth ultrasound yesterday morning.
Chris called at 6 to let me know that he wouldn't be able to make it to the appointment. His other full timer called out and they were short staffed as is. It's the first appointment that he's missed and, looking back, one of the handful he REALLY should have been at. Bummer.

So I go in for the scan, it's just your basic ultrasound, and right away she's able to tell me that she's head down and facing my spine like a good girl - no more fears of delivering sunny side up - but because of that we probably won't be able to get any pictures. No biggie. At this point I know I'll be able to see her in a few weeks and really, I'm not that concerned about grainy ultrasound pictures anymore.

She starts looking things over. Checking kidneys (I ask if she has three like my great grandmother and unless it's hiding, she probably doesn't *wink*), looking at the bladder and spine, Checking the blood flow to the heart... etc etc.

All of the sudden I get tunnel vision, extremely nauseated, wicked lightheaded and feel like I'm going to pass out. I've never felt like that before. So I stop the scan and take a breather. She was sitting with all her weight on my artery and there was an issue with blood flow. The rest of the ultrasound is done with me laying on my side.
If we were in AP English, the teacher would point out that this was a foreshadow moment.

So the tech started taking measurements. For those that haven't had an ultrasound recently, when they measure... let's say the diameter of the head for example, the find a specific cross section by looking for anatomical landmarks, then they draw a circle around the skull's edge and as they size the circle to get it to fit perfectly, there is a number on the screen that gives you the measurement in centimeters as well as the corresponding gestational age. So she measures the diameter of the head (37 weeks) and the circumference of the head (39weeks 3 days), then she measures the femur (39weeks 3 days) Keep in mind that I turned 38 weeks yesterday so she's still tall! :)

She measures the amniotic fluid levels and tells me the placenta is about 4 cm thick. Good to know.

Then she measures the tummy.

She finds the correct cross section and starts drawing the circle. As she's sizing the circle, I'm watching the gestational age go up. 37 weeks, 38 weeks, 39 weeks, 40 weeks, 41 weeks, 42 weeks, and then. To my horror. It stops listing weeks and switches to just a centimeter reading. Oh My God.

So clearly, I'm thinking this chick SERIOUSLY screwed up with that measurement. Good thing they take 3 readings and average them.

The next one was 41 weeks 1 day.

The next was 42 weeks 0 days.

This is not comforting.

All of the sudden the ultrasound is over and she tells me the doctor will be in to go over the results in a few minutes.

I grab my clipboard and write down the recordings so I can tell Chris. The average tummy measurement was 41w 5d. Almost 4 weeks ahead of where she should be. I do a rough calculation, dividing the circumferce of her tummy by pi and realize that the diameter is greater than 10 cm.

All of a sudden I realize that she is really going to hurt me and rethink the epidural.

About 10 minutes later the doctor comes in. She's a woman and I recognize her name as a perinatologist my midwives referred me to. She said that the baby looks healthy and will probably be tall, which isn't surprising. She said the amniotic fluid level is normal, but at the high end of normal. Better than the low end I think and imagine a giant tidal wave when my water breaks.

Then she says that the concern is the weight.

Her tummy is measuring very large and they think she currently weighs 8lbs 11oz.

Wait a minute.
Wait just a minute there Missy.

In my head I freak out a little.
I'm thinking about how I weighed myself right before I came in for the appointment and I was only 8 pounds 14 oz above pre-pregnancy.

How can she weigh 8lbs 11oz if I've only gained 8lbs 14oz and I don't have gestational diabetes.

It's not like I've gained 50 pounds with this pregnancy.

My midwives joked on Monday that I should expect an 8.5 to 9 pound baby. When my eyes bugged a little she said "What do you expect a 5lb baby? You're 6', your husband is 6'2". Big people make big babies. Small people make small babies, that's just the way it works." Which is fine. Because that's based on the assumption that that's how much she'll weigh WHEN SHE'S BORN. Not 2 weeks before her due date with no labor signs anywhere on the horizon.

The doctor asks me to wait in the waiting room and another perinatologist will consult with me in a few minutes.

I go out into the empty room to tell Chris the 'good' news and imagine the doctors convening a huddle to talk about the giant baby with the ginormous tummy.

While I'm talking to Chris and my mom in the waiting room I try to rationalize the news in my head.

It'll be fine. They'll probably just induce me early. If she's this big already, and I have a clotting disorder, certainly they won't let me go past my due date and risk a c-section.

I'm called back by the nicest nurse ever named Malorie. Melody. Marjorie. Something. Nurse M.

She has me do the usual weigh in and pee in a cup routine. At this point, I'm a natural at this party trick. I don't even flinch at the thought of a public weigh-in anymore.

Then we go back into the room and she tells me she's going to take my blood pressure.
I remind her that I've just been told my 38 week fetus weighs almost 9 pounds and ask for a few minutes to calm down. She takes my medical history and a few minutes later, when she takes my BP it's 120/70. WAY lower than I thought it would be.

So the resident come in and starts talking to me about the Factor V leiden issue.
They must see this all the time because she's telling me that since I'm hetero vs homozygous (meaning I only inherited from one side of the family and not both) that they consider me a fairly low risk patient.

Instead of the 6 months of blood thinners, they'll probably only do 4-6 weeks. Which is fabulous because then she goes on to tell me that it's not a pill, it's a SubQ shot that I give myself once or twice a day depending on the dosage. ugh. shots.

I ask about side effects and whether it'll be a issue for breastfeeding. She says that bruising at the injection site (duh, it's a blood thinner) and platelet counts can be effected so I'll need to do weekly blood work for the first two weeks. Meh, no biggie. Apparently I'll start this regimen 12-24 hours after delivery.

Then we talk about the humongous baby I'm growing.

She asks about my weigh gain and seems surprised when I tell her the low number. She grabs my chart and I know she's looking at my glucose test results Which Are AMAZING. She's surprised to say the least. I can tell she's a resident. She hasn't developed her poker face yet.

I ask about inducing early. 'Oh no, we'll probably only discuss induction at 41 to 42 weeks.'

But I thought I wasn't going to go past 41 weeks because of concerns for the placenta?

'Well, obviously the placenta is functioning well because your baby is getting plenty of nutrients and you're getting weekly non stress tests, so we're not concerned'

Glad to hear you're not concerned.
Isn't she gaining a half a pound a week at this point?

'Yes, but the ultrasound could be off by 10% which is a pound."

So she weighs somewhere between 7lb 11oz and 9lb 11oz. And if she goes to 42 weeks she could weigh between 9lb 11oz and 11lb 11oz.

'That's possible'

And you're not concerned about that?

'We'll repeat the growth scan at 41 weeks if you're still pregnant. If she weighs 5000 grams, we'll offer an elective c-section.'

How many pounds is 5000 grams?

'... ugh, about 10 pounds' Oh nay nay, stupid resident. I googled. 5000grams is ELEVEN pounds.

*blank face* So. a c-section. With a clotting disorder.

This is where I start crying.

The doctor comes in and basically says the same crap.

They won't induce early unless my blood pressure goes up to 140/90 because if my cervix isn't favorable it will just lead to a c-section.

They told me they won't use forceps or a vacuum extractor. If her head won't fit, her shoulders won't fit and they'll do a c-section.

They also mentioned that the should issue, distocia, could be 'catastrophic'.

Bad choice of words. I had just stopped crying and then I started again.

If my labor isn't progressing, they don't want to risk a blood clot, so they'll do a c-section.

Basically, the perinatologists really like c-sections.

By the end of the appointment, besides crying, all I wanted to do was go to the midwives because I know their goal is NO c-section. I also wanted to go on a long walk, eat a lot of pineapple and spicy food, do jumping jacks, bounce on an exercise ball, schedule daily acupuncture sessions and just about anything else to GET HER OUT.

I'm not done being pregnant, but I'm done baking this little girl.

As far as I'm concerned, I'm issuing an eviction notice and operation 'Get the Eff Out' has begun.

Here's hoping for an August baby.


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