Decisions, Decisions

When last I updated, I had my 18w midwife appointment the following day. Ugh - what a disaster that was.  It seems that rather than support me in my efforts to achieve a VBAC, they're determined to keep reminding me that I'm a failure. If I hear one more time, "Well, if you couldn't push out a 5 1/2 pound baby...", as if that's all that matters. Take a baby, make her posterior and malpositioned, and you tell me how easy it's going to be to push out a baby who is banging her head against your hip bone. Here's a hint: it wouldn't matter if that baby was 2 lbs or 10. If they're in the wrong position, THEY'RE NOT COMING OUT. 

And I can't forget how I'm completely out of shape and gaining way too much weight (14lbs in 18w). I know I only gained 20lbs with Anna. But she was only 5 1/2 lbs (as you keep reminding me). If she weren't borderline IUGR, i would have gained more. So, telling me to "lay off the chips" isn't just rude, it's downright judgmental. Especially considering I don't eat junk (save the occasional cupcake). And I was particularly happy to hear that the beans I've been eating (because they're a source of protein I can keep down) aren't "good enough" as a source of protein and are too high calorie. What? Whatever.

I left there feeling like a complete failure, that I couldn't do anything right and that once again, I was going to fail.

The funny thing is, I should be a GREAT candidate for a VBAC. I went into labor spontaneously, I got to 10cm, I certainly was able to push and I wasn't a c/s for "failure to progress". I even found a study that indicates I have an 88% chance of success based on their scoring - the only thing keeping me out of a higher bracket being that I haven't had a previous vaginal delivery. 

I went to my monthly ICAN meeting this past Wednesday. I've always heard such awesome things about this midwife group there, so I really couldn't wait to get some input from my group leader. There were a bunch of girls there that I hadn't met before and two of them are using the same midwives (one for #2 and one for #3, both due in January, a little over a month ahead of me). Anyway - as we all started talking, it became clear that these other two girls are having the same exact experience that I am, down to the disparaging weight comments. Our leader was shocked. No one has really said anything negative about the midwives before. 

The one potentially good thing is that one of the girls has a friend who had a miserable prenatal experience with them but a fabulous delivery. Said they were amazing in labor. She also was a primeip though, not a VBAC. 

One of the two girls is having her second VBAC. Her first was with an OB who also delivers at the hospital where I want to go. I asked her why she didn't go back to him with this pregnancy, because she seems to have a great experience with him, and she said it was because she wanted to have an experience with a MW. There was no other reason, but she was seriously considering going back.

Anyway - he takes my insurance and when I checked his website, this is the first thing I saw:

I  made an appointment for a consultation with him. He's out all next week, but I'm going in the following week. I'll be 21w. At 22w, I have my next appointment with the MWs. I'm going to take my visit with Dr B (the OB) plus my 22w visit with the MWs, where I plan to voice my concerns, and then make a decision on what I'm going to do. 

Here's where I'm struggling. I KNOW that the MWs will give me the labor I want and every opportunity to deliver vaginally, IF they let me get that far and don't push me to a CBAC. That's my concern. My concern about the OB is that apparently only 2 or 3 of the doctors in that practice deliver and they are backed up by a secondary practice that I know nothing about. I am concerned that the back up practice WOULDN'T be supportive of a VBAC. 

I have so many questions for both groups. 

Anyway - that's where I stand right now. I have my anatomy scan on Tuesday and then my appointment with Dr B next Thursday and my fetal echo the day after. 

I'll update more when there's news. In the meantime, I'm just doing what I can to figure this all out. 

NT Scan and Perinatologist Update

I swear that was the longest appointment ever.  It was good news. Squishy looks great. But because of some of the issues with my last pregnancy and with Smudge, there was a lot to talk about .

First, the NT Scan. It looked great. Squishy is CRAZY active. More than Smudge ever was. Just as stubborn too. Goodie. But the NT measurement looked awesome. 1.4mm. The perinatologist said that's a great measurement at any point in the pregnancy. They also saw the nasal bone, which is good news. There were no other soft markers present that would indicate a chromosomal abnormality. They saw all of the major organs they were looking for, 2 arms and 2 legs. The umbilical cord has 3 vessels and Squishy is measuring a couple of days ahead, at 12w2d. 

See... Squishy.

It's a picture of a monitor, so please forgive the quality.
Our actual pictures won't be scanned until tomorrow.

We talked a lot about my Smudge pregnancy. He's concerned that I won't be able to VBAC, but that's not his expertise, so I'm not really considering his opinion. If Dr Z and the midwives think I can do it, that's all that matters. Dr C (from the perinatology institute) can make sure Squishy grows and thrives while s/he's inside, my midwives will take care of things from there. He had some concerns about placenta placement, but it's nice and posterior for now, so there are no concerns with my incision. Two fibroids have made an appearance (background: I had three at the beginning of my Smudge IVF cycle and at my c-section they found nine. At the beginning of my Squishy cycle there were none, so we fully expected them to make an appearance at some point, since they're likely hormonally driven) but they're on the exterior of my uterus, like the other ones were, so not concerned about them at this point. Also, the cyst that was on my right ovary (and at one point the size of my head) has completely resolved. So yay that. 

I brought up my concerns about Smudge not having grown in my last month of the pregnancy. (At 35 weeks, she was measuring approximately 5lbs 12oz, and then was born 5 weeks later at 5lbs 8oz - just this side of low weight for gestational age.) He reviewed all of my records from my pregnancy, and said that at every scan I had, she was measuring 40-50%.  He agreed that it was concerning that it appears she didn't gain any weight from 35-40 weeks. He plans on monitoring me a little bit closer at the end of this pregnancy. I'm okay with that. A few extra ultrasounds aren't going to hurt - but it they indicate that the baby is in trouble, then we will be able to do something about it. We were fortunate that Smudge was healthy, despite her lack of growth. It might not be the same next time. 

We also discussed the two congenital issues that Smudge had. Her severe hip dysplasia and her cardiac defect. The latter automatically got me signed up for a fetal echo. I'm okay with that. Dr C said I could go back to Smudge's cardiologist for the echo, which is great. I just love her (another Dr C). Her hip dysplasia was another story. As of right now, Smudge's orthopedic surgeon at Children's Hospital of Philadelphia (CHOP) is calling it Developmental Dysplasia of the Hips. If Squishy is born with hip dysplasia as well, both babies will be given the diagnosis of Congenital Dysplasia of the Hips. Unfortunately, this is something they can't look for in utero. Dr S (the ortho) has already agreed to see us soon after birth for an ultrasound, rather than waiting the standard 4 weeks. I just can't wait that long. Smudge was in treatment at 6 days old. I'd feel negligent if Squishy needed something that we weren't providing in that time. 

I know this has already been so long - but wait - there's more. 

My MTHFR comes back into play, as being homozygous for the mutation makes me a higher risk for having a child with a spinal/neural tube defect (which we were initially concerned about with Smudge). However, since my homocysteine level has been normal, he's less concerned. Even though, he's recommending that combined with my age, I have the 2nd trimester AFP blood test done. He said at their clinic, they're 95% accurate with picking up spinal defects via ultrasound, but it's better to be safe than sorry. 

After all of that, I had my blood drawn for my 1st trimester risk of chromosomal abnormalities. 

He also told us that the clinic has been involved in some groundbreaking research, and that they're now offering a blood test (not covered by insurance now, but hopefully one day will be) which can indicate the trisomies and certain other genetic disorders like Turners Syndrome with 99% accuracy. That's just amazing. Hopefully we won't have to be concerned about the risk enough to pay for this test, but it's nice to know there's a more accurate blood test available prior to having to submit to an amniocentesis, should it come to that. 

That's enough, right?

It was a lot of information in one day. I practically fell asleep on my way home and I'm still really dragging. Smudge's Dad is working hard on trying to get her to bed, because I'm pretty sure if I were doing it, I'd be asleep before she would. 

Now we wait for the results. But based on the ultrasound, we hopefully have little (other than my age and egg quality) to worry about. 

Stay tuned....

I'm not feeling clever today... but I AM still pregnant!

I'm too tired to be clever today (or at least to pretend i'm clever), but I still wanted to update on my first appointment with my midwives. It went really well. I'm 10w2d today and I was nervous. I know way too many girls who have had late 1st tri losses lately and I was sure something would have happened between my 8w at Dr Z and today. But my midwife (today I saw Louise) didn't make me wait at all. I didn't get a picture, but i can't believe how big Squishy has gotten in the last 2+ weeks and I saw the heartbeat immediately. So, that's the baby update and it's a good one. 

Then we talked a lot about my labor with Smudge. She said there were positive indications for a VBAC. 1) I was full term and I went into labor sort of spontaneously (I told her about the acu-induction and everything else I did) and 2) I did get to 10cm and pushed for a long time. She said those are both very good signs that I should be able to have a good trial of labor. That made me feel a lot better, because one of the other midwives wasn't as positive at my annual, when we talked about my contractions spacing apart. But that didn't even phase Louise when I told her. I also had a VERY uncomfortable pelvic exam, where she was feeling out the shape of my pelvis.  She said that the top of my pelvis is more pointed than rounded (which would be normal), but there's plenty of posterior room and there's no physical reason she could see for why Smudge couldn't descend other than her posterior position. So, that's another check in the right column. 

She talked about nutrition, and like so many ladies have told me, told me really not to sweat the numbers right now; to try to increase my protein to stay fuller longer. She has the same goals I do: to keep my gain under 25lbs total. So, hopefully we can stay under that number. 
We also talked about the possibility of having to have another c/s, which I definitely would like to avoid. But in the case we feel like that is where I'm headed, or even if we don't think that, but I decide to for my own comfort, I can make a prenatal appointment with their cooperating doctor (Dr M) so I can meet him and discuss some of my concerns about my last c/s. Louise also told me that it's policy at my new hospital that when the baby and mother are stable, the baby is admitted in the OR and stays with mom in recovery. Since one of my biggest issues is that Smudge was kept from me for HOURS after my last c/s, that really reassured me. 

I scheduled my NT scan, anatomy scan and fetal echo (which apparently is now standard with our perinatologist, but we have no problem with that since Smudge had a cardiac defect when she was born). 10 days until we get to see Squishy again! <3

I'll leave you with pictures of our newest acquisition: A City Select Stroller with a second seat. OMG. I don't know how I haven't had this stroller the whole time, but we found an amazing deal on craigslist.

Smudge really LOVES it too. We can't get her out of it. She actually climbed into it herself this morning. So, we're going to be using it as a single stroller until Squishy gets here, which is one of the great things about it. 

Hopefully, next time I'll have some pictures for you of Squishy, and not just toys.

Pomp and Circumstance

Last weekend, this was me:

That stomach virus was AWFUL. I haven't been sick like that in a long time. Dr. Z told me just to stay hydrated and the baby would be fine, so I shouldn't worry. Yeah, right. Whatever. But I dug in with my vitamin waters and chicken broth. Stayed hydrated and 72 hours later felt so much better.

TOO much better. 

All of my symptoms were gone. I wasn't bone tired anymore. I ate eggs and CHICKEN. 

Tuesday morning I called my nurse and asked if there was any chance she could get me in earlier for an u/s. So, the next day (because Fran is awesome), I went in for my 8w ultrasound.

And Squishy is still going strong. HB 170, growth right on track at 8w0d. The Visible Embryo says Squishy has a four chambered heart now. Fetal development is chugging right along. Oh - and Squishy is no longer an embryo. S/he's now a fetus. Which means:

I hate leaving Dr Z, especially for unknown waters. I am very glad to have changed providers to the midwives at a great hospital and Dr Z really likes them and their cooperating doctor, which is great news (he didn't love the OB who delivered Smudge). But at Dr. Z's office, I know everyone and they spoil me. I  guess we'll find out soon enough. Our first appointment with the midwives is at 10w2d.

Meanwhile, my dizzy spells are back and I'm a little queasy again. Someone remind me, the next time I start to feel great to just embrace it and not question everything. 

3-4 weeks until I'll be able to hear Squishy's heartbeat for myself on the doppler. Until then, I'm just going to get through this one day at a time. 

Cleared to Call!

Last week, Dr. Z told me not to call my midwife yet. We emailed our doula anyway, and good thing, too, since that same day she got emails from two other former clients saying they were due in March too! She only takes four clients a month and we're #3!

This week, even though I had a moment of panic because I couldn't see the heartbeat, Chris and Dr. Z both assured me they saw it just fine. Fran told me it was averaging 135 but as high as 150. And when the u/s was over, he told me to go ahead and call the midwives.

Squishy is measuring 8.3mm and 6w5d (which incidentally is the same Smudge was measuring one day later, just 7.9mm. Smudge's heartbeat was 158). Everything looks perfect. Dr. Z is not concerned about the gigunda cyst. He says it will resolve. Still no sign of any of the nine fibroids I had at the end of my pregnancy with Smudge.

So, phone call made. 10w2d appointment with the midwives scheduled.

So far this pregnancy, i'm just really hit by a truck exhausted. And chasing after a toddler like this is no easy task. I'm a little queasy and my chicken aversion is back and rearing it's ugly head again. I'm also gaining weight like there's no tomorrow. I'm not eating a whole lot more, so I'm hoping I can blame some of it on the crazy progesterone doses I'm on. I know part of it is also that I'm not eating fat free dairy any longer (like I was with Smudge's pregnancy). Now that I'm dairy free, the alternatives are not fat free, so I probably need to try to make some adjustments there as well. I only gained 20 pounds last time, and I'm practically 1/2 way there already. Disgusting. I'll get this under control. I refuse to add a weight issue to this pregnancy. 

And here is Squishy at 7w: