19w6d: An Anatomy Scan in Pictures

Meet Squishy!

Just lounging. Hard to tell in the picture, but in this shot baby's right arm is hanging down by my cervix, knocking on the exit.

We have the same shot with Smudge, with the exasperated hand on the forehead, saying,"Really, mom? Are we done yet?"

We got shots of Smudge's hands. Seems only poetic that this time we got feet.

Hand on the forehead

Hi Squishy

Profile

We saw baby yawn and then shove fingers into his or her mouth.
S/he looks just like Smudge. 

Everything looks perfect with Squishy. The perinatologist once again said he doesn't understand why I needed the c/s with Smudge and that he thinks I have a reasonable chance at a VBAC. Baby measures perfect - exactly 19w6d - and in the 40-50% for weight and length. 

I've also met a handful of people who have used the doctor that I have a consult with next week, and say he's fabulous. My midwife appointment is the following week. By the end of the month, I will know who my provider will be. 

Meanwhile, Squishy is bouncing around like a wild person and we're still firmly on Team Green.

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. 

I'm a Bad Blogger. 18w Update

Stephen King always talks about his "faithful readers". Well, if I have any, i owe them an apology. I've been very lax at blog upkeep. It's been over a month, but it's been a VERY sleepless month, in my defense. Do you want to know the main difference between being pregnant with #1 and #2?

The toddler.

And I love that toddler more than I ever knew possible. But man, if having one doesn't make being pregnant a LOT more difficult. Gone are the days where when I was tired, I could just put up my feet and try to rest. Enter The Toddler. She needs attention and mommy time and honestly, who could blame her? She's going to have to share me pretty soon, and although I'm so happy to be giving her a sibling, I know it's going to be an adjustment for all of us. But man, am I tired. I'll be really happy when this latest round of teeth are in.

But here we are at 18w. And just because nothing can be easy, i spent this morning at the perinatologist. Over the weekend I had a lot of intense cramping and a little bit of spotting. Finally monday morning, I called the midwives just to get their opinion. Fast forward to today.

A picture of an 18w Squishy picture

Baby looks great. So, no worries there, and I'm perfectly happy with no documentable reason for what I experienced. It's certainly better than some of the alternatives, like pre-term labor, placenta previa, etc. But when the perinatologist du jour came in to check on me, he saw that I was worried and told me we could chat in his office before i left.

We reviewed my c/s (again) and Smudge's birth history, which led to a shocking statement from him that still has me reeling.

He doesn't think I had a complete abruption. 

No, that's not what he said. He said I DIDN'T have a complete abruption. And what he says makes sense, because he just highlighted every doubt I've had over the last 22 months. A complete abruption would be the equivalent of severing the adults aorta. Completely cutting off blood supply and oxygen to the baby. Babies who have complete abruptions die and those that don't, have resuscitations. They don't have 1 minute apgars of 9.  Maybe they don't have normal placental pathology either (my placenta was completely normal - i saw the report).

My OB lied about so many things. For example: when I had my 35 week scan, and Smudge weighed in at 5-12,  we laughed about it, because I had "requested" a 6 1/2 pound baby. Then when she was born, my OB said, "well, we always knew she was going to be small". You f-ing liar, do you not think I remembered that 35 week conversation? You may have dozens of patients. I only have 1 OB. I know what we talked about. Truth is, you missed an IUGR situation, and you just didn't want to get called on it.

My doula told me months after Smudge was born that my OB had been pushing for a c/s for hours. Did i just become an inconvenience who was taking up a hospital bed for 2 shifts? Did she just pull out the ONE reason she knew I wouldn't refuse?

Did I really have a c/s that I didn't need?

I'm so upset. I'm heartbroken and hurt and all of these adjectives I can't even name. And I'll never know the truth. My chart is a mess. It's handwritten, not even computerized and my doctor can write whatever she wants. No one has to corroborate anything. 

My c/s was a huge step in my feeling like a complete failure. 1st having to do IVF, then the c/s and then not being able to breastfeed. I feel like my body has completely failed me. And I know that the c/s is partly responsible for the breastfeeding issues, because the IV fluid lead to increased swelling that my 5lb baby couldn't maneuver around and the IV narcotics I was forced to have (i refused them, and the anesthesiologist gave them anyway. He said I "had" to have them, but he would give me a smaller dose) then impacted my ability to breastfeed in recovery. 

I'm still dealing with the emotional impact of all of it. I really hate my body, I feel like I can't do anything right. 

And this may have not been my fault. This could be just a freaking OB on her own schedule who didn't want to just let me take more time when my contractions spaced. So convenient that my contractions spaced and then I had the decel that sent me to the OR. 

I'll never know.

18w midwife appointment tomorrow. Smudge's appointment at CHOP is Monday. Anatomy scan the following week and Fetal Echo with Smudge's cardiologist the week after. 

October is going to be busy. So much to think about right now. Really didn't want to add to the pile. 

Please send hugs and vegan cupcakes. 

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....

Music to My Ears

11w6d: I'll be 12w in 2 hours. I made it through the day without an emergency midwife call. No bleeding or spotting to speak of. And even better, a successful 1st home doppler (HB 164 after a while of looking; s/he was hiding under momma's pubic bone).

I give you, Squishy.

Honestly - How Many Pregnant Chicks Check the Paper EVERY Time They Wipe?

I can't be the only one.  Not by a long shot. 

Today is 11w6d, which is an interesting anniversary of sorts. With Smudge, at 11w6d, I started bleeding. I'll never forget shaking like a leaf, calling Smudge's Dad and then my nurse. Then my emergency u/s where I could breathe when I still saw her heart beating. 

Sub-chorionic hematoma AKA the scariest day of my life. The day I thought I was losing her, just like I lost her twin. 

And today, in the face of my newly surfaced pregnancy nightmares, I'll spend the day waiting for the other shoe to drop. 

Tomorrow is my NT scan. Between my age, my egg quality, my nightmares, my teething toddler and my lack of sleep, I just need it to get here already. 

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.