Wednesday, 3 September 2014
Lots has happened since I last posted!
Last Monday we went to the hospital for an ECV - most painful thing ever, but Pod turned! We now have a head down baby, my cervix is safe from tiny feet, we're back on the CMP and all set for a home birth in a couple of weeks!
I should write down what was involved with the ECV so I don't forget, and I WILL come back and do that (just as soon as I've had a nap). We were at the hospital for hours and hours for what should have been a 2 hour in and out, basically because our baby is so zen and they couldn't get a rise in heart rate out of her. Anyway, she seems to have coped fine with the procedure (my tummy is still bruised though!).
The other thing that's happened is my birthday. As of yesterday, I am 30. THIRTY. Good thing I'm so pregnant or I might be having a meltdown... Baby trumps the 30 crisis somewhat.
Baby has also sapped my iron stores in the past few weeks (last blood test was totally normal, this one is waaaaaay low). My levels have always been off the charts but now my ferritin is completely depleted! This might be why I feel so tired and groggy - going to start a supplement today.
First up, that nap.
Oh, also, my body has completely changed shape since they turned mini-me. Behold:
Thursday, 21 August 2014
And breeeeathe. That was a bit of a ranty post (though not entirely out of character; this whole blog thing is a bit ranty).
On Friday I saw my midwife who told me I'm entitled to a second opinion and referred me to KEMH for just that. KEMH is the state's largest maternity hospital and takes all high risk cases, but best of all, their medical director of obstetrics is experienced in "assisting" vaginal breech birth.
It's a public hospital so we weren't expecting an appointment immediately, but on Tuesday they texted to say I had an 8am appointment on Wednesday. Speedy. Yesterday was anything but. I left the house at 7 (traffic was a bitch the day before and although the hospital is only 20-ish mins away, traffic get s awful at 7:30), and sod's law arrived before 7:30. The clinic opened at 8 and I was the first one at the desk (small victories), but even so I wasn't seen by a triage midwife until almost 10. She took my BP and went through my notes in the bit between the corridor and the waiting room because there were no rooms available - amazingly (given how pissed off I was with waiting), my BP was normal. Then I had to wait to see the doctor, convinced that I would have a parking ticket given that my parking expired at 10, but not wanting to leave to move the car and miss my place in line. DILEMMA.
The doc was really nice, we talked a bit about breech options and ECV pros and cons and she sent me for a growth and wellbeing scan to look at Pod and fluid etc. then saw me back in the clinic. My fluid level has almost doubled and Pod is growing just fine - she's bang on average - so we're booked in for an ECV on Monday. This will be at 36 weeks, they usually do them a bit later but Pod is already settling down into my pelvis getting ready to engage with her legs rather than her head. Originally we weren't thrilled with the idea of an ECV and the associated risks (tiny risk but big consequences), but they are successful 60% of the time. This goes down to 30% for me apparently because I'm a first time mother and my core is strong and tight. 30% is still better than nothing, and the foggy moxibustion and the pseudo-scientific chiropractic sessions haven't worked. If Pod doesn't turn, or if she flips right back to where she's been for the past couple of months, I'll see the same doctor again to discuss ALL of our options, not just a caesarean. Mission accomplished? I think so. If we have to have a c/s I feel that now it will at least be for a good reason, not purely due to lack of training, experience and confidence of the obstetrician prescribing it.
We're missing one of my oldest friend's weddings in Brisbane this weekend. Not awesome, but I really don't want to give birth hover there! Nor do I wish to sit on a plane for 5 hours and then drive for 2 (selfish?), and I really can't be bothered to fight with the doctor and the airline about flying more than 4 hours past 36 weeks. So I did as I was asked and recorded a super awkward (that wasn't part of the request) video to play during the speeches. 1 minute and 7 seconds proving why I will never be a YouTube star. You win some you lose some.
I'll probably put a tummy picture on here when I get home - I have ballooned somewhat. Wearing a pair of non-maternity pants today though (WIN). I'm up 10 kgs from the start and don't even want to think about how long it will take for my legs to get back to their pre-baby shapeliness :(. At least I'm not swollen (yet); my ankles may even look thinner than they used to purely because my legs have grown around them. AGAIN with the small victories.
Just cancelled my remaining appointments at the you-must-have-a-caesarean hospital. Feels good.
Tuesday, 12 August 2014
Where were we?
Oh yes, IUGR, fluid, growth scan. We went for the scan and Pod is GROWING! Best news ever. She's measuring just fine, totally average, which is rad. So no IUGR at the moment (although I have to have another "growth and well-being" scan 10 days from now), and no major cause for concern. That was a stressful week - obviously I read the entire internet and all the papers I could find, trying to figure out where I went wrong and what the possible causes and outcomes could be, how we would cope if Pod was disabled physically or mentally or both. The internet didn't help with the last part, but HN1 and I talked about it which we hadn't done before, and decided we would all be just fine so long as Pod made it to the outside.
She is still facing the "wrong" way (seems alright to me, maybe she doesn't fancy hanging out upside down until her birthday), which means we have some other decisions to make. My fluid levels are right on the low end of what's considered NORMAL, which might mean it's harder for her to turn on her own and might make an ECV impossible.
I think she likes being head up. Sometimes her legs are straight, bent at the hip with her feet by her face, sometimes her legs are down and she dances on my cervix and bladder, sometimes she lies across me. But her head is always above and to the right of my tummy button. She must like it there (unless her upper body is stuck, but we won't dwell on that).
Yesterday I had the follow up to the growth scan and saw a different obstetrician. It was an altogether disappointing appointment.
"Oh. I see you're planning a home birth" (looking appalled). "You do realise that home birth is not supported by the Royal Australian College of Obstetricians and Gynaecologists?"
I tuned out for a while, wasn't up for a lecture ESPECIALLY since we made an informed choice after a lot of research and thinking, plus I shouldn't have to defend my choices at my back up hospital. Home birth is supported enough that there's a government programme and I'm part of it. I trust my midwives, and I trust my body.
She assumed we'd be going ahead with an ECV without discussing the risks or likelihood of it working (50% at this hospital apparently, although I know for a fact it's less likely to work for first babies, when you have tight abs, when there is low fluid and when the baby has its feet dangling in the pelvis. So less than 50% for us given that I tick all those boxes, which she wouldn't tell me. I asked if we went ahead with an ECV and it was successful, would be be back to home birth provided the baby remains head down... She told me I should come to the hospital anyway in that case. Erm, why? Surely it becomes a "normal" delivery? I'll ask my midwife on Friday but I'm pretty sure the obstetrician's response had more to do with her personal feelings about home birth than anything else. So then I asked what happens if the ECV doesn't work, and our tiny baby decides upright is how she'd rather stay?
"Then you'd come in for a caesarean".
Are you fucking kidding me??
"What if the baby is bottom first, as in the bottom is the presenting part"
"You should still come in for a caesarean - the results of the Term Breech Trial BLABLABLA"
(let's ignore the fact that the TBT was skewed and flawed and has been widely criticised for its methodology and conclusions)
"I'd rather go into labour naturally and try to deliver her breech if she's bottom first"
"Well, I SUPPOSE you could have a trial by labour, it would depend on the doctor"
AH, so there ARE options? Not just a caesarean? If I didn't know anything about the subject I would have nodded my head and signed up for a c/s then and there. How can they possibly think that it's OK to only offer one option when more exist? I'm pretty mad. I'm considering finding a private obstetrician who will agree to deliver a breech vaginally. But urgh. Just urgh. It used to be normal to deliver a breech vaginally, now it's a speciality because people listened to one trial that said c/s was a safer method of delivery than vaginal.
The whole thing is making me tired. She couldn't even tell where Pod's head was without using ultrasound! I tried telling her exactly where it was, but why believe me? Surely better to do ANOTHER scan.
We have another growth scan in 2 weeks and an appointment with yet another consultant 2 days later. In the meantime, I'm going to keep standing on my head and I'll also give acupuncture a whirl. Not entirely sure how burning moxa sticks next to my little toes is going to help, but it can't hurt. Our hypnobirthing teacher is going to bring some extra info over tonight and go through some options with us. Fat waste of time and money that will be if they cut me open, but whatever. It's quite calming I suppose (plus HN1 is taking part which is super super cute).
It was our wedding anniversary at the weekend, he bought me a necklace with a heart pendant with the chemical structure for oxytocin (the love hormone) engraved on it. See? Super cute.
Tuesday, 29 July 2014
You know what? Two weeks ago I was feeling calm and happy and totally sane. Pod being in a breech position tipped that a teeny bit sideways, but didn't totally shake things; there was still a good chance she could turn or be turned (even though she was in an unlikely position). But this week I'm definitely wobbling.
Went for booking appointment at Kaleeya hospital yesterday, routine thing because it's our back up and where I would be transferred if required before/during/after birth. I saw an obstetrician who gave me a once over and the following news:
- Pod is still breech (this we knew, I can feel her head to the right of my tummy button and it hurts like fuck when she dances on my cervix)
- I have low amniotic fluid (my uterus isn't as big as it should be, there's a void under my ribs, my tummy is all baby and no swimming pool)
- Pod is measuring 28/29 weeks rather than 32
- We have suspected IUGR (intrauterine growth restriction - or retardation if you're American or insensitive)
This means that (for now) our care has been transferred to the hospital (our normal midwife is away this week but I have to remember to talk to her about shared care. If everything turns around, including Pod, and I become low risk again then we can still have an unmedicated homebirth as planned). I'm going back early next week for a growth scan to see how much/little fluid I have and how big/little Pod is.
So now we have more possible outcomes than we did before:
- Fluid level climbs, Pod turns on her own into a good position and doesn't have IUGR = homebirth
- Fluid level climbs, Pod is turned by ECV, stays head down and doesn't have IUGR = homebirth
- Fluid level climbs, Pod stays footling breech, no IUGR = cesarean at 39 weeks
- Too little fluid for Pod to turn, no IUGR = cesarean at 39 weeks
- Way too little fluid, no IUGR = induction or cesarean earlier than 39 weeks
- IUGR = monitor Pod very closely, try to determine cause of IUGR (fluid/infection/placenta/genetic or other defect), depending on severity possible cesarean at 36/37 weeks (I think they'll let her cook until they feel she'll do better on the outside)
Right now it feels like a lot has to come good in order for us to achieve a normal birth with a healthy baby. Google is a scary place again with this latest acronym in my hands. I've known for ages that Pod's in a weird position, and that her head seems to be right against my skin without much cushioning, and that there's a big hole between my ribs and where I feel like the top of my uterus is, but we've been told until now that even though I look small, she's the right size. Now suddenly she's probably not the right size, she's possibly stopped growing or her growth has slowed so much that it's a problem.
I tested negative for the common infections that can cause IUGR, I don't smoke, drink or take drugs, I don't suffer from malnutrition, advanced diabetes, high blood pressure, kidney or lung disease, or sickle cell anemia, and there's only one baby in there. So this leaves 2 possible causes for IUGR (if that's what's happening): a problem with the placenta, or chromosomal defects in the baby.
Low amniotic fluid could also be due to a problem with the placenta or a problem with the baby (kidneys, urinary tract, heart or chromosomal). I don't think I'm leaking fluid, and I'm not taking any medications so that's not why.
So now when people say "OMG you're so small" I want to cry and punch them in equal measure. HN1 is trying not to be worried, and he's right when he says there's no point stressing about what might happen. We need to get to the scan and go from there. Although it doesn't hurt to think about what might happen - I mean, wouldn't it be worse if I just kept skipping through the wildflower meadows with my face towards the sky, dreaming of rainbows and planets, and then all of a sudden we get to the scan and it's bad news? I don't know. I'd rather be a tiny bit prepared for an IUGR diagnosis in case they do want to snatch Pod out of me sooner rather than later.
Whatever happens, now there are lots of those feelings things happening (aside from panic). I feel scared that there's something wrong with my baby, possibly something that can't be "fixed". I feel inadequate and like I haven't done this job well enough, that my placenta and I aren't good enough. I feel guilty in case there is some sort of infection I've passed onto her, or in case my predominantly vegan protein intake hasn't been enough to sustain her growth. I'm anxious that the position she's in now is due to my uterus not being big enough or containing enough fluid to cushion her or allow her to float in peace - instead she's squished up against the outside world with not enough protection. What if she's uncomfortable????
I can't just stop feeling these things - I imagine I won't stop feeling them until we're told that Pod is fine and strong and healthy. Hopefully this is what they'll tell us next week. I REALLY want the scan sooner but it's a public hospital and we have to take what we can get. Trying to find a private hospital with a good OB this late in the day in Perth would be pretty impossible. Plus I'd like our homebirth option to remain open should everything turn around, and we chose Kaleeya as our backup because they're midwife run and into normal, natural birth.
Trying to get my head around a c-section too. If it's best for Pod, OF COURSE I'll have one. Though I worry about what we'll be missing out on - not that I'm anti-intervention; when it's necessary it's necessary, I just don't want it. I want the labour and the hormones my body would release and I want Pod to have those that her body would release, I want that journey with my baby, I want delayed cord clamping, I want to birth my baby, not have her pulled out of me before she decides it's time. None of that sounds like me, it all sounds way too crunchy, but I worry about the effects of a medical birth full of drugs and lights and surgeons vs a calm, natural birth. I might not want to eat my own placenta or deny my child vaccines, but I do want the most natural possible start to life for Pod, and the most natural start to our lives together.
Then I feel like a dick because actually what matters is that she arrives, not how she arrives.
Tuesday, 22 July 2014
Everything was going so well! Still is really, but baby is breech (just like her daddy was - this propensity for remaining upright must therefore come from him). I have 5 weeks to convince mini-me that upside down is awesome or we face being removed from the home birth program and having to deliver in hospital. Not cool tiny baby, not cool. From next week (32 weeks) it's less likely that she'll turn... at 30 weeks, 20% of babies are breech. At 32/33 weeks, 5% remain breech. so while there's still time, there's not much room in this mini womb palace I'm providing, and as she grows there will be less and less room which in turn will make it harder and harder to do the required somersault.
So I'm trying not to stress (only one sleepless night with dreams of inverted babies so far) and I'm spending more time upside down to try to create more space for acrobatics. For the record, headstands are not a good idea after a bowl of rice crispies (can't get enough of those bad boys) and a pint of fizzy Ribena. Another good position is apparently bum-in-air-face-on-floor - I've got it down, it's elegant.
C-section will, of course, be absolute last resort. But "they" like to recommend it for full term breech babies. Urgh. I will be gutted if I'm forced to wrench my baby into this world surrounded by bright lights and strangers and drugs. I'm not thick or naive, and of course we'll do what's safest when it comes to it. But our decision will be informed and I'll do my very best not to be pressured or scared into anything.
Now we just have to think head-down thoughts and practice head-down positions and good posture. Failing that we'll get some acupuncture. Meanwhile, HN1 is supposed to talk to the bottom of my tummy to encourage her down. I'm also supposed to play music to the bottom and shine lights down there - curiosity could be a pre-birth thing. Right? I don't play music through headphones, we usually just rock out to the speakers; if she can hear HN1's voice she can certainly hear the thrash metal and grunge (and folk and acoustic) I play us.
What else has happened? Not too much really. MIL has very kindly knitted a couple of cardigans for the baby but I am (possibly overreacting) pretty upset that they're pink. She knows full well that I don't want to be inundated with pink crap, that I don't want this sexist gender stereotyping. She ASKED which colours I wanted, and I said rainbow - any colours (there are SO MANY COLOURS), but not exclusively pink. Why ask? What's the point? This is a recurring theme in our relationship. She will undermine me (and HN1) and the way we decide to bring up our child. I feel ridiculed for my lifestyle choices when it comes to food (vegan, and not a fussy one), I dread to think how they will react to however we decide to raise our child. Every time we talk it seems she's taken our nephews to MacDonald's again*. I'm still haunted by the "what happens at nana's stays at nana's" email subject line with pictures of the baby boys eating nutella on their breakfast cereal (sent to aunts and uncles but not to mum and dad). If their mum is fine with that, then groovy. What I am not OK with (in the least) is the secrecy and making it alright to "not tell mummy". Who ingrains that shit in a child? All it does is make them more vulnerable to other people saying "don't tell mummy, it will be our little secret". I want my child to feel they can tell me anything, and without repercussions from nana or the perv at the park. HN1 doesn't understand; he thinks I'm overreacting about the pink, but the pink is the tip of the iceberg for me.
Urgh finished ranting. For now. But seriously, if we die I want my brother and his girlfriend to have custody of our baby (with help from my mum). Mum might not agree with everything I do but at least I trust that she'll respect our wishes when it comes to our baby.
*If you want to feed our child burgers, when she's old enough (and if she's not vegetarian), at least take her somewhere where they make them from REAL meat, and where they have actual nutritional content rather than pieces of cardboard, a host of chemicals, and a ton of salt and sugar. Fuck. MacDonald's isn't a treat, it's a punishment.
EDIT: I am overreacting, I need some perspective. Baby will be warm, fed, and loved so why sweat the small pink stuff? Clothes on her back are clothes on her back, she's blessed to have people care about her so much before she's even arrived who will make said clothes for her with their own hands. We'll cross the food bridge when we come to it.
One day I'll write a nice blog for people to actually see and I'll omit the angry imp side of me. Until then, on this blog, I'll be as unreasonable as I like (within reason, I'm not a total bitch).