Week 32 Update: Prenatal Appointments and much, much more...

There has been a lot going on so this will be a whirlwind sort of a post. I try to "save" up my updates for times when I have photos to share for those of you who only make your way over to the blog to see how big my belly has gotten and what Peanut looks like these days. So I waited until we had another ultrasound photo in hand from a Level II Ultrasound appointment at the Antenatal Testing Center (ATC).

Well, let me get started, then...

Here is what I look like now. The photos just don't do justice to how very big my tummy has gotten, though. You may not believe this, though it is true, I still haven't gained any weight. All of that is baby and pregnancy stuff (uterus, placenta, amniotic fluid, etc.). The only place I am bigger is my belly. My arms, thighs, and so forth are the same as before.

The bump at 31 weeks

Peanut was kicking up a storm.

I can't see my toes anymore if I don't stick my foot out.

Since it has been awhile, I have to go back to March 5th to start the updates, unfortunately. I had my sixth prenatal appointment with the high risk folks that day. I feel like I got really lucky because Patty was in that day and pulled my chart. She was the one who handled my appointment and I was able to get a little clarity about why the change in my care had occurred. Peanut and I both got good reports and all of our measurements and vitals checked out. Patty explained that they really don't know what is going on and are not sure how worried to be. They decided it was best to cover their bases and to play it safe. Transferring my care means that Patty and the midwives will be able to stay involved and also have access to the high risk doctors at each appointment if needed. The answer to who will deliver the baby now is no one knows. It will all depend on how the pregnancy continues to progress and who is on call on the day I go into labor. Patty did tell me to go ahead and call the midwives answering service when tI am in labor and we will hope that they are able to work something out to get one of them to me if at all possible.

We left that appointment feeling better about the choice to transfer my care but wary about what it would mean for delivery. I just don't feel comfortable with the idea of having to depend on someone that we don't know for something so important. It also has been extremely difficult feeling like we are not being heard. Brian and I decided that we really needed to try to see if we could find a birth doula.

"What is a birth doula?", you may be asking. Well, simply put, a birth doula is a labor coach. Here is a clearer definition if you need one. I had put my feelers out there earlier in the pregnancy to see who I may be able to find, but had had little luck. The women I found were either not accepting clients for the time I needed them or charged a higher fee than we could afford. Then I stumbled across The Nest. The Nest is a pregnancy wellness center in Little Silver, NJ which is owned and run by Nancy Freeman. Nancy is a certified childbirth educator and a certified labor/birth doula. She runs her business, Ready for Birth, out of the Nest. I contacted Nancy, hoping that she might be able to help me find someone with lower cost services, since I was aware that Nancy's fee was more than we could afford. She responded that she had a woman who was training to be a doula under her, Colleen T. Fay, whose fee we absolutely could manage. Colleen is a certified infant massage instructor and a licensed massage therapist. She works at the Nest and also runs her own business, Zen Babies Massage.

We met with Nancy and Colleen on Wednesday, March 14th. Brian and I immediately felt comfortable with both women. Their concern and empathy was evident right away. They were hearing us. We went over the contract and Nancy did a wonderful job of explaining exactly how everything would work. She and Colleen were so thorough that they left me few questions to ask. We gave them all of the information about how the pregnancy has been progressing, including the complications. Neither was deterred; as a matter of fact, both Nancy and Colleen expressed how glad they were that we found them and how helpful it would be, especially given our particular circumstances, for us to have the support of a labor doula. I was so relieved that I burst into tears! I was overcome with gratitude and a sense of comfort. They were both so very kind and I was so touched by the concern that they had for us. Nancy has access to a lot of resources and I have great faith and confidence that she can help us find whatever we need if she is not able to accommodate herself. Colleen has a great deal of experience working with medical massage in addition to the prenatal, postpartum, and pediatric massage. This will be enormously helpful given the issues that I am having with my hip. With Brian, Nancy, and Colleen in my corner, I know that I will have the support I need to deliver the baby safely no matter what happens. What a relief!

I haven't been able to shake the nausea and vomiting during the pregnancy. As a matter of fact, I got sick as soon as I got up the past three mornings. I was CONSTANTLY sick until somewhere around week 17. Now it is occasional. So, I wasn't really worried when I was sick on the 15th and 16th. It was episodic; and, though I was tired, it seemed like it might just be a pregnancy phase. When Brian started not to feel well on the 17th and vomited that night, I thought we might be in trouble. I slept on the couch with Punky in the hopes that Brian would get some good rest and that I could avoid extra exposure to any virus that he had. I started feeling unwell in the middle of the night and was vomiting by the morning. Brian and I spent the next two days battling the illness. I alternated between chills and feeling overheated and had terrible body aches. Brian didn't fare much better.

We wound up having to cancel our tour of the hospital's labor and delivery unit that Sunday. We didn't want to spread our germs around, especially not at the hospital. I decided to keep my prenatal appointment, though, just to be sure Peanut and I were still doing OK despite still not feeling well. We both got good reports. On Monday, March 19th, we wound up seeing Maria, the midwife who we saw at our first appointment with the high risk people. We have yet to have to "deal with" the residents because one of the midwives has stepped up and pulled our chart. Hmm...I wonder how that keeps happening...LOL! All of our vitals were fine and everything checked out great. I lost two pounds, though, most likely from the vomiting. However, my tummy measured right on track, so it hadn't affected Peanut's growth. Maria was happy with how were both were doing and sent us on our way with instructions to continue to try to keep hydrated (more Gatorade!? Sheesh!). They got us in and out of there in record time for this appointment, probably so we would take our germs away quickly. Our next appointment will be on April 2nd.

Brian and I were feeling much better by the time that we arrived at the ATC for our Level II Ultrasound with Dr. Malik on Thursday, March 22nd. Everything looked great on the scan. Peanut's growth was normal and proportional again this time. She was estimated to weigh 3 lbs 5 oz and is right on track. She is still little, but it is clearer at every appointment that that is from her genes and not a "problem". She inherited her Mommy's little legs and petite frame. She also seems to have gotten my resiliency, which suits us just fine. Dr. Malik actually smiled *gasp* when giving us all of the good news and didn't want to see us again for four weeks so we were really reassured.

Peanut at 31 weeks. Sorry that it is so grainy, but the tech forgot about our photo and we wound up with a tiny one this time.

We had to drive to Hamilton, NJ on Monday, March 26th for an appointment with an orthopedic specialist. The office was a little over an hour's drive away from our house. We weren't thrilled to have to go so far, especially given how much pain I have when I am sitting in and getting in and out of the car. However, they were the only practice that would give us an appointment. All of the other places that are covered by my insurance wanted me to wait until June or July for an appointment. Obviously, that wouldn't be helpful. So, we saw Dr. Bills at Mercer-Bucks Orthopedics in Hamilton. Brian and I both liked Dr. Bills and felt comfortable with him. He was a "straight shooter" who also had a sense of humor, which is nice given how badly he had to hurt me during the physical part of the exam and how uncomfortable that could have been having just met him. He was clear that he was "flying blind" since he was not able to obtain x-rays or other images of the hip because of the pregnancy. In his experience in dealing with pre-existing hip issues in pregnancy, the effect on women he has treated has been so variable that he is unable to predict where this is headed. He did not feel that a cesarean section was necessary, though he did give me the option that it could be scheduled simply to avoid the whole issue of further pain in the hip during delivery. I explained that I felt that with the level of pain that I was coping with and the with limits to my mobility already, I wanted to avoid a c-section if possible so that I would not be adding more pain from the surgery and further limiting my mobility. I think that it would probably mean that I would be nearly incapacitated and likely unable to care for Peanut. No thank you! I will only consent to a c-section if it is emergently necessary. He felt that my range of motion was actually still good and that there were no contractures (shortening of the soft tissues) when I adducted (brought my legs together) or abducted (brought them apart) my legs. He also did not believe that the hip is currently dislocated based on the range of motion and the lack of contracture. He doesn't believe that it is likely to dislocate, either, even during delivery. This all means that I would be able to get into any position that they could want for delivery without being concerned that I would damage anything. It might hurt like Hell, but it wouldn't injure me further. He believes the "popping", "grinding", and "clicking" are from a malformation in the ball and socket of the hip joint and that the times that I have felt it "pop out" have been when it has gotten "hung up" or "stuck" on a bony prominence or flat area. It seems like my body is especially sensitive to relaxin, which is a hormone that rapidly increases during pregnancy. Relaxin causes the soft tissues to soften in the pelvis, allowing it to widen. In my case, the relaxin is causing the hip and pelvis to be even more unstable than they were previously. He considers my issue now to be a "mechanical issue". As far as pain management is concerned, he deferred to the obstetricians. He did not feel comfortable making recommendations for pain medications while I am pregnant. I don't want to take narcotics or pain killers other than Tylenol, anyway, so that was fine. He did not feel that physical therapy would help at this point and thought it might actually aggravate the condition. The bottom line: he recommended "enforced rest". He wants me to stay off of the leg as much as possible and even recommended crutches or a cane to see that it happens. There is a huge amount of inflammation in the tissues and it is going to get worse until I am "unpregnant", as he put it. He said that the more I am up and walking on the leg, the worse I am making everything. I appreciated that he didn't sugar-coat things. I was pretty sure that it was likely to worsen given how much bad it has gotten from week to week this far. Once I am "unpregnant", he would like to see me back to be thoroughly evaluated. He thinks it likely that the hip will need to be replaced but is willing to work with me to postpone surgery until I am ready. I really don't want to be rehabilitating from surgery while trying to care for a child.

So to sum up, there wasn't much that he could do for me (though he offered and asked me to tell him what he could do to help several times). It is a waiting and resting game now. I feel a little less "silly" after seeing Dr. Bills. Why do I say that? Because I have had to have help getting dressed, into the bathtub, up sets of stairs, and other such nonsense. I sort of felt like a "wimp". Probably some due to how stubborn I am and some to how cavalier the other doctors have been about the issue. Dr. Bills took it far more seriously than I expected. It was validating. I am far less worried about delivery now, too.

I don't have too much longer to go, thankfully! Doing even less than I have been able to do is going to drive me nuts! I am really glad that it won't be for long.

So there you have it! You are all updated now. I will try to be better about rolling out the updates more regularly. I hope you are all well.

Thanks, as always, for checking in with us!                          

Week 28 Update: Third Trimester Drama brings some new caregivers

I haven't taken any belly photos this week, but here is one from last week:

The bump at 27 weeks

I postponed writing this update because I wound up getting so worked up with all of the changes that have happened in the last few weeks and I didn't want to needlessly worry anyone. 


So here's the scoop:



I had the appointment with the general practitioner on Tuesday, February 21st.  Her name was Dr. Dahr and she was really very sweet.  She agreed that I needed to be seen and evaluated by an orthopedic doctor and made a referral.  I had the second glucose tolerance test (GTT) at the same time.


I got a phone message the next evening from Judy, the prenatal nurse, letting me know that they were transferring me to high risk care.  I tried to call Judy back, but I got her voicemail.  I wasn't able to get Judy or Patty on the phone, which was pretty distressing.  I guess the figured that the folks at the Antenatal Testing Center would fill me in about the changes and why they were necessary.


I went to the Antenatal Testing Center on Thursday, February 23rd.  The ultrasound went much faster this time.  Peanut is bigger and easier to measure, and this ultrasound technician seemed to be more proficient as well.  The tech said "Boy, she looks just like her Dad!" right away. 

Here she is at 27 weeks.  Do you think she looks like her Daddy?

This time we met with Dr. Malik, who is an associate of Dr. Nath's.  She had a look at Peanut on the ultrasound machine but didn't really take any measurements on her own.  She was super speedy; I think we met with her for all of five minutes.  She said that Peanut's growth was normal and proportional and that she would wait four weeks to see us again for a follow-up ultrasound.  She couldn't (or wouldn't) answer any of my other questions, though she would say that the placenta is functioning normally despite the abnormal hormone profile, as evidenced by the baby's health and growth which means that she was getting good oxygen and nutrients.  She told me to hold the rest of my questions until my prenatal appointment.


Now that I am designated as "high risk", my care has been transferred to a practice on the campus of the hospital.  Monmouth is a teaching hospital and so it is staffed by resident physicians who are supervised by nurse-midwives and by faculty physicians, including the Maternal Fetal Medicine staff.  I won't be seeing Dr. Nath or his associates except for the days we need ultrasound done at the Antenatal Testing Center or if there is a complication that crops up when we are under the care of the residents.  This is the bad part of dealing with a teaching hospital.  The good part of delivering at Monmouth is despite the fact that it is a teaching hospital with lots of high-tech equipment and procedures, they are so midwife-friendly, the midwives not only practice right inside the hospital, they also are as integral to the residency program as the supervising physicians are. 

I had to do a full intake with the high risk folks on Monday, February 27th.  This was my fifth prenatal appointment.  Despite the fact that they are being really cautious, everything is still fine.  The residents wound up needing to leave to go for rounds and so one of the midwives, Maria, did the prenatal check-up.  My blood pressure continues to be normal (127/80, even with all of the added stress), the results of the GTT were normal (95, which is actually an improvement over the last one), my weight has been fine, my tummy is measuring right on target (fundal height of 30 cm- should be 26-30 cm), and Peanut's heartbeat was strong and regular.  The only current issues are the problems with my hip and the fact that my iron was still a little low.  I headed over to the hospital after that to get a shot of Rhogam to prevent any issues from the fact that I am Rh negative. 

The doctors and midwives have been frustratingly vague and playing a nice game of "pass the buck".  I think the real, true answer is that no one knows what is going to happen (which is the case with every pregnancy, really) and the uncertainty has them all being overly cautious.  Which includes protecting themselves from possible litigation down the road.  So the midwives tell me to ask the perinatalogist and the perinatalogist tells me to ask the midwives and most of my questions go unanswered.  I keep asking, though, because these things are important, and I have a right to be informed.  I would even accept "We don't know" as an answer, but not answering is not an option.  The one bright spot of the whole day was the prenatal nurse, Carla.  She was wonderful about keeping me informed and tried her very best to get answers from the doctors and midwives for me.  She is also extremely proactive and helpful, so I have an ally in keeping things on track.  She is going to make sure that I get an appointment to see the orthopedic specialist that the high risk doctors use and will keep pushing the doctors to answer my questions.  Right now, I don't even know who is going to deliver this baby now that things have changed.  All of this uncertainty is completely unnecessary.   

The good news is that none of this has affected the baby.  Peanut is healthy and active.  I am less happy, but that is honestly more due to the constant pain in my back, hip, and leg than to anything else, even the new stress of the change in doctors.  It is pain with a purpose, though, and I know it has an end point.  Just another reason to look forward to her arrival.  :)

I'll be heading back for another prenatal appointment with the high risk people on Monday, March 5th and I'll update you all then. 

Thanks for "listening"!       

Week 25 Update: Fourth Prenatal Appointment

I can't believe how fast my belly is growing!

I swear that I am getting bigger by the day!  It is so crazy to me to look back at the photos that I have added here and see how my body has changed.  I am so glad that I have been letting Brian take photos so we will have the record of it.  Trust me, some days the very last thing I am interested in is letting someone take my picture.

Another angle of the bump.

My belly is big enough now that the "normal" pregnancy issues have either begun or intensified and the issues with my hip and leg seem to be worsening.  I don't mean to complain, I am thrilled to have our little Peanut cooking away in there, it is just where we are at now. 

Here I am.  Not enthused to have my photo taken, but I relented.

I am so very grateful to all of the wonderful family members who knew more than I did and went ahead and bought me maternity clothes even though I thought I wouldn't really need them.  Clearly, even the Bella Band wasn't going to help me fit in my pants at this point!

Punky has been my cuddle buddy.  She loves to lay on my belly, though she doesn't so much like getting kicked.

I have been home a lot lately.  My job consists of being on my feet for hours at a time with no breaks, so I haven't been able to tolerate working much and the issues with my hip make getting around difficult.  It is really frustrating to me; but, Punky is loving it!  She is getting spoiled spending all this time with me.   

Like the pout?  This is the look I get when I don't want to play. 

I hope that it doesn't cause us problems later when we bring Peanut home.  She is our first "baby" and I am sure that there will be some jealousy.  She has been extremely protective of me, even more so than she was before, and I imagine that might worsen.  She loves my niece and plays really well with her, but she has never been around an infant.

Ready to play with Peanut?

I am sure that it is going to be difficult for us all to adjust to the changes that will come once Peanut is here, but Brian and I are aware of that and committed to doing what we can to make things as smooth as possible.  Which will mean doing our best to each spend time with Punky without the baby and making sure that she isn't displaced.  Peanut will be our primary focus and responsibility, but we won't forget about our other baby.




We had our fourth appointment with the midwives on February 9th.  We got to see our favorite midwife, Patty, for this appointment.  I was so thrilled; I can't even explain how relieved I was!  This was the first time that I was nervous before a midwife appointment.  I was not sure what they were going to have to say about their communications with Dr. Nath and the other doctors.  I was also beginning to really worry and stress about some of the unresolved issues, like "How in the world am I going to deliver this baby with my hip and leg causing so much pain?!".  I felt like Martha was really dismissive when I would ask questions and as I get farther and farther along, it is more bothersome. 

I gained some weight finally, which I figured I would based on Peanut's growth alone.  My blood pressure is still in the normal range.  Peanut's heart rate was normal and she was extremely active, which made them happy despite it making it difficult to get a good heart tone with the Doppler.  They measured the size of my belly and that was normal. 

I asked Patty about what they felt about Dr. Nath's findings.  She went through the reports that he sent over to them with me.  He was much clearer in the reports than he was with me, which is no surprise.  Much of what was in there I already knew, but he was clearer about stating that the growth was normal and he was not concerned about further complications.  That being said, he told us at our last appointment that it was absolutely fine with me continuing my routine care with the midwives, but he clearly said in his report to them that he recommends that I see the high-risk doctors.  She was frustrated that he was being so unclear and plans on having a meeting with him and the rest of the team to clarify what is actually going on and what the best course is to take to provide me and Peanut with good care.  Her feeling about how worried to be is that the honest truth is that they don't know what is going on and even the ultrasounds are not going to really tell us very much.  She feels that, in her experience, fetal movement is a better indicator of fetal well-being than any of the tests or procedures that they have.  She felt really good about the amount, regularity, and strength of Peanut's movements.  She sure seems happy and healthy in there to me and Patty agrees. 

Patty doesn't want to wait anymore to see what this hip is going to do.  I have an appointment with a general practitioner on February 21st.  In addition to repeating the glucose tolerance test on that day, Patty wants to see what the doctor has to say about the issues I am having with my leg/hip/back and wants a referral to an orthopedic specialist to be made.  Finally!  Patty wants to know what the orthopedic doctor recommends for the pregnancy and for delivery.  She doesn't want to wait any longer to come up with a plan for delivery.  I am so glad someone was finally listening to my concerns.  The very last thing that I wanted to have happen was to continue to be put off and then go in to labor and have everyone be scrambling trying to figure out what is best to do. 

I left the appointment feeling much better, despite so much being unresolved, simply because I knew that I was heard.  I am a little nervous about the team meeting because I am not sure that I will be heard if my care is transferred to Maternal-Fetal Medicine.  For our next appointment at the Antenatal Testing Center on February 23rd, we will be seeing an associate of Dr. Nath's.  I can't remember the doctor's name, but we are hoping that maybe we will feel more comfortable with this doctor's manner and communication. 

We'll let you know how we make out!

Thanks again for checking in on us!

Week 24 Update: Second Maternal-Fetal Medicine Appointment

I guess I need not have worried about the bonding issues because at this point in the pregnancy everything is very real to me.  I haven't stopped feeling anxious about something going wrong, but that seems really normal given what complications we may potentially face.  I think that knowing who is in there has really helped and seeing Peanut looking healthy and very much like a baby on the Level II ultrasounds has helped dispel that feeling that somehow I was "making it all up".  I actually had a moment of true pride when I saw her move her hand and could see all the little tiny phalanges (finger bones) working as she made an itty-bitty fist.  I thought, with a sense of awe and amazement, "I made those hands!".  It is amazing to me!  I am sure the change also has some to do with the fact that I can feel her move all the time now and feel like I am getting bigger everyday.

Here we are at 24 weeks.  Obviously pregnant.  :)

You can see "the bump" better in this photo.  Strange how big I am considering I haven't gained any weight.  Peanut got bigger but not THAT big!

 We had a follow-up appointment with Dr. Nath at the Antenatal Testing Center on Thursday, January 26th.  They checked Peanut's spine again and it looks perfect.  Everything with my anatomy looked fine, including the amniotic fluid level.  They also checked on Peanut's growth.  She gained 5 ounces in the two weeks between appointments!  She is still pretty little; she averages in the 45th percentile for growth and weighs slightly less than most babies at this stage (1lb 2oz).  However, she did grow at a normal rate, she is just small.  (I guess her nickname winds up being apropos.)  They really tend to focus on the femoral length, or the length of the thigh bone, for checking growth, probably because it is the largest and longest bone in the body.  Her femur is small, but I did challenge the doctor a bit on how much to be worried about that issue.  After all, I have very short legs. (A 28" inseam!  LOL!)  But, he can be very dodgy and is extremely frustrating to talk to.  *Sigh*  Specialists are generally like that, in my experience.  He wouldn't say how worried we should be moving forward or how he felt things were progressing, but he didn't want to see us for four weeks, so I took that as a good sign and told him so.  We also have been given the go ahead to resume our routine care with the midwives, which is more evidence that I should probably relax more now.  I will have a regular prenatal appointment with the midwives on the Febrauary 9th and they will continue to stay in close contact with Dr. Nath.

        

This would have been another cute profile shot but then she moved.

We caught her yawning or drinking...well...we're not quite sure what she was doing!

So, to clarify for anyone who is concerned about how we are being cared for during the pregnancy...

As of right now, we will be seeing the midwives for our routine care.  The place that we go has three midwives and we have seen two of them so far.  One I really like and one I really don't, so I am guessing I will be ambivalent about the third when I finally see her.  The midwives are supervised by an ob/gyn that keeps track of everything that is going on in case there are complications during the pregnancy or delivery and are part of a practice that is based at Monmouth Medical Center.  Dr. K has been working with the midwives all along, and also with Dr. Nath, though I don't see him for my appointments.  He will continue to keep appraised as things progress and will be my doctor should I no longer qualify for midwife care or have an emergency during delivery.  He will defer to the Maternal-Fetal Medicine specialists should I develop complications from the abnormal placenta or if it seems like there are issues with Peanut, but until then there is no need for them to be involved daily or weekly.  Dr. Nath will continue to follow us as our perinatologist and will work with the midwives and Dr. K to ensure that they are taking the best care of both of us as is possible.  Due to the complications that could possibly arise, I will deliver at Monmouth Medical Center, which is where Dr. Nath practices and where the dotors that supervise the midwives are based.  We hope not to need it, but they have a Level III NICU should Peanut need any extra help.  One of my friends delivered there and was happy with her experience.  I am hoping we are as lucky. 

This could all change at any moment, but that it what is happening right now.

My hip and leg are still a really problem, but I have been blessed with a few good days and so I haven't gone over the deep end.  Yet...LOL!  I am still waiting to see if I can get a referral for the chiropractor or for the orthopedic specialist.  (Ugh! More specialists!)  I have had some days where my leg completely stops working, which is frustrating and scary.  Besides that and the normal pregnancy issues, I feel pretty good.  Just really, really, REALLY tired.  Which is totally normal in pregnancy, I am told, but I imagine the placental issues are also a factor in how ridiculously exhausted I have been feeling.

I have been spending lots of time lately chatting and reading to Peanut and just trying to enjoy her. She does seem to be happy in there...and for that I am truly grateful.  We've done some shopping, which has been fun since I was so unwilling for so long for fear of "jinxing" ourselves.  I can't seem to do as much as I would like to without causing my leg and hip to really start hurting, but our short excursions have been successful all the same.  Gotta love finding 40% off the lowest clearance price sales!  Unfortunately, we're not taking as many rides as we used to because sitting in and getting out of the car is something that hurts even on good days and I have had to miss visiting with folks for the same reason (Love you, Court!). 

Things are going really well right now and it is great to share good news with all of you!  Thanks for keeping us in your thoughts. 

Week 22 Update: Meeting the Perinatologist

Well, there's lots to update you all about...

I have been dealing with a great deal of pain in my back, hip, and leg.  It seems like it could be sciatica or possibly what they call "pelvic girdle pain".  I already struggle with this leg because I have congenital hip dysplasia in the left hip which has also caused all sorts of issues with my left knee (in addition to injuries from a horseback riding accident) and back.  That is why they think that the issues have started so early in the pregnancy.  Yay for me! *rolls eyes* 

But, I had a WONDERFUL prenatal massage this morning.  This was a Christmas gift from Brian.  Felicia Gaines Sachs from Healing Through Bodywork came to the house for my appointment.  She was amazing: compassionate, empathetic, gentle, thorough, and knowledgeable.  She had excellent "table-side manner", communication, advanced knowledge of anatomy and pregnancy, and the "magic touch".  I hope that I can afford to have her come back.  She was able to work on the areas that are causing me problems and I am hoping that I get some relief tomorrow.  For today, the muscles got sort of irritated which meant that I had some issues with the sciatica.  No numbness in my foot or leg, though, which was a treat.  I felt very relaxed afterward and had a nice nap. 

I had my blood drawn on January 10th for the Glucose Tolerance Test.  Then we had an appointment with the midwives on the January 12th.  Things with my health are really going well.  My glucose came back normal, which is wonderful considering the high risk I am at for gestational diabetes.  They will check my glucose levels again around 28 weeks.  My blood pressure is still great, my weight is still the same from losing fat at the same rate as the baby is growing, and my regular blood work was normal.  I wound up having to see the midwife that I don't like, but the appointment was rather quick, and we had to prepare for another appointment the next morning so I was distracted. 

We did hit a bit of a "speed bump".  They had run a Quad Screen on my blood to screen for birth defects and the results came back abnormal.  I was referred to the Antenatal Testing Center at Monmouth Medical Center for an appointment with a genetics counselor and with a perinatologist from the Maternal-Fetal Medicine Department.  Maternal-Fetal Medicine is a group of obstetricians who specialize in high-risk pregnancies.  A perinatologist is an ob/gyn the specializes in problems in pregnancy.  The Antenatal Testing Center has more sophisticated equipment to test for issues in pregnancy, including more in-depth and sensitive ultrasounds.  Because our anatomy ultrasound was incomplete, a Level II ultrasound was included in our appointment. 

We met with the genetics counselor first on at our appointment on January 13th.  She went over our family histories and a brief summary of the test results.  The marker that is used to screen for spinal abnormalities was a tiny bit high (one tenth of a point).  Our risk was very low that there was any spinal abnormalities, but due to the fact that we got no good images of the end of the spine in the last ultrasound, there was a concern about spina bifida, which is where the backbone and spinal canal do not close.  She felt that the anomaly on the blood test results did not warrant further testing besides the Level II Ultrasound. 

Next we had the ultrasound with the ultrasound technician.  She got lots of good images for the doctor.  The baby was much more cooperative this time.  Peanut was head down and stretched out which made it much easier for the tech to get images of all of the anatomy.  She did have some difficulty because of the extra abdominal fat that I have from being overweight.  I spent most of the scan lying on my left side, faced away from the monitor.  I didn't get to see much of what was going on, which made me a little sad.  What I did see was great, though, because this type of ultrasound has much more detail.  Peanut looked like an actual baby and not an alien!



This is Peanut at the 20 week anatomy scan.  This is the only printed image we were given.  Looks like an alien...or Skeletor!

The perinatologist, Dr. Nath, came in to finish the scan.  He took lots of measurements and got extra pictures of the spine.  Then we met with him in his office to go over everything.  It turns out that the midwives were not clear about the concern over the test results, and the one result was not the only one that was abnormal.  Dr. Nath is concerned because ALL of the hormones that they measured were abnormal.  Apparently, the placenta is "leaky".  It is producing unusually high levels of hormones and pumping them into my blood stream and into the amniotic fluid.  The good news is that they were able to see through the ultrasound that the placenta is otherwise normal.  It is good size, has a normal shape, has a nice smooth texture, good blood flow, no tears or abnormalities, the umbilical cord insertion was great, and the umbilical cord had normal blood flow.  The level of amniotic fluid was also normal.  Dr. Nath felt that Peanut looked healthy and normal with no spinal abnormalities.  But he is concerned about the hormone levels from the placenta and will be keeping a very close eye on us from here on out.

So, we will most likely not be able to see the midwives anymore and will be followed by Maternal-Fetal Medicine for the remainder of the pregnancy.  We are a little sad that things have become more complicated, but we felt really comfortable with Dr. Nath's expertize and are confident that his care will increase the likelihood that we prevent any further problems and effectively handle those that we know we now have.  This doesn't mean that we will have more problems, I could go on to have no other issues at all.  It just means that we will be watched closely to catch any problems from the very start if they should crop up.  It is sad, though, because we were really hoping to avoid this type of medical involvement.  With the high level of stress and added emotional content from the miscarriage and fertility issues, it would be nice to avoid the high-drama and high-stress situations which come from including specialists.  That being said, we want the very best for Peanut and will do whatever it takes to make sure that we are both safe and healthy. 

Here is Peanut at the Level II Ultrasound

          Dr. Nath gave us other news, too...

PEANUT IS A

GIRL!!

Please keep me and this little girl in your thoughts and prayers.  We are hoping that everything stays normal and healthy and that this placental issue turns out to be a nagging worry and nothing more.

Thanks!  We'll be keeping you updated when we can...

Week 20 Update II: Anatomy Scan

One would think that being pregnant after struggling with infertility would be a relief.  I truly wish that were the case.  What seems to be reality for most is that the struggle with infertility permanently changes how you relate to your body and how much you trust "nature", your body, and yourself.

In my case this has meant that I have a strange and overwhelming feeling that I am deluding myself into thinking that I am pregnant when I am really not.  I got past the constant fear of miscarriage, but not the fear that *something* is wrong.  I feel movement, have heard the heartbeat, and have seen the baby on the ultrasound screen; yet, I can't seem to shake his sense that the whole thing is unreal, that I am "making it all up".  It has made it extremely difficult for me to bond with the baby and I have felt really guilty about that.  I just don't trust my body anymore.

We were hoping that the anatomy ultrasound would help remedy some of these issues.  I hoped that seeing that everything was fine and seeing the baby in there would stop the doubts and that knowing the gender would help me bond with the baby.  I thought that seeing that my body had managed to support the pregnancy thus far and created a healthy baby, placenta, and umbilical cord would help me begin to trust the process.

We invited Brian's mom along to the scan.  She had never seen a pregnancy ultrasound before and we thought that it would be a nice experience for her.  My mom lives eight hours away and wasn't able to be there, so we planned to call her on the phone so that she could be a part of things.  We waited a long time for our appointment as they were busy and running behind.  We finally got our turn and the ultrasound tech got started on taking the images that they needed.     

The point of the anatomy scan is to determine whether the dates are correct for the pregnancy, that the baby is the appropriate size for the gestational age, and to check to make sure that there are no defects, malformations, or other issues with the fetus' anatomy, the placenta, amount of amniotic fluid, or the uterus and cervix. 

Here is a list of what they want images and measurements for:

• Face (profile, lips, nose)
• Brain (ventricles, choroid plexus, mid-brain, posterior fossa, cerebellum, cisterna magna, measurements of anterior and posterior horns of lateral ventricles)
• Skull (shape, integrity, Biparietal diameter-BPD and head circumference-HC measurements)
• Neck (nuchal fold thickness)
• Spine
• Heart (rate, rhythm, 4-chamber views, outflow tract)
• Thorax (shape, lungs, diaphragm)
• Abdomen (stomach, kidneys, liver, bladder, wall, umbilicus, cord and cord insertion, abdominal circumference- AC)
• Limbs (femur, tibia, fibia, humerus, radius, ulna, hands, feet femur length- FL)
• Genitals (gender, abnormality)
• Cervix (length and opening)
• Placenta and amniotic fluid

The ultrasound tech was able to get good images and measurements of:

• The placenta, which has a fundal location.  That means it is at the top of the uterus, which is great. 
• The amniotic fluid level was fine.
• The umbilical cord and cord insertion looked good.
• The baby's abdomen was normal, though they need more images for liver, kidneys, and bladder.
• The heart was perfect.
• The top of the spine was looking great, though we need more images of the end of the spine.
• The neck looked OK and she got clear nuchal fold measurements which will indicate the risk of Down syndrome
• All of the brain and skull measurements were normal and images were clear.

The baby was in a longitudinal lie in the breech position with it's legs crossed underneath it, its arms held tight to the body, and it's head down and leaning forward (sort of like it was looking at my cervix).

Peanut was in this position with its head down, tough it is MUCH smaller

It made it so that we weren't able to see or get images of the face, thorax, limbs, genitals, and cervix.  The ultrasound tech tried changing my position, having me walk the halls briskly, and having me use the restroom.  Nothing was getting Peanut to budge.  Despite all of the pushing and pressing from the transducer (which is the paddle that transmits the waves through the abdomen), Peanut was enjoying a cozy nap.  We were there for a really long time trying to get the images before the tech decided that it was time to give up. Peanut was not going to cooperate.

They made us an appointment on the 18th to come back for a follow-up ultrasound to get the rest of the measurements and images.  We'll hope that Peanut is less stubborn and more cooperative at the next appointment. 

We went out to lunch after the ultrasound and when we were riding in the car on the way to the restaurant, I felt Peanut start moving around.  Of course!  Peanut was also active after I ate my lunch.  Maybe the fact that the next appointment is after lunch will be helpful. 

I left the appointment disappointed.  Not because I didn't know the gender, which is the impression that people seemed to get.  It was a letdown because I can't say that I know that everything looked fine and I can just relax.  I am trying to remember that our parents and grandparents survived their pregnancies not knowing what was going on "in there". It is difficult, though, as I already pointed out, when you spent your entire adulthood dealing with hormone imbalance, convinced you would never conceive or have a normal pregnancy.  I am doing my best to relax and enjoy the process.  But it is HARD.  And Peanut is stubborn.  I guess I will have my hands full.  :)

Week 20 Update: Happy New Year!

20 weeks

It's January 1, 2012 and we're 20 weeks today. 

We're very much looking forward to all that 2012 has in store for us! 

2011 was a mixed bag:

We got married, got pregnant, lost a number of family members, had friends and family move away (and one very important one move back), made some new friends, lost touch with a few friends, were reunited with some family members, dealt with illness, had friends welcome new babies, saw friends lose jobs...it was a roller-coaster sort of year.

I was not at all sad to see 2011 come to a close since it was such a whirlwind.  I am imagining, however, that 2012 will be nearly as chaotic, though infinitely more happy, with this baby on the way.

Our holiday was really wonderful, despite the fact that I felt pretty rotten when we started our travels to Maine. I was still struggling with the cold and feeling totally exhausted. The exhaustion only increased, but I was able to enjoy all of the celebrating and visiting despite it. We were able to spend lots of quality time with our five-year-old niece, my Mom, and my step dad. It was the first that I saw my Mom since finding out that I was pregnant. I was not really "showing" still when we arrived at my Moms, but Peanut decided to make its presence known while I was visiting. I think it was nice for my mom to be included in that since she is so far away. She was the first to notice how much I had "popped". She said, "How in the world did you grow so much in three days?!". I think it might have had something to do with the nausea and vomiting finally abating and all of the eating the occurs at Christmas.

Me and Punky on Christmas Eve

My Mom & Step dad gave me maternity clothes...so now I don't have to go and buy them

We were able to visit with my step dad's wonderful family, most of whom I hadn't seen in years. It was so nice to spend time with all of them and get to see how much they enjoy spending time with my niece. I am sure Peanut will enjoy the same amount of love that she does. We also had a nice time visiting with my other stepfather, who took us out for a nice dinner with our niece. We would have liked to do more visiting and see more family, but I was just too tired and felt that it was most important that I spend whatever time I could afford to with my niece. Brian and I are extremely close with her and it has been hard being so far away from her. I have also been struggling with the changes that I know are coming once Peanut arrives. Next Christmas, I will have an infant to care for and won't be able to give her much undivided attention.

Me and my niece on Chrismas Day

The Peanut has become quite the wiggly worm!  I feel lots of movement these days, which is so nice.  Brian hasn't been able to feel it yet, though our niece swore she did.  It doesn't really matter if she did or not; thinking she did was enough to make her feel special and included.  Peanut definitely can hear pretty well.  When our niece had two rough nights with very loud tantrums, the baby went NUTS.  I think Peanut must have enjoyed all of the bedtime stories that we read together.

The clothesline was so cute!

We made a stop in Connecticut on the way home to attend my cousin's baby shower.  We were able to squeeze a visit in with my Dad, who lives in Virginia but had work in Connecticut while we were there.  I hadn't seen my Dad since we found out, either, and it was great to spend what time were we able to with him. I was able to see some of my Dad's family at my cousin's shower.  My Aunt even had a gift there for us.  She crocheted the cutest little hats and two blankets for Peanut.  We stayed for a little while, but then pushed on home so that I could sleep in my own bed.  We had hoped to do more visiting in Connecticut, but, after all of the travelling and visiting, I had had it.

Peanut's hat & blankies

I slept for nine straight hours that first night home!  It was so nice to sleep through the night for a change.  Brian and I had a very low key New Years Eve.  We spent the day and night together at home, cuddling on the couch, watching TV, and resting.  It was lovely. 

We have one more Christmas left to celebrate tomorrow with Brian's family.  We are looking forward to seeing them.

We hope that you all enjoy a happy, healthy, and prosperous new year filled with love.