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"!