Yesterday and Today

Yesterday I spent a good part of the afternoon hanging out with a couple of my girlfriends... in the sizable [and currently dry] inflatable pool in the spare room where I hope to spend the early stages of active labor. Mister Nygren came in to find us lounging there and, without missing a beat, asked whether we'd like him to make us some mojitos.

Neither of those friends are mothers yet, so they spent a lot of that time picking my brain about the biology of pregnancy and the logistics of birth, giggling at each other's questions as well as their own. (One confessed that she'd always assumed the umbilical cord just retracted into the body after delivery like a tape measure; this emboldened the other one to admit she'd always thought of the placenta as something that just dissolved rather than an actual organ that the body created just for this occasion.)  I loved being able to tell them things about the physiology of labor and birth that eased their fears about the eventual possibility of experiencing it on their own.

I was reminded of the methodology prescribed for when your dog or cat is expecting a litter: you set up a "happy place" for them -- someplace comfortable and private -- and then spend time with them there, giving them extra attention and offering them special treats, so they won't want to go anywhere else (e.g., the middle of your bed, the expensive rug under the dining table) when it's time to deliver. As I spoke the thought aloud to my friends, they exclaimed, "Aww... we're special treats!"

Indeed they were.

That was yesterday.

in just over an hour, though, I'll be back in my OB's office for my weekly round of pee tests, fetal heartbeat screenings and quizzical looks. :)  If there's a legitimate medical issue that calls for intervention, I have no doubt they'll tell me the instant they know. And as much as I enjoyed the time spent yesterday in my "happy place," that was yesterday. If today we find out that my daughter would be safer out than in, then today I'll be having a baby.

Prayers would be deeply appreciated. Keep you posted.

Update on Monday, October 20, 2008 at 11:57PM by mrs. nygren

Maybe tomorrow, but not today!

To the chagrin of the OB staff, today was another unremarkable checkup. All my levels are still within range, and the baby's heart is strong and steady. They left me on the fetal monitor an extra long time today -- "well," the physician's assistant kept saying after eyeballing the printout again, "I'd like to see just a couple more accelerations" -- and I suspected she hoped to keep me on the monitor until she saw anything that could justify an immediate delivery. As she was in the middle of saying it a fourth time, the strip of graph paper finally ran out. In that moment, I knew my suspicions were right... and she knew I was going home still pregnant. Again.

As always, I assured her I'd call if anything came up... and that otherwise I'd see her in a week. "Dr. D will be back in town tomorrow," she replied. "I'd expect a phone call from him." I don't think she intended it to sound so much like "just wait till your daddy hears about this!" as it did, but I had to fight back a giggle just the same. "Sounds good," I told her. "Thanks!"

A Pound of Prevention?

Against all predictions, I am now two full weeks past the day my Sugar Bean was supposed to be enormous enough to punch her way through my abdominal wall like something out of the "buried alive" scene in Kill Bill Vol. II. I'm also a week past the day my OB started trying to talk me into inducing labor using the same what-if scenarios I heard towards the end of my last pregnancy...

As you know if you've been reading here for a while, I'm all for being prepared. You'll almost never find me without clean sheets for our twin-sized sofas since we've been known to host eleventh-hour visitors, and it's an equally rare occasion to find my pantry bereft of something I can throw together for surprise dinner guests. There's certainly merit in being ready to meet unexpected challenges.

That said, I don't have an epinephrine syringe in the house, so if we discover the hard way that one of us is deathly allergic to [peanut butter] [bees] [shellfish] [overuse of brackets], we may be out of luck until the paramedics arrive. And if I should whack my head and lose consciousness -- God forbid, but it's an even greater possibility than the allergy scenario -- then my not-quite-three-year-old son would be left to entertain / fend for himself until someone else got home. He can't get to anything poisonous, but heaven help the cat...

Fact is, you can't possibly be prepared for all the things that probably will go wrong at some point in your life, much less for all the other things that could... and attempting to do so can often make things worse, not better. Ask the people who blew their savings on remote acreage, MREs and firearms they didn't end up needing for Y2K... or the families of the folks who suffocated in their airtight rooms after following U.S. government-issued instructions to protect them from the possibility of chemical warfare.

I'm sure by now the point I'm trying to make is as obvious as my protruding belly: interventions in childbirth -- which simply aren't as necessary as they're often made out to be here in the U.S. --  are almost always offered under the guise of preventing undesirable outcomes... but for the love of Benjamin Franklin, since when is having your gut slashed open and stapled shut a "desirable outcome"?

In case you haven't heard me say it at least a dozen times before, yes, I will absolutely take another cesarean if a legitimate need arises. Until that moment comes, though, I intend to continue taking my prevention by the ounce...

Not Tonight, Sweetheart

Today I went back in for my weekly checkup. As anticipated, Lisa -- the PAC who's done all my checkups for the past month or so -- waited until the end of my visit to drop the bomb: "You know," she said gently, "we'd really like her to come out today."

She must have heard how the conversation went with my favorite nurse, because she didn't look altogether surprised when I smiled and replied, "I'm sure."

The unmistakable this-might-prove-more-difficult-than-I-thought look came across her face. She made only one brief attempt to work the medical angle, noting, "Your sonogram showed that you have polyhydramnios--"

"-- which can simply mean I have higher levels of amniotic fluid," I interjected. "That isn't news to me. Dr. D had his nurse tell me that I had 'plenty' of fluid but that the levels weren't anything to worry about. Is that not the case?"

("Polyhydramnios." In that instant I was reminded of how halitosis was actually a medical-sounding word invented by the advertising department of the makers of Listerine so that people would think of bad breath not as an embarrassing hygiene issue but an actual disease that required medical treatment... namely, theirs. Hmm.)

She admitted she hadn't personally seen the numbers from the sonogram in question, and didn't press the issue any further. We talked a bit longer -- a very pleasant exchange, if not one that brought the results she'd been hoping for. I told her what I'd learned from the studies I mentioned in the last entry, assured her that I was keeping a keen eye on all my readings, and that I'd call them on my way to the hospital the moment any of those started looking unfavorable. She relented.

We stopped into the lab on the way out for one more blood pressure reading, and from around the corner I heard her sigh deeply before saying, "I couldn't talk her into it."

Dr. D looked around the corner to see me grinning at him. "So," I asked him point-blank, "I'm negative for preeclampsia, the baby's readings are still fine, my blood pressures and blood sugars are still okay, my fluid levels aren't dangerous... and the only reason you want to induce is because you think she's big?" He too got a turn to stare blankly at me as I quoted the medical studies from his own colleagues that supported my position. "Listen," I went on with a smile, "if I make it to Week Forty-One and I'm not showing any more signs of progress, we'll probably talk about scheduling a cesarean."

"We don't have to do that," he was quick to offer. "We can try induction..."

...but as the words left his lips, I was instantly back in the delivery room three years ago where, after fourteen painful hours of chemically-driven labor, we discovered I hadn't made any progress and was going to require a cesarean. In all that time I didn't cry out once from pain, but I will never forget the sound that I made -- the low wail that emerged from somewhere deep inside my aching body and crestfallen spirit --  when I learned that I'd chosen one difficult thing in hopes of avoiding the other, and instead I was going to get both...

Fighting back tears, I raised my hand and took a moment to regain my composure before I replied, "I honestly don't think I could handle another induction attempt. If it comes down to it, I really think I'd rather just skip to the surgery."  Dr. D, who knew about my last birth experience, read my expression and nodded understandingly. Then he said the most beautiful, unexpected words I'll probably ever hear from an obstetrician: "I'll do whatever you want."

"Cool," I told him with a grateful smile. "See you Monday."

Living Mammoth Discovered?

The title isn't nearly as newsworthy as it might first appear, but neither is it as non sequitur as you might think...

By the fact that I'm still blogging, you can probably guess my doctor opted not to order a cesarean delivery for my daughter. At least, not yet. After waiting for what seemed like much longer than 48 hours, I finally got results from my OB's office late yesterday. I tested negative for the dreaded preeclampsia, and although I do have plenty of amniotic fluid, they assured me those levels are still well within range. As his nurse relayed the findings to me, I could almost feel my blood pressure dropping... until she concluded with, "but Dr. D says your baby's a mammoth, so he said to let you know that on Monday you guys'll talk about induction."

I made sure she could hear that I was both smiling and completely serious when I replied, "No, we sure won't."

From my first visit, this particular nurse and I have enjoyed an easy rapport  -- to the point that when I called the office to check on my findings, she saw my number on the caller ID and answered, "What, woman? Whatchoo want?"  :) -- so it's for the best that she was the person on the other end of the phone yesterday.

"Girl," she went on in tones of genuine concern, "the sonogram says your baby's over nine pounds!" I laughed. "Honey," I told her, "that's the very same thing they told me about my son, and he was barely eight. Heck, I've seen them be off by more than two pounds." When she offered a conceding grunt, I continued: "...and the fact is, nine pounds didn't used to be considered a 'mammoth' baby before so many women started getting induced early and delivering six- and seven-pounders. If all my tests say she and I are still doing fine, I'd rather go into labor on my own and try to push out an eleven-pound kid than get induced again. You're welcome to tell Dr. D we'll talk about THAT on Monday." 

She laughed. I could almost hear her shaking her head as she told me, "Will do. See you Monday, sweetie."

I'm sure I don't know everything about childbirth that my doctor does, but I do know he belongs to the American College of Obstetricians and Gynecologists (ACOG), and here's what I learned from medical studies they've published:

Ultrasonographic measurements have been studied extensively, with the mean absolute error of sonographically predicted birth weight ranging 6–15%. These estimations can also be significantly less accurate in infants less than 2500 g (5.5lbs) or greater than 4000 g (8.8lbs).^6–10 Direct comparisons of clinical and sonographic estimates of birth weight have found ultrasound techniques to be superior for preterm infants, clinical assessment to be superior for infants between 2500 and 4000 g, and both techniques to have similar accuracy (or inaccuracy) over 4000 g.^11,12

(excerpted from "Prediction of Birth Weight by Ultrasound in the Third Trimester," Obstetrics & Gynecology 2000;95:502-506.)

With elective induction, the cesarean rate was 57%, significantly higher than the 31% rate with spontaneous labor. [...] 

Conclusion: Because elective induction of labor increased the cesarean rate and did not prevent shoulder dystocia, we conclude that mothers with macrosomic fetuses can safely be managed expectantly unless there is a medical indication for induction.

(excerpted from "Elective Induction Versus Spontaneous Labor After Sonographic Diagnosis of Fetal Macrosomia," Obstetrics & Gynecology 1993;81:492-496.)

In plain English: even America's leading [self-appointed] authorities on childbirth have conceded that a) birth weights determined by ultrasound can be off -- way off; and b) that inducing a mother because her baby might be over eight pounds can only guarantee a "significantly higher" chance of cesarean delivery... and nothing more.

I really like my OB as a person -- he's a better listener than I've ever found in a doctor before -- so I have good reason to think he'll hear me out when I go over the facts with him on Monday. Between now and then, I'll be gathering contact information for the important folks at National Geographic. If I am indeed about to give birth to a mammoth, I can pay for her college by selling them exclusive photo and interview rights...

The Rest is Still Unwritten

So yeah, hey, Sugar Bean might get delivered as soon as... tonight. Just FYI.

My blood pressure readings -- even the ones NOT taken under circumstances like those described in the previous entry -- are trending upward... which is how it usually works when you're approaching delivery, but mine have officially left the "we aren't concerned about it" range. So I'm currently in the middle of a 24-hour test to determine whether I may actually be developing the preeclampsia the hospital was worried about... and at the end of it, I'm having a sonogram to measure my levels of amniotic fluid (since elevated blood pressures can adversely affect those). "If we determine you're showing signs of preeclampsia or she's showing signs of distress," my doctor said flatly, "then it's time to deliver your baby."

It's almost eerie to me, that I should be so at peace with the possibility...

I was pretty stressed about it until a few days ago when a friend gave me some sage advice: "You already know everything about blood pressure and pregnancy that you can. Reading any more of it isn't going to make your blood pressure go down. Go re-read Ecstatic Birth instead." It's not that she was telling me to ignore the possibility of medical complications; she just knew -- as well as any reasonable [non-pregnant] person would -- that dwelling on it would be counterproductive. Another good friend  -- someone who's experienced the whole spectrum of best- and worse-case scenarios in the deliveries of her five children -- had some wise counsel for me today too: "You've done absolutely everything you should and everything you can to ensure the best possible outcome. At this point, it's out of your hands, and  you're just going to have to trust that God's going to work it out for the best." 

Yes, my ideal birth experience would involve going into spontaneous labor, using the kiddie pool I bought as a place to let my labor progress (hint: laboring in water helps keep blood pressures lower) and only going to the hospital once I'm sure I'm past the need for chemical augmentation.  I'm hoping for that sort of experience until I have reason to do otherwise. That said, as I've learned time and time again, what we want is not always what we need. So rather than fixating on the "how" of my delivery -- either on my hope for a better birth experience or my fear of a less-than-ideal one -- I'm keeping my mind focused on the far more important "what": my little girl making a safe transition from the warm embrace of my belly to the warm embrace of Mommy and Daddy's arms.

Prayers are, as always, most welcome. I'll let you know how they get answered.