Doctor Visit

I saw Dr. Lopez yesterday. I'm so glad I didn't waste too much energy on worrying about stuff. (Yes, I had some concerns, but I didn't lose sleep over them.) He is feeling good, pain free and moving well. The reason he didn't come to the meeting last week is because he didn't have permission from his surgeon; he was still on bed rest. He says he is still enthusiastic about the home birth.

I came with a list of questions and he answered them mostly to my satisfaction. The only outstanding question is about the dosage and formulation of the Rhogam shot but he told me where I can get the information I want. He had an interesting reason for feeling strongly about me getting the shot postpartum if Baby is Rh+. He said that if for some reason in the future I need an emergency blood transfusion and they don't have Rh- blood available they could still give me O+ blood safely as long I have not already been sensitized. Hm.

Last time I saw him he had said he wanted to do an ultrasound. I told him I would give it some thought and I have indeed spent quite a bit of time thinking and doing additional research. I had eventually come to the conclusion that I would decline it. But he didn't even bring it up!

We did discuss and disagree on a couple of things. He believes that a single clamp should be applied once the cord stops pulsing since the baby will be up above the level of the placenta and gravity will cause blood to drain out of the baby and back into the placenta, causing anemia in the baby. My research indicates that once the baby has reached optimal blood volume, there is a reflexive closure of the umbilical blood vessels. So probably it's a moot point, since by the time Dr. Lopez wants to clamp the vessels would have closed themselves already. But I would prefer to keep the cord unclamped and uncut until after the placenta has been delivered.

The other point we disagreed upon was cervical checks. I don't want any, but he would like to do between one and three. To be sure I'm not in false labour, or way beyond where I think I am or seem to be. He has seen both cases fairly recently. It is for his own preparation and I appreciate that. He'd rather not be hanging around my house if I'm at 2cm, or be too relaxed and unprepared if I'm complete but coping so well that no one can tell. Again, I know that we don't always know how labour will go but I think that most likely I will know and they will be able to tell well enough how far along I am without doing an internal exam. And really, it's not the end of the world if either situation occurs. We left that one unresolved for the time being.

Andrew's advice was to concede on a few points so that the doctor can come into the birth feeling comfortable. Andrew makes a good point. On the other hand, I am not making these choices out of principle or stubbornness. I truly believe them to be the best choices for our baby. So I'm not inclined to compromise on anything. But then if our birth attendants are not totally comfortable that itself introduces an element of risk. So it's worth considering making a compromise or two.

I haven't gained any weight since I saw him three weeks ago. I've put on 30lbs total. My blood pressure was 100/70. Baby's heart rate was 128. I was a little surprised that it was lower than the 140's it has usually been at but he thought that was fine. He said Wee3 is for sure head down (whoohoo!). But floating quite free still. Head was much higher than where Lucia found it. Interesting. But it's not uncommon for baby #2+ to drop/engage right at the time labour rather than weeks ahead like with baby #1. He was happy with my blood and urine test results.

He wants me to have a non-stress test next week. They measure baby's heart rate and reaction to any contractions for 30 minutes. It also measures the health of the placenta. In Canada this is typically done when baby is overdue or if there are complications with the pregnancy. He would like to do it because he said it gives him quite a good insight into how baby will handle labour. He said it doesn't involve any ultrasound or anything. I did a little research and unless Lucia has a different kind of machine, it appears that the baby's heart rate is indeed measured by a doppler ultrasound. I'll be looking into it a little further.

In other news, I'm back to feeling really good!

Birth Attendant Home Visit

Lucia and the pediatrician, Dr. Luis Flores, just left. Dr. Lopez didn't come because he's still recovering from his back surgery. That worries me a bit, and I'll discuss it more later on in the post.

Let me start with an on-the-record apology to my family. I slept in a bit this morning and during that time I dreamed that the team came over for this meeting but the house was a wreak and I was so upset and embarrassed. The bed wasn't even made. The playroom was a disaster. And Andrew had decided to revamp the living room configuration into something that was hugely aesthetically displeasing. I was mad at my family and mad at myself for letting it happen and the anger carried right into my real morning. Sorry family, for being so grumpy and impatient and curt this morning. I shouldn't have slept in if I was so concerned about getting the house in shape for visitors. I really wanted the house to look orderly and clean for this visit, because these people are doing something out of the ordinary on our behalf and I wanted them to feel very comfortable with their decision to attend our home birth.

Anyway we got the house cleaned up to my satisfaction, the kids went to Xochi's house to play while we had the meeting, and the meeting itself went quite well. We went over the list of supplies and who was responsible for what items. Then we toured the house. I had thought that we would put the tub in the front entrance but we decided to put it in our walk-in closet. Not as weird as it might sound. It's actually a walk-through closet. We walk through it from our bedroom on the way to our bathroom. Which means that I have shower, toilet and bed all nearby, and it's a nice intimate setting. Not the best for photos unfortunately. But I'm confident my highly motivated husband will figure something out. I'm sure it will include hanging some sort of backdrop. I can see it now... it's 3am, I'm in the throes of labour, and Andrew is hammering nails into the cement walls so he can get nice photos. Which of course I'll be glad we have after the fact, but possibly not so much at the time.

The neighbors also might not be so happy with this plan if I give birth in the middle of the night. But I've put up with a party or two so they can put up with some birthing noises (and some hammering) ;)

The pediatrician seemed quite relaxed with the home birth and with my low-intervention preferences. He thought it would be fine to wait on the vitamin K injection and just watch baby for any sign of hemorrhage. When I mentioned oral vitamin K he put it in my court so I am going to follow up on that. The oral application seems like a good compromise to me, plus ensuring that I have lots of vitamin K rich food in my diet.

About the OB. He had his surgery 2.5 weeks ago. I spoke to him a week later and he was feeling great and said that his recovery was ahead of schedule. He expected to be back in action two weeks after his surgery. So I was surprised to hear that he couldn't be here today. I think he may have overdone it or something in the last few days. Yikes. Of course I wish him a full and speedy recovery for his own sake. And also of course I'm a little concerned about what this might mean for my birth, especially if Wee3 decides to come a little earlier than we expect.

But there's not much I can (/will) do to influence Wee3's birth day and there's nothing I can do to influence Dr. Lopez's recovery. All I can do is continue to pray that God blesses this birth. I think we do have a backup OB, but I don't really like that element of the unknown. That said, Andrew expressed again that he is more than willing to protect our birth plans if things start to go off track without good medical reason.

On Tuesday Lucia will pop by with the hose from the tub so we can make sure that it fits my plumbing. The following Tuesday we will pick up the tub and stash it here in the house.

Before Lucia left I had her check baby's position again. It was the same as last time... at first she thought that baby was breech. Then she really dug in low and felt fairly sure that she had identified a head. I believe it that Baby's head is really low because I am feeling it in my ligaments, muscles and nerves. I sometimes get shooting pains down my thighs and I have to be a little careful how I move and turn otherwise I get very sore in my groin area.

Wee3, we trust you and our Lord to choose the perfect birth date. We will do our best to provide you with a gentle, peaceful, safe entry to this world, and we trust that God is in control even if the circumstances aren't exactly as we planned. We love you so much and we can't wait to meet you!

Thrashing Baby

Last night in the middle of the night I woke up to Wee3 doing some serious thrashing about. It was very uncharacteristic. So naturally I worried. That something was upsetting babe and/or that babe was making a big move back to breech or worse, to transverse.

Things seem to be ok today. I've felt some regular types of movements and I think baby is still head down.

The last part of yesterday baby moved from his/her usual right-facing position to left-facing so maybe he/she was just struggling to turn back over in the increasingly cramped quarters? Who knows.

The other kind of weird thing was that yesterday when I went for a walk my belly was rock hard for like two laps. A pretty long Braxton-Hicks. I finally stopped walking for a minute and just consciously relaxed and then things loosened up.

Leopold's Maneuvers

This is the technique used to assess fetal position by feeling the pregnant woman's abdomen. I actually found this much more helpful than the spinning babies belly mapping methods.

Leopold's Maneuvers are described in Wikipedia as follows:

First maneuver

While facing the woman, palpate the woman's upper abdomen with both hands. A professional can often determine the size, consistency, shape, and mobility of the form that is felt. The fetal head is hard, firm, round, and moves independently of the trunk while the buttocks feel softer, are symmetric, and have small bony processes; unlike the head, they move with the trunk.

Second maneuver

After the upper abdomen has been palpated and the form that is found is identified, the individual performing the maneuver attempts to determine the location of the fetal back. Still facing the woman, the health care provider palpates the abdomen with gentle but also deep pressure using the palms of the hands. First the right hand remains steady on one side of the abdomen while the left hand explores the right side of the woman's uterus. This is then repeated using the opposite side and hands. The fetal back will feel firm and smooth while fetal extremities (arms, legs, etc.) should feel like small irregularities and protrusions. The fetal back, once determined, should connect with the form found in the upper abdomen and also a mass in the maternal inlet, lower abdomen.

Third maneuver: Pawlick's Grip

In the third maneuver the health care provider attempts to determine what fetal part is lying above the inlet, or lower abdomen. The individual performing the maneuver first grasps the lower portion of the abdomen just above the symphysis pubis with the thumb and fingers of the right hand. This maneuver should yield the opposite information and validate the findings of the first maneauver. If the woman enters labor, this is the part which will most likely come first in a vaginal birth. If it is the head and is not actively engaged in the birthing process, it may be gently pushed back and forth. The Pawlick's Grip, although still used by some obstetricians, is not recommended as it is more uncomfortable for the woman. Instead, a two-handed approach is favored by placing the fingers of both hands laterally on either side of the presenting part.

Fourth maneuver

The last maneuver requires that the health care provider face the woman's feet, as he or she will attempt to locate the fetus' brow. The fingers of both hands are moved gently down the sides of the uterus toward the pubis. The side where there is the resistance to the descent of the fingers toward the pubis is greatest is where the brow is located. If the head of the fetus is well flexed, it should be on the opposite side from the fetal back. If the fetal head is extended though, the occiput is instead felt and is located on the same side as the back .

A 1993 study concluded that "...the maneuvers used by experienced clinicians can be effective as a screening tool for fetal malpresentation, particularly in settings where ultrasound may not be readily available."

A Cautious WhooHOO!!

Yesterday I used Melissa's trick: I laid on my back with my hips elevated and had the kids talk and sing to the bottom of my belly. My two didn't get such a kick out of it as Melissa's two. But Wee3 did, it seems. Afterward my belly and pelvis felt different. Instead of a shelf, I now have a steep slope. And it just feels a little different in my pelvis area. Seemed to me that meant the baby had settled in. And hopefully head down!! The other thing I noticed was movement up under my ribs, something I had never felt before, just movements in the upper quadrant. So I was hopeful that meant longer reach and therefore legs up!

Naturally I poked and prodded extensively. Seemed to me that the lump I felt at my fundus was just too big and a little too soft feeling to be a head. But I couldn't find a head down low.

So I called Lucia to ask if I could pop by for her to check. Con todo gusto, she replied. She had a feel and at first said that it was the head at the top. Then she did more feeling around, and had to really dig but thought she finally felt the head deep in my pelvis. What it comes down to is that she can't say with 100% certainty but she is inclined to believe that Wee3 is now head down and well engaged in my pelvis. (!!!!!)

She mentioned that baby felt big... well no surprise there given that Eva and Micah were 8 and 9 lbs respectively. I told her I wasn't scared of a big baby. She didn't seem worried either. I feel good!

Praise God for today's special blessings: cooler weather and a very possibly head down baby!

A Little Worked Up

I'm feeling much better today, but the last few days I have been a little stressed. I've been trying, semi-successfully, to keep it under control. Then yesterday a friend suggested that perhaps I might have polyhydramnios (excess amniotic fluid) given that I seem large for dates, I have trouble figuring out baby's position, and baby has been breech. A reasonable suggestion, and one I appreciated her bringing up, from the point of view that it's something I would want to know before going into labour.

So I've been praying and I've been researching and I've been looking forward to today's visit with Lucia.

The prayers helped... by the time I got up this morning I was feeling much more peaceful.

The research in some ways eased my mind and in other ways worried me more. Many cases of polyhydramnios are for reasons unknown. Other causes could be any number of conditions of the central nervous system, heart or kidneys, in which the baby either can't swallow properly or produces too much urine. Whatever the reason, polyhydramnios can lead to premature labour/rupture of membranes, prolapsed cord, placental abruption... all very not good things. Signs of polyhydramnios include shiny, tight belly (doesn't describe mine), breech baby (because baby can float around so easily), difficulty identifying baby parts during palpation (I think I am just inexperienced and not gifted at this vs not being able to find baby parts. Neither Lucia nor Dr. Lopez has had any difficulty identifying baby's position), difficulty finding a heartbeat (never a problem), heartburn (not a problem), swollen legs (mine get slightly swollen, but not extreme and it only makes sense that it is heat related given the heat here), varicose veins (not a problem).

Of course the idea that my baby might have an abnormality is stressful, and the idea that it might cause problems during birth is disconcerting to say the least. But the good news is that most women with polyhydramnios go on to deliver healthy babies.

We saw Lucia today. She palpated and quickly discovered that the baby was full on head up. She laid a rebozo (a rectangular piece of fabric traditionally used as a shawl or a baby sling) on the floor and had me lay on my back on top of it. She and Andrew each took an end, lifted my bottom/middle about a foot off the floor, gave it a little shake to disengage the baby from my pelvis, then wiggled me by alternately pulling on the ends of the rebozo, for about 10 strokes. Lucia checked after that and baby had rotated a quarter turn! Cool.

She didn't express any concerns about my size or how my belly felt, and she seemed fairly relaxed about baby's position. Obviously we'd all be reassured if baby were in a favorable position, but it is good news I think that baby doesn't seem to be locked into breech.

I asked her a little more about everyone's role at the birth. Lucia will be a doula. She will be concerned with my emotional and physical well being- comfort measures, making sure I'm hydrated and fed, etc. She will spend the most time with us. Dr. Lopez will be there, I assume from the time active labour gets well underway, for medical support. He will watch for any developing complications, suture if needed, etc. The pediatrician will be called when the birth is imminent, and will be there for the baby, to give medical attention to the baby if needed, and to perform the newborn exam.

I'm feeling a little better about not having met the pedi yet. Andrew is totally on board with what I want and more than willing to run interference if the pedi (or Dr. Lopez for that matter) wants to take baby before I'm ready or perform some sort of intervention I don't want.

I did mention to Lucia that I don't want the baby vigorously cleaned up after the birth, just covered to stay warm (like that will be a problem if this heat continues!). I've seen lots of birth videos where baby is briskly rubbed, wailing, and imagine that is not a happy time for baby. There's no harm in leaving the babe vernixy and even a little bloody. In fact, from what I understand the vernix is terrific skin conditioner. :)

We talked also about home birth supplies and I'm in pretty good shape. I got the absorbent bed pads at the store yesterday, and Lucia told me that Depends make great postpartum pads. She thought we might be able to get the pharmacy at the entrance to our area to have an order ready for pickup if we need it, so we wouldn't have to purchase things we wouldn't necessarily need. She told me to get a 30cm wide tensor bandage for belly binding so that answers that question. I also tried the plastic sheet yesterday and it covers the bottom half of the bed completely so I think that will be good.

We'll have our care provider meeting here at the house a week from Sunday. I will be 36.5 weeks. A little closer than I'd like but I think it will be fine. It gives me a little more time to get the house a bit more organized as well.

So, I left feeling pretty good. I'll still be curious like crazy to know about baby's position but there are things that we can do to encourage baby to turn vertex and then I'll just have to leave the rest of it in God's hands.

Just a Teeny Bit Worried

I spoke to Lucia the doula this week, trying to organize a gathering at our house with all the care providers so they can see the space, so I can meet the pediatricians, so Andrew can meet everybody, and so any outstanding questions can be answered. But Dr. Lopez had his surgery on Wednesday, which is great, but means we'll have to put off the big meeting for a couple of weeks. Which brings us quite close to full term.

So I'm feeling a little uneasy leaving this so relatively late. Also, Lucia said that Dr. Lopez had mentioned that the baby was breech when he saw me and she wants to take some action in that department. She wants me to crawl around for 5 minutes three times a day, and she wants us to come by so she can use her rebozo technique to encourage the baby to turn. All very good stuff, of course. But the fact that she is concerned gives me a tiny bit of stress. Add to this that I cannot tell what position the baby is in, which is so frustrating! I have been poking and prodding the baby and probably annoying him or her like crazy but I still can't find a head or a bum.

I'm also a little frustrated, because it's not like I spend my days slouched back on the sofa. I am conscious of my posture, and at yoga we do a lot of hands and knees and downward dog, both of which are positions which are recommended to encourage a baby to turn head down.

So I will do my crawling, I will do inversions, I will continue going to the pool, and today we are hopefully going to get over to Lucia's to do the rebozo thing.

Belly Mapping

Spinning Babies is a cool site. It is a "unique, step-by-step approach to Optimal Fetal Positioning. Certain positions of the baby make labor easier than others."

There is a section called Belly Mapping which a mother can use late in pregnancy to try to determine baby's position on her own. I've been poking around a bit and I haven't quite got it figured out, but it's nice to have a resource to reference.