Doctor Visit 39.5 Weeks

I saw Dr. Lopez today. Another good visit. BP 100/70, baby heart rate 143, no/little edema, weight good, baby moving well. He spent about 10 minutes just gently palpating. He counted 3 movements, which he said was quite a lot. Good that baby responded to external stimulation. He said the baby was a little lower than last week- which I have been feeling- but still has room to move down more.

He said he had some good news- he had done an emergency surgery since I saw him last, and he was physically very comfortable. So he's in good shape for our birth. Of course I'm hoping he won't even need to be, but it's good to know.

He told me I was a good patient because I'm so well researched. Asked if I had considered becoming a midwife. I told him that I feel more called to the education end of birth than to the hands-on practice of midwifery. But that was flattering.

I'm still feeling very good, sleeping well, etc... Still have the very mild backache. Continuing to have very irregular contractions. Some mild and painless, some more intense. One woke me up the other night. The stronger ones are a good opportunity to practice my relaxation and to experiment with different techniques.

Off to get my rest! Don't want to be tired when B-Day comes upon us!

39 Weeks

A healthy range of weight is between 5 pounds and 11 ounces and 8 pounds 5 ounces. Your baby is probably somewhere in this range now. The umbilical cord doesn’t have any nerve endings (this means that you and your baby will not feel any pain when it is cut!) and is about 20 inches long and about ½ inch thick. It’s pretty common for the umbilical cord to get knotted at this point, because things are so crowded inside the uterus.

All of your baby’s organs, including the lungs are ready for birth now. Your baby’s immune system is gaining strength at this point. Right now, you are probably very uncomfortable and can hardly stand the wait. Try to take it easy and rest when you can, long naps and reading can help you through the last few days of your pregnancy. Remember that very few babies are born on their due date.

I am blessed to not be uncomfortable, swollen or impatient about baby's arrival. I feel pretty much prepared and I am excited, but not increasingly desperate for the time to come. So far!

My energy levels are good, my sleep is interrupted more by the other kids than by being so pregnant, and while I do get some aches and pains they are intermittent and not overly bothersome.

Baby is moving well. I notice movement after most meals/snacks, and generally between 11-11:30pm. This baby seems to like to stretch his or her legs which makes for fun belly shapes. Wee3 also likes to punch. The punching doesn't feel so great.

I seem to have a pattern of getting a series of stronger contractions in the evenings. I like them because it makes me feel like things are happening behind the scenes.

I have been doing some emotional/spiritual preparation. Today I spent some time with A Celebration of Pregnancy booklet. I got it through a wonderful ministry called Blessing God's Way. The booklet lists a whole bunch of scripture which is particularly encouraging for pregnancy and childbirth. I have also been imagining how I see the birth going and how I see myself coping with the unexpected. I have also been talking to the baby about the birth and how a nice anterior position would be most comfortable for both of us.

Napping has been a bit tricky. Micah is starting to grow out of naps, so in the interest of a decent bedtime experience we have been taking power snoozes of about 30 minutes. I get a glimpse of teen-Micah when I try to wake him up after only half an hour.

Did I mention that Dr. Lopez said he and Lucia are not expecting a big baby? He figures long, but not "big". We will see shortly!!

Speaking of expecting, Andrew and I realized last night that we would both be very surprised if this baby were a girl. That said, we were convinced that Eva would be a boy, too. Got talked into it by people's predictions. I'm getting really excited to learn all about Wee3!!

Prayer Answered!

Had my appointment with Dr. Lopez today and it was great! No mention of the non stress test!!!

And..... one of the first things he said was that he was ok with not doing cervical checks during labour. Whoohoo!

Babe is lower than was last week, my bp was 110/70, I forgot to ask what baby's heartbeat was. My weight was about the same as last week. Reflexes good, kidneys good, edema situation good.

I asked him if he had any concerns going in to this and he said he's excited and that he's comfortable with everything. He said he felt like we had a good dialogue going on.

I asked what he thought of the reading material I brought him last week- the chapter on third stage from my Anti-D book. He said he agreed. Last week he had said he would let the placenta go undelivered for maximum 30 minutes before intervening. This week he offered that he would feel comfortable letting it go to an hour. Based on my history I don't imagine it will be an issue, but that's nice to know. We also discussed the idea of baby's blood flowing back into the placenta after the cord stops pulsing and he was open to the thought that the cord vessels close physiologically thereby preventing that from happening. But then he wondered if that would make it more difficult to obtain a good blood sample for baby's blood typing. He was going to look into that further with colleagues.

So I came away feeling very very good about things. There is nothing left to worry about. Now I'll concentrate on resting and enjoying the anticipation of meeting our baby. (And maybe some crocheting.) We just realized that this is our very last weekend together as a family of four! Even if Wee3 isn't born by next weekend, Mom will already be here bringing our count up to five.

In other news, last night I had three contractions in an hour. Each one didn't last all that long, and after that my contractions were back to the usual irregular every few hours. But that was a bit different. Felt a bit uncomfortable in the cervical area too. The bod is tuning up!

Apart from Mom not being here yet, I'd prefer babe waits for a day when I'm feeling well rested. We had a crazy night last night! It rained so it was muggy, and both kids woke up in the night and were wide awake for hours. We played musical beds- Andrew and I trying to get away from the kids more than anything. I couldn't stand Eva's body heat and her obvious wakefulness so I moved to her bed. Then later on Andrew came into the room trying to escape both wide awake kids who had moved in with him. He was so confused to find me already there. Despite all that, surprisingly, the kids and I are in really good spirits today. And planning to bake cookies this afternoon. After our nap, of course.

Sigh of Relief

Today Lucia came over and we completed (oral vit k excluded) the preparations for the birth!! It feels GREAT!

We checked that the hose fit my shower- it didn't- and got an adapter which does the trick. I now have the birthing pool at my house. It will fit just fine in the space we have planned for it.

We also got the medical supplies on her list such as sterile gloves, gauze, syringes, IV equipment and syntocinon. These things are in case of postpartum hemorrhage and for repairs. Hoping none of it will be necessary! But glad to be prepared. The docs will bring instruments and oxygen and whatnot, and Lucia will bring a bunch of other things from flashlight to birthing stool to fetal doppler. Quite a lot of stuff, really.

It was good with Lucia. I felt like I made a good impression, one of health and organization and rationality and caring. Which I think is good for our birth team. While I'm not the first to have a home birth in their care, it's still far from common and I recognize the effort they are going to on my behalf. I'm glad for every bit of confidence I can build in them about my commitment to this.

She hadn't spoken to Dr. Lopez I guess, and I didn't bring up the non stress test, so that was averted. Phew. I have an appointment for tomorrow. I think I'll pray that the NST slips his mind so we just don't even have to have the conversation.

So, all that's left is for my Mom to get here. Six more days! I'm excited to show off my nice organized piles of birth and baby stuff, and to talk through how I see the birth going. Andrew doesn't have quite the same interest in these types of details :)

The birth and brand new baby corner. Two mesh bags with all my birth supplies, and the diaper bag full of brand new baby stuff like clothes and receiving blankets. Car seat and playpen. Planning to use the bassinet for baby to sleep in beside our bed.

Baby Shelves. Diapers, and bins of clothes ready to be washed up once we know whether it's a boy or a girl!

Doctor Visit Addendum

I forgot to mention that Dr. Lopez did say that my belly looked quite big. I asked him if he had any concerns or theories about it and he just shrugged his shoulders and said, "That's just the way it is."

Nice.

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!

Doctor Appointment

I had an appointment with my OB today. I took Eva with me and he seemed glad to meet her. Eva was a little shy but I'm glad she got a chance to meet him. She tried to hear the heartbeat with the Pinard horn but I guess the baby had moved since he heard it in that location. I'll bring Eva along again next time and hopefully she'll be successful then.

Let's see.... baby's heartbeat was 139.... and I have gained about 30lbs according to his scale. Can't compare to my scale since my scale seems to be on the fritz. As much as both Andrew and I would like to believe what it says, I'm pretty sure Eva hasn't lost 10lbs.

What else... reflexes are good. Hm, he didn't take my blood pressure. I have some edema (swelling). I knew that... I have noticed that my rings are a little tighter and that my ankles aren't quite so slender. But I am pretty sure it's nothing more than the heat. Edema can be a sign of preeclampsia, a very dangerous condition, so it's important to keep an eye on it.

He has a herniated disk and is going in for back surgery at the end of July. I will go see him again in a month. I hope his surgery goes well and he's recovered by the time I need his services! The last thing I want at this point is a change in caregiver.

He ordered a a urinalysis and couple of blood tests including the coombs (which tests for Rh sensitization). He mentioned that he didn't think the prenatal Anti-D vaccine would be necessary and I was so glad that we agreed. That's pretty much what I had concluded from the Anti-D in Midwifery book I bought last month. We talked about how the baby's blood type would be determined and he said he would do his best to get a good sample from the cord/placenta but if he couldn't then we'd have to take the baby down to the women's hospital so the NICU staff could draw some blood to have it typed. I'm not excited about the idea of taking a brand new baby out, especially since one of the benefits of the home birth is cocooning at home, but I do agree that it's important to get the blood typed as soon as possible. There is about a 72 hour window for applying the vaccine, but sooner is better in the case that fetomaternal hemorrhage occurred during birth. Which is difficult to determine, therefore the Anti-D is recommended if the baby is Rh+.

Baby was in breech position when he palpated my belly, but constantly on the move. Still very much free floating. He encouraged me not to worry that baby was breech right now because there is still lots of time. I appreciated that. While he didn't measure with a tape, he commented that my uterus isn't overly big. I think what's going on with the big belly is that rather than expanding to the sides or upward it is expanding outward.

I asked if he is comfortable with vaginal breech birth and he is!!! What a pleasant surprise!! It would have to be in hospital rather than at home, but that's all good. What a relief to know that a breech baby wouldn't automatically mean surgery like it so often does in Canada and the US.

Dr. Lopez wants to do an ultrasound at my next visit to double check the position of the placenta. Less than a minute, he said. I asked him wouldn't there be other signs, like pain or bleeding, if the placenta were low lying? He admitted that is usually the case but did say that it's not always true. I told him I'd do a little more research and think about it. He nodded knowingly and said he knows what that means... when his wife says, "I'll think about it," that means no. Heheh. Anyway he said he would never force something on me that I don't want, and I appreciate that. I will consider it carefully though.

He told me that the team is very excited about my birth, and they have high expectations of it. I pray it will be a wonderful experience for all of us.

Prenatal Class

Today was a speedy class because one of our classmates is in labour and Lucia had to head out to support her. She is 40 weeks today. She was VERY ready to meet her baby and has been hoping labour would start sooner than later. I saw her today at the doctor's office and she was still status quo, but by the time I got to class at 7pm she was heading for the hospital. How exciting!

The info part of today's class was a video of a c-section. I had a lot of trouble watching. I felt stressed, tense, and upset. I felt bad subjecting Wee3 to those stress hormones. There were two aspects to my feelings. The first was empathy for the baby and mother. The film didn't even show the mother's face until right at the end. All we saw was the surgical site. I felt terrible that she was so detached from what was happening. I know that in some hospitals they will lower the drape so Mom can see the baby emerge. Then I felt bad for the baby who was pulled out, immediately detached from his/her lifeline and mother, handed to a stranger, suctioned, scrubbed clean, left laying alone between procedures. I longed on behalf of that baby for some skin-to-skin contact, some warmth, some familiarity. What an abrupt and I'd imagine frightening transition to this world! The other reason I got upset was thinking about how things could be for me and my baby if we ended up needing a surgical delivery. I asked Dr. Lopez a little about it today; in particular whether Andrew could be in the OR during surgery. He said he would have no problem with it but hospital policy is no. He did say that it might be possible to request an exception. The idea of undergoing emergency surgery all alone upsets me greatly. I know that I would cope by detaching emotionally and I don't know how easy it would be to re-engage and bond with our new baby. And the idea that Andrew wouldn't be there to hold my hand and then advocate for the baby... turns my stomach.

These are things that we will address during our meeting with our attendants so we can have as much influence as possible on procedures and protocols, and provide our baby with as gentle a birth as possible under the circumstances. Until then I won't stress about it. But I do want to address it so that we can have an opportunity to choose where choice exists.

Doctor Visit

I saw Dr. Lopez today. All is well. Blood pressure 100/60, heart rate 67, no edema, reflexes good. He palpated and listened for the heartbeat with a pinard horn (see photo)! Baby's was running at 158. Was head up and pointing to my right today.

I asked what he thought of my birth plan and he said again that it's all good and whatever I want is good with him. But then something else we talked about made me realize that he hasn't actually looked at it yet. Once I get back from Canada we'll have a meeting with him, the doula and the two pediatricians we would like to have on call, and work through any concerns.

He wrote me letters confirming my weeks gestation and health in case the airline requires them. And that's it til I get back!

Today I also had a terrific conversation with Abigail, our midwife for Eva's birth. Still four and a half years later she remembers so much about us and the birth itself! She is going to request the hospital records so we can go through all the details of Eva's birth. I think it will be so interesting!! We did talk a little about it. Suctioning is not something she does routinely so she probably didn't suction Eva and cord cutting is not something she rushes so it probably didn't happen until a little while after Eva was born. I'm so pleased to know that Eva got her full complement of blood! Andrew and I were talking about the kids' births the other day and while he doesn't remember a lot of the details he does remember noticing just how gentle both Abigail and Sari were with the babies. Makes me feel so happy to know they were treated so gently and respectfully. I have been so blessed!!

Another interesting thing is that she is on the committee for the birth centre that is going up in south Winnipeg. I gave her my email and asked her to keep me in the loop. They will definitely need a childbirth educator so there's an employment opportunity! ;)

Prenatal Class

I enjoyed today's class a lot. I enjoyed the exercise/relaxation part (and the massage part, naturally) more than yesterday. Now that I knew what to expect, I didn't feel like I was fumbling around trying to keep up at an aerobics class.

The information part was a natural childbirth movie which I thought was quite good. Covered a lot of bases in a short period of time. I was glad that the first-timers at class had the opportunity to be exposed to the many options and variations and to see what a natural birth can be like. Quite a bit of time was spent going over how the baby comes through the pelvis, and it really struck me just how much work birth is for the baby too! I'll be cheering this baby on when our time comes. It's a team effort! I also want to pay specific attention (assuming I have the presence of mind) to the movements of the baby throughout the labour and birth process.

Check out this cool animation of childbirth (it is not graphic):



Lucia and I went over my birth plan today. She referred to herself as a doula so from now on that is how I will refer to her. I believe she is certified as a nurse-midwife and I wanted to acknowledge that, but given my understanding of her role in the birth process, "doula" is the best fit. I loved it when she said that, to her, the labouring mother is a queen. Yessssssss.

Anyway she said she was completely in agreement with all of my desires. She thought I might have some work to do with the OB regarding cervical checks. She has two pediatricians in mind. One is a woman who lived in England for a time. She will most likely be ok with all of my requests pertaining to newborn care. However she works at the seguro social (public hospital) and wouldn't be able to miss work if my birth happens during her shift. The other pediatrician might be more resistent to my requests. I think Lucia was planning on talking to them very soon so I might know where we're at in short order. The good news is that they both speak English so I'd be able to forward English language literature to support my requests.

Grrrrrrrrrreat Prenatal Appointment!!

All signs of urinary tract infection are gone! I was dreading the possibility of needing antibiotics so that was a relief. Seems that the vitamin C tablets and copious amounts of cranberry juice did the trick. That or the sterile sample container vs the jam jar I used for the first lab test ;)

My blood pressure was good at 110/70, though perhaps slightly elevated due to the doctor's scale indicating a 22 pound weight gain since my first appointment!!! Definitely wrong. Most definitely incorrect. Heart good, kidneys good, reflexes good, no edema, fundus height bang on. Baby's movements very good. Too early to detect a heartbeat with a stethoscope unfortunately, but the movements tell most of the story.

I passed along my Dr. Sarah J. Buckley Gentle Birth, Gentle Mothering book with a few chapters marked for his special attention (Ultrasounds, Undisturbed Birth, and Third Stage). He seemed interested in reading through it. He is also planning to attend the conference in Monterrey at the beginning of May at which she will be speaking. I'm SUPER DUPER EXCITED to be planning to attend this conference.

Then we talked. I told him that I have been thinking, dreaming and praying about the birth... and I am seeing it at home. His response? "Why not?" My heart leaped! I love how this has fallen into place so naturally. At first I received a lukewarm response to the idea from Andrew, Dr. Lopez and from Lucia. I didn't want to push for anything with which my support team was not comfortable so I focused on planning a waterbirth in hospital. But every time I thought about having this baby, I was labouring in water at home. I have even been looking at appropriate kiddie pools and daydreaming about it while I'm grocery shopping. I spoke again with Andrew about it a while ago and he was much more open to it, quite supportive in fact. Dr. Lopez's response seals it.

We are officially planning a home birth!

For those who are concerned about my and the baby's safety, here is a link that might help to ease your mind: http://www.gentlebirth.org/format/myths.html

I am thrilled for so many reasons. I won't have to endure the uncomfortable drive to the hospital or dance through contractions while trying to answer questions about who I am and how I'm paying or deal with the limbo that is triage. I will be able to focus entirely on relaxing into the process of birth and letting my body do the work God designed it to do. I won't need to worry about childcare (assuming Mom can be here at the time that baby chooses to join us on the outside). Eva and Micah will get a chance to witness the miracle of birth if they choose. We will all five get to climb into our deliciously cozy bed and get to know the new member of our family very soon after he or she is born. I will have my own food, my own bathroom, my own familiar spaces and things, my whole family surrounding me during and afterward. There is less risk of infection and unnecessary intervention. With no hospital staff waking us up to poke and prod us, baby and I will be able to enjoy the beautiful undisturbed restorative sleep of two people who have worked hard and need the rest. (I experienced this with Micah, coming home a few hours after his 1pm birth; that first night was a wonderful gift).

My hope and desire is for a straightforward, undisturbed birth and I believe I am doing my part to that end: nutrition, education, exercise and prayer. In the event that this birth requires medical help, I will have three skilled and prepared caregivers in attendance (midwife, OB/gyn and Pediatrician) and a top quality hospital within 15 minutes drive.

WOW I'm excited. :D

Doctor Visit #2

I saw my OB today. It wasn't a good start as he was an hour late, but the visit itself went pretty well.

I'm measuring right on target, no edema, kidneys sound fine, blood pressure good, 100/60 I believe.

He asked me if I would consent to two ultrasounds, one nowish, and one at the end of the pregnancy. He said they would be just about 30 seconds mainly to check on placental position and a quick assessment of the baby. I did consider consenting during this visit, briefly, mainly I think because I am a person who likes to be "good" and please authority figures. Also the fact that it would be quick was compelling. In the end I told him I wanted to wait and as I thought about it afterward I was so glad. Because as I discussed at length in an earlier post, I really don't see a good reason to have an ultrasound at this point in the pregnancy. All indications are that this is a healthy pregnancy. If the placenta were low-lying chances are very good it would migrate away from the cervix by the end of the pregnancy. According to The March of Dimes site, more than 90% of cases of placenta previa diagnosed in 2nd trimester have resolved by the end of pregnancy. And if he found anything else of concern, chances are we wouldn't be able to do anything about it anyway. Either way, the information would do nothing but stress me out, thereby paradoxically increasing my risks.

I may consent to the end-of-pregnancy ultrasound. At that point there could be benefits to be gained from the ultrasound information. If the baby were breech, we could attempt to turn her/him. If the placenta were obstructing or partially obstructing my cervix, a surgical delivery could be life-saving and I'd be grateful. Also the baby would be much more developed and therefore much less vulnerable to any risks posed by the ultrasound itself. And admittedly it would be handy to know whether it's a boy or a girl; then I could order non-generic diaper covers and leggings.

I can't blame Dr. Lopez for wanting to do an assessment. He just had a patient whose birth I was hoping to observe for my childbirth education course requirement. Turns out that her ultrasound at term revealed a partial placenta previa and so she had a c-section. A very risky surgery, Dr. Lopez tells me. He had to actually cut through the placenta to deliver the baby. And the surgery obviously had to be super fast, because the placenta is the baby's life support system until baby is out into the world. He said that it is not uncommon for women with this condition to end up with a hysterectomy. But things went well and thank God everybody is fine. So I'm sure that he would probably be thinking about that case the whole time I labour if we don't do a quick ultrasound to confirm placental position.

My labs revealed an asymptomatic urinary infection, which annoys me. Normally this would be treated with antibiotics, but he suggested we start with vitamin C. I like that very much. Pray for me that the vit C takes care of it! Internet research indicates that this type of infection may lead to low birth weight and premature labour so something must be done about it.

Otherwise my labs were good... including iron levels, yay!

I asked him if he has attended waterbirths and he said yes, and they were wonderful. I am getting quite excited about this part of the plan. I also asked him if he would have a problem with me catching my own baby and he said not at all. Yess! Now I have to convince him to avoid internal exams altogether during labour, and skip suctioning if baby is doing fine.

Very Encouraging Doctor Visit!!!

I took my sick self to my OB appointment this morning. It went great!

The clinic was very plain, sparsely furnished, with paper signs... But a lavish clinic wasn't exactly an important criteria. It was clean, and he seemed to have everything he needed. I felt at ease when he came in, energetic and smiling.

He was right on time, and it turns out he speaks perfect English. Not a requirement for me, but definitely a bonus.

He seems to be everything I am looking for in a birth attendant. He says he doesn't ever do anything the client doesn't want. He was extremely open to dialogue and my input. When it came the time that he would normally do an ultrasound and I expressed my concerns, he was totally ok with that. He told me that the intensity of exposure has dropped over the years and the recommendation is for one ultrasound per trimester, but he was happy to work with my wishes.

He took my blood pressure (a little low- maybe that explains my coldness?) and had me jump onto the exam table. He watched to make sure that motion wasn't an issue for me, then he checked my feet and hands for edema (none) my hands for circulation (good), my nails (perfect) and my abdomen and back for kidney problems (none). He felt my uterus (yep, there it is) and my heartbeat (very low, must be my elite athlete status, ha ha).

We talked for a while more and he told me I was smart and enthusiastic about my health. Finding out that he let his wife go 5 days with ruptured membranes told me he puts his money where his mouth is. He told me he does few internal exams, which I also like very much. I wouldn't mind avoiding them altogether if I can help it.

He sent me for labs which was an experience in itself. He said he likes the lab because they're very non interventive with the tests. The place was a weird combination of house and office and lab. The doctor who runs it was labouring to breathe so much he was obviously very sick with some condition. He gave me a jam jar for the urine sample which was almost too tall to fit under me. But he was very good a drawing blood! I didn't feel a thing. I'll pick up results on Monday.

Thank you so much to those of you who prayed about this- they were obviously answered. I'm feeling quite comfortable about my care now. All signs are now pointing to hospital waterbirth, as this doc would support a homebirth but wasn't too excited about it. I do sometimes daydream about having this baby in a pool in my living room (so nice not to have that uncomfortable car ride to the hospital! and just jump right into my own wonderful big bed with my family afterward) but if my support team doesn't feel great about it then I probably wouldn't push it. Unless I started to really really have strong feelings about it, I guess.

So now my prayer requests and concerns centre around the time after the baby is born. I asked about suctioning and eye ointment and he said they both are standard. My research indicates that neither may be necessary (depending on the baby and mom's status). He said that the pediatrician may give mom and baby as long as 10 minutes together after the birth. I'd prefer to have much longer together undisturbed, and for my child not to be suctioned or given eye ointment as a matter of course. I'll have to start photocopying and highlighting! And have a chat with our pediatrician to see where he stands on this stuff.

Overall I feel really encouraged. Whoohoo!

Doctor Appointment

I finally made an appointment with the doctor that the midwife recommended. It's on Saturday morning. I have been going over in my head what I will say to him. I feel strongly about keeping the interventions to a minimum during this pregnancy and birth. I don't want to go forward with any test or procedure that may disturb or potentially harm my baby (or me!) unless the benefits clearly outweigh the risk. But I don't want to come across as a crazy lady and alienate this doctor either. The culture here is very medicalized and I doubt many people question their doctors' recommendations. So I want to choose my words and timing carefully.

I haven't completely decided what to do about ultrasound. I expect that he will want to give me one on Saturday. If I were in Winnipeg, a midwife would be using a doppler to listen for the baby's heartbeat. That instrument also uses ultrasound waves, but a doppler is continuous, whereas ultrasound is intermittent. Which means that exposure is actually higher from a doppler.

What is the risk, you may ask? Doesn't everyone get at least one ultrasound and plenty of dopplers?

There are a number of possible risks. These include cell damage from the waves and from the temperature increase caused by the scan. Also because they are sound waves it is possible that the baby can actually hear them and that may be very disturbing to the baby.

Unhindered Living cites a number of studies:

Newnham, J.P., Evans, S.F., Michael, C.A., Stanley, F.J., & Landau, L. I. (1993). Effects of Frequent Ultrasound During Pregnancy: A Randomized Controlled Trial. The Lancet, 342(Oct.9), 887-891.

A study of over 1400 women in Perth, Western Australia compared pregnant mothers who had ultrasound only once during gestation with mothers who had five monthly ultrasounds from 18 weeks to 38 weeks. They found significantly higher intrauterine growth restriction in the intensive ultrasound group. These mothers gave birth to lower weight babies.

The researchers concluded that prenatal ultrasound imaging and Doppler flow exams should be restricted to clinically necessary situations. This recommendation comes at a time when ultrasound during prenatal visits has become increasingly popular and serves as a kind of entertainment feature of office check-up visits.


Campbell, J.D., Elford, R.W. & Brant, R.F. (1993). Case-Controlled Study of Prenatal Ultrasound Exposure in Children with Delayed Speech. Canadian Medical Association Journal, 149(10), 1435-1440.

Delayed speech is not a pathological or organic syndrome but developmentally defined symptom complex. Clinicians have noted an increased incidence of delayed speech in pediatric patients.

This is a matched-case control study of 72 children 2 to 8 years old presenting with delayed speech of unknown cause. The children were measured for articulation, language comprehension, language production, meta-linguisticskills, and verbal memory. When checked for ultrasound exposure, the speech-delayed children were about twice as likely to have been exposed to ultrasound than the matched controls.

The authors believe that delayed speech is a sensitive measure reflecting sub-optimal conditions for development. If ultrasound can cause developmental delays, the authors are concerned about the routine use of ultrasound and they warn against it.


Devi, P.U., Suresh, R., & Hande, M.P. (1995). Effect of fetal exposure to ultrasound on the behavior of the adult mouse. Radiat Res (QMP), 141(3), 314-7.

Pregnant Swiss albino mice were exposed to diagnostic ultrasound. There were significant alterations in behavior in all three exposed groups as revealed by the decreased locomotor and exploratory activity and the increase in the number of trials needed for learning. These results indicate that ultrasound exposure during the early fetal period can impair brain function in the adult mouse.


If I have no ultrasounds during this pregnancy, we won't have a chance to hear the baby's heartbeat until at 16-20 weeks, when a fetoscope or normal stethoscope could pick it up. Will my caregiver even own a fetoscope? If no ultrasounds are given, the caregiver will need to be hands on, palpating my abdomen and doing fundal measurements instead of relying on ultrasound technology. Will he be comfortable or willing? How much experience would he even have? The OB/Gyn I saw when I was pregnant with Micah never touched me except to help me on and off the exam table.

The benefits of routine ultrasound are a double-edged sword. Ultrasound is used to screen for abnormalities. An "all's clear" can give families a wonderful sense of relief and well-being. Unfortunately the false-positive rate is very high. Stories proliferate about families who underwent substantial stress due to the diagnosis of an abnormality, and then went on to have perfect babies.

How often does ultrasound detect something where that something can actually be treated and corrected? I can't think of many cases. I know one woman whose baby was diagnosed with a diaphragmatic hernia. (This diagnosis caused A LOT of stress for the family, because the survival rate with this condition is quite low.) The diagnosis allowed for arrangements to be made for the baby to have surgery shortly after birth- and he today he is perfect!!

In my mind, then, this is what it boils down to:

I have had two healthy babies. I am a healthy person. There is no reason to believe that this baby has any sort of abnormality. Chances of us being able to do anything about a potential abnormality before birth are very low. I would rather be able to enjoy this pregnancy to the end than spend much of it stressing out about possible problems. Stress is known to have a negative effect on pregnancy and baby. I believe that the risk from an ultrasound scan itself exceeds the risk from not finding out about some sort of abnormality. Therefore I am inclined to refuse ultrasound (and doppler) scans.

The complicating factor may be if this doctor has little hands-on experience and skill. If he would be unable to diagnose through palpation, for instance, that the baby were transverse (lying across the uterus instead of head down), then the risk of refusing ultrasound may indeed exceed the risk of having it. BUT, that ultrasound wouldn't have to take place until the baby were full term, and therefore somewhat less vulnerable.