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

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!

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."

My Visit with Abigail (midwife for Eva's birth)

I had a great visit with Abigail. She was so open and easy to talk to and she filled in most of the blanks I had about Eva's birth, and about childbirth in general.

She was running a little late so she gave me my chart to flip through, which was fun and interesting, and it gave me some time to make notes.

Here are some details of our discussion:

When my water broke during my labour with Eva, it was bright red with a tinge of green. I would have thought that would be alarming since bleeding can indicate placental abruption. So I was curious to know whether she was alarmed, since I didn't sense any concern about it. She explained that assuming the bleeding doesn't continue (and it didn't in my case) and especially if it's not accompanied by non-labour-related pain (which mine wasn't), it would be considered 'bloody show' and quite normal. The green was meconium (Eva poop) but it was thin and not a big problem. Probably by the time I got to the hospital and saw her my waters were clear or just tinged with thin mec and so there was no need for alarm.

I arrived at the hospital at 9am at 5cms, and by 4pm I was 6-7cms and my contractions were spacing out. She consulted with the OB on call and they started a pitocin drip. She said the hospital standards are to set up 5mu in a 500mL IV and set the drip at 1mu. Twenty to thirty minutes later if no change had been noted the drip would have been upped to 3mu, and so on. My records weren't clear about exactly how much I was given, but as I recall it didn't take much before things really got moving. The doctor's notes were that fetal heart tones were normal, reactive with variations, it was an average sized baby, my pelvis was adequate, baby was vertex occiput anterior, head not moulded and no caput (scalp swelling). His assessment was uterine dystocia and he recommended augmentation and analgesia as necessary. In retrospect Abigail still felt like it was absolutely the right call.

Eva was born 4 hours later. I pushed for 20 minutes. The placenta was came along spontaneously 8 minutes after Eva did. Abigail gave me 5mu pitocin 1 minute after that. She gave me the pit because I had been given pit during labour. Blood loss was within the normal range. Eva had apgar scores of 8 and 9 (or possibly 9 and 9). She weighed 3621g/8lbs. I had a second degree tear. Eva received an IM shot of vitamin K. Micah was born after 9 minutes of pushing. Sari gave me 5mu pitocin 1 minute after he was born. The placenta was born 3 minutes after that. She gave me the pitocin because she prefers to be proactive vs reactive. Blood loss was in the normal range. Micah had apgar scores of 9 and 9. He weighed 4089g/9lbs. I had a small labial tear. I recall Sari saying that it wouldn't have needed any stitches except that it was bleeding. Micah received an IM shot of 5mu of vitamin K.

I asked about using doppler to monitor fetal heart tones and she felt like it is the best way to go during labour. She said it's hard to hear with a fetoscope and really listen for variations while mom is labouring. She felt like intermittent auscultation monitoring about every 15-20 minutes gives a good feel for how baby is doing. I learned that not only is it concerning if baby's heart rate decreases dramatically, but also if heart rate is not variable. A flat heart rate could indicate that baby is conserving energy because of distress.

I mentioned that my blood loss with both kids was in the normal range (<500mL). Risk factors for post partum hemmorhage are: previous PPH, prolonged rupture of membranes, fast labour, large baby. I am planning to decline postpartum pitocin injection with this birth- as long as there is no substantial blood loss- and I asked Abigail her opinion of that. She thought that considering how quickly the placenta came along after my babies and that my previous blood loss was in the normal range, it would probably be fine to decline.

I asked about being GBS positive. She brought up something I hadn't considered. In her opinion it's harder on the baby to receive antibiotics as a newborn than it would be to receive them via the placenta while in utero. Ok, now I'm praying even harder that I'm GBS negative.

I asked about the WinRho/Rhogam shot as it relates to delayed cord clamping and she said that many birth attendants prefer to clamp on the early side with an Rh- mother because they want to make sure they can get a good enough size and quality sample of cord blood to send to the lab. Abigail said that she has experience in finding/using just the right vessel to access in the placenta so that even with delayed clamping she doesn't have a problem getting a good sample. Interesting. Also if this next baby's placenta comes along as quickly after baby there should be no problem getting a good quality blood sample. She didn't see any risk to the baby or to me related to delaying the cord clamp. As far as declining the prenatal WinRho/Rhogam shot, she wasn't too enthusiastic about passing it by. I look forward to reading the book I ordered so I can make the best informed decision about this. I hope I get it before we leave to go home to Mexico, because already my 28 week shot is pushed out to at least 33 weeks which is when I get back.

The other thing we discussed was vitamin K. Hemorrhagic disease of the newborn comes on quickly and can in rare cases cause severe brain damage. In fact, one of her colleagues has a baby who ended up nearly brain dead as a result of this disease. I had read that there had been a study linking vitamin K administration to childhood leukemia, and she said that there were a number of studies done after that one. None of them were able to reproduce the results and therefore that study is now considered invalid. I just did a Google search and found a recently released joint position statement of the Fetus and Newborn Committee, Canadian Paediatric Society (CPS), and the Committee on Child and Adolescent Health, College of Family Physicians of Canada. It mentions that the study linking vit k to cancer had been discredited, and strongly recommends an IM shot within the first 6 hours of life.

I was leaning away from giving this shot but now I'm leaning back toward it. It really bothers me that the routine administration of this shot kind of assumes that God forgot to take care of something somewhere along the way. Seems to me he would have made sure that baby has exactly what it needs when it's born. But maybe it's not about the baby missing something by design, maybe it has something to do with the food or air or water that we mothers are exposed to or choose to ingest which causes there to be a deficiency or imbalance. That wouldn't be so surprising.

I asked how she felt about the idea of not doing any cervical checks during labour. It was not a big deal to her. I think many or most mothers like to hear about their progress. She does often like to check right before pushing to make sure there's not a cervical lip. I saw first hand at Tara's birth that a birth can go very smoothly without a check at prior to pushing. She thought that a check would also give the birth attendant time to prepare him or herself for the imminent birth. Again, with Tara, it was pretty clear that birth was imminent. But of course that's only one birth. My plan is to hold off pushing until my body absolutely won't take no for an answer, and I plan to catch the baby myself (or perhaps Andrew will!) so I think that declining exams during our upcoming birth is a fairly reasonable request. Again assuming things move along smoothly.

We talked about Micah's birth a little and she described it as a "textbook 2nd birth". She said in many cases the third is very much like the second, though it does happen that it is much harder than the first. I had heard anecdotes about the third birth being kind of a wild card so while I am hoping and planning for a beautifully smooth birth I recognize that things don't always go as we hope and plan and I accept that. I am grateful to have expertise and resources available should they be needed.

See my comment on the previous post for followup thoughts about my big bump.

29 Weeks

This week your baby weighs in at 2.6 pounds and measures at about 16 inches. To help with the discomforts of pregnancy that you may be having at this time you should get plenty of rest, wear comfortable, supportive shoes and continue to eat a healthy balanced diet. If you haven’t started working on your birth plan, now is the time to get started! Be sure to get your partner’s input on this important document that will help guide everyone during your labor and birth.

Baby’s head is no longer disproportionate to the rest of the body. The senses are functioning and the eyes can move around inside the eye sockets. Little boy’s testicles are now moving toward their scrotum and little girls will have a prominent clitoris because it is not yet covered by the small labia, as this happens in the last few weeks of pregnancy.

Baby’s skin is becoming less wrinkly as they continue to add fat and gain weight. The uterus is becoming more cramped now and the kicks and punches that you have felt will probably feel less pronounced at this point. You’ll definitely still be able to tell that baby is there, though!

All is well. I have a cold and that is very annoying, but pregnancy-wise I still feel really great. No complaints at all. I have been going for chiropractic adjustments and he has noticed that my right hip is a little bit forward so that is what he has been working on. I think it's probably because of my somewhat heavy and low hanging purse so I've been shopping for a short handled purse which I think will be more comfortable. Yesterday I went shopping for walking shoes (couldn't make a decision) but I still wear my flip-flops daily, and very comfortably.

Everywhere I go people say I must be due really soon. I just smile and answer "not as soon as you think!" Mostly I feel pretty comfortable with it, but I do have a small worry that there might be something undesirable going on to cause me to be so big. I'm meeting with our midwife from Eva's birth today so hopefully she wouldn't mind logging an opinion. I saw our midwife from Micah's birth yesterday and she was kind of rushed so I didn't get her opinion on that. She did say a number of times how good I looked which made me feel happy.

Baby is moving around more than ever! Lots of twitching, rolling around, and kicking. So far nothing uncomfortable at all.

Yesterday I ordered Sara Wickham's book "Anti-D in Midwifery: Panacea or Paradox?". I agonized about it because it's quite expensive. Apparently it is THE go-to book for Rh negative expectant mothers. Decisions surrounding my Rh status are very important and I don't just want to rely on internet research since there isn't a huge amount of information available on it. Yesterday when I asked Sari about delayed cord clamping she said that she generally doesn't rush to clamp, unless the mother is Rh negative. According to her research there could be danger to the baby as the placenta comes away from the uterine wall. I was alarmed at first but the more I think about it the more it doesn't make sense. It is I who would be sensitized by exposure to the baby's Rh+ blood, but my blood has no Rh factor in it so exposure to my blood wouldn't be dangerous to the baby unless I had already been sensitized and started to produce antibodies. At least that's the way I understand it. I've done some further internet research with Google Scholar and the study abstracts that I found which addressed Rh- mothers and delayed cord clamping showed that it is especially important to delay clamping with Rh- mothers because early clamping could actually cause infant and maternal blood to mix as blood "backs up" through the umbilical cord to the mother's bloodstream.

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.

A Little More on GBS

This is a very comprehensive article about Group B Strep and antibiotics. Well worth the read for anyone pregnant or planning a pregnancy.

Here is an interesting excerpt:

While many studies have found that giving antibiotics during labor to women who test positive for GBS decreases the rate of GBS infection among newborns, research is beginning to show that this benefit is being outweighed by increases in other forms of infection. One study, which looked at the rates of blood infection among newborns over a period of six years, found that the use of antibiotics during labor reduced the instance of GBS infection in newborns but increased the incidence of other forms of blood infection.23 The overall effect was that the incidence of newborn blood infection remained unchanged.

Homebirth and GBS

Louise asked a very good question in her comment to a recent post. How would a positive GBS (Group B streptococcus) test impact plans to homebirth?

"GBS is a type of bacterial infection that can be found in a pregnant woman’s vagina or rectum. This bacteria is normally found in the vagina and/or lower intestine of 15% to 40% of all healthy, adult women." (American Pregnancy Association website)

GBS is not a problem or risk to the woman herself, but it is possible that the baby may become infected during the birth and become seriously ill or even die. For this reason many countries have a protocol to test women at approimately the 37th week of pregnancy. If they test positive for GBS, then antibiotics are administered intravenously during labour.

Antibiotics have proven quite effective at reducing the chance of baby becoming ill. However, the Cochrane Collaboration database indicates that there is not an impact on infant mortality. That is to say, though fewer infants get sick from GBS infections as a result of the mother receiving antibiotics during labour, the same number of GBS-related infant deaths occur regardless of whether antibiotics are administered or not.

There are a number of factors which indicate an increased risk of infant GBS infection:

- fever during labor
- rupture of membranes (water breaking) 18 hours or more before delivery
- labor or rupture of membranes before 37 weeks
- A urinary tract infection as a result of GBS during your pregnancy
- A previous baby with GBS disease

According to the CDC, if you have tested positive and are not in the high risk category, then your chances of delivering a baby with GBS are:

1 in 200 if antibiotics are not given
1 in 4000 if antibiotics are given

So. Less than 1% of babies will be born with GBS to a GBS positive woman who has not received antibiotics. What are the risks to the 99.5% of women taking antibiotics unnecessarily? According to Lisa Barrett's blog :

1 in 10 chance of an allergic reaction.
1 in 10,000 chance of a severe allergic reaction like anaphylaxis.
1 in 100,000 chance of death from taking antibiotics.

Also important to consider are the risks and impact of messing with the newborn's gut flora, and adding to the antibiotic-resistant bug problem.

Is there anything a pregnant woman can do to reduce her risk of testing positive for GBS? There are a number of home remedies that women have found effective at eliminating GBS. Natural substances used for treatment include probiotics, garlic, vitamin C, vitamin B6, grape seed oil, colloidal silver, and tea tree oil. Antibiotic treatment prior to labour will not protect the baby during birth, since the GBS could recolonize between the time of treatment and when labour begins.

I can't find the source of this percentage right now, but I believe that 90% of babies experience early onset GBS infection, where symptoms present within hours of birth. They include:

- Breathing problems, heart and blood pressure instability
- Gastrointestinal and kidney problems
- Sepsis, pneumonia and meningitis are the most common complications

Baby is then treated with antibiotics.

When I was pregnant with Eva, I believed that if I tested positive for GBS at 37 weeks, there was no way around IV antibiotics. If I had only known, I could have tried some of the natural remedies and been retested prior to going into labour. As it was I dragged around an IV for the 14 hours of active labour, had at least two courses of antibiotics, and I blew up like a balloon from all the fluids. Unattractive and uncomfortable. I would have at least asked them to turn off the IV between course of antibiotics. I was so relieved when I tested negative when I was pregnant with Micah. But who is to say that I wasn't positive at 39 weeks- GBS comes and goes, without symptoms. Or that I wasn't negative by the time Eva was born.

The protocol isn't perfect, that's for sure. It tries to reduce risk, but it also assumes that antibiotics are free of risk. Which isn't true.

So to answer the question. If I tested positive (and continued to test positive- because I would aggressively pursue the home remedies and retest at least weekly) and chose to accept antibiotics, then probably my OB could hook me up to an IV here at home. In Canada or the US it may be a different story as I don't believe midwives are allowed to administer drugs. I have read of labouring women going to the hospital for their antibiotic treatment, then returning home to give birth. And there are also women who refuse the antibiotic treatment despite a positive test.

If I tested positive right up to going into labour, and didn't have any of the high risk factors, I'd think long and hard about accepting antibiotics. It's just not such a straightforward decision as many of us have been led to believe.

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.