36 Weeks

Last fall, when I found out I was pregnant, there was a lot of speculation among friends and family members about all the unknowns. Would I deliver early again? Would it be a girl or a boy? When asked what I thought, I once said, "Oh, I don't know, but a small, six pound girl born at exactly 36 weeks with no NICU time would be nice."

Two months into this pregnancy, my friend Heather gave birth to a small, six pound girl at exactly 36 weeks with no NICU time. I knew then that for me it would be a completely different story.

It's hard to believe that in just a couple of months time, I've gone from obsessively wanting to keep this baby in to now wanting this baby to come out (well, soon, at least). I RSVP'd to a birthday party yesterday for June 7, thinking that hopefully, by then, this baby will be here. I'm going to state right now for the record, if I go into June, I'm going to be pissed. If I go to 42 weeks (June 11), this will be a pregnancy that was two months longer than my previous one.

Weights and Measures

Well, apparently I do have that much room in me for a baby. And measuring at 32 weeks means nothing.

The ultrasound went well, although I knew it wouldn't be very exciting. When the PA had said to me on Wednesday, "At least you'll get another look at the baby!" My thought was, "Well, not really..." I'd had an ultrasound at around 28 weeks with the Monkeyboy and I remembered how crowded he'd been then. I couldn't even begin to imagine how cramped and pretzel-like this baby must be at 35 weeks.

Uh, pretty damn cramped and pretzel-like.

The ultrasound tech was very nice, one we'd had before. Although I could see the ultrasound screen they have angled for the parents to view, I couldn't read the measurements at the bottom. I saw the Hubster shift in his seat so that he could read them, so I knew he'd tell me later. (I almost wish he hadn't.)

After taking her time with all the usual measurements, including checking the amniotic fluid level, the tech spent a long time trying to get us a good 3-D (4-D?) ultrasound picture. I've always thought they were kind of creepy, but I guess when it's your baby, it's a little cooler. Kind of creepy-cool. But it still kind of looks like a generic baby, all smooshed up.
The baby kept his hand in front of his face almost the whole time (I'm sure due to the general smooshed-ness), but the tech was very persistent and even had me change positions a couple of times to try to get a good face shot. (I think she felt badly that we hadn't been able to get a video last time because they didn't tell us that they'd switched to DVD. I noticed that now in the waiting room, they have a sign that says you can buy a DVD or CD.)

After all if this, the tech left to make some calculations. When she returned, here's what she laid on us: The amniotic fluid level looks fine. The baby looks just fine and based on the measurements they took, they can estimate the baby's size at this time. The baby is not measuring small for dates like the PA worried.

Now, just for fun, let's peruse a few selections of Your Pregnancy, Week by Week (Remember, I'm at 35 weeks):

Week 35 "Your baby now weighs over 5 1/2 pounds." Uh, no. But that's about what the Monkeyboy weighed at 34 weeks.
Week 36 "By this week, your baby weighs about 6 pounds." Keep guessing.
Week 37 "Your baby weighs almost 6 1/2 pounds." Getting warmer...
Week 38 "At this time, your baby weighs about 6 3/4 pounds." Ding ding ding ding! We have a winner!

Right now they estimate the baby weighs about 6 pounds, 12 ounces. At 35 weeks 2 days. Now, I know that ultrasound estimates of the baby's weight are notoriously inaccurate, but it's hard not to get wrapped up in the numbers.

She said, "If you go to full term, we think the baby will weigh about 9 pounds, 1 ounce."

Part of me is hardly shocked by this. When I was pregnant with the Monkey, I kept saying "If he goes to full term, I expect he'll be at least an 8 pound baby." My mother-in-law once asked me why I thought this, as the Hubster wasn't that big at birth. "What did he weigh?" I asked her, although I knew the answer. "7 pounds, 15 ounces," She answered. "You do realize that one more ounce would be eight pounds, right?" I asked.

Research about pre-term infants suggests that by their due date, they have caught up to what their birth weight should have been. By his due date, the Monkeyboy was 8 pounds 3 ounces. I myself had weighed 7 pounds, eleven ounces 35 years before when I was born (although I'm a short little thing now). Babies are just getting bigger these days, for a variety of reasons (like more nutritious foods and moms who don't smoke through pregnancy or try to keep their weight gain to the recommended twelve pounds that was told to OldChristine's mother back in 1970).

Now, I know that ultrasound estimates of fetal weight are notoriously inaccurate, with a margin for error reported, in the past, as being as high as 15-18%. However, they're getting better. My research shows that while these estimates are somewhat unreliable when done after 37 weeks gestation (birth weights currently reported as within 11% of estimates), they're considerably more reliable when done between 34 and 37 weeks (birth weights closer to within 6.2% or less of estimate). Much of the reason for ultrasounds being unable to reliably predict fetal weight after 37 weeks is that often by then, the baby's head is engaged low enough in the pelvis that an accurate measurement can't be made. So I guess there's something to be said for the -2 station he's been riding at, after all. The Hubster reported that when the ultrasound tech was determining the head circumference, the measurement came back as 37 weeks 4 days.

How is it that my fundal height suggests 32 weeks, but the ultrasound suggests a fetal weight of 37-38 weeks? I'm only 5'2"! Where the hell is this baby finding the room? Is my uterus a biological tardis, with more room on the interior than the exterior? Or is this an indication that in my case, the ultrasound is inaccurate and I'm just having an average baby?

Nobody is more aware of the truly ironic dichotomy presented by two of my biggest birth fears. First, that I would pPROM again and this baby would be born even earlier than the Monkeyboy. That obviously didn't happen. Now I can replace that with the newfear, first foreshadowed by my 18-week level II ultrasound back in December, that this will be the Incred.ible H.ulk Baby.

When I raised this concern months ago with my OB (and reminded him that he commented on my small pelvis size during my first birth), he said we'd revisit the subject again if it became an issue. By the time I see him again on Wednesday, I'll be 36 weeks and the baby, if the ultrasound is even reasonably close to accurate, will be about seven pounds (estimates usually add at least an ounce a day). I think the time has come to revisit this subject. (Fears: cephalo-pelvic disproportion, c-section due to macrosomia, shoulder dystocia, second-, third-, or fourth- degree episiotomy, among others).

I don't know that there are any good answers to my questions or solutions to my concerns, but I'd like to start thinking up strategy. What I'd love is for this baby to decide to come on his own sometime within the next couple of weeks. I'd be open to discussing an induction after that point, after about 38 weeks, if my Bishop's Score improves, but not before there's some progress. My biggest fear is that I'll just go to term with no plan, a possibly too big baby (for me) and the big sword of "what if" hanging over my head.

Wednesday Afternoon Slap and Tickle

We interrupt the regularly scheduled programming for a current news update. Conclusion of Monkeyboy's birth story will come soon, I promise.

Yesterday was my weekly appointment (35 weeks), which for the last several weeks has gone past the usual wee n' weigh to include a check under the hood. As I told the Hubster the other day, "I'm getting more action from my doctor than I am from you these days." In the matter of good news/bad news, the good news is: I'm not progressing; the bad news is: I'm not progressing (I don't want to be pregnant forever, okay?)

Progress is usually calculated using the Bishop Score, which is comprised of five components: cervical dilation, effacement, consistency, position and the baby's station. Although the PA threw me a bone by saying the baby is at a -2 station (moving him ever so slightly south from the -3 where he's been), everything else on that list was a big negative. My cervix is still long, firm, closed and posterior (so for effacement, consistency, dilation and position, that's a big no, no, no, and no progress). The good news is that, for now, this baby isn't going anywhere. The bad news is that, well, is he ever going anywhere?

The baby's heart rate was around 142. My weight is at 154 1/4 which is a two pound weight gain since last week (but averages only to a pound a week since I hadn't gained any last week. It's only a 29 1/4 weight gain overall, so that puts me at where I was nine days before the Monkey was born (I only weigh myself at the doctor's office). My blood pressure was somewhat elevated (for me, that is), at 138/60 (I'm usually about 110/60 max), but there's no protein in my urine and I have no swelling going on, although, apparently swelling isn't considered to be the significant factor it once was when diagnosing pre-eclampsia. And of course, HELLP syndrome is high on my list of things I like to obsess about during this pregnancy, so it's always nice to have another, related concern along for the ride (especially because I've had low grade headaches, slight nausea, and pain under my right-hand ribs for the last few weeks -- all of which I forgot to ask the PA about).

The baby is still head down, and the PA commented (for the third time now) that it was a very clear exam. She had a student with her and asked if the student could palpate my uterus to see what it felt like, because it was so obvious. They played around for a few minutes, feeling for body parts. It was interesting hearing them talk about it, because it confirmed what I've been thinking I could feel when I do the same thing to myself. The PA (really wish I could come up with a cool pseudonym for her) told the student that it was not always as easy to tell on some women and commented that my exam was so clear because I'm so petite and really "all baby." This is a double-edge sword, as we will see in the next paragraph.

The most significant factor right now -- and there's always something, isn't there? -- is that I'm measuring 32 weeks at 35 weeks. For the last month or so, pretty much since I started my weekly appointments, I've been measuring a little behind where I should. At first, it was only by a week, which really means nothing, but then it was by a couple of weeks and now by three weeks, so tomorrow I'm going for another ultrasound. The PA said she wanted to make sure that I didn't have low amniotic fluid and that the baby was measuring appropriate for the date. She also said not to worry, that the small measurement could be due to the fact that, as she had said before, I am very petite and "all baby." I'm trying not to worry, but my mind goes in all sorts of unpleasant directions. I'm not the only one. After I called the Hubster to tell him I was scheduling the ultrasound, he texted me "What is she concerned about? IUGR?" ( We have a friend whose first baby was an eight-plus-pounder, but then had two IUGR babies.) I've said it before: In pregnancy, anything's possible.

As I mentioned the other day, I've never been this pregnant before, so it's hard to know what to expect at this point. Is it possible that I just don't have that much room in me for a baby? I remember reading on a message board a comment by a women who had had three pre-term babies. She said they had all been born healthy and with developed lungs, even as early as 32 weeks. She said her doctor suggested that since she was petite, it was like her body got the babies ready and just said, "Five pounds and... you're out!"

I also had the Group B Strep test done, which, if the past is any predictor of the future, will end up being some further complication I have to deal with. (Sorry for that dive back into the Sea of Pessimism.)

Edited to Add: All afternoon I felt pretty crappy, had a headache and just felt terrible. The more I thought about my blood pressure at yesterday's appointment, the more it bothered me, so I stopped at the drugstore and took my BP this afternoon, which registered at a reassuring 118/65.

Uncharted Territory (or the Monkeyboy's Birth Story, Part 2)

I have never been this pregnant before (and I can say that every day until this baby is born). With the Monkeyboy, at what would have been 34 weeks 6 days, I was holding him in my arms in the rocking chair in the NICU. While I try not to dwell on the increasing discomfort that the next, possibly-five weeks are sure to bring (remember, I'm still in denial about the possibility of going overdue this time), I'll try to finish the Monkeyboy's birth story.

* * * * * * * * * *

Part 2...

I continued to leak amniotic fluid as I cleaned up the puddle I'd made on the bathroom floor, and called the Hubster. "Where are you?" I asked.

"I'm on my way home for lunch," he replied. It was about 11:30 a.m. on Saturday.

"Good, because I think my water just broke. I'm going to call the doctor. See you when you get here."

I called the answering service and waited for the doctor to call me back. After asking me a few questions (he was probably trying to make sure I hadn't just peed myself), my OB told me I should head in to the hospital (it's an hour long drive for us) and, if they determined that my water had broken, he'd be in to see me.

I got dressed and finished throwing together my hospital bag. I was very glad that I had struggled through my shopping trip of the night before. The one thing that I was lacking were comfy socks to deliver in, but nothing could be done about that (although I did briefly consider stopping at Wa.lm.art on the way to the hospital).

When the Hubster got home, he packed a bag for himself, too. "So if the hospital determines that your water has broken, what then?" He asked.

"They'll deliver the baby."

Oddly, I was not scared by what was going on. What a difference nine days make. It was simply the magical number "34 weeks" that gave me peace of mind. My friend, OldChristine, had eight-year-old twin sons that had been delivered by the same OB at 34 weeks. I knew that they had been fine and had required a NICU stay of less than two weeks. That single bit of information kept me from feeling anxious. Also, I knew that if my water had broken and labor started, at 34 weeks the hospital would not try to stop it, so, in effect, that train had left the station. All we could do was ride it out.

We threw our bags in the car, and at the last minute, I grabbed all of the baby name books and tossed them in, too. We had been going 'round and 'round about baby names since we found out the sex. Finally, a few months before, we had decided to table the discussion until the beginning of November, six weeks before the baby would be born. At this point we were each to have a list of five to ten serious contenders, which I was confident we could narrow down before the baby was born. I had been sick since the beginning of October and had not made my list yet (although we were five days into November, already). The Hubster took a piece of paper out of his wallet and waved it at me.

"I guess I get to name the baby, after all." He said, teasing.

As we got in the car, I used my cell phone to call OldChristine. She was shopping with her hubby (one of the Hubster's best friends) and sons, who were all excited when I told them what was going on. I told her I'd call her when we got to the hospital and knew what was happening. Other than the Hubster calling work to let them know he wouldn't be back, this was the only phone call we made. Until we knew what was going to happen, I didn't want to start calling family. I'm the opposite of a drama queen, more of a private, Greta Garbo-"I want to be let alone"-type. The last thing I wanted was anyone showing up at the hospital. OldChristine had expressed a desire to be there, and she was the absolute single person other than the Hubster that I was willing to have in the delivery room (other than the obvious necessary medical personnel).

By the time we made it to the hospital (after driving through a Wen.dy's on the way, because I knew the hospital wouldn't let me eat once I got there), registered and were placed in a triage room, it was about 2:30 p.m. I had soaked through the giant pad I'd put on to contain the amniotic fluid. There was a big wet spot on the butt of my jeans. The nurses and resident that saw me asked if I was sure of my gestation (I put that to bed pretty quickly with a discussion of fertility meds), asked my plans for pain relief ("An epidural," I told them. "Well, probably crying, and then an epidural."), and checked to see if my water had really broken. The resident said they use three tests to check for amniotic fluid, to make sure that at least two agree. I know they tested with a nitrazine strip and did a slide to check for ferning, but I can't remember what the third test was. I do know that the tests (like four out of five dentists quizzed on Trident gum) agreed -- my water had broken.

At this point, I'd been having only some low back pain, nothing I could label as contractions. Instead, it was more like menstrual cramps. Before doing a cervical check, the resident asked me if I'd had any leaking prior to that day. As I thought about it, I realized that I probably had been leaking since Wednesday or Thursday of that week. I remembered how at work, by the end of the day, I'd felt "sweaty," and that because of that I'd changed my pantiliner before leaving work. The more I thought about it, it occurred to me that it was a "wet" feeling, not like anything I'd had before. I told this to the resident and then added, "I probably should also mention that last night I took a bath."

The resident did a cervical check around 3:00 p.m. and declared me to be "maybe one centimeter." She tested me for Strep B, since it hadn't been done yet, and the test came back as inconclusive. So for that reason, as well as the bath issue, she decided to put in an IV , so she could start me on antibiotics. I've always been complimented by phlebotomists on my large, cooperative veins (comments like, "You must work out"), but the person they sent in to put in my hep lock took several, painful tries before she asked for help. The nurse hooked me up to a contraction monitor and a fetal heart rate monitor. Then the resident said she was going to call my doctor and she'd be back to check on me. It was more than two hours before we saw her again.

Around 3:30, a nurse came in to check on me. She said," Umm, your sister's here?" I was starting to get uncomfortable, so I apparently wasn't very patient or nice to her. I hardly remember the conversation, but the Hubster told me about it later. His actual words were, "and then you were mean to that nurse."

When she told me my "sister" was here, evidently my response was a curt, "That's impossible." (In retrospect, I'm sure it made sense. After all, we still hadn't called our families yet.) The nurse persevered. "A woman... about your age... long dark hair... she has two boys with her?"

"That's OldChristine." I snarled. "She's insane."

Since only one support person is allowed in triage (the rooms are very small) -- and I was starting to act just a little like Regan from The Exorcist -- the Hubster generously offered to step out so OldChristine could come in. He also said he was going to call our families.

"Be sure to tell them not to even think about coming to the hospital, that we'll call them when we want them here." I ordered, as he fled from the room.

OldChristine came back, very excited to be there. She said they had been shopping nearby and, since they hadn't heard anything, they stopped to see what was going on. I told her we were waiting for the doc to show up , but that they said they would probably move me to labor and delivery soon. OldChristine and her husband were going to drive home to drop the boys at her mother's and were going to come back to the hospital. "Stop at Wa.lmar.t and bring me some comfy socks," I told her, before she left and the Hubster returned.

In the meantime, the Hubster's phone began to ring. And receive text messages. (I had turned my phone off when we got to the hospital). When he'd called work to tell them he wouldn't be back, he had told them that my water had broken (I didn't know that's what he said up to this point). Through an odd set of circumstances, the wife of one of his coworkers (who wasn't even working that day!) had found out. She was also the friend that I'd talked to that morning just before my water broke. She was also the biggest gossip in our group of friends, coworkers and acquaintances. She was digging for information as to what was going on, because she wanted to be the first to know, so she could spread the word. I just wanted to be left alone. We just called our parents, for Pete's sake. When she didn't get any response from us, she proceeded to call or text every other person that we both knew in common and ask them if they had any information. This is how all of our friends found out I was in labor.

By now, I was definitely feeling something. A painful something. An unending, unrelenting, painful something. Although the Hubster and I tried to interpret what we saw on the monitor, we couldn't tell when one contraction stopped and when another one started. Apparently, this is because once contractions started they came one on top of another, with almost no rest in between. I didn't even have time to catch my breath.

Since we hadn't seen the resident in over an hour, I hadn't seen a nurse since the one I was mean to had brought OldChristine back, and my doctor had yet failed to arrive, I told the Hubster that he needed to go find someone and tell them I needed something for pain. He returned from his mission to say that he had told someone at the nurses station.

And yet, no one came to check on me.

After another half an hour -- which felt like one long, body-tensing contraction -- I sent him back out to the nurse's station. He returned again, saying this time that he had found the nurses and the resident (Remember her? The one who said she'd be back to check on me two hours ago?) watching TV. He said he was less than nice to them, and that they were right behind him. It was now about 5:30 p.m.

When they walked in the room, I was doing my best to bear the pain. I was straddling the bed and leaning forward to try to alleviate the tautness of my body, to get some relief. My entire body felt tense, from shoulders to hips. I still was unable to tell when contractions began or ended; it was just constant pain. I had tears running down my face.

"Oh, honey," the nurse said. "You said you were going to cry, but I thought you were only joking!" Suddenly, the resident was all business. She checked me again and said I was a little over three centimeters. She and the nurse started to make arrangements to move me to an L & D room, so I could get the epidural I wanted.

To be continued...

34 Weeks 5 Days (or the Monkeyboy's Birth Story, Part 1)

This was the point during my pregnancy with the Monkeyboy where he was born. I thought I'd commemorate this pregnancy milestone by finally writing the story of his birth (two and a half years later).

* * * * * * * * * *

The story really begins nine days earlier (at 33 weeks 3 days, for those of you playing along on the home game), when I arrived at work on a Thursday morning and stopped in the faculty restroom for my pre-homeroom pee break to discover that I was spotting. Since I hadn't seen blood in, oh... 33 weeks 3 days, I panicked and immediately called my doctor's office. They said it was probably nothing to worry about, but to come in anyway just to be sure (I had been there only two days prior for a routine wee n' weigh check). I started to cry a little when I told my principal I had to leave, because I was scared. It was only the end of October -- and I wasn't due until the middle of December. My due date seemed like a long way off. The Hubster met me and we drove in to the office. On the way to the office, I had my first couple of real contractions (actually, I never noticed Braxton Hicks contractions during that pregnancy at all), but it was only one or two. When I returned to work, I told a pregnant friend there (another first-timer) that I had a couple of real contractions and, "For the record... Ouch!"

At my OB's office, I was seen by the PA and her intern. They did a pelvic, declared my cervix to be long and closed (I swear I remember her saying "high and tight" because it made me think of a Marine's haircut), but discovered that I had a BV infection and a yeast infection. Lucky me; two for the price of one. For good measure, they also did a non-stress test, which found the baby doing just fine. I was sent home with a couple of prescriptions and the usual admonition not to engage in "relations," including those of the oral variety. The next morning I was still spotting a little, so I took another day off work. Since it was Friday, one more day gave me three days to rest before returning to work the next week.

By Monday I felt just fine (well, as fine as I could at that point in my pregnancy), so I was back at work. I had a new fire lit under me with the recent scare, so I frantically tried to finish getting ready for my long-term substitute. I was also trying to get my labor/hospital bag ready at home. By the end of the week, I was tired and felt terrible. In fact, I felt so terrible by the end of the day Friday that during my the last class I had another teacher watch my students for a few minutes so I could run (okay, waddle) to the nurse's office.

"Do you have a BP cuff?" I asked her when I walked in. She laughed.

"Usually teachers come in to ask me if I have a bandaid. What's wrong?" I told her I just didn't feel right, so I wanted her to check my blood pressure. She checked it, and said for good measure she'd take my temperature, too, but eventually declared everything to be normal.

"I guess I just feel like crap because I just feel like crap," I commented after I thanked her. I returned to my class and finished out the day. But I just still felt "off." It was nothing I could describe -- I just felt miserable.

It was the Hubster's last weekend scheduled to work "before the baby comes," which meant he was working that Friday night. Although I was tired and felt miserable, I still went shopping to finish getting what I needed "before the baby comes." I remember complaining on my cell to the Hubster as I drove to Ta.rget. He suggested that if I felt that bad I should just stay home, but I told him I just wanted to finish my preparations -- things like getting a nursing bra -- so that I could maybe relax a little.

My shopping seemed to take forever. They were either out of what I needed (like comfy socks for delivery) or the choices were completely new to me (I had never bought a nursing bra before). I was also not operating at peak performance due to the way I was feeling. I think I spent about fifteen minutes standing in front of the maxipad selection alone, trying to determine what I needed for postpartum (since I hadn't used them since junior high). On the drive home after my marathon shopping trip, I was so tired, felt so strange, and yet was still being plagued by my usual late-pregnancy complaints (like tingly, painful hands that fell asleep as I drove), that I cried. In retrospect, driving along, alone in the dark, crying, was not a good sign. At the time, though, I didn't see it as a foreshadowing.

At home, I soaked in a bath because it sometimes reduced the swelling in my feet and calves and calmed the restless leg syndrome to help me sleep. Then I went to bed, determined to sleep in the next day. I also had plans to do laundry and clean my house. These needs had built to embarrassing proportions because I had been so sick for the last month, I could do nothing but lie around and try to feel better.

Saturday morning, I chatted with a friend of mine on the phone (she had just had her baby nine days previously, the day I had started spotting). She asked what I had planned for the day, since the Hubster was working, and I said, "I'm going to go to the grocery store, then come back, do laundry and clean my house."

I got dressed and, before I left the house, decided to check something in one of my pregnancy and birth books. As I bent over to get the book from a low shelf, I sneezed and felt a small gush of fluid. Did I just pee myself? I wondered. I had just gone to the bathroom, but knew that in late pregnancy, just about anything's possible. So, back to the bathroom I went, to be absolutely sure this time that I emptied by bladder. As my little "accident" had overflowed my pantiliner, I changed my clothes from the skin out. Then, while washing my hands, I felt another small gush of fluid. What the hell?! I thought, although it was starting to dawn on me what was probably happening. Remembering that the Girlfriend's Guide to Pregnancy said if at all possible, take a shower as soon as labor starts, since you don't know how much longer it will be until you get another one, I decided to take a shower before I went to the grocery store, just in case. I undressed, and as I crossed the bathroom to the shower, the floodgates opened. This was no small gush. It was absolutely, undeniably, obvious to me that my water had just broken.

To be continued...

No credit for time served

Julie over at A Little Pregnant came up with this concept, refuting the idea that if you've suffered with infertility, your subsequent pregnancy and birth should be smooth sailing. And although my first pregnancy wasn't as tough as some women's, and eventually had a good outcome, it wasn't exactly a dream cruise, either.

This time around, I've been expecting all along to be hit by not only my old battery of symptoms and side effects, but a whole new barrage of uncomfortable experiences. And at 34 weeks 4 days, I'm still waiting.

Sure, I've had a mild recurrence of restless leg syndrome, but it's been very sporadic and hardly worth mentioning. And some days my hands seem a little puffy and stiff, but I've avoided the carpal tunnel and ulnar neuropathy that made my upper extremities numb, useless stumps last time. The only real condition of concern is my anemia. At this point, my hemoglobin is up to 10.6, so it has been creeping upward, just incredibly slowly. And the most recent bloodwork I had done was not reassuring to the PA, who at this weeks appointment asked me to up my iron to twice a day, although she noted, "sometimes all that does is double the side effects without really increasing the absorption," so I'll be having bloodwork done again this coming week. She rattled off the entire results of my most recent bloodwork, but most of it meant nothing to me. The one alarming thing she mentioned and -- sort of -- explained was that my "stores" were at 6, when they should be over 100. I've subsequently been trying to figure out exactly what that means, but I can't. (Could she be referring to the mean cell volume? I have no idea...) She did say that if things don't look up, she might refer me to a hematologist.

I feel like I'm bragging when I check off my list of fears in the negative. Baby is still vertex LOA and at about a -2 or -3 station ("still ballotable" according to the PA); at this point my weight gain is a respectable 27 pounds (holding steady since 33 weeks); I'm BV-free and yeast-free; the fFN test they did Wednesday at exactly 34 weeks came back negative. For Pete's sake, I'm even still wearing my normal-sized shoes. Other than the extreme fatigue that accompanies the anemia, this has been a picture perfect pregnancy. I feel pretty good most of the time. I don't just feel like I can reasonably hope for a term baby, I'm fully expecting one.

So why does this lack of worrisome symptoms have me worried? I didn't expect, and frankly don't feel I deserve, such an easy time of it. So I keep expecting some bogeyman to jump out and surprise me. I have a nagging feeling that there's something terrible lurking that I just don't know about yet. I'm well aware that with potentially six more weeks of pregnancy ahead of me (okay, possibly even eight weeks, but please don't wish going past due on me -- it would certainly push me over the edge), there's still a lot that can go wrong. With my blood-related concerns being the only real complication so far, I'm starting to really worry about the birth. I was expecting that if I reached this point and felt as good as I do, I'd be relaxed and enjoy it, but instead I'm feeling more anxious. I'm beginning to wish that this was over soon, that May could just get here, damn it, just so I could put my anxiety to rest.

I touch the future. I... yadda yadda yadda*

I teach. I don't write much about work here, mainly because I don't want to get dooced. Yes, I admit that the real reason for avoiding discussions of my work is not because of some high moral imperative about not making fun of students and coworkers. Believe me, if it weren't for that, I'd have some real gems to share.

It just so happen to work out that my due date is two days before the last day of school this year. Virtually every single person, upon asking my due date, responds, "You planned that perfectly!" Although I've had it said to me dozens of times, I still don't have a response prepared. I usually just say nothing, or change the subject.

When I was pregnant with the Monkeyboy, his due date was mid-December, right before holiday break. A coworker remarked the familiar, "you planned that perfectly," to which I replied, "Well, when we started trying two years ago, we were aiming for May." She didn't say anything after that. I didn't mean to be curt; I just wanted to set the record straight.

I know that in terms of infertility and treatment, I've only experienced what can be considered Entry-Level Infertility Treatment (What Akeeyu calls Clomid and Fucking). We were lucky that Clomid worked for us. It's really the gateway drug of infertility meds, after all. Many people move on to bigger, scarier, more expensive and more powerful treatment. But just because on the spectrum of infertility treatment we were at the "easy" end, that doesn't mean it was easy. Not when judged in the overall fertility arena. (You know that arena, the one with events like "We got pregnant the first month trying" and "Our fourth child was an accident.")

I feel compelled to educate people about fertility and infertility (I've certainly developed a reputation as the go-to girl among friends and at work to women who have questions about getting pregnant). But, why is that? Am I really looking to "help" people and inform them, or am I looking for getting credit for my own struggles? It's probably a little of both.

So today, in my bag, I carried to school to loan to a friend and co-worker, Taking Charge of Your Fertility (book and software) and a few copies of my very own favorite BBT charts, because she is in her thirties, getting married this summer, and "wants to start right away." (Don't worry, she asked for my "help;" I'm not big on giving unsolicited advice, especially of the personal nature.) And I've told her I'll teach her "everything I know."

As a planner of things by nature, infertility has made me painfully aware that some things are out of our control. And I hate it. It's not the actual struggle to get pregnant that I hated and still resent, it's the uncertainty. If I would have been told, "it will take XX years and XX dollars and XX sometimes-painful tests and treatments to get pregnant," but there was a guaranteed baby at the end of it all, then I know that every woman suffering from infertility would say, "Where do I sign up?" But, we all know women who have sacrificed physically, financially and emotionally to treat their infertility and still are left with nothing but empty hands and a head full of unanswered questions. With years of hindsight, I'm able to realize that I'm very lucky to have been able to get pregnant at all. And planning a pregnancy is such a foreign concept to me that I just freeze at the mention of the word, dumbstruck.

So, I guess my response to the comment, "You planned that perfectly!" should be, "No, neither of my kids are planned. But they are very much wanted."

*With my apologies to the memory of Christa McAuliffe.

A Long Hallway with a Closed Door

Nothing new here, nothing to report. My cervix is still long and closed, the baby is still head down (vertex LOA, that is), the baby's heartrate is still around 138, and I've gained 1.5 pounds since last week (total gain, 27.5 pounds).

I feel so very different from how I felt at this point in Monkey's pregnancy, that I am optimistic... confident, even, that I'll go to term.* (Let's not dwell on how big this baby will be at term and how I am praying I don't go late by one second. Suffice it to say that at nearly six weeks pre-term, the Monkeyboy was not even considered low birth weight for a full term baby. And second babies are usually larger.)

I go back next week. At this point, I've had more action at my doctor's office in the last week that I've had at home in the last month. Unfortunately, it doesn't look like that's going to change.

*And this is where I should make a comment about hoping I'm not jinxing myself, but I don't feel it. Nope, just don't feel jinxy at all.

A Woman's Place is in the House... and in the Senate

I just learned Pennsylvania Senate Bill 387 left the Senate for the House of Representatives. If it passes, Pennsylvania parents of stillborn children will be able to get a certificate of birth resulting in stillbirth. I wasn't aware until very recently that in many states (and PA is apparently still one of them), parents of stillborn children do not get any sort of birth certificate at all. Trite as the expression is, there's no better way to sum it up than to say: that's adding insult to injury.

One of my oldest, best-est friends (back to kindergarten... and we were each other's maids of honors twenty years later, too) lost a son at twenty weeks gestation, so although I haven't been there personally and can't empathize, I can sympathize. Although she had C-sections for her other three children, this was the only one that she was able to deliver vaginally. She delivered him. He may not have been born live, but he was born.

As of last May, there were three states that offered birth certificates and provided tax deductions for stillborn children (Arizona, Missouri and Indiana). Seventeen states offer birth certificates for stillborn children. Seven (including Pennsylvania) are considering bills to offer birth certificates. "In the laws, the gestation period at which a fetal death is considered a stillbirth rather than a miscarriage varies among states, with some starting as early as 20 weeks."

New Mexico's governor (Bill Richardson, recent Democratic candidate for president) vetoed a bill last year to allow certificates. Part of the reason for the veto was the concern that anti-abortion advocates would use the legislation to undermine abortion rights. I understand these concerns. I'm adamantly pro-choice. I've marched for women's reproductive rights in Washington, D.C. I've helped more than a few friends sort out unplanned pregnancies, even going so far as to be the support person who drove one to the clinic on the day she terminated. I'd like to think that there's a logical answer to resolving this issues and concerns, but I know well enough that when it comes to reproductive rights, common sense seems to fly out the window. However, I'd think that the language used would be a start. A New York Times article from last year states that stillbirth is "generally defined as a naturally occurring, unintentional intrauterine death after more than 20 weeks of gestation." So, how about we start there? It's not perfect, but it's a start.

I don't have all the answers, but that doesn't mean that we should stop looking for them.

If you're from Pennsylvania, and so inclined, you can send a message of support for this bill to the House by visiting here.

Update

Fetal Fibronectin test was negative. (Insert more wooting/dancing here.)

32 Weeks

Actually, Wednesday of this week marked 32 weeks. I also had an OB appointment that day, and since I never posted an update after my 28 week appointment, I'll jam information from both into the same post.

Most importantly: The baby is head down. (Isn't this where I should insert a little "Woot! Woot! and then dance around raising the roof?) My appointment was with the Physician's Assistant (PA) who said, when I quizzed her on the baby's position, that it was a "very clear exam." So it seems, for once, I knew what I was talking about. I now have one fewer thing to obsess about, so that opens the way for all new sorts of obsessions and fears to jockey to take its place.

I almost titled this post Vagina as Petri Dish, as I have another BV infection, also known in my house as the "Holy- shit- my- water- just- broke- at- 34- weeks- infection." After checking the slide, the PA said that there was "just a little bit of bacteria," not a full-blown infection, but that she wanted to treat it anyway. I agreed. Apparently, I am just prone to having the balance of my good bacteria thrown off. (Interestingly, the Wikipedia article linked above cites a "2005 study by researchers at Ghent University in Belgium [that] showed that subclinical iron deficiency (anemia) was a strong predictor of bacterial vaginosis in pregnant women.") Luckily for me when I am not pregnant, these infections personally manifest as symptom-less, so they're not a bother. Unluckily for me when I am pregnant, these infections personally manifest as symptom-less, making it hard to detect and treat.

Just like every time I've had it, the PA seemed a little uncomfortable telling me that one reason for it is "oral relations" (her words, not mine) and that the Hubster and I have to abstain from all relations (oral and otherwise) until we both finish our rounds of Fla.gyl. She worked her face into a sympathetic, "knowing" look and said "I know it's hard." I gestured at my huge belly and said, "It's not going to be that hard; what he's going to find harder is that he has to give up drinking beer for the week he's taking the medicine."

The third thing of note was that she did do a fFN test. The results were supposed to take about 24 hours, but I haven't yet heard anything from my doctor's office. She did say if I was curious and hadn't heard from them, to give them a call (they get busy and phone calls seem to fall between the cracks sometimes), but I'm not all that concerned about it. Regardless of the results, it's not going to change anything. If I get a chance though, I'll try to call them later today just to see what the test said, out of curiosity.

As for the stats of the exam, I'm up to 151 pounds; that's a 26 pound weight gain so far (at 28 weeks, I was up to 146). At both this appointment and the last, the baby's heart rate was about 138-140. I neglected to note previously that I passed my Glucose Tolerance Test with flying colors (85), Oreos be damned! But at my 28 week appointment, after a month of iron supplements, my hemoglobin, which had been 10.1 when I was first tested for anemia, had come up to... drumroll please... 10.2. I know, impressive, right? So, although the PA said she was not worried about the implications with regards to birth (because I asked what they could be), she did send me to have repeat bloodwork done.

As for the internal exam, my cervix is still long, high and closed. Which, for the record, is exactly where I was nine days before the Monkeyboy was born and my labor with him was only 10 1/2 hours. As I said to the PA, "Dilated. Not dilated. It all means nothing to me. It made no difference last time." She agreed, saying, "You're right... every woman is different." The baby is at about a -3 station, which I can't compare to that same appointment from the Monkey's pregnancy because I don't remember her commenting on it, but it's pretty high. However, everything I've read says that subsequent babies often don't engage until labor starts.

Instead of coming back in two weeks, I will starting weekly appointments now. So next Wednesday, back I go. I keep thinking, "not that it matters..." It's not pessimism on my part, though, it's that I'm sort of at a Zen place with it all now. 32 weeks was a milestone I had in my head, that once I reached it, things would be okay. After all, at 34 and a half weeks, the Monkey did damn near fantastic. If this baby were to be born at the same gestational point the Monkey was, it would come on April 21. I think that, mentally at least, I'm ready.

The Politics of the Fetal Fibronectin Test

At my six week post-partum check-up after the Monkey's birth, I asked my OB what the chances are that I could deliver prematurely again. He guessed (and admitted it was sort of a guess) that my chances of having the same thing happen again were further increased only by about 10%.

"But there's a test we can do next time that will let us know if you have an increased risk of delivering early."

At that time two and a half years ago, I had only just heard of the Fetal Fibronectin (fFN) Test, but I assumed that was what he was talking about. So I left it at that, knowing we'd revisit the subject when it became relevant. Of course, once I became pregnant again, I started doing my own research before I even talked to my doctor about it.

Fetal fibronectin is the "glue" that attaches the fetal sac to the uterine lining. It can be present in vaginal secretions before 22 weeks gestation and after 35 weeks, but between 22 and 35 weeks it can be a signal that the bond between between the two is starting to break down and that pre-term labor may be imminent. May. Be. The most interesting fact of all is that a positive result doesn't necessarily mean anything. Other than that you will deliver a baby at some point before the end of time.

A negative result, on the other hand, is a fairly good predictor that you won't deliver within the next two weeks (although I do know of a woman who did deliver early after a negative test, as the test is only about 95% accurate -- although the company that makes the test reports it as 99.2% accurate).

So, of course, I asked my doctor about if he was still planning on using the fFN test. This was at my twenty week appointment where he checked my cervical length, as well as testing me for infections again -- all part of the slightly increased vigilance this time around. Interestingly, in the two and a half years since we had that conversation, his attitude about the test had changed.
His opinion is that the test is of limited value. The information that a positive test provides to medical professionals isn't very reliable or helpful. And that the information a negative test provides is merely just reassurance, not medically helpful. His (near)exact words were

Insurance companies love this test, because it allows them to force women who may be showing signs of pre-term labor out of the hospital, therefore saving them money. That's where the value in the test lies.

But he offered to start doing the test if it was what I wanted and if it would make me feel better. Since I could find very little information as to whether it was reliable regarding pPROM, and since I trust my doctor a great deal, I told him that it was up to him, that I trusted him, and that if he didn't think it was of value in my case, then we could skip it. A month later, at my 24 week appointment, the PA told me that she wanted to talk to the doctor about doing the fFN test soon. I didn't bother to tell he what he had just told me -- I figured they could have their own conversation, since they both know a lot more about pregnancy and childbirth than I do.* Yet another month later, as I checked out after my 28 week appointment, the nurse told me that my next appointment at 32 weeks would be with the PA, and that it would involve another internal, as they'd be checking my cervix, running cultures again to check for infections and "doing the test for pre-term labor."

Since the test doesn't actually hurt anything, I didn't question it. And after seeing the NICU bill for the Monkeyboy's stay, I'm sure my insurance will be glad to cover the $200 that the test costs. But I wonder what was said during the meeting of the medical minds that made them decide to do the test after all.

*Although, come to think of it, he's a man, and she's a young women who I don't believe has any children yet, so I bet I have a few bits of knowledge that they don't have.

Organic Milk as Calendar, Take 2

It's what I've been waiting for... Now the milk and I have the same due date.