Endings and Beginnings

And now you are here, dearest one.

After all the angst, the worry, the hope, the expectation, you arrived quite simply. A quick, straightforward labor and delivery.

Here is how I felt as I saw you...

And how we looked as we learned to be together in a new way...

You announced your imminent arrival by waking me at 3AM with labor pains, and you can see how excited I was to meet you when we arrived at the hospital at 5 AM...

I thought you were an angel from the first - I am sure you were smiling!

Everyone else was excited to meet you as well ...



You are welcome here with us, dear one.

Just waiting...

I will be 39 weeks tomorrow. I have already thought I was starting labor twice - last week Thursday, I woke up at 5 AM and was sure I was in early labor. I paced about the house, timing contractions and fretting. However, by the time the kids were off for school at 7:30, all was calmed down again. No such luck.

Last Saturday, I again got out the stopwatch. I had odd shooting pains down one side of my abdomen for several hours. If I hadn't been watching for labor, I would have said that I had just pulled a muscle in my stomach (which is certainly not out of the question, given how far it sticks out now). But, the pain got worse with each contraction, and the contractions got painful enough that I couldn't talk through them. So, I was really sure that this was it. Then, after after 3 or 4 hours of painful but irregular contractions, everything settled down again.

After both of those episodes, I have gotten a bit disgusted with myself. After all, I have been through this three times. I ought to know if I am in labor or not. I do recall, and Jeremy agrees with me, that when labor actually started with Maggie and John, I didn't have to wonder if it was labor. I knew. Thus, although both of these recent "labor alerts" felt significant, in the end I didn't call the doctor because I figured if I wasn't sure, then it wasn't so. Which proved to be true.

After Saturday's episode, however, I did have quite a burst of energy. I was quite productive around the house for two days, waking early, staying awake late, and not even napping at all! Jeremy began to fear that this was the true early labor warning sign - my "nesting" burst of energy. I got all the rest of the baby stuff located and put away in the dresser. I caught up all the laundry in the household. I finally packed a bag for the hospital. I survived a 2+hour-trip to Meijer with John.

Then, starting on Tuesday morning, the fatigue set in again. Which is not to say that I could sleep any better at night - I continue to wake at 5 or 6 every morning, against my will. However, I was was now tired (and admittedly a bit crabby) all day becasue of it. Since the big snowstorm was predicted to hit Tuesday night, Jeremy figured this was it. But again, not so. The storm came and went, with no baby. I am still tired, but feel no signs of labor whatsoever.

Just waiting can be a bit frustrating, as I keep feeling like I can't commit to anything since I might be going to the hospital at any time. And I have worn myself out making plans and more plans, all unnecessary, for what to do with the kids if today is the day I am headed to the hospital.

So, I am back to the belief that this baby will never come.And, trying to stay focused on getting as much productive activity in as I can.

The home stretch

I reached 38 weeks on Thursday (2 days ago). This definitely feels like the home stretch. I am now at that point where there is a sense of endlessness to the pregnancy.

1/24/11 ...37.5 weeks

Maggie asking me every day "When is the baby going to come?" strangely doesn't help my impatience or restlessness. I try very hard not to take out my frustrations on her each time she asks.

Of course, having been told by the doctor over 3 weeks ago that I would likely have delivered before now doesn't help either. Now I can't help but feel overdue. I try to remember that I really still have 2 weeks to my due date, but that doesn't help much. Jeremy thinks it is humorous to point out my past pattern:
James 1 week early
Maggie 1 day late
John 2 weeks early
THUS...
Next baby (girl) will be 2 days late. Grr. That would be another 2 weeks from today.

I saw my OB yesterday afternoon. Still in what she calls the "ready to go into labor but not there yet" stage. She says the baby hasn't fully dropped and engaged, which is what is needed. She blamed this a bit on being a 4th-time-arounder - muscles more stretched out and it allows the baby room to just float around a bit in there. I found this strange, since I am still 2 weeks from my due-date, but she actually gave me all kinds of unsolicited advice about how to bring on labor.

Actually, she started by saying, "When do you want to have this baby?" That seemed to me a strange question, but I did tell her I was ready anytime. She asked if I wanted to schedule an induction. What? Really? I asked if there was a medical need. "No... the baby is not over-sized. But it is an option." Well, I definitely found labor easier without an induction (Maggie and John) than with (James) so I prefer not to go that route yet. Then she gave me a list of things to try to bring on labor on my own. Okay, odd. I later speculated with Jeremy as to whether any of these are more than just old wives' tales - a way to fool myself into feeling like I have some control over the uncontrollable. But I must confess, I am planning to try them all. :)

On the other hand, I have a competing urge to not push this delivery. I am not actually physically so uncomfortable as I recall being with other pregnancies. (James was fine, but for Maggie I felt huge and bloated - my largest weight gain at 35 pounds, and it was a hot August - and for John I had indigestion all the time - nothing tasted good and I was so anxious to just eat a meal that I could enjoy again.) I am very anxious to meet this baby and hold her. But, after 3 other newborns, I am keenly aware that she is much easier to care for on the inside. I reflect on this when I try to get John in and out of the car for an errand. This is hard to do in my highly pregnany state - I am not strong enough or quick enough to just pick him up and move him if he is feeling uncooperative. Still, it is not going to be easier to manage when I instead am lugging a loaded infant seat everywhere. Or, I think about this when I toss all the kids in the car, late for somewhere, and realize that at least I didn't have to nurse anyone first, or change any diapers.

I also have been in a bit of a panic about work (my professional work). I didn't accomplish as much as I had hoped to during January Interim. I got through the teaching just fine, but it fatigued me, and the afternoons and evenings were only enough time to prepare for the next day, finish grading, and nap. None of the other projects got worked on, contrary to how I had planned.

So now, I have the research project due in 2 months, and the reappointment papers due in 1 month. It seems like I should get as far as fast as I can with those before the baby arrives. It is easy to feel like I will have plenty of time on my maternity leave, with just the baby, but when I stop to think about it, I know that won't be the case. I will have about 8 hours a week when John is in preschool. I should be able to get another 4-8 hours a week when Jeremy can be home. But of that 16 hours, the baby will still need to eat, and I may still be too sleepy to work effectively. In any case, I know intellectually that I must make as much progress as possible now.

So, here I am, waiting. Excited on the one hand to "get this over with," yet also feeling that the longer I wait, the better.

Relief and Joy

Funny how adrenaline works. I spent the morning feeling sluggish and sleepy, perhaps partly from hunger (fasting till 4 PM procedure) and partly from having a cold and partly from nerves. We got to the hospital at 2 PM for the cordocentesis check-in, and I continued to feel fairly calm, even sleepy. Then, during the procedure itself, I felt quite tense as I lay perfectly still, breathing deeply and trying to stay calm and relaxed so that the pain wouldn't break through. Finally, back in the hospital room for recovery and I was feeling shaky and my heart raced and the contractions came non-stop. I guess, once it was all over, my pent up emotions flooded out all at once and I felt like a basket case.

Fortunately, the results were quick, and very good! So good, in fact, that it took me a minute to even digest them. The doctor looked almost disappointed that I didn't react more to her pronouncement, but I was in semi-shock at that point, I think. :)

So, overall, because all went well and the results were good, I can look back with hindsight and say how glad I am that I chose to do this procedure. Since I am no longer paralyzed by fear of all the things that could have gone wrong, I can just reflect on what an interesting process it was.

I had my last food and drink at 7:30 AM since I had to report ready for a C-section, in case that became necessary on an emergency basis. I spent the morning at home with John, who we kept home from preschool because he had a bout of stomach flu last night. He was feeling fine this morning, which is good, but it meant that he was full of pep, and clearly missing the chance to rund around and play at preschool. He was cranky and out of sorts. Still, we made it through until lunchtime when Jeremy returned from work and Jeremy's mom arrived to provide childcare.

At 1:30 PM Jeremy and I left for the hospital. Check-in was a lot of waiting. I got in a hospital gown and answered questions for a parade of people - a nurse, a medical student intern, another nurse. Spent some time on the monitor for the baby. Got an IV started. During this time, my anxiety built a little bit when I overheard conversations between my nurse and another like, "Yes, I need to look up the protocol for it in the book," and "I am waiting for the doctor to find out how she does this." This didn't inspire great confidence. Apparently this procedure is more rarely done here than I was led to believe. My nurse tried to reassure me by explaining that usually there were just 1 or 2 nurses on the floor who always assisted with this procedure, because they liked to do them, but those nurses weren't here today. So, I apparently got the second string. Oh well, she was friendly, at least, and seemed competent in other ways.

Finally, my doctor came in to answer any final questions of mine. Then, the anesthesiologist came in. He was planning to give me "mild sedation, because we can't give more when you are pregnant." I asked if I really needed any at all and he looked surprised. "No, I guess not, if you don't want it." Well, I didn't. I did feel badly for him, though. He ended up looking bored and restless during the procedure. Poor guy had nothing to do. I wonder if he was secretly praying for disaster so he could knock me out for an emergency C-section, just for something interesting to work on.

Finally, my nurse brought the sterile cap for me to wear. Jeremy stepped forward and asked for his outfit to come along. The nurse said extras weren't generally allowed in. He insisted. I would have backed down at this point, but I am very glad that my dear husband is more cantankerous than I am, because the nurse went to ask and came back with sterile gear for him! He got a jumpsuit, shoe covers, a hat, and mask. And, as it turned out, the whole thing took longer than I had been led to believe and having him there was wonderful.

Then, it was time to go, at about 4:10 PM, so reasonably on time for the 4 PM scheduled time. I had the strange experience of walking myself into the operating room. Must be strange for the nurse, too, because she forgot to tell me which way to go at first - I was just standing dumbly in the hallway until she realized that she needed to direct me.

I have never been awake in an O.R. before, so it was actually a fairly fascinating experience. The room itself didn't look like I expected based on the movies and T.V. It was really a dumpy, dingy, cluttered room with white painted cinder block walls - fairly  depressing, overall. I was led past the table full of implements and reminded to stay back from the "sterile" blue table. There were tons of people in the room. It was a bit strange because they looked familiar but not quite, since I could only see eyes above the face masks. I later determined it was my doctor, the resident/intern assistant doctor, my nurse, maybe another nurse (?), an ultrasound tech, a "scrub tech," and the anesthesiologist (the only male besides Jeremy, so the only one I could easily recognize).

I looked at the high, narrow patient table and couldn't figure out how to get up there. Obviously, the team was used to lifting a body off a bed and didn't really know how to do it either. "I think there is a stool around here," offered the anesthesiologist. Fortunately, someone found the switch to lower the bench before I had to climb precariously up a stool and heave my ponderous body onto the truly narrow table.

The anesthesiologist attached "arm boards" which made me much more comfortable - it helped with the feeling that I could roll off at any moment (especially after someone tilted the table a few degrees to one side). Next, he attached his machines that go "ping," - a pulse monitor and EKG leads. He made sure he had quick access to the arm with the IV then draped the other arm with a heavy blanket to help me remember not to move it.

The doctor left to "scrub and suit" and returned quickly with many more layers of sterile blue paper. The entire staff went through an elaborate choreographed dance of suiting each other up and preparing instruments. I could only see it out of the corner of my eye, since I was staring at the ceiling, but Jeremy described it to me and it sounded intriguing as a ritual.

I was next to be sterilized. My entire abdomen was scrubbed, then draped with a large sterile blue paper. It had a hole in the center for where the procedure would occur, and adhesive all around the hole to hold it in place. Then, the edge of the paper was draped in front of my face to block my view. While I agree that is a good idea, I was surprised at how claustrophobic that made me feel. There was my body, laid open for all to mess with, and I was cut off in this other zone. Strange. It certainly gave me a new level of sympathy for moms who are enduring a C-section in this bizarre arrangement.

What made it all bearable was that Jeremy was there, so I was doubly glad he had insisted. He sat on a stool by my head, where he could see over the drape if he wished to, and gave me a quiet running narrative of the process. He described disinfecting the ultrasound probe, and seeing the baby on the screen. He could see the ultrasound picking up her pulse, then finding the placenta and cord. They identified a spot near my belly button for the insertion.

Next, the doctor gave me a numbing shot with a topical anesthetic for the needle insertion point. It felt like a poke and a long burn, like at the dentist's office when getting the numbing shot. And similarly, it felt like it went on way too long. Just as at the dentist's office, the thought ran through my head to say, "That numbing shot is so unpleasant, why don't we just skip it and do the needle without it? How bad can it be?" Fortunately for me, sanity won out. (I actually did try that at the dentist once, and I found out how bad it can be, so I know that shot is not actually worse, even though it might seem like it would be.)

Next, the needle was inserted for the cordocentesis. She warned me that I would feel a cramping as it hit my uterus since she couldn't numb that. I did feel it, but not nearly as much as I had expected to. However, it also wasn't as quick as I had been promised. I had been told "60 seconds" by more than one doctor for this procedure, and Jeremy confirmed for me by clock-watching that it was close to 10 minutes. It was not extremely painful, but it was uncomfortable, so having it stretch out that much longer was an unpleasant surprise. Again, Jeremy to the rescue. He kept up a calm, running commentary in my ear so that I didn't have a chance to panic that the longer time was a sign of trouble. Apparently, they just needed several tries from several angles to catch the cord. Then, it was done.

Next, the amniocentesis. It took a moment to reposition the ultrasound. This time surprised me a bit, as the cramping was much more than before, and more than I had even expected initially. Fortunately, it was very quick, and then it was all over. There was a few minutes of bustle as the staff figured out how to bag and label and sent the samples to lab. The anesthesiologist detached me from the EKG leads. A wheelchair was brought in for me.

There was a bit of an awkward moment as I tried to figure out how to get down off the table. The staff were used to lifting a patient onto a bed. They had no practiced protocol for helping me sit up and climb down. But, I needed help, as I couldn't do a sit-up past my big abdomen, and I couldn't roll to the side on the narrow bench. Eventually, we all figured it out and I was back in my original hospital room. As we headed in, my doctor headed the other direction to deliver twins. Thus, I figured it would be a while before she came by to clear my departure.

It was now about 5 PM, so the whole procedure in the O.R. took close to 50 minutes, I think. I was hooked back up to the baby monitor for a while. Now, the shakes set in for me, mildly, as I had the adrenaline rush of realizing it was over and had gone fine. No emergency C-section, no troubles for the baby. I did have rather frequent and uncomfortable contractions (every 3-5 minutes). They weren't painful so much as "pinching" and they made it hard to breathe. My only concern was that I was actually starting labor. The doctor eventually did come in (maybe 5:45 PM?) and said she had no concerns about labor starting  - that it would have been very evident by now if that were going to happen. She also had our test results back from the lab... baby's platelet count was over 200,000!

I think she expected me to look as excited/happy as she did, but I confess I was in a mild-shock state and unable to react. Once it finally sunk in, I was of course elated. So, I was cleared to wait for labor whenever it arrived, and have a simple, straightforward, vaginal birth.

I dressed, signed the discharge papers, and was on my way at 6:00 PM. Jeremy drove me for celebratory J.B.'s pizza for dinner before we collected the kids at church from WAS night Gems and Cadets, where Grandma Di has left them for us.

I continued to have nearly continuous feelings of contractions (cramping? both?) until 8:30 or later. It was, again, uncomfortable, as it interfered with breathing, but not painful. We arrived home safely as a family. Nothing had changed, except on the inside I wanted to shout for joy. I felt like we had been given a new chance with this pregnancy, to put aside all the worry and concern and just enjoy our baby. Which is what I fully intend to do.

Just a general update

It seems past time to just give a general update on this pregnancy journey. That was how I had originally intended to use this blog, after all. I didn't expect things to get so sidetracked by all my angst regarding pregnancy outcomes and medical issues.

So here I am at 36 weeks and 1 day, and feeling reasonably good. My weight gain is reasonable (about 20 pounds). My blood pressure (as always, thankfully) is fine. My general pain and discomfort is remarkably low. (I had some significant shoulder and neck pain last week, but the chiropractor has set me straight, at least for the moment.) I still find any exercise difficult - walking, or even standing, for any length of time, especially at the end of the day, leads to excessive and uncomfortable contractions. But otherwise, I feel like I am in reasonably good shape.

The baby is very active - more than I recall from any previous pregnancy. She kicks and prods and rolls to the point where it is almost unpleasant at times - but it is at least reassuring that she is alright. I would prefer the movement to not having it, especially giving all the other angst I have felt surrounding this particular pregnancy.

I am dilated to 2.5 cm as of a week ago, and Dr. R concludes that "all the preliminary work is done. All you are waiting for now is active labor, which I think will be 2-3 weeks early." So, I now find myself on pins and needles a bit, expecting every new sensation to signal the onset of labor. Two nights ago, I was starting to convince myself it was time. I had had a long afternoon nap, so was up late that evening with Jeremy, and we decided to watch the first of his Dr. Who videos (his Christmas present from me). I was just lying down on the futon the whole time, but felt decidedly "off." I went to bed half-expecting to wake in the night in full labor. Obviously not, though. I guess it doesn't always hold true that an experienced mom will better know true from false labor. ;)

I am actually not feeling larger than previous pregnancies. The main difference I feel this time is that there is a lot more baby down low, in my groin, to either side. Dr. R keeps talking about a "normally more stretched out uterus from a repeat mom" so maybe I just have a looser, saggier pocket for the baby this time around. It can be a bit unpleasant to feel little feet or hands poking me there when I am sitting, as there is not much room or much padding. But bearable. I also feel the baby more up high than I did with John - more lung constriction and more heartburn. So, she is not a very large baby, according to the ultrasounds (maybe 35th percentile) but she sure has managed to spread herself out.

Well, even with a long nap at bedtime tonight, it is getting late. I need to get myself to bed. I have reached the point where I am don't wish to leave myself too short on sleep, knowing that any day just might be the one. Very excting!

A Decision Made.... Finally

I saw Dr. R. again on Wednesday - she squeezed me in based on a request from the nurse who ran my NST (non-stress-test) on Monday and concluded that I and she were both a bit confused. She re-explained all the options to me.

I was amused that Dr. R. explained it to me with a decision diagram that looked remarkably like the one I had sketched out for myself the night before. (The main difference, of course, is that mine is slightly more legible.) I suppose there is something reassuring, at least, to feel like your doctor makes decisions the same way that you do.

I followed up with asking for her to spell out clearly the risks of a C-section, so that I would know that I was making that decision based on good data also. It isn't actually the risks that lead me to want to avoid the C-section; it is just that I have a different birth experience in mind. But, knowing the risks (real, not imagined) seems like a valid part of the decision-making process. So, what she laid out was:

25% occurrence of "minor issues" including: loss of ability to urinate (I assume this must be temporary if considered minor!), urinary tract infections from catheter, blood loss (typically double a vaginal birth), wound failing to heal properly.

Less than 1% occurrence of "major issues" including: blood clot, pneumonia, transfusion, and some sort of infection of endometria (can't read her writing here) that leads to high fever, IV antibiotics, and rehospitalization for several days.

Less than 1/1000 occurrence of very severe issues, neither of which I can read or recall.

So, actually, it sounds worse than I expected. But still, not the real issue in my decision.

Dr. R. then proceeded to give me all kinds of amusing advice.  "You don't really have a wrong choice to make here. Many of my patients would just choose the C-section - they actually prefer that for their birth experience. But I don't think that would be you." [Correct.] "You know, it is possible to think too much, and agonize too much, over decisions like this. Some people can easily make up their minds, and be 100% committed to that. Others (like you or me) always have that doubt - we can never get past about 97% sure. But, when I have patients in these situations, I find that they generally make the right decisions for themselves, so just go ahead and choose and trust yourself. I also find that about 50% of the time, nature intervenes and somehow makes its own choice, anyway. For example, you choose a scheduled C-section for 39 weeks and instead go into labor at 37 weeks. Or, you choose a vaginal birth but then show up in labor and breech and get a C-section."

After talking it over with her, I came home and talked with Jeremy. "Suppose the baby's platelet count is 100,000 or more...then we definitely would want to proceed with a naturally timed, vaginal birth. Suppose the baby is breech... then we would definitely choose a C-section, since this is not the right birth to take a chance on a difficult situation. Suppose the baby's platelet count is 10,000...then we would definitely choose a C-section." In the end, I decided that my fear of harm coming to the baby would likely cause me to be tense during labor and make the process harder, so just knowing the situation is important information. Also, since I would in fact prefer the C-section if the platelet count is low, then I need to know if it is low. So, I called to schedule the cordocentesis.

This ended up requiring yet another visit to the doctor, this time a consult at Maternal-Fetal Medicine. That made how many trips to the doctor this week for this pregnancy? Two on Monday, one on Wedneday, one on Thursday, one on Friday. Not bad. Fortunately, I think it was a valuable consult that I had this afternoon. I talked with yet again a new doctor (to me) in that practice, Dr. D. It turns out that she will be the one to do the procedure, so Dr. F. (whom I saw in December and had said Dr. S. would do it) thought I should meet with her.

Fortunately, I liked Dr. D, on the whole. She seemed perceptive and sensitive to my concerns and questions. She said the whole point of the consult was to be sure I understood the procedure and felt comfortable to proceed. She seemed a bit younger than I might prefer (probably younger than I am by a few years) but maybe that gives me the benefit of fresh training and steady hands. She seemed sympathetic to my desire to not have a C-section, and able to see that as a reasonable choice. She confirmed that the risks of the various options are all somewhat unknowable, but that I was making a reasonable choice under the circumstances.

I did ask the blunt question at one point: "I don't mean to offend you, but Dr. F said that Dr. S does these the most often. How often do you do them?" She claimed to do them the second-most frequently. She didn't come right out and say how often, which left me a bit nervous. At least, though, she did seem quite familiar with the process. I didn't get the impression that I would be the first case since her residency, for example.

She explained the process a bit more than I had heard before. I would have fairly extensive prep, but the procedure itself would be about 60 seconds or less. She would not plan to give me anesthesia, but would have the anesthesiologist standing by in case an emergency situation arose. I would be prepped as if ready for surgery, therefore (IV, drape, etc.). I would have a local/topical anesthetic for the needle insertion, but she couldn't numb the uterus, so I should expect some significant cramping, something like bad menstrual cramps. (Why is it that every medical procedure involving any part of me from the breasts down to the hips is reported to feel "something like menstrual cramps?" I have never even observed that these are a very universal experience of pain or discomfort.) I would need to lie perfectly still, so if I felt anxious at all the anesthesiologist could give me an anti-anxiety medication of some sort to relax me. She recommended that I not plan to drive myself home, just in case the cramping was enough that I didn't feel up to it.

Her perception of the risks? A 1% chance of an emergency C-section. NOT a 1% chance of loss, as I had been told by Dr. F and Dr. R. So that seemed more encouraging, and yet that 1% loss was for all situations, and mine was supposed to be much easier, so I was already assuming a much lower risk, so now that 1% seems high. She said that emergency C-section might be needed if there were a bleeding event (ruptured artery in the cord, for example) or if the baby's heart rate dropped and didn't recover (there would be constant monitoring of that). On the other end of things, there was a small chance of rupturing the bag of waters, which would require a delivery within 24 hours, though not necessarily an emergency c-section. And in between, which she thought more likely than either of those outcomes, was the chance that the needle would irritate things enough to put me into regular labor after the procedure. So, since I will be essentially full-term (36 weeks and 6 days), not a huge concern, fortunately.

All of that information actually made me feel less comfortable with the procedure somehow, but it didn't change my mind about it being the right thing to do. The unfortunate thing I feel in all of this is that I don't yet have the sense of "peace" that I have experienced in the past after making a difficult decision. Other times, I have made the decision, not always fully understanding it, but feeling confident that it was the right one, within God's will. I don't have that now. But, I didn't have it for the week when I was essentially deciding to not do this, either. So, maybe I just won't find that peace with this situation.

So, that is that, at least for now. I go into the Labor and Delivery ward at 2 PM next Wednesday. The procedure is set for 4 PM. I expect I should be out shortly after that, if all goes smoothly. Di has already offered to take the kids, so that Jeremy can come and stay with me. I don't know if they will let him in, but having him there makes me more comfortable, somehow, so that if something does go wrong, I know there will be a conscious advocate around for my baby and for me.

Now, to turn my mind away from all this for a while. What will be, will be.

35.5 weeks and all is well!

I saw Dr. R. last Friday - last appointment of the day and week. Of course, it made for a late evening, since she is far behind schedule by then. She gave me her full time and attention, as always, which I appreciate, but tossed some new information at me which I couldn't fully absorb and process at that point. Of course, after the weekend to ruminate on it, I don't feel much further ahead.

First order of business - she set me up for the appointment schedule from now until delivery, which is basically to camp out at her office full-time. :)  I get blood draws once/week, Non-stress-tests twice/week, ultrasound once/week (quick ones, at least, just to check position and fluid levels), and doctor check-ups once/week. The scheduler at the check-out desk thought she could make all that happen in just 2 visits/week, of 45-75 minutes each. But, then she looked at the calendar and couldn't quite swing it. After 25 minutes of standing at the counter with her, contractions going the whole time, I gave up. She said she would find "whatever" and have the list ready for me when I next came in. Agreed!

Jeremy clearly feels this is excessive doctoring. I am inclined to agree on the surface. On the other hand, after 10+ years, I feel like I understand how Dr. R. works. She is thorough, definitely - more likely to order a test than not to. And she presents everything as low-key; nothing to worry about. But she does all the worrying herself. Then, if she finds a problem, she talks to me about it. If not, she doesn't worry me with it. I have learned to accept that style, and accept the tests she needs to make it work. They may be time-intrusive, but they aren't invasive or risky, anyway.  And in her defense, I do seem to have a complicated OB chart, this time around. Every medical provider who has the misfortune of drawing my case on a fill-in basis (new nurse, or a doc covering vacation, etc.) comes into the room scratching their head after trying to decipher all the notes. And this is in no way meant to disparage Dr. R.'s ability to document. There just happen to be a lot of unusual circumstances, together.

Anyway, once we agreed on a schedule for poking and prodding every 3-4 days, Dr. R. did a quick exam. She pronounced me dilated to 2.5 cm already, with the baby probably still in a breech position (as she was at the 32 week ultrasound). She then threw out one of her infamous Dr. R. predictions... "I'm gonna say...2.5 more weeks to delivery." Now, she loves to toss these sorts of things out, and is clearly joking at least some of the time. (For example, when she claims to call the sex of the baby after hearing the heartbeat at the 12 week check-ups, then reports that she gets those right 50% of the time.) I might have assumed the same for her delivery date predictions, except that for the rest of our meeting, her counsel seemed to be based on her presumption that I would in fact go into labor well ahead of 40 weeks. So now, of course, I am excited for an early delivery (and will be grumpy and out of sorts for every day past 38 weeks!). I had already been feeling ready to be done - turned that corner just past 34 weeks.

Dr. R did stress that it is certainly possible to be at 2.5 cm for another 5 weeks to full term. She just said that she didn't think I would do it. "You have done all the preliminary work for labor; all that is left is the active labor phase." She also based her guess on my previous deliveries at 39 wks (induced), 40 wks, 38 wks. So, I guess we will probably find out, eventually.

Then, we turned to the complicated discussions - how to deliver this baby. I am still stuck on that. She seemed to expect that I would just choose a C-section at this point. She also seemed fine with my suggesting that I might not. She seemed very well-apprised of the advice I had been given about being a good candidate for cordocentesis. (She even mentioned that she had lunch with Dr. Z from Maternal-Fetal Medicine this week and they discussed my case. Hmm. Wierd.) But then she threw in a wild-card on me. "Well, then we would do the amniocentesis at the same time."

"Wait, hold on, no one had mentioned amnio before now. I don't know that I want to take that risk!" Now, she actually did seem surprised. "But it is less than the cordocentesis risk by nearly an order of magnitude and you are contemplating that!" Well, I didn't calculate it quite the same way. Yes, the "published" risk of an adverse outcome for cordocentesis is 1/100. For amnio at this point, it is 1/750.  But Dr. F had convinced me that my REAL risk from the cordo is much less than 1/100, because of my particular circumstances. Dr. R. agreed that would be the case, but wouldn't seem to budge from the 1% risk as a marker or comparison point. Somehow, I had become comfortable with a risk of "way less than 1% but it can't be quantified" but couldn't be comfortable with a risk of 0.13%. Perhaps it is illogical, but there it was.

So, why did Dr. R. want me to do the amnio, when no one had mentioned it before? Well, it seems that she is "not allowed" to schedule a C-section for earlier than 39 weeks without it (it demonstrates lung viability). I didn't connect the dots at the appointment, but later thought, she must be assuming that the point of the cordocentesis is to determine a problem with platelets, and if it is there, we would want to do a C-section right away, so having the amnio would be needed. Plus, amnio seems like no big deal to her. "We do it all the time; we used to not even use ultrasound at this point in the gestation - we can just feel for a soft spot." But I don't know that the plan with Maternal Fetal Medicine had ever been, necessarily, to do an early C-section; only to rule out a vaginal birth, so they didn't mention the amnio. Or, perhaps, they didn't mention the amnio because it is so routine to them they didn't even think it was worth mentioning.

So now, I am a bit confused about the medical advice. To add to the variables, it was clear from our discussion that Dr. R doesn't really expect me to go to 39 weeks. Thus, if I skip amnio and schedule a C-section for 39 weeks, she expects me to end up at the hospital in labor anyway, in which case I would be facing a decision on the fly for the C-section rather than a planned/scheduled one. (Which she said is also fine, but just may require more forethought on my part to be able to make these decisions.) Then, to complicate the whole mix a bit more, the baby was breech at last known positioning. In that case, I would almost certainly have a C-section, so the cordo and amnio would both be moot.

Today, I went back for the first NST (passed!) and blood draw. The nurse (new to this pregnancy, but familiar from John's 3.5 years ago) seemed a bit bewildered by my case file, although I appreciated her general level of experience and willingness to sort through it rather than just rubber stamp things. She thought the baby was probably not breech now, so I should move up my first ultrasound from Thursday to today so I can at least answer one level of "what ifs." So, I scheduled to come back a second time in the same day for that.

Sure enough, baby is head down as of today (Monday). And, she has lots of fluid (good news)... which also means that she could easily flip breech again in next few weeks, if she feels like it. But probably won't. Still, I confess I felt a bit disappointed by this news. If she were breech, I would feel like I could just plan the C-section in good conscience, and quit the navel-gazing over it all. Since she is now head-down, I still feel like I need to make a good decision about delivery. C-section would be "easier" in many respects, but if not necessary, it just doesn't seem like a good idea (for me or the baby). So, the clock ticks away and I am no closer to a reasonable decision. Perphaps I will end up making this one by not making it, showing up in labor with my mind still not made up. At that point, I have to decide whether to proceed with a regular delivery (and hope for no bruising and/or normal platelet count) or to proceed with a C-section (and perhaps kick myself afterwards for the unnecessary trauma if her platelet count after birth turns out to be fine).