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).
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