Another sonogram and looming deadline

My due date is Saturday. And it is as accurate as you can get, because I knew the day I ovulated (July 8th). That date matched up perfectly with the 9 week sonogram. So there is no avoiding the actual 40 week mark (although I read that white females with private insurance...i.e. healthy and well-educated pregenancies, tend to have a gestation period 10 days longer than the 40 week average of other ethnicities or socio-economic groups).

I had another ultrasound this morning to re-measure my fluid index. As I posted earlier, It was 27 at Christmas, 34 in February, 32 last week, and today it was 30. I had thought the top of the normal range was 25, but Jessica the ultrasound tech said normal actually topped out at 20, and medical professionals start to look worried when it goes over 25. Either way, I'm not sure I'll hit a low enough number by next week to make everybody happy. But I am going down. That's a good thing.

The babies biophysical profile was 8 for 8 again today, including a nice long session of practice breathing and all the body parts with the appropriate amount of movement. She was so active in fact that Jessica had a hard time capturing the heart beat and blood flow through the cord. When she finally caught the heartbeat, she seemed to see a dip in the rate, so she called Susan the midwife and confirmed that an NST (non-stress test) would be a good idea, just to make sure. I personally think any heart rate problems with the sonogram were a result from me laying on my back (the bed-angler was broken) and the overactive baby that wouldn't let her get a good solid reading.

A non-stress test is basically ten minutes or more on the fetal monitor in the observation wing of labor and delivery. So I drove to Baylor Medical Center, signed in, firmly told them I was laying on my left side for the reading (they said it didn't matter either way), and waited for a long enough test strip to show up that Susan could review. I was there for about an hour, which was fine because my results were spectacular, including some small contractions with perfect response from the baby's heart (the medical professionals are very reassured when the baby responds well to contractions...they use that as a forecast for how the baby will handle the rigors of labor).

Susan actually came down to labor and delivery to see me, which was nice because I wanted to talk to her about the fluid levels and what would happen next. She was very happy with the readout and said I was free to go. She said that 30 was still high, and that they would still want to induce me, probably early next week; and that would be decided sometime between tomorrow and my visit with an OB from her office on Thursday (routine procedure for all midwife clients to see an OB from the practice at least once). I told her Lindsay had been talking about starting off the induction with artificial membrane rupture, which I had read in What to Expect When YOu're Expecting and several other books was a big no-no with high fluid levels...it increases your risk of cord prolapse just as much as if you were to spontaneously break your waters, which is what the induction was supposed to circumvent. Susan replied that they wouldn't use the usual crochet hook and rip a hole in the sac, but rather a small pin-prick for a slow leak that would let the head settle slowly onto the cervix (which I had read was a viable alternative in my situation). Going into labor with strong contractions is still preferred, so we are still working on natural induction methods to get me going this week.

I know that ruptured membranes is the point of no return as far as induction goes, so I asked her what would happen if I didn't go into labor with this step. Susan said that 18 hours after membrane rupture, they would give me antibiotics as a precaution, and would let me go as far as 24 hours before they needed to see signs of active labor. This is a big improvement over many OB's, some of whom do a c-section as soon as 12 hours later, and most will do a c-section after 24, no matter how far along you are. Susan also said the second course of action would be cytotec 25 micrograms (vaginally inserted cervical softener), which I still want to research. Cytotec is FDA approved for ulcers, not induction, and tends to be so strong that the side effects in some cases are really horrible, including a few cases of maternal death. I think Susan referred to it as the rocket fuel of birthing babies or something like that. I know there are other cervical softeners out there, and want to read up more on them so if it gets to that point (hopefully it won't) then I could have a substitute request. Susan said pitocin was not a good choice for secondary induction methods, and I tend to agree. It makes contractions harder for both me and the baby, puts me in the bed with the monitor (to watch for the very likely fetal distress), gets an IV in me, and all sorts of other interventions that go down a road I want to avoid at all costs. Susan told me drinking rasberry leaf tea and evening primrose vaginal suppositories would be good to add to our list of attempts.

Susan did a cervical check on me and said my cervix was very soft (so soft it was hard for her to pin down), posterior, 50 or 60% effaced, and just about 3 cm. A soft cervix is good because that means it stretches easily with pressure from a baby head. Posterior is bad, but might be a temporary thing just because the baby is not at a lower station (susan said she was high, but didn't give me a number). 50 or 60% effaced is the same as last time, but 3 cm is definitely an improvement. It means I am officially done with early labor, lol. I passed my mucous plug today, which doesn't mean much, except that I am still dilating and opening up. My books say a mucous plug comes hours or sometimes weeks before labor.

Susan didn't know how to figure my Bishop's score from her new findings (which surprised me), but said it might not be relevant in my case because of the babies failure to drop consistently. I don't know if I believe that or not, but I am reassured that I got another cm and considerable softness to add to my score. My guess is it brings me up to a 6 or so. I would still like to be at least a 9 before they do anything permanent like break my water.

In other news, Hailey has a virus. It is not influenza, because Michael took her to the pediatrician and had her tested, but it does come with a really high fever (104.3 at one point, and around 102 with tylenol and ibprofen). The Pediatrician said to limit her exposure to me, which means I haven't touched her since this morning; Michael has been medicating her, holding her, etc. It's a good thing he is working from home this week, but also awkward at points when he needs to actually hunker down and get seriously focused on an assignment...This afternoon I just watched Hailey from a distance, ready to call Michael if physical contact was needed at any point to help Hailey. I've purelled myself like three dozen times today, and bought another container of clorox wipes. I washed all our sheets, because Hailey has visited our bed recently in the morning. Michael aired out the house by opening lots of windows, even though it was raining outside. It would be very bad if I had a virus with a high fever and went into labor.

38 (almost 39) weeks

Picture of me at 38 weeks on Saturday.

On Friday, I had an ultrasound to check baby's well being and fluid index. It was lower for the first time since they started tracking it at Christmas. Thirty two. Last time it was 34, and the time before that, at Christmas, it was 27. The baby is healthy as a horse with 8 for 8 of vital signs, including practice breathing.

I also had another visit with Lindsay on Friday, who said she didn't think this would be the week to go into labor (and she was right, because I made it through to the next appointment). She didn't do a cervical check or even a fundal measurement. We discussed different positions for pushing and which ones would slow down the probably fast descent and decrease the chance of tearing.

Today, I went back in, and requested a cervical check out of curiosity. The dilation and effacement were pretty much the same (2 and 60% instead of 2 and 50%), but she was quick to point out that those meant nothing about predicting the onset of labor. She said because I was almost 39 weeks, that there was a good chance I could go into labor any day now, mostly because it's near my due date and Hailey was born at 39.5 weeks and Ansley at 40.5 weeks.

Lindsay's big concern was that the baby was still not consistently engaged. I was at a -1 station last time she checked, and now I'm at a -3, with a pocket of fluid in front of the face (which is at least pointing the right direction; anterior or towards my back). She knows very well that it might have been at a -1 or even 0 just yesterday because the baby isn't sticking in position.

While this is not uncommon in subsequent pregnancies, it poses a bigger risk for babies floating in extra fluid. If I am not in active labor when my water breaks, the lack of contractions may mean there is not enough pressure to get the baby's head to "cork" up the cervix right away, and the cord might slip in and get pinched or fall out. This is a small risk with every pregnancy, my extra fluid just increases the risk slightly. So she told us to call right away if the membranes rupture before labor begins. Then they can help us assess fetal movement and position to rule out emergency situations.

Of course, the easiest thing would be to have contractions and be well into labor before the water breaks, so the contractions funnel the head in the right direction in a timely manner. So we're going to do what we can to bring about that scenario.

I have another ultrasound on Monday to recheck the fluid levels. Lindsay did say if I could get back down to a normal fluid index of 25 or less, then her worries would go away. But if I can't, they want to look into induction after the due date, as natural as possible of course, starting out with just breaking the water and see if labor kicks in. My current Bishop's score is only 4, so I hope if it comes to induction that my score is higher by the time they decide it's time to do it (scores of 4 or less tend to fail with induction, 5 to 8 needs cervical softener before trying to induce, and 9 to 13 is likely to succeed).

I am taking hope from the fact that my fundal measurement hasn't changed in over two weeks. (I think the last time she checked it was 38, so I'm guessing that's what it is now) Perhaps that means my fluid is going down steadily, and that I can be officially declared low risk again with this next sonogram.



3-d picture of baby's facial profile from Friday's sonogram (sorry it's sideways).

Michael's shower project

I really can't believe I haven't posted about this yet, since it has been such a big part of our lives the last three weeks. Michael went to re-grout some loose tiles in our master shower and one came out altogether, revealing rotting and molding board beneath. He kept pulling at tiles until it was obvious to him that he might as well rip the whole thing out and redo it. He bought super-filter masks to keep the mold from making him sick, tore out everything, including insulation, down to the studs, bleached the studs, and then started rebuilding. Dan and his Dad have been a big help to him along the way. Now he is tiling and hopefully we can have the shower glass estimator out early next week to give us a price on a new door and install it asap.

Shower renovation pictures


And here I am at 37 weeks. Everyone at church today told me I was ready to pop, especially since you could see my belly button poke through my sweater like the indicator on a Thanksgiving turkey. And apparantly, I am in full waddle-mode now, or so I hear. It only makes sense that I would walk that way when it feels like I am carrying a bowling ball between my legs. Is there anyway to carry a bowling ball between your legs without waddling?

36.5 Weeks

Here is a picture of me at 34 weeks. We missed the picture of 35 weeks and 36 weeks is on the new camera, which needs hardware to upload the image.

Saw the other midwife, Lindsay, today. Very nice. I'm excited about delivering with this practice.

I had high blood pressure (for me, anyway) 108 over 60 something. I'm 38 pounds over my pre-pregnancy weight, which is about normal for me, maybe a smidgen high, for this stage (I can tell by my hips that about 15 pounds will be mine to keep and work off later).

The baby's heart rate was in the 150's. Lindsay says sometimes the heart rate slows down before birth because it doesn't need to be so fast, but keeping up a good pace like this one is still normal and doesn't mean anything (she was sure to point out that it was not an indicator of how active a newborn it would be :)).

They took a sample for the GBS test today and will find out the results in two days. If it's positive, I'll get antibiotics in labor every four hours through a heploc. I told Lindsay about my concern about a yeast infection in reaction (since I've had so many in this pregnancy), and she said they would be very proactive about dealing with that and other side effects of such powerful antibiotics. She jokingly told me to think "negative thoughts," but only for this test, not in general.

My fundal height is still measuring 2 weeks big, about 38 weeks, and Lindsay said she could feel all the extra fluid near the top of my uterus (yes, I am just like a big water balloon right now). I joke that our baby just loves swishing around in her own personal swimming pool. Lindsay smiled when she said she would have to put a note on my chart to watch out for projectile fluid when my water broke. It's happened to her before and she wanted to be prepared. :)

The cervical exam was optional, but I opted for it out of curiosity. I am 2 cm dilated and 50% effaced. This is about where I was with Hailey a few weeks before I delivered, so it doesn't mean anything other than I won't need a cervical softener at 42 weeks to induce (doubt I will go that long, anyway). At least I'm 20% of the way there already, even if it's the easiest 20% of labor.

Lindsay said the baby was at a -1 station and she pushed it to a -2, so in the right spot, but still able to float out of it. That would explain why I sometimes suddenly get a lot of pressure in my hip and lose the ability to control my leg muscles for a few seconds. It probably also means that we'll go straight to the hospital when my water breaks just to be sure the baby was properly engaged at the time.

When I was headed down to my appointment, the office called and said that one of Lindsay's patients was on her way and in labor, so I should expect my visit to be short and sweet. It wasn't. I waited for twenty or thirty minutes, which surprised me. Lindsay came in and said she had just come BACK from a birth. Apparently it was a women with a speedy labor, and they had labored at home for a few hours and waited a little too long for the sitter, so the baby was born only 15 minutes after they arrived at the hospital. This made me glad that, first of all, their office is on the hospital campus, and secondly, that Dan has offered to watch our kids, and he lives a few blocks away and works in Michael's building. I'm not worried about waiting too long because our sitter has a long commute.

I am feeling great these past two days. I had horrible ankle swelling and fatigue through Sunday. But this week, the swelling is gone, I'm not tired during the day, and I'm running errands and cleaning out closets (sounds a lot like nesting, doesn't it?).

Michael bought a new camera (since our old one only works when it feels like it). He also got the crib put together in the upstairs bedroom. We'll probably move the nursery downstairs in the summer, but for now, Hailey is still occasionally coming into our room in the middle of the night with a huge blanket wrapped around her, which isn't a safe situation for stairway travel in the dark. And the baby will be in the portable moses basket for the first few months anyway, so the crib location is not really important.

I have all the baby clothes washed and in drawers, and bought a few basic things like diapers and pacifiers at my last grocery store trip. We really need to practice our relaxation exercises and I need to finish packing the hospital bag. So I'm hoping this baby gives us at least another week to pull things together.