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Thursday, July 8, 2010

Pregnancy update - 12 weeks (again)

Last week, I had two prenatal appointments: one at my birth center and one with my Ob/Gyn.

In my appointment at the birth center, I met 2 of the 4 midwives over the course of my initial appointment.  It was all pretty routine: get your weight, measure blood pressure (manually, yay!), pee in this cup, yadda yadda.  Until we got to the point where we were reviewing my medical history and the midwife asked me how long my menstrual cycles typically were.  I explained to her that I had always had very regular 28 day cycles my entire life, including after Mira's birth, right up until last November when I missed a period.  After that my cycles were typically around 40 days.  She asked me about my doctor's findings relating to that and asked if she could request the records from him to see if there was any additional testing they wanted to do about it.  "Of course," I replied.  Then she said that she'd like to do an ultrasound to date the pregnancy since my cycles were abnormal. She explained that my prolonged cycles probably also corresponded to a delayed ovulation, which would effect my due date.  I was hesitant.  I told her that the way I felt about it was that the baby is going to come whenever the baby decides to come and what do I care if it's a week early or a week late?  I'd like to avoid unnecessary tests.  Couldn't we just wait till I get the anatomy ultrasound at 20 weeks and use that to date the pregnancy?  She explained that we couldn't combine the two ultrasounds that way because using ultrasound to determine the date of conception is accurate to within 5 days if done around 10-12 weeks because at that point fetal growth rate is pretty similar from one baby to the next, but by 20 weeks the baby's genetics are starting to have an effect on their size so the accuracy drops to 14 days at that point.  She went on to explain that the reason she wanted to have an accurate due date was because, being a birthing center, they can only deliver babies born between 35-42 weeks.  Outside of that window, they have to refer the patient to the hospital.  So in order to increase my odds of delivering within the safe window, they needed to make sure the window was placed accurately and not skewed one direction or another.  She then asked me if my hesitance was due to financial reasons or if I had some other concerns about getting an ultrasound.  I told her that my hesitation was purely financial, as all of our maternity costs are out of pocket.

The midwife then went on to try to listen to the baby's heartbeat with the doppler.  She was uncertain whether she'd be able to find it though, since I was still only in the first trimester.  Sure enough, she couldn't locate the heartbeat.  So she asked me if it'd be ok with me if she wheeled in the ultrasound machine just to check out what was going on.  "We don't have to charge you for an ultrasound unless we have to call out the sonogram technician for official documentation," she explained.  Sure, why not.  So she went out of the room and while she was in the hallway, she ran into another midwife and she asked her if she would assist in dating my pregnancy.  So these two midwives bustle into my room with the ultrasound machine and in a jiffy they have performed an unofficial (i.e. free) ultrasound in which we saw the baby's heartbeat, watched as baby rolled over, and got the pregnancy dated.  They even printed a picture for me.  (Baby is in profile, with the head to the right, hand up in front of his/her face.)



So anyway, they found that my pregnancy is actually about a week younger than my last menstrual cycle would indicate, likely due to a delayed ovulation.  So they adjusted my due date from January 9th to January 15th.  Which essentially means that I'm currently "repeating" my 12th week of pregnancy.  *Shrug*  I've adjusted my pregnancy ticker accordingly.  -->

Anyway, I left there with pretty good feelings about my decision to birth there.

A couple days later, I went to see my regular Ob/Gyn, the one who I love and who has been providing all my feminine care since forever.  My mom said before I went that I needed to be prepared for him to try to talk me out of the birth center, since she thought that would be his reaction.  I doubted that would be the case, but I prepared myself mentally for that situation anyway.  When I got back into the exam room and had a chance to talk to him, I told him that I had decided to use a birth center.  I was just about to explain my reasoning when he chimed in with, "I think you're an excellent candidate for that type of delivery."  I just shut my mouth and took a second remembering why I love my doctor so much.  I told him that the birth center provided prenatal care, but I still wanted to see him a couple of times throughout my pregnancy, just to know that I have an MD's blessing to continue with an out-of-hospital birth.  (The birth center has a perinatologist to oversee emergencies, but I want to know that any warnings/red-flags are recognized and addressed by a doctor *before* the emergency arises).  He said that that was not a problem at all; he has many patients who do the same thing.  He said that I'd just need to have the birth center fax over any test/procedure results and then he'd want to see me back in my third trimester.  He told me that the birth center I've chosen has an excellent reputation, but that if at any time I become uncomfortable with anything or I have any questions for him, to just call and set up an appointment.  Awesome.  How great is my doc?

So... that's the business end of things.

As far as how I'm doing... My morning sickness is almost completely gone.  (Yay!)  I still occasionally get a little queasy when I haven't eaten in a while or when I try to force myself to eat something that I'm just not in the mood for.  But otherwise, my stomach is so much better.  I'm exhausted a lot of the time, though.  And over the July 4th weekend, by belly seemed to explode outward.  It got really hard and then just bulged right out, all over the course of about 4 days.  I'm wearing my maternity clothes now, but I'm unfortunately in that awkward phase where anyone who doesn't know I'm pregnant probably just thinks I'm really fat.  I'm thinking of going out to buy some maternity t-shirts that say "baby bump" on them or something; I need some more casual maternity tops anyway....

2 comments:

Marcy said...

Yeah, not many women realize that ovulation usually happens about 2 weeks *before* your period, not 2 weeks after your cycle "starts." So date of ovulation will be totally different for a 28 day cycle (~day 14) vs say a 32 day cycle (~day 18) vs a 40 day cycle (~day 26).

Glad to hear the initial appointment with the birthing center went well, and that's awesome that your OB is so open-minded. And, as always, very exciting to get to see the baby. =)

Anjea said...

Yay that you got an u/s anyways and could see the little one! That's really awesome of your MD. There aren't many, I would think, that would take that same position. I'm really happy for you that he's supporting your decision.

You're now due on our anniversary, whee!
Anjea