December 29, 2004
36wk Checkup
Yesterday I had my first prenatal appointment with the ob/gyn in Houston. This doctor and her partner had been highly recommended by a friend of Jill's (Dale's sister).
I had figured the appointment would be more lengthy than usual, even without them doing an ultrasound, since I was a new patient and I'd have to fill out paperwork and give them time to go over the records I'd brought down from Austin. I was right. We arrived about 30 minutes before my appointment time but weren't called back until 45 minutes or an hour later.
First, the nurse did the usual vitals stuff. Then she went over some of my records with me, trying to clarify the ectopic/heterotopic pregnancy stuff. After several minutes she finally understood that 1) I had been pregnant at the start of the year, but it was ectopic and I started to miscarry but had to use methotrexate to end the pregnancy, 2) I was diagnosed as pregnant in May, then at the end of the month, I had another ectopic pregnancy removed, this time surgically, and 3) I had a normal uterine pregnancy at the same time as the second ectopic, and that is the baby I am carrying now.
I really hate meeting a new medical person who looks over my records and says, "oh, you're carrying twins?" Please, just keep reading and don't make me answer that again.
After the question and answer session, I got to strip from the waist down. When Dr. Storey arrived, she surprised me by walking in, announcing her name, then going right past me to the counter where she started to flip through my records. I'm sort of used to shaking hands when I meet a new doctor, or at least having them make eye-contact. Dr. Storey asked a few questions then came over to examine me. I had my uterus measured again and she (painfully) checked my cervix. She said I'm not dilated yet, but my cervix is getting "soft and mushy." I guess that's progress.
Dr. Storey then told me that as a gestational diabetic patient, she would probably want to have me deliver 1 1/2 to 2 weeks early. Since gestational diabetic patient babies tend to be a bit larger, she wanted an early delivery to reduce the chances of needing a C-section. I have to confess that got me a little excited, but I was honest and told her that based on the weekly ultrasounds I've been having, my Austin doctors hadn't seen any reason yet for the necessity of an early delivery. She said they would decide soon, based on my next ultrasound and check up, and the "readiness of [my] cervix."
After that, the nurse came back in and we did a fetal non-stress test. Two elastic bands were strapped around my torso, one high, one low. The upper one measured contractions of my uterus. The lower was positioned to record Olivia's heartbeat. I was given a small control to hold with a button on top that I was supposed to push whenever I felt a movement. Olivia had been fairly active shortly before the test because I'd had some carbs (snack time), but she was still and sleeping again by then. The nurse pulled out this little device and said she was going to "zap" the baby to wake her up. She assured me it doesn't hurt and zapped my arm to prove it. Basically, it's a big joy buzzer that vibrates very rapidly and makes a loud buzzing sound when the trigger is pulled. She placed the head of it low on my belly and gave Olivia a quick zap. There was an immediate reaction. My uterus contracted and I could feel the baby spasm and kick in protest. Satisfied, the nurse left, saying the test would last about 15 minutes.
Though the zap startled her, Olivia was back asleep almost immediately. I only felt a movement every couple of minutes. After what seemed like more than 15 minutes, we stopped being able to hear her heartbeat through the monitor. I looked over at the machine, and the heartrate display was all over the place. It would jump to 220, then drop to 80, then go to 150. The printout that was feeding out of the machine no longer showed the fairly consistent jagged line of her heartbeat. Instead, it was a very broken set of small dashes and marks. I wasn't worried about the baby at all. I knew she'd just shifted and the monitor couldn't read her any more. I told Dale to get the nurse but he was being ornery and refused to move. After about 5 minutes of this, the nurse came in and repositioned the monitor.
She said we'd probably be done after about 5 more minutes. I was really glad because the position wasn't particularly comfortable and I was getting really restless. The monitor started to lose the heartbeat again, so the nurse ended up standing there for 5 minutes pressing it against my belly and zapping Olivia about once a minute. The baby was being so stubborn! She would jerk when zapped then immediately go back to sleep. Finally, the nurse went out to get the doctor. I pressed the monitor until Dr. Storey came in. She looked at the printout and said it looked good, so I was finally unhooked. I swear the test went on for 30 or more minutes. I think Olivia and I were both relieved when it was over.
That was pretty much the end of the visit. As we were checking out, Dale asked about preregistering for the delivery. We were instructed to asked for a form at the information desk downstairs, which we did. But there we were told we had to go to the information desk in the east wing. (We were in the north wing.) So we walked down to the east wing and I got a folder of forms to fill out. The preregistration itself I was told I could do online, but there are other papers I'm going to have to fill out and bring back next week.
So, Olivia and I are still healthy and doing well. I will get the results of my group B strep test later this week and have them sent to Houston. Then Dale and I will head to Houston again next week for my next ultrasound and prenatal appointment.
December 22, 2004
Getting scared
Prior to my appointment today, I broke down in the shower and started crying. I was just suddenly overwhelmed with the realization that in a month, I wouldn't be pregnant any more. I would be a mother. And I felt totally unprepared.
Not only are Dale and I moving in the next few weeks, I'll be switching doctors. I have my first appointment with a new doctor next week. Fortunately, she's been highly recommended by a friend of the family (who also dealt with gestational diabetes), but it's still a big change to make at this date.
We also still have so much baby gear to buy. Necessary items, like diapers, bottles, clothes. We don't even have the crib yet! My parents ordered the crib for us months ago. We were told it would take 8-12 weeks for delivery. It's been 8 weeks and we haven't heard anything yet. I just called the store and the woman looked up the order info, then said she'd have to call the manufacturer tomorrow then call us back.
When Dale found my crying in the shower, he talked to me and tried to comfor me. He even declared we'd go shopping tonight to get some of the stuff we need.
I was also freaking out because we haven't taken any childbirth classes yet. No tours of the hospital and labor/delivery areas. All that I know to expect is the bits of stories I've heard from other women. I just shocked myself with how unprepared I am and there's no time left. Olivia could be born any time in the next 4 1/2 weeks.
Although the appointments this afternoon reassured me about my and Olivia's physical status, I'm still feeling very stressed, scared, and emotional. On the way home from the clinic, I was listening to Evanescense. In particular, the song My Immortal. I was listening to the lyrics very closely as usual, because I can't decide if she's singing about a relationship that broke up or someone who died. Either way, it's a heartbreaking song and I started crying again. Then the song ended, I was still crying, and I started it up again and cried until I distracted myself from the CD by stopping to get the mail.
I'm still feeling drained but edgy. Suddenly, the biggest event of my life is upon me, and I feel totally unprepared.
35 wk Ultrasound and Checkup
At last week's checkup, Misty had been a little concerned that I would be in Houston next week and unable to get an ultrasound, so she suggested moving the next measuring session to this week. I commented on that to the tech before my ultrasound and she cleared it with the doctor, so we did the full check today.
I'm 35 wks 4 days. Olivia's still measuring about a week ahead. They estimate her weight at 6lbs 6oz., so she's gained about a pound and a half in the three weeks since the last measurements were taken. She's also moved up to the 67% percentile, size-wise. She's still within the normal range though, and Dr. Darby said he can't see anything at all to be concerned about. Her heart rate is good, all four chambers are visible and working, she was fairly active (thanks to caffeine and a proscribed cinnamon candy on the way to the appointment), we saw her practice breathing, and the placenta is still in place. She basically showed or did everything they want to see during one of these exams.
I know she's been head-down for a while now, but I asked the tech to show me how she's positioned inside me. I tend to feel the strongest movements in the upper left side of my belly. The tech explained she's head-down, facing my left side. Her back is on my right with her little butt on the upper right of my belly. Her legs are tucked back down along my left side, so the movements we usually feel on the left are her feet and hands.
Right at the start of the ultrasound, we got a fairly good view of her profile. Later, I asked about getting some pictures and when we tried, Olivia was being coy. She basically had her face pressed against the placenta, so we didn't get a good profile. We did manage to capture a bit of her current pretzel posture, with a foot and hand both up by her face.
(Click for a slightly larger image that's not semi-transparent)
Once again, her parts are obvious to me. If you're having a hard time figuring out what is what, I've also uploaded a copy of the picture with a bit of outlining.
Before I left Dr. Darby's office, I did asked about having to deliver early because of the gestational diabetes (something the endocrinologist's nurse had touched on briefly on Monday). Dr. Darby explained that with most g.d. patients, early delivery isn't a concern, but they wouldn't want me to carry past my due date. I'm anxious to have her now, while being afraid of delivering early, just because I know it's best for Olivia to stay in utero until she's full term. At least I don't have to worry about her going post-term.
I thought my checkup would be the usual quick exam/how am I feeling routine. It diverted a bit. After my vitals were taken, I was told to strip from the waist down. Ann came in and swabbed my cervix with a giant q-tip for a Group B Strep test. Apparently, I can be carrying the bacteria and not show any ill effects, but it can be passed to the baby during vaginal delivery. So if I come up positive, they'll be putting me on antibiotics.
I've had strep throat before, numerous times. I never thought I'd have to have the other end of me checked for strep!
While I was in position, Ann also checked to see if I've started dilating. I haven't.
I think Olivia has started to drop. Since Sunday, my belly suddenly feels much heavier and unwieldy. Even sitting is more of a challege, because rather than just letting my belly rest on my thighs, it feels like it's so low, I should let it hang between my thighs. But I don't feel any more pressure in my pelvis. It's more like she dropped forward and out than straight down.
Earlier this week, I also saw tiny amounts of semi-old blood after peeing, but not in the last two days. That turned out to be common as well. Intercourse or just standing extensively can cause that at this stage of pregnancy.
Finally, the bad pelvic pain that was my biggest problem during my second trimester has started up again. It never went away completely, but it dulled down to where I hardly noticed it any more, even though it was constant. This week, it's back with a vengeance. Any movement such as putting on or removing pants, stairs, and just walking results in a very sharp pain low in the center of my pelvis. This also makes turning over in bed a very painful and tedious process. I can barely get into our own bed because it's so high and it hurts so much to lift my leg like that to crawl onto the bed.
Still, all my complaints are normal and nothing that makes the doctors and nurses worry about me or the baby.
One last thing, in the three weeks since Olivia was last measured, she's gained about 1 1/2lbs. I've gained - nothing. So, my little baby has sucked away another pound and a half from me. No wonder I'm constantly hungry!
Gestational diabetes update
Monday I had another appointment with my endocrinologist's nurse about the gestational diabetes. It was a routine meeting. She looked over my logs, decided how much to increase my dosages, and discussed non-carb snack options with me. She also reminded me to have someone call my endocrinologist when I go into labor because they want to have someone constantly checking my glucose levels.
She also told me to schedule a follow-up one-hour glucose tolerance test six weeks after the baby is born to make sure the gestational diabetes is gone. When I asked her if that meant I had to continue with the special diet until then, she said no. As soon as I deliver, I can start eating normally again.
After I got home and shared the news with Dale, I jokingly told him to be ready to hand me a Snickers bar as soon as the umbilical cord is cut.
One Month Left!
It's now just one month until my due date of January 22, 2005!
December 16, 2004
34 wk Checkup and Ultrasound
We had our weekly ultrasound and checkup early this afteroon, and we're both doing fine. I tried to time my second morning snack to stimulate Olivia for the ultrasound, but I was only partially successful. She moved, but wasn't very active, though she did give the doppler a really good kick once that took the tech by surprise. The biometrics they were looking for were fine. Amniotic fluid volume, position of baby (head down, feet to my left) and placenta (anterior), four chambers of heart working, and the practice breathing movement of the diaphragm.
After the tech was done, Dr. Darby came in and did a quick look. He said everything about Olivia looks great and he can't see anything that would be a cause for concern.
This time, we were lucky enough to get a quick picture of Olivia's profile. Her lips are pursed like she's blowing bubbles and the funny shape above her forehead is one of her hands.
(Click for a slightly larger image that's not semi-transparent)
To me, her features are obvious. If you're having a hard time figuring out what is what, I've also uploaded a copy of the picture with a bit of outlining.
My vitals were fine too. No weight gain since last week, but no loss either. I'm still at 9 lbs gained. I did discuss a couple of things with Misty. First, I've started to get nauseous and sick in the mornings. I've thrown up three times in the last week and a half. Each time, it was right after to an hour after having milk. Misty thinks I may just be becoming intolerant to the milk. I've had so much since the gestational diabetes was diagnosed. WAY more than in the past. Maybe it's because I switched from 2% milk to whole milk. I didn't get sick when I was drinking 2%.
The other thing is that I've recently noticed that the skin at the front of my belly (around my belly button) is kind of numb feeling. It almost feels like a circle of skin 8" across my stomach has been novacained. Misty said that's just from the skin getting stretched so much, which is what Dale and I had figured. It's just so weird feeling! And none of the pregnancy stuff I've read had mentioned this little aspect of maternity.
Oh, I almost forgot to mention that when Misty measured my uterus, it was about 36 wks. I'm 34 wks 5 days. So Olivia is still running about a week ahead of schedule, size-wise. She's the one doing all the weight-gaining these days!
December 10, 2004
33 wk Checkup and Ultrasound
Today's ultrasound was shorter than the last one, because they didn't measure the baby. (They won't do that again for another 3 wks.) Nancy (the technician) measured the amniotic fluid, watched for practice breathing, checked the placenta, and did a general once-over. Olivia is still positioned head-down. She was more active for this appointment because I timed my first morning snack to stimulate her for the ultrasound. It worked, though she's much more active right now (as I have my second morning snack).
I forgot to mention last time that the technician said that Olivia seems to have a good head of hair. She pointed out what just looked to me like thin fringy tendrils and said it was hair flowing off the back of her head.
Nancy tried to get a nice picture of Olivia's face, but she just didn't want to cooperate. The best that we could see was part of her profile, with one hand up to her face. She appeared to be sucking her thumb or wrist or something like that. Vague as it was, it was cute to see.
My regular prenatal appointment was short also. Just the usual checks: blood pressure, urine, weight, uterus measurement. Everything is normal. I'm back up a pound or two. And my uterus size seems to be measuring a bit ahead again. I failed to ask exactly how far ahead.
December 03, 2004
32 week ultrasound and checkup
It's a girl! Oh wait, we already knew that. Well, today it was confirmed. She's now positioned head-down and is in the typical 'fetal position.' This afforded us a great view between her legs, leaving no doubt as to her gender.
Olivia (yay, I feel more comfortable calling her that now) was measured via ultrasound this afternoon. Her skull diameter measured about 32 wks while her abdomen measured at 35 weeks. She's right at 5lbs and is in the 65% for weight. We have a slightly chubby little girl, but not anything to worry about.
The technician would occasionally stop moving the doppler and jiggle my belly with it while poking me with her other finger. She spent most of the ultrasound trying to get Olivia to wake up so she could watch for "practice breathing" movements. The baby stubbornly resisted waking until near the end of the visit when the senior technician came in and did the wrap-up. Even then Olivia moved minimally, but enough for us to witness a few practice breaths.
Though Olivia's growing well, my weight was down a pound from last week. This is the first loss we've recorded since I was post-op and morning sick. Hopefully, it won't be a trend. (Just last night I switched to drinking whole milk for the extra calories.) The rest of my appointment was fine, and very brief.
Misty assured me that I look right on track for my January 22 due date, no signs of complications. The weekly checkups will be watching for any signs that the baby is getting too big and whether we'd need to induce early because of it. On one hand, I'd be happy to deliver early, because I'm impatient to see her. On the other hand, I know it's best for her to go to term.
"Term" is technically 38-40 weeks. I hit 33 weeks tomorrow, so that means "full term" is just 5 weeks away!
Update: I forgot to add that we did NOT receive any ultrasound pictures this visit. :( We never even got to see the baby's face. It seemed like it would be hard to get a good view of her face because of her position, but maybe it's just not part of the clinic's policy with these types of ultrasounds. We didn't ask.
Gestational Diabetes Update 4
I met with my endocrinologist's nurse yesterday. We went over my insulin logs and discussed my eating habits. Overall, she's pleased with the way / what I've been eating, but I was still having some hypoglycemia issues between breakfast and my morning snack. So, she went to talk to one of the dieticians and they decided that I needed to schedule my meals so that I have TWO snacks between breakfast and lunch, no more than two hours apart. So I'll get up in the morning, check blood glucose, inject insulin, then eat breakfast. One hour after that, I have to check blood glucose again. One hour after that, I have to eat a snack. Two hours after that I have to eat another snack. Then two hours after that, I have lunch.
The extra snack is probably going to require some big insulin adjustments, and we were finally getting to the point where my glucose was consistently testing in range after meals. The only issue was my morning fasting glucose still stays 5-10 points out of range.
I think I'm getting better at guaging carb servings. Last night we had dinner at Outback Steakhouse with some friends and I helped myself to some cheese fries. I also had ribs and steamed vegetables (skipping the zucchini), and my post-meal glucose was right at 120, so yay.