The Third Trimester

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Week 28

OMG OMG OMG OMG OMG OMG OMG OMG OMG!!!! WE ARE HAVING A HOME BIRTH!!!!! AAAAAHHHHHH!!!!!! I AM SO EXCITED!!!!! BUT… I can’t call anybody! I can’t tell anyone without getting into a “you’re crazy”/”no I’m not” argument! I’d like to enjoy our decision for a little while… so I’m just going to keep this to myself for as long as I can without BURSTING! Here’s what happened:

Based on the unpleasant meeting with Midwife C, but before we got their letter kicking us out, we decided we needed a pick-me-up. So we called up Sarafina Kennedy (our birthing class co-teacher) fully intending on getting a pep talk about hospitals, because Sarafina has worked in that setting before dedicating full time to home birth midwifery and has had some good experiences with Newton-Wellesley midwives. But before we could talk, we got that unfortunate letter dumping us from the WHA practice, and NWH was no longer in the picture… but we still wanted to meet with Sarafina.

We told her our whole story, and she was APPALLED at the letter (GOOD, outrage is exactly what people should feel about this). We asked her about the Cambridge Birthing Center (back to square one), and she said that her own experiences and that of her peers has not been the best there. Mostly because the Birthing Center is very quick to transfer people to the hospital if they fall into their “risk” categories, because their rules are still dictated by the hospital. Some situations where they might transfer you to the hospital but you would be fine with professional help at home would be situations like: there’s traces of meconium in the amniotic fluid (that’s not ALWAYS a guaranteed intervention), or if the baby is in the wrong position, or if the baby’s heart beat slows down, etc. We knew this, but we were crossing our fingers that everything would be ok.

Seeing as I wasn’t feeling much better about institutions, I asked her straight on: tell me that it’s possible to have good experiences at hospitals. She said that absolutely you can, and mentioned some situations in her experience that were handled very well at hospitals. However, it does mean working a little harder to get everybody on the same page. I still wasn’t feeling it.

Then I asked her everything I needed to know about a home birth: cost, situations when it would require a transfer to the hospital, situations that have prompted her to call 911 in the past, situations when being away from the hospital would be life or death situation for me or the baby (which are a couple of situations in which minutes would matter and happen once in a blue moon), etc. She answered every question openly and completely truthfully. Brian and I looked at each other, and we both agreed that there is a higher chance that things won’t work out at a hospital (c-section, bad experience overall) than of having a lightning-strike probability of bleeding out at home. We simply couldn’t excuse planning to avoid a lightning strike by aiming for a car wreck. We agreed home birth was looking better.

Sarafina said that our inquisitive nature and our wish for taking control and assuming accountability for our decisions made us perfect candidates for home birth. Home births are not for everybody. They are not for people who would rather leave all decisions to professionals. It’s more for people who want the responsibility for the entire experience, and it looked like to her that we were.

I won’t lie: I wanted this so bad. After spending the past 6 months hearing every story about home birth, every story about hospitals, watching every video and reading every website, there was no doubt in my mind that a home birth was the right one for me. So I looked at Brian, and asked him to ask any questions he needed to ask about home birthing, ’cause I most likely was going to try to get him to agree to one 😉 He said he had had all his questions answered (including price, Sarafina’s availability for September, risk factors at home, etc). By the end, we both just knew. We wanted this. As soon as Sarafina left, Brian asked me “so are YOU going to tell my mother?” I was SO happy! We did sit down to say things that we couldn’t share in front of Sarafina, like what he was so worried about. He said he wasn’t worried about the birth, he was actually kind of giddy. He even likened it to asking me to marry him: it was a “giddy” kind of nervous. I knew this was a great sign 🙂 I was jumping up and down, I was BEAMING… I couldn’t believe it! All my anxieties can be kissed BYE BYE. I was going to have exactly the birth I wanted, exactly where I wanted it, with a team of people who actually care about ME, our plan, our wishes, and who prefer to get questions and to spend the time discussing anything we want. THIS is the path for informed individuals. I’m still so surprised more people don’t go for it…

Anyways, we still had the daunting task of telling our families… we knew they wouldn’t like it ONE bit.

First, I told my mother over the phone. I was scared out of my mind, so I had to get it out of the way ASAP. I explained everything from Sarafina’s visit through my train of thought, and tried to remain cheerful. I stressed how much thought and research had gone into this decision, how it was not a light one, and how much I think she will enjoy the experience once she’s in it. She started to cry and said that if that was my decision, then there was nothing she could say. She tends to do that thing where she keeps all her feelings bottled up inside (but they still manage to come out her eyes), while saying whatever she thinks she’s supposed to say. Then my father came into the conversation because he saw my mother was upset and he was already hearing her side of the conversation, so he wanted to be let in the loop.

I started with an inside joke we have where I say I’m scared (of him). They laughed a little, and I told my father what was up. Again, I kept a cheerful attitude and explained this feels right and we have not totally improvised this, it’s well thoughtout and we are in great hands. Then he started with his (expected) questions about the qualifications of the midwife, and how I should get seen by a doctor that could confirm that I’m really fine (he doesn’t have much faith on midwives because they don’t have a medical degree). I assured him I was in good hands, but I would let him know what we decide about his suggestion that we see a doctor for a pre-natal appointment to make sure everything is alright. I don’t know what to do about that one yet… I don’t see any harm in getting checked out, but it’s unnecessary. It might just be $15 and a few hours off work for me. Maybe I’ll do it just to appease them, but I don’t think that’s a good reason to do anything. Brian says that if that’s all we have to do to keep them happy, then we have to pick our battles and just do it. I’ll keep thinking about it. I managed to keep my cool through his remarks downgrading midwives, and didn’t argue for the sake of argument. I only answered questions when there was any.

He asked me about Plan B for complications, I told him our midwives normally use the Brigham and Women’s Hospital, but if it was a 911 situation, we would go to Norwood Hospital (5 min from my house). He seemed ok with this.

Other than that, they just said this was a “revolutionary” thing they are not used to, and they hope it works out. I was out of the dog house!

Then came the task of telling Brian’s mother. He called her on the phone, and just stated that we are doing a home birth matter-of-factly, and expecting her to make a scene. Well, she didn’t disappoint. She started ranting about disabled kids she works with that stayed too long in the womb, etc, and started to really cry. Then she said she couldn’t talk anymore and hung up the phone.

Later that day Brian called her back to see how she was doing. She was upset that her input and experience weren’t thoroughly inquired upon and utilized in the decision-making process, therefore we must not appreciate what she can offer. Brian didn’t quite know how to react to this, because he pretty much calls her to consult her on EVERYTHING under the sun… in his mind, it was simply not true. I think she avoided us for the whole weekend, but hopefully she’ll at least get over the shock and we can have family dinners together again. She’ll be ok, I’m sure.

That was the hardest part: telling our families. People are worried about all sorts of things: whether we are getting good prenatal care (after all, to paraphrase my father’s words, if the care provider is not an MD and can’t prescribe medication how good can they be?), or whether I will actually be able to withstand the pain and end up regretting not getting immediate relief, or whether a sudden death situation presented itself even if risk factors remain low. All of these concerns are founded in fear that others have around birth. It’s our job to be here for them to provide information, but it is not our job to chase after them and make them understand. They might never understand.

I think what makes the discussion so difficult is that there is no right or wrong in this situation. Mothers who pick hospitals are not wrong, and mothers who choose home are not wrong. It’s just two different ways to do things based on present risk factors. I can’t argue that any mother could have avoided a c-section if they had been at home, because the facts of the case may be completely different. Just like they can’t for sure say that giving birth at home will lead to death for all involved. There are just a lot of grays, and we both have to agree to disagree.

For all who wonder why we are doing this, this article roughly walks you through our thought process: Mothering.com: You want to give birth where? There are some things I wouldn’t say exactly like that, but it kind of gives you an idea for how the whole home birth concept came to mind as a viable alternative.

In my mind, there is a very simple explanation for our decision: with a home birth, I have a 95% chance of having the birth I want outside of a hospital environment. In a hospital, my chances drop to 30% (there’s already a 30-40% chance of a c-section, coupled with my own fears around hospitals which will have the effect of exacerbating labor difficulty, plus the risk of running into a care team member that is not in alignment with my birth plan). So the choice was really a no brainer for me.

Alright! Parents have been notified, first prenatal appointment has been set up, so it’s now onwards and upwards! 🙂

Weight: 135lbs (delta 20lbs)

Symptoms

• Terrible back aches wake me up in the middle of the might. I attribute this to our very uncomfortable bed.
• I’m getting more tired as the day goes by. I find I can’t walk around or stand for long periods of time without needing to rest.
• Strange but true: one night I was feeling anxious about something, and noticed that whenever I shifted focus to my belly, it started to hurt a little. It was more of a nervous feeling that can be felt not only in my chest, but all around my stomach. There is no reason for pain, so I basically managed to isolate the impact that anxiety alone can have on your body on the day of labor. I want to remain calm that day, but it’s harder said than done!
• Sarafina said I have a lot of water in there. Maybe that is why my belly looks so big. Babycove’s size is fine.
• Sarafina checked babycove’s position: head is down, ladies and gentlemen! She also taught me to feel for the head, the bum, the back, the feet. AWESOME.

Actions

• Bought a new bed! Memory foam rocks! Now, I wish I had a new ergonomic pillow
• Continue practicing Hypnobirthing CDs. Started listening to the “Affirmations” and they are great!

Reading

• Mothering.com: You want to give birth where?

Week 29

This week has been less stressful than last. Now that we are “out” with our decision, our parents have begun the process of getting used to the idea. I still have to get some answers for my parents, such as: will I get an x-ray to determine whether my pelvis is large enough to see a baby through (uhh no thanks), and whether I can get lab tests reviewed by an MD (unlikely). I’m still working on figuring out how to address those types of questions/suggestions; at the same time, I’m trying to get my mother prepared for the birth, since she’ll be present. She said she’d be open to checking out home birth videos and information while she visits prior to the birth. I thought that might be a good way to set expectations and calm some anxieties.

As for Brian’s mother, she has begun asking questions (and expressing opinions) about vitamins, vaccinations and circumcision. It’s a good thing to see she has reestablished communication and does care. I still think it’s a bit strange that she won’t talk to me directly… I feel like a 12 year old being left out of the parents conversation about “grown up” things. I’ll just give her her space.

Going back to the “MD” stuff, I did email my PCP to see what she recommended as far as getting checked out by a doctor and be “cleared” as low-risk. As far as I understand, pregnancy is considered a single episode of care by insurance companies, and OBs don’t actually get paid after every appointment, but only after the baby is delivered (I suspect this is one of the reasons we got kicked out of WHA: the risk that they would spend all this time with us, without getting paid in the end if we decided to leave). So what can I do to get a checkup? I’ll wait for my PCP’s answer.

In the meantime, we were supposed to have a prenatal appointment with Sarafina and her partner, Jessica, but a birth presented itself and we had to reschedule for next week. I was a little bummed, but I’m so looking forward to it!

Lastly, this week we got to meet our doula (labor coach/assistant) for the first time. She’s only starting out now, so she doesn’t have much experience at all, but she’s very eager, very passionate, and very organized! I know she’s not going to let us down 🙂 We basically covered what is included in her role, and all of my wishes and expectations. I’m happy 🙂

Symptoms

• Babycove is doing CARTWHEELS in there. You can totally see it from the outside… it’s very alien-like!
• Constipation continues, although I have managed to continue going “No. 2” at least once a day, even if it’s not much. I’ve been getting up too late to make my prune juice smoothies, so maybe that’s making things worse.

Actions

• Met our doula for the first time!
• Penny pinching has begun! Since home births are not covered by insurance, we are left to pay upwards of $3000 on our own. So we have started cutting back on luxuries, such as parking (we walk to the train instead), piano lessons (*sniff*), gym membership (or as I like to call it, “my favorite charity”), and eating out. We also make sure our daily lunches stay in the $5 range. We’re going to save a LOT this month!
• Emailed my PCP to find out what to do to get a checkup to “clear” me of any risks.

Reading

• Healthy Sleep Habits, Happy Child – my neighbors gave us this book so we can start thinking about establishing healthy sleeping habits that may help us in the long run.

Week 30

This week started with a tiny budget and a huge task: organizing the gazillion boxes of baby stuff that my sister so generously left at my house before her big move down south. After all, we have to figure out what we have in order to figure out what we need. It was a very pleasant task, and it made for a very relaxing Fourth of July weekend 🙂

This week we had our first prenatal appointment with Sarafina Kennedy and her business partner Jessica Petrone (visit their website at HomeBirthMatters.com). Lovely women. We spent about an hour doing a full medical history, and spent the last half hour checking out the baby’s position (head is still down!) and doing certain measurements. Turns out I’m doing textbook well 🙂 My blood pressure was 118/60 (compare to “optimal” 120/80 for healthy non-pregnant people), which is not surprising considering I’ve always been on the low end of normal. They also measured the size of my belly and I’m at a perfect 30 cm, which is supposed to match the number of weeks you are (30!) 🙂 They also made me pee on a stick of tests for protein, glucose, and some other gazillion tests, and they all came out completely negative. Basically, I could not be any healthier if I tried. I do have homework: to keep track of everything I eat for 7 days. What? Keeeping track of stuff? That’s what I DO! Not a problem there 🙂

I was so excited to talk them. We covered everything under the sun. I asked them about the birth tub (do we really have to buy one to just use once??), they said they rent one out so we’d have to pay $200 for that. In terms of hygiene, the tub comes with a plastic lining, so renters never actually touch the tub and they have their own disposable lining for the duration of use. We also have to buy the birthing kit… price TBA. I also mentioned to them that my parents wanted an MD to check me out, and they had no problem at all. For this reason, I decided to hold off on having them take my blood, assuming a doctor will order blood tests (maybe we can save us all a little money that way).

When they were feeling for the baby’s head, they said they could feel his little hands on the head, so maybe he was sucking his thumb. It was so cute to hear them talk about him! It’s like he’s really in there!

In the end, I was very happy and very excited about the whole thing. I was jumping for joy!

On a side note, I downloaded a countdown application for my phone and a birth companion application. I use the first one to track when my full term date is, so I know when little babycove will come “any minute.” There are a couple of reasons why this date is more important than the due date: (1) since only about 5% of women actually give birth on their due date, it is actually quite meaningless; and (2) most first time mothers are actually late in delivering, the average being 41.3 weeks into the pregnancy, so sticking to a certain due date can be stressful for the mother. What you do is leave the date tracking to your care providers. They will tell you if the time to wait is up (42 weeks for most providers before you are induced).

The second app, the birth companion, is there to help you track the length and frequency of your contractions. This is a better tool than using pen and paper because usually the job of tracking falls on the dad, when really that’s the moment when mommys need him to be there with them the most! So tracking by way of pressing a button is a convenient way to remove all the distraction. It even has a setting to send an email to your care provider when the surges (aka contractions) are 1 min long and 5 min apart (which is the very definition of active labor). I guess I’ll let you know how it works out!

About the OB visit, I tried to get a specific doctor that was recommended by my coworkers, but she only services high-risk pregnancies. So I was assigned to another one and the appointment will be next week. I’m still afraid they won’t help me because they won’t be delivering the baby. Why does this matter? I’ve heard that they don’t get paid for prenatal appointments unless they ultimately deliver the baby, and I have also heard that if they are not certified for home births, their insurance won’t cover them for anything that may happen. All these things are motivations for doctors to turn us away. We’ll just do our part by trying.

I know this post is long enough already, but for the past couple of weeks I have been feeling these uterine spasms. At first I was afraid that it would be the baby having seizures or something. It feels like the whole baby is shaking, and you can tell it’s not a normal movement. I went online, and found out that many women feel this around 28-32 weeks (phew!). Here’s a forum I found on Baby Center where mothers talk about the “Seizures in utero (forum)” they have been feeling:

We are feeling the Uterus going through a fit of spasms. If any of you have ever exercized to the point where your muscles seem to “quake” or “shake”, this is the same thing for the Uterus. It is getting a constant workout by the Braxton-Hicks contractions. And we don’t always know when we are having Braxton-Hicks Contractions…but they are purposefully to “exercise” the uterus for labor and delivery. Since all of our timelines are late in the pregnancy, we’ve probably been experiencing these contractions for many weeks now, which would explain the uterine muscle spasms. I confirmed this with my Ob-Gyn, and was reassured that this was the most likely cause, since I know-as the pregnant one-that there is NO WAY my baby could be moving that fast!

I’m reassured it’s the uterus and not the baby 🙂 Phew! That was scary. If you’re experiencing this, I encourage you to read other women’s responses… they all explain exactly how it feels and what their doctors have told them. Surprisingly, not many women talk about this openly, so doctors may tend to overreact and put you on bi-weekly ultrasounds… so make sure you read and save yourself the anxiety over this one!

Symptoms

• I am Nap Central. I wish there were nap times at work so I could rest during the day without worrying about my schedule.
• A few weeks ago I had to take off my wedding band and engagement ring because they hurt going in. Midwives said that I did not look like I was retaining fluid, and that because I am producing 50% more blood, it is expected that I’ll be a little “fuller” around my face, fingers, etc. It’s good to hear I wasn’t swollen from fluid retention.
• Uterus spasms

Actions

• Sorted baby clothes
• Started creating a baby registry online
• Had first prenatal appointment with home birth midwives
• Pinching pennies and selling books on Amazon continues! This home birth stuff can be really pricey if you were counting on an insurance-covered hospital birth!

Reading

• Forum topic: Seizures in utero — NOT 😉
• Home birth on the rise by a dramatic 20 percent – Brian found this article in the Boston Globe, and I forwarded it to my parents before realizing that all the comments below the article were very much anti-homebirth. Yikes! But the stats are good and real and wouldn’t be on the Globe if they hadn’t been verified, so I thought it’d be good supporting material for them.

Week 31

This week I finished logging all my meals in the 7-day food journal that Sarafina, my awesome midwife, had me fill out. I’m feeling ok about it, but I’m sure she’ll ask me to add more veggies to my diet.

Anyways, something more important happened this week: we went to see an OB at the request of my parents. Here’s the play-by-play:

I called the outpatient OB unit of the hospital where I work, and made a plain old prenatal appointment. I didn’t think it was worth explaining the whole situation to the receptionist, I just wanted to see an OB. So I got my appointment for the following week.

When we got there we were first seen by the nurse. She took my blood pressure (120/60 – perfection), got my weight (140 lbs – perfection), and told me to wait for the senior nurse, who was going to get the scoop before we saw the doctor.

The senior nurse was very sweet and nice. We explained to her that we are having a home birth, and we were just there to get a second opinion on my overall health. In other words, is there anything we may have missed to test, or we should make sure our midwife tests? She was a bit confused… we were having a home birth, we were not there to get “talked out of it,” and still we wanted to see an OB? She excused herself and went to talk to her boss, the Nurse Practitioner, to ask her how we should proceed. She said that in her 30 years in this field she had NEVER ran into this situation. When she came back, she informed us that, first off, the kind of appointment we got was wrong. They were under the impression I’d be transferring care, but all I needed was a consult. Luckily, the fellow doing the consults, who is a high-risk pregnancy OB, had a cancellation, so he could see us right away. Yay!

So we went to see the fellow (a fellow is an MD in training on a specific specialization in his field). At first, he was going to try to give us the hospital side of birth and see if that would persuade us to not have a home birth, but I stopped him before he started and clarified why we were there: we just want you to check me out and make sure that my midwife and I are correct in believing that, at this point, I am a healthy person. He was SO confused! He said he’d probably just need to get a CBC (to get my hemoglobin level), get a syphilis test (routine), and have me take the glucose test that I missed on week 28. I told him all that sounded good, and he left the room. He came back with HIS boss, the attending high-risk OB, and now SHE wanted to know what is it that we wanted from them again? So I explained one more time:

Me: We are here for a second opinion on my overall health at this point in my pregnancy.
Doc: Don’t you already have a care provider?
Me: Yes, that is the 1st opinion. I’m here for a 2nd.
Doc: But what makes you think you are unhealthy?
Me: Absolutely nothing!

This is where she caught me. I couldn’t excuse in any logical terms WHAT ON EARTH I was doing in their office. I had to come clean. I explained that my parents would feel more comfortable if an MD could confirm my current health status. She seemed to understand that, and explained that pregnancy is a continuum of care, and that a single evaluation would not make her feel comfortable “signing me off” for a home birth. I told her I completely understood, and I just wanted to get this over with for my parents’ peace of mind.

She explained that she concurred we should do a CBC to check for anemia, a syphilis test, and the glucose test. I asked her if I could do the jelly-bean version of the test, and she said that their results were standardized so the process for taking the test was only the drink. I told her I’d just take the test with my midwife, and she was totally fine with that.

So, they measured my belly (31 cm at 31 weeks – perfection), and they just told me to come back to get my blood drawn, which I did.

Then, I called my mother. I told her the whole story. She was surprised that this was such an unusual request that they were all so confused. I explained to her:

Me: Ma, people don’t usually go to an OB to get a consult when they have decided to do a home birth or they are with another practice, ESPECIALLY if there is nothing wrong with you.
Ma: but your care provider is not a doctor!
Me: that is irrelevant!
Ma: How could it be irrelevant??? It’s like going to the butcher shop, and the cheese guy ends up cutting your meat!
Me: No Ma!!! The cheese guy has nothing to do with meat, but the midwives ARE the care gives for birth!!! I could have chosen the midwifery group at the hospital, gotten through my entire delivery, and STILL not having seen an OB doctor ONCE!!! Midwives are trained, knowledgeable and educated in this!!! This is what they do! And BY THE WAY, you can lay off wanting me to have a pelvimetry. They haven’t done X-rays on pregnant women in more than 30 years!
Ma: (laughs) You guys are so weird! You go back to the 1800’s way of doing things, and you expect us to agree with everything!
Me: No, Ma! You guys are the ones that are stuck in the 1980’s when we are all the way over here in the 21st century!
Ma: (laughs) Could be… fine!
Me: So now you feel good? Are you happy?
Ma: Now let’s wait for the test results!
Me: Sigh…

So things turned out fine in the end. I hope they are coming around to the fact that this is not weird, and they simply just don’t know anything about it. I really hope that home birth movies and the documentary The Business of Being Born (2008) bring my mother around to our way of thinking. Fat chance, but there’s hope.

Weight: 140lbs (delta 25lbs)

Symptoms

• Little babycove woke me up with his kicks at 3:30am one morning. I couldn’t get mad, though, I just held onto my belly to make sure I didn’t miss a second of it.
• I’m definitely starting to feel the effects of this new body weight on my legs. I can’t stand for long periods of time, and I am walking quite slowly.
• I am so tired all the time…
• I felt a weird pain on my belly this week. It’d go away when I moved around, but it was very different from the usual intestinal discomforts… it was a bit scary, but there was no sign of preterm labor at all (some of which are passing your mucous plug, bloody show, feeling the baby drop). It was just a different kind of pain. Could have still been intestinal for all I know. It’d gone away by the time I had gotten home. Weird…

Actions

• Visited an OB
• Penny pinching continues, to save up for the birth!

Week 32

Welcome to my 8th month of pregnancy! Little Babycove is super active and I’m feeling good!

Tons of things to talk about this week. Let’s start with: my lab results are back! I only know this because I work at the hospital and I have access to my own medical record, otherwise, I’d still be waiting for a call-back from one of the physicians to interpret my results. Doesn’t anyone follow up on these tests??? Anyways, here are my results:

The results scared me a little at first. I was convinced I was anemic, and perhaps, technically, I am. The lower limit for hemoglobin is indicated to be 12g/dl, while mine is 10.4g/dl. But how do you explain that the quality of my red blood cells (MCV, MCH) are normal? I searched online, and I found a few things about anemia during pregnancy:

• I found multiple studies (here’s one: The Journal of Nutrition: Iron-Deficiency Anemia: Reexamining the Nature and Magnitude of the Public Health Problem) that showed that there was no direct link between taking iron supplements and preventing preterm labor or low birth weight, which are the risks of gestational anemia.
• A pregnant woman’s body produces more plasma than red blood cells. It’s a fact of the condition and it is ubiquitous by design.
• Because of this, the “floor” value for hemoglobin in pregnancy is supposed to be 11g/dl, and in some countries even 10.5g/dl.
• Anemia presents with clear symptoms: being tired all the time, looking pale and exhausted, even lifting your arms seems like too much work.

After I did my homework, I realized that although my hemoglobin count is “low,” it’s really border line. Also, taking into account that this is the way the woman’s body is designed to work during pregnancy, and that I am asymptomatic, I have no other option but to accept the fact that I am not anemic.
I even went on Yahoo! Answers and asked the question: “why would a woman’s body be designed to dilute hemoglobin?” and I received a very thoughtful answer from a user named “C.J.” Here’s the answer:

By Yahoo! Answers user C.J.
I had thought about this when I first got pregnant. I had decided against any sort of supplements while pregnant and through my research I found some interesting theories on this. Most surround the idea of the balance between calcium and iron in the pregnant woman’s system. As I am sure you know, too much calcium in the diet can block the absorption of iron.

The theories I saw talked about how it is possible that pregnant women in a natural state probably do NOT need higher levels of iron in their diet in order for the fetus to develop. In fact, the recommendations and definition of a pregnancy levels of anemia are based solely on ratios of plasma and red blood cells in non pregnant women, then applied to be the same ratios in pregnancy. But why must this be? There is no evidence that the fetus actually requires such high levels of iron. In fact, it is thought that any woman within a normal pre-pregnancy range while pregnant is providing enough for her child.

Now obviously this means that some women will likely still not be in this range if their diets continue by modern standards. The use of calcium supplementation through pills, tums and fortified foods is a major problem here. Calcium is of course important for a healthy pregnancy and to help prevent against osteoporosis. But the most healthy way to gain this calcium without interfering with iron is through cheese and yogurt as your primary sources, with milk secondary. Obviously most pregnant women end up eating more milk and taking supplements nowadays, leading to a distortion in our data on the actual consumption needs of pregnant mothers.

So, it appears that iron levels may not really need to increase (or not by much) while pregnant, and thus our red blood cells do not need to increase as much. Plasma does need to increase because of the variety of other nutrients that needs to be processed through our systems at higher rates than pre-pregnancy.

I ran all this information by my midwives. They didn’t seem to necessarily agree with my “screw iron supplements” attitude, but they did agree that my condition was border line, and that if I wasn’t feeling any symptoms, then they really don’t have any reason to recommend that I take iron supplements. However, they did say I should be adding more protein to my diet, incuding beans, red meats, and dark green vegetables. They said they have been successful in bringing an actual anemic pregnant woman back from the depths of anemia to a semi-normal level by diet alone. They also said that although studies can’t find a link between iron deficiency and risks to the baby, they do believe that the iron deficiency, rather, is a risk for the mother. They didn’t want ME to be anemic. Mothers should stay healthy. I don’t really have a comeback for that 🙂 It’s their job to take care of me.

So that’s my iron update, for whatever it’s worth.

On related news, we had our second prenatal appointment. My pee-stick test continues to be perfectly negative, my belly measures 32cm at 32 weeks, my baby is moving like there’s a dance party in my belly, and the heart beat is strong. This coming Sunday I’ll be making a carb-rich breakfast and measuring my own glucose levels with a diabetics hand-held device my midwives gave me. Brian is worried that I am thirsty all the time, and that might be a sign of diabetes. Recall that the risk of diabetes is that the baby will grow too big, and considering my baby is growing just fine, I don’t really think it’s a concern at this point… but it doesn’t hurt to test it out and see how it goes. I’ll let you know what happens.

On unrelated news, Brian and I continue to pinch pennies like we never have before. I’ve been taking care of our meals during the week by doing very conscious grocery shopping on weekends, and cooking at night. This week I even made one of my mother’s staples: Pasticho (it’s sort of a meat lasagna). It took me 1.5 hours to make, but it fed me for 6 more meals after! 🙂 I also continue selling my books on Amazon, and I’ve made around $350 in one month! I think that’s pretty good, don’t you? So we keep on churnin’!

ALSO, Brian’s family threw us a baby shower this past weekend 🙂 It was very nice and everyone was so generous with their gifts. I’m lucky to be a member of such a caring family 🙂

–I thought I was done with this week, until something happened at the last minute…–

As I’ve been shamelessly posting in these updates, I have experienced on-and-off rectal bleeding throughout pregnancy. On Friday of this week, I went to the bathroom and struggled a bit, which resulted in quite a bit of bright red blood releasing. I assumed this was related to the same thing, and tried not to give it too much thought… until I realized that I was still “spotting” after going to the bathroom. I called my midwife, and she asked me a few questions: had I had sex in the past couple of days? Had I made any significant changes to my diet in the past couple of days? Was I feeling any preterm labor symptoms (i.e. lower back pain, cramps, etc)? The answer to all these questions was No. She said she would recommend an ultrasound, and given that it would be easier for me to get it at the hospital where I work, I might as well do that. The outpatient clinic directed me to the emergency room, and the emergency room directed me to the Labor & Delivery unit (where I recognized everybody because I had been there for work-related observations that same morning — so embarrassing!). Anyways, they put the fetal monitor on, and at 10 minutes, I asked for it to be removed. The baby’s heart rate was fine (~135-140 bpm), and I did not see the necessity to keep blasting my baby with high-frequency ultrasound waves just for the sake of it. To my surprise they did not recommend an ultrasound, but a vaginal exam. Reluctantly, but understanding the necessity, I agreed to it. (All gory, humiliating and horrifying details have been omitted). As it turns out, I have a small benign polyp hanging from my cervix, and it was bleeding. They confirmed I am not dilated, so the blood is coming from outside the uterus. I was relieved to hear a reason for it. The nurse midwife said to just keep an eye on it, and to not ignore it if I bleed through a pad in an hour. She said they don’t usually do anything for those, and I could get it removed after the baby is born. She also made clear that she did not think it was ok for me to refuse the fetal monitoring. She said they like to make sure the baby is moving and there are no neurological issues that prevent the baby’s heart from increasing when he moves around. Considering that I KNOW the baby moves around A LOT, and I did see a spike while he moved during the 10 min it was strapped on, I said I understood, and still refused it.

My discharge orders were to watch out for preterm labor symptoms: contractions, bleeding, decrease in baby movement. They said the baby should be moving 8 times an hour. I won’t lie to you, having refused the fetal monitoring, I had to be reassuring of myself that I had done the right thing, so every 7.5 minutes or so I had to make sure the baby was moving. Even through the following morning I was just feeling for the baby’s movements. It’s been a couple of days now, and my little babycove is as active as he usually is. Nothing to fear. Spotting has not gone away, but it’s not a lot, so I can live with it.

To read more about other women’s experiences with cervical polyps during pregnancy, read this BabyCenter forum.

Symptoms

• I can’t stand for more than 3 min at a time… my legs hurt like a motha’! I can walk longer lengths, though, as long as I do it slowly.
• Felt light-headed at times. This happened especially after learning about my test results. I may just be very susceptible to suggestion. If you are anything like me, just be really conscious of when your “symptoms” begin — did you just get a lab test that matches those symptoms? You may be bringing them onto yourself! What “cured” me was finding out more about iron supplements and understanding exactly what was going on.
• Been wanting to get home, have dinner immediately, and crash. Sleeping at night is still very uncomfortable, so I appreciate the comfortable times I spend napping on the couch.
• Spotting due to cervical polyp

Actions

• Had my 32 prenatal appointment with my midwives. These last approximately an hour, where we get to discuss ALL of the questions I’ve been gathering for the past 2 weeks. Good prenatal care cannot be served in 20 min intervals… it just can’t!
• Got my lab results back
• Started eating more red meat, and adding spinach to my morning smoothies

Reading

• The Journal of Nutrition: Iron-Deficiency Anemia: Reexamining the Nature and Magnitude of the Public Health Problem
• BabyCenter forum: Cervical polyp during pregnancy

Week 33

Other than feeling like I REALLY didn’t want to work at all, this week wasn’t half bad.

I took our home-made glucose tolerance test. I made a sweet breakfast of 3 organic buttermilk pancakes, 1/4 cup of syrup, 1 egg over-easy, 1 Dunkin Donuts chocolate chip muffin, and a smoothie containing about 1/2 cup of strawberries, 1.75 cups of all-natural prune juice, and spinach. Here were my glucose test results:

• Fasting, before getting out of bed: 77mg/dL (normal range*: less than 95mg/dL)
• 1 hour after finishing breakfast: 115 mg/dL (normal range*: under 200mg/dL)
• 2 hours after finishing breakfast: 126 mg/dL (normal range*: under 140mg/dL)
• 3 hours after finishing breakfast: 107 mg/dL

* Normal ranges obtained from MedLinePlus

My question is: why was the 2 hour one higher? I would have expected the number to come down… I guess it doesn’t really matter. My numbers don’t even touch the limits of the normal range. The only thing I can think of is that the measurement unit I used has a 10% or so margin of error, so the 115 was actually meant to be higher, and the 126 was meant to be lower. Also, fats added to the carb-full breakfast are supposed to delay the absorption of carbs, so maybe that egg slowed down the results. That’s all I can think of. My midwives said that as long as I was below the limits, they could safely assume I did not have diabetes and was not at risk for it. Obviously, keep an eye on any symptoms in case a follow up test is needed. Yipee!

As a somewhat-related update, someone from the hospital is yet to contact me about my hemoglobin lab test results. Seriously? Not that I want to talk to them at all, I guess I would have expected someone to call me to read the results to me.

Symptoms

• Swollen ankles after having tons of sodium-packed chinese food, and being exposed to extreme heats of summer. You could tell it was related to dehydration (due to the increase in sodium and sweating) because if you pressed the swollen ankles with your thumb, you’d see the imprint after you let go. Yikes! This got better by the next morning.

 

• Upper backache. On my left side, in a particular spot. Someone suggested it could be deferred pain from a gas bubble… I don’t know enough to confirm nor deny such a theory.
• Going to the bathroom (to do number 1) at least once an hour. Sometimes multiple times an hour depending on how much water I’m drinking.
• Still can’t sleep comfortably at night. Wake up in so much pain all over!
• Pressure from my baby on my rectum worsened my constipation, which, combined with a pre-existing condition of internal hemorrhoids, turned into external hemorrhoids this week 🙁 Luckily, every website says that this is very common among pregnant women, and it’s bound to resolve itself after the baby is born. But still! 🙁

 

Actions

• Finally got around to buying a body pillow for bed. Seriously, I can’t stand it anymore!

Reading

• Cure Hemorrhoids Naturally
• Wikipedia: Hemorrhoids

Week 34

This week was mostly marked by drama than anything else (really, what are shower thank you notes for if not to spice up your life?). But moving on, little babycove is moving around and getting bigger every day. Just 2 more weeks until full term! We are so close!!!

This week we also made some amazing advances in the setting up of the nursery. I managed to organize all the gifts we got (which were ABUNDANT), and Brian’s family very kindly volunteered to come and paint the room. It looks beautiful! I can’t wait to start putting things in their rightful place and getting it all ready to go. I’ll do some more organizing this weekend, and then have Brian’s family over the weekend after to help me organize some more. Hopefully that will be the end of it and we will be ready so that we can put the birth tub in place (in the living room) on week 36, and everything looking good for when my mother arrives on week 37. Things are coming together!

I also noticed that I’m missing a few things from the registry, such as a diaper genie! I had a long discussion with Brian about it last night, and it appears as though he is against having one! He thinks we should just have a regular trash can, and take out the trash every day. So, basically, he’s missing the very important factor of odor control. I decided to compromise a bit and buy a used one on Craigslist for $5 (as opposed to the $35 one on Amazon), and see how it goes. But of course, I can’t get over the fact that each bag costs around $6!!!! That’s how they get you! So I read some advice online, like putting only poopy diapers in the genie, and all others in a regular trash. That way the bag lasts a lot longer (it holds up to 270 diapers)… I just wonder if the odor will remain hidden for 270 diapers. Anyways, we’ll figure it out!

Other things I’m still missing are a hooter hider, a breast pump, a white noise maker, a sound monitor, and a moby wrap. I hope to be able to use most of my gift certificates for these… ayayay. $_$

Next update: I had my prenatal appointment with Sarafina. Everything seems fine, but I seem to be leaking some white blood cells (leukocytes). She mentioned that, all on its own, it’s not really an indicative of anything major, but coupled with some other results, it could mean a urinary tract infection (UTI). I have not had any burning while urinating, and my test didn’t come accompanied by anything else, so we’ll just keep an eye on it.

In this appointment I got to ask about the Group B Strep test. Sarafina said we could do it in our next appointment, and she explained briefly how the treatment at home would go. Instead of getting IV antibiotics, I would basically get a vaginal wash with Chlorhexidine, which is apparently the way they do it in the UK, every so many minutes during labor. I found an article on PubMed saying that the treatment is 50% effective, so I got curious to see how effective antibiotics were. I found an article on PreciousPassage.com from 2003 saying that:

Approximately 0.5 percent of women found to have GBS bacteria in their genital areas at 35 to 37 weeks into their pregnancies and who are not treated with antibiotics will go on to deliver a baby who becomes ill from GBS.

and that

Some studies have shown a decrease in GBS infection in newborns whose mothers accepted TV antibiotics during labor, but no decrease in the incidence of death. (8,9) Still other research has found that preventive use of antibiotics is not always effective. (10) In fact, one study found no decrease in GBS infection of deaths among newborns whose mothers were given IV antibiotics during labor. (11)

I thought I should find more sources before building an educated opinion, so I looked further and found this article from 2011 on ScienceDaily.com that basically said that the third trimester test was only 69% effective, so even if they had GBS, they would go on to have their babies without any treatment:

Among 559 women, GBS prevalence was 19.5% with the third-trimester culture and 23.8% with culture performed on samples collected during labor. Compared with the culture obtained during labor, the third-trimester culture correctly predicted GBS positivity at the time of labor only 69% of the time versus the rapid test which correctly predicted GBS positivity 91% of the time.

I only wish they had reported how many babies actually got the infection from the positive-test mothers in this study. So I found this article on PubMed that actually said how many babies were infected in another study:

568 cases were identified, equivalent to a total incidence of 0.72 per 1000 live-births […]; the incidence for early-onset disease (n=377) was 0.48 per 1000 […], and for late-onset disease (n=191) was 0.24 per 1000 […]. Risk factors were identifiable for 218 (58%) cases of early-onset disease. 53 infants died (overall 9.7%)

So, in other words, in this study between 2000-2001 in Northern Ireland and the UK, they found that 568 babies were infected, which was the equivalent of 0.72% of the total population. And only 58% of those had been identified as high-risk. This paints quite the picture: although the consequences of being infected with Group B strep can be quite dangerous (meningitis, or death), the risk is actually quite small EVEN if you have been identified as high-risk.

Considering that the test poses quite a small risk to your pregnancy and the baby, and it can be done by yourself with a cotton swab, I don’t really see any reason not to do the screen. It’s just important to know that although I have a 30% chance of carrying the bacteria, my baby still has less than 1% chance of becoming infected. It’s just some food for thought.

Weight: 145lbs (delta 30lbs)

Symptoms

• It’s getting harder to breathe. Little babycove is pushing up against my diaphragm and restricting my breath, especially when I lie down.
• For the first time I felt him pushing against my cervix. It only happened for a second, but I think he’s finding his way to the “locked-in” position. Some women have reported the baby locking in as early as week 33, so I gotta watch for that!
• My ankles tend to swell at the end of the day now… I don’t know if it’s the weight, the heat or the things I’ve been eating (or all of the above) but I really gotta start being more careful. I’ll start after my pizza leftovers for lunch 😛

Actions

• Painted the nursery, sorted baby shower gifts

Week 35

This week I have been feeling that breathing issue that I’ve read so much about. Women experience shortness of breath because the baby gets bigger and starts pushing against the diaphragm. Well, now I feel it whenever I walk a lot, walk up the stairs, or when it’s muggy outside. I just have to remember that I’m not superwoman and I should take it easy.

Also on the forefront of my mind this week is how uncomfortable it is to wake up in the morning. I sleep just fine all night (I’ve never had any issues sleeping), but in the morning (or the middle of the night, 3-4am), I wake up in a sea of muscular pain: my hip, my legs, my back muscles, all of it hurts. I change positions at that time so I can survive the next hour or so (I believe my exact feelings at 3am are: “screw sleeping on your left side!”). After my alarm sounds, some days I get over the leg pain right away, and I just feel tired. Other days I am in such state of discomfort that I opt for driving to the train station and paying the $4 for the day just so I don’t have to walk for 10 min uphill. I don’t like to do that often; after all, it’s better for you to remain active and walking around.

I do have to admit that I don’t understand my limitations yet. The day will come when I can follow these easy rules to avoid further aggravations:

• Rule: Drink a glass of prune juice every day.
  Consequences of noncompliance: I do not get to go to the bathroom that day.
• Rule: Eat moderate amounts for every meal, and keep snacks between meals small and healthy.
  Consequences of noncompliance: belly pains, gas, abdominal discomfort.
• Rule: Watch for signs of tiredness, and give in to them.
  Consequences of noncompliance: you’ll get whiny, your muscles will start to hurt, won’t be able to find a comfortable position sitting down, lying down, or standing up, unless you are in your bed, and, last but not least, you might succumb to the temptation of throwing a temper tantrum (à la misbehaved 4-year-old) at your in-laws house, making a sad spectacle of yourself. Ahem, or so I’ve heard.
• Rule: Limit foods high in processed sodium (aka junk food).
  Consequences of noncompliance: Shrek feet (aka swollen feet)

I’ll learn my lesson one of these days…

On other news, my department at work threw me a little baby shower 🙂 Isn’t that sweet? Some of them had heard me complain of how poor I had been feeling now that our financial situation was about to change, and they were very generous in their gift. What a great way to show me they care 🙂

Symptoms

• Random and short-lived episodes of shortness of breath
• Abdominal discomfort. Most likely rooted in my ongoing constipation issues.
• Tired, aching muscles. Absolute need to rest.
• Swollen feet happen whenever I have junk food. Moral of the story: stop eating junk food! It gets better as soon as my diet changes.

Week 36

Ok… so I am shamelessly giving up on taking care of myself. I have had more pizza, more take-out, more ice cream, more cake, than I have ever had in the span of a week. My body aches, my ankles are swollen, and it is clear that I’m just letting myself go. At 9 months of pregnancy, people’s reaction to this is “good for you! You’re pregnant! You can get away with it!” But I say NO. I should not ever put my own health second, even when I’m “eating for two.” Sure, my blood pressure continues to be normally low (this week it was 98/54), and my pee-stick tests are all perfectly negative at every appointment, but that does NOT give me the right to put myself through this much completely-avoidable discomfort. On Thursday I even went the extra mile (quite literally) and walked to and from a meeting that was WAY too far away in another building. My legs were hurting so much that my department let me borrow a wheelchair to get to the break room and the bathroom all the way down the hall. After a couple of trips, I felt way too silly to continue. I wish I could just make sensible choices the first time around, and then these measures wouldn’t need to be taken!

Just to give you an idea of the excess I’ve been “enjoying” this week: On Tuesday I had pizza left overs for dinner, followed by a big bowl of Cookies n’ Cream ice cream (my favorite flavor), and then a bowl of pop corn with some Crystal Light fruit punch. I mean, seriously, did I need to eat all of that? Not only that, but Friday I got free pizza lunch at work at a meeting, and then go to Brian’s parents’ house to celebrate his father’s birthday where they served… anyone?… you got it! PIZZA. Come ON people! Not helping here!

Oh, btw, a different team from my own department at work threw me and another pregnant girl (who’s due on the same day as me) a baby shower this week. They were so generous and so thoughtful. What a gesture.

Anyways, this week was action packed, especially in the house organization department. Brian’s mother and two sisters came over and smelled, vetted, washed and folded every little piece of hand-me-down baby clothes I got from all sort of different sources. They were AMAZING and now the baby’s room is almost done. We just need one more weekend to finish cleaning everything up and getting my mother’s room all set, and we will be ready for this little fella to join us whenever he feels like it 🙂

There was also some action regarding maternity leave. Long story short: I might be able to take 12 weeks after all, AS LONG AS I deliver by September 1st. There was some drama at one point because HR had told me my benefits would stop after the 8th week, but I’ve cleared all that up and I might be able to make this maternity leave last 3 months. Wouldn’t that be sweet? Details are yet to be ironed out, but it’s all good. Please please please let’s hang on for 2 more weeks! It’s funny how things change: I wanted to last until week 37 so bad, and now I have a new goal 2 weeks away from now! Will I make it???

My mother is coming to stay for a few months starting next week, so she’ll be present at my next prenatal appointment, and I’ll be showering her with videos and imagery of a home birth. The best case scenario would be if she felt comfortable with the idea and felt like she could ask questions about it. I’ll let you know how that goes as well.

In other news, one of the girls from my birthing class had her baby! Read her story at the Good Morning Gloucester blog. What’s neat is that she told her side of the story, and then her husband did. It’s a great read.

Also this week, our doula and our midwives met for the first time. They all came to our house and we walked them through every room of the house, where we keep towels, where we keep paper towels, and we reassured them that we purchased all the items on the list they gave us, plus the birthing kit. As long as we can finish cleaning up the house and putting things in order this week, I think we’ll be good to go!

Lastly, like you haven’t read enough, I am a lot more comfortable telling strangers that I’m having my baby at home 🙂 Ever since I went to visit my friend in Rhode Island, and she told me how excited she was for us, and how she would be screaming it from the rooftops herself, I got a whole new level of confidence 🙂 I’m not shy about it anymore! Bring it on!

Symptoms

• Terrible muscular pain when I get up in the morning or in the middle of the night to go to the bathroom
• Getting up at 2, 3 or 4am every night to go to the bathroom
• Ankles continue to swell like a wet straw wrapper when you add water.
• Legs hurt a LOT aft