I’ve Been Kicked January 22, 2010

Sometime in the past week, my belly has grown.  It’s still not enough to put me in maternity pants (I’m still wearing my regular jeans and still need a belt, albeit on the last hole), but enough to be a little bit noticeable.  I think it must change the way I stand, because my (male) boss commented a week or so ago that I was starting to look like I had a bump under my coat.  I told him it’s mainly because it’s a maternity coat (so it cinches like an empire waist and the flows out over my belly), but it’s also because of the way I was standing (almost arched back and belly pushed out).  I don’t think I would normally stand like that!  (A story for another day is how and when I told my bosses I am pregnant.)

Earlier in the week I had a meeting with an undergraduate student who didn’t yet know I was pregnant.  I caught her eyes making a sweep over my belly and I knew in that moment that it had occurred to her.  So a few minutes later (after I’d left the office to get something and come back), I told her I was pregnant, and she indeed said that thought had occurred to her today when she was looking at me!

I think at this stage it’s helpful to tell people because otherwise, they really don’t know.  A friend of mine keeps gets congratulated on her pregnancy, and she’s not pregnant!  I remember the last time I was pregnant, looking around at women on the street and thinking that so many people really look like they could be in the earliest stages of pregnancy!  But there’s no way that all of the women with little bellies could actually have been pregnant.

I also, finally, felt the first “real” movement!  I was sitting at my desk, just after lunch, and I felt a series of definite bumps in the upper right part of my belly.  It was exciting enough that I almost got up to tell people about it, but then I decided they either wouldn’t care or would find it weird.  (The two people just outside of my office are both male and recent college grads, so I think pregnancy is probably still fairly foreign to them.)  So I just IM’d my husband instead, who was very excited to hear it.

I actually think I’ve felt movement in the past few weeks, one that even felt as early as 12 weeks.  I know that’s supposed to be too early, but what I felt then felt more like a mass turning over than a jabbing kick, so it seems reasonable to me.  Since then, I’ve felt an occasional something which seems to me to be baby movement, but it wasn’t until yesterday that it was really definite.

Oh!  And maybe I’m feeling something right now!  (I just ate breakfast.)

16 week ultrasound and consultation January 6, 2010

There’s a real baby in there!

16 week ultrasound:  On Monday morning, I had my first ultrasound. The ostensible purpose was for dating the fetus, but since we know my LMP (last menstrual period) and have some vague temperature information about when I might have ovulated, I wasn’t too my concerned about this. I don’t think my doctor was either, but she knows that dating ultrasounds are covered and that patients like them. And she probably figures it doesn’t hurt to have some confirmation about dating.

The fetus measured about two days younger than the date calculated by my LMP, but they don’t actually change the due date unless there’s a discrepancy of 10 days or more. So I’m still due on June 21 (or June 25th in my head, based on the above mentioned vague temperatures). The technician explained everything she was measuring, so we could really tell what we were looking at. The only part that threw me off was when she was apparently measuring the kidneys, but before she told me what it was, I thought we were looking at girl parts. I now have no idea what we were actually looking at, but I’m pretty sure that the perspective needed to see the kidneys is not the same as needed to tell the sex. And unfortunately, the tech said that 16 weeks is too early to tell the sex! So we still don’t know.

Here is the picture they sent us home with.

January 4, 2010 16 week ultrasound

After the ultrasound, my husband and I met with a doctor at the hospital for a consult regarding VBAC (Vaginal Birth after Cesearean) and AMA (Advanced Maternal Age).

VBAC:  My medical record shows nothing from my previous experience that they would anticipate occurring again so they say that makes me a good candidate for VBAC.  Another thing in my favor is that my labor was so short.  I got to 10 centimeters within just a few hours of the onset of labor, and the whole thing took 7 hours including the c-section.  They say that longer labors are a concern for VBACs because c-section scars may be stressed the longer the uterus is in contractions, and that short labors tend to be repeated in women.  (Yay, wouldn’t that be great?!)  They do recommend an epidural from the beginning, mainly because if I would need a repeat c-section, then I already have a needle with anesthesia already in place.  And they don’t recommend inductions, which is fine by me!  They said that usually a doctor will allow a VBAC, but if you go too far past your due date they consider a repeat c-section rather than an induction.

Of course, they also discussed the risks involved with VBAC.  They quoted the same 1% chance of uterine rupture that I’ve read about everywhere, but they further clarified that within that 1% there is about a 25% risk of maternal or fetal death.  My husband doesn’t like any odds that aren’t one in million when it comes to life and death, so I think he’s still wary about the idea of a VBAC.  But I am strongly leaning towards it.

It was really nice to have a long conversation with the doctors about this and get some personal anecdotes as well.  One of the doctors told me he’d seen only two uterine ruptures (out of hundreds of VBACs) and in both cases the women were on 5- and 7- previous c-sections!  Both women were fine in the end.  And he explained how you know if there’s been a uterine rupture:  abnormal heart tracing indicating fetal distress, baby moving back up in station, and/or pain.  In the case of the two ruptures he saw, it was abnormal heart tracing that sent the women into the operating room and they then discovered the scar had ruptured.  I asked whether there was any chance of a rupture happening undetected and what the outcome would be, and the doctor responded that the uterus would just heal itself as it contracts.  I found that sort of strange, so I ask that same question of my regular doctor the next time I see her (Jan 12).

The doctor also pointed out that the more c-sections you have, the more scars you have, and the greater likelihood you have for problems in later pregnancies (like placenta accreta).  Well, we aren’t planning to have  eight kids; we’re thinking two or three.  So maybe that’s not an issue for us, but I like that he told us about those experiences anyway.

Both of the doctors seemed to almost assume I would go with a VBAC, which I appreciated.  They said that there is a risk to consider, but also pointed out that there is also a small risk in c-sections.  They didn’t (or couldn’t) quantify that for me, though my guess is that the risk of maternal or fetal death is lower.  I read a study when I got home comparing women having elective c-sections due to breech presentation (since otherwise their pregnancies are uncomplicated and the c-sections are scheduled, and thus considered elective) to attempted vaginal births (which included those that actually ended up in emergency c-sections) and they found that the risk of severe morbidity (which doesn’t include death, but includes a bunch of other bad things like infections, hysterectomy, etc.) was significantly higher (though still extremely small) in the elective c-sections.  That is, worse things happened in the c-sections.  However, there were something like two deaths (out of over 2 million women) in the vaginal birth group and the problems they tended to have included things like uterine rupture (and these weren’t VBACs).

So personally I am leaning towards a VBAC because the pros involve things like 1) no surgery, 2) no recovery from surgery, 3) fewer medications during surgery and recovery, and 4) all the good hormones, etc. and things that happen during natural birth.  The only con is the very small risk of complications from uterine rupture.

(I will note, however, that I’m also a little scared of a vaginal delivery due to pain and possible tearing.  But I wonder if recovery from tearing could be as lengthy and hard as recovery from major abdominal surgery?  I guess it probably depends on the tear.)

AMA:  The doctors also told me a little bit about screening for genetic disorders, particularly Down’s syndrome.  They didn’t really tell me too much I didn’t already know, but again it was nice just to have the conversation.  The only screening test available to me now at 16 week is the quad test, which could then be followed up by a diagnostic amnio if we wanted.  I think they said that they will only do the quad test up to 20 or so weeks because you can’t terminate a pregnancy after 24 weeks in this state.  I was asking about whether the screening became more or less accurate (whatever that would mean for a screening) if you waited (e.g., if you were doing the screening because you wanted the information, but not because you intended to terminate the pregnancy) and they said no, it actually gets worse because then there are other hormones and things in the maternal blood that just confuse things.  I then asked what happens if you want  to terminate a pregnancy after 24 weeks and they said people go to Kansas or Nebraska where it’s legal!  I really wasn’t asking for myself – I was just curious to know what people do!  And I thought it was really interesting to observe the doctors’ demeanors – they were very straight forward and non-judgmental.  Since I wasn’t actually worrying about this being an issue for us, I felt like I shared their theoretical / academic interest in the topic.  I guess that’s an easy place to be, rather than actually faced with a choice in the very middle of a wanted pregnancy.

I’d gone into the appointment feeling like I probably wouldn’t want to test for Down’s and I left feeling the same way.  But my husband is leaning towards us getting the blood test done because he would prefer to have all the information when it’s available.  I guess that makes sense.  I think I’m more worried that we’ll get all worked up if we get test results showing a risk of 1/100 or something that is technically a “positive” screening, but still a very small risk.  So then what, we get the amnio that carries a 1/200 risk of miscarriage (or maybe it’s much lower, like 1/1600 as a recent study has suggested)?  I guess I’d want to know, but I hate the idea that the chances are good that our baby won’t have Down’s and yet we could easily suffer a month of worrying about it if the screening test suggests the possibility of Down’s.  And the screening test could be wrong – it could show us as low risk and yet the baby could still have Down’s.   Anyway, I have until my next appointment to think about this.