Tuesday, August 28, 2012

If only they made this in my size

Here we are at 31 weeks, 3 days! Yay! Unbelievable! And my bladder has never felt more full. Things changed maybe a couple of weeks ago to where I began to miss what had become the feeling that I must pee every hour. I progressed to something new.

Now sometimes when I am walking, Magpie shifts herself and I am left thinking not that I need to pee, but that I am going to pee, right there on the sidewalk, or in the street, wherever I happen to be. This can happen a mere moments after I have just gone to the bathroom, and it is intense and feels like I will lose control. So far it hasn't happened, but honestly, I'm expecting to pee all over myself one of these days.

If only there were a "Mama's Carry Potty" I could purchase that would allow me to just plop down wherever I am and relieve myself (yes, I am losing my dignity rapidly at this point). I'd be happy to schlep it around with me. I would choose one in black, to match many of my outfits and to give me an urban sophisticated look. I would carry it with pride. And relief.

Instead, I have been left wondering, Who will be in diapers first, me or Magpie? I think it really may be a close call.


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Thursday, August 23, 2012

Hypnobabies training experience

Great to hear a couple of your experiences with Hypnobabies and hypnotic childbirth in general. It has re-inspired me on the concept - and I deeply appreciate it.

I was hesitant to post here that we'd done the Hypnobabies course, because what if my labor is difficult and I need an epidural? What will it feel like if I've annouced that I think (hubristically?) that I can do this most challenging thing without medication? I felt like by telling anyone I might set myself up to fail.

And then a couple of things happened that made me doubt that hypnosis could work.

I came down with food poisoning part way through the hypnosis course (the night before my 3 hour oral glucose challenge test). I had simultaneous diarrhea and vomiting, starting suddenly in the middle of the night. My whole middle section seized up from my pubic area to my breasts. As I sat hunkered in misery on the toilet at 4am with the trash can in front of me, I had several self-defeating thoughts. I thought that this is maybe a little what labor is like. I thought - you know what, let me do the hypnotic self-anesthesia. And I tried. And it helped some - mostly to allow me to relax rather than tense up around the pain. but I was still in pain. And the main thought I had (that really scared me) was that I didn't think I could endure the type of pain I was in for 24 hours (my guess that night on a length of labor). That I was in too much pain. That I "couldn't stand it."

And then I got the gestational diabetes diagnosis, and my doctor told me she plans to induce if I get to 40 weeks with no baby. That final bit of news really took the rest of the wind out of my sails. I started to doubt I could do an induced labor without pain medication. I started to doubt everything.

To back up a bit, Will and I recently attended a series of six classes in Hypnobabies, which is basically a medical self-hypnosis course to help women and their partners achieve an "easy and comfortable" childbirth. It was cool and useful. Overall, we felt the particular class that we took offered maybe less hypnosis training than we were hoping for and much more "medical" advice on childbirth in general ("Medical" in quotes because the instructor had no medical training and her teachings were often incorrect in their details, one-sided, or non-evidenced based). Because of that, I'm thinking of finding a new individual instructor to coach me further on hypnosis and we are also planning to take another short and more general class to learn about some of the medical aspects of this. The goal of a second short childbirth course is perhaps more for Will - you may have picked up by now that I'm an obsessive researcher about some of these things... And Will is not. For me, the only utility of a second course (maybe a weekend course) is to try to get an unbiased view of what our hospital-based birth experience is likely to be like and how to work with the system we have chosen to deliver in, rather than against it (our Hypnobabies instructor gave birth at home and seemed to have a limited understanding of the hospital system).

We've also hired a doula who was recommended by my OB and who was also Will's sister's doula for her three non-medicated deliveries (two at the hospital where I will deliver). I really, really liked her and her partner when I met them, but I still hope to get a better sense of what the "rules" will be at my hospital and how to best maximize our chances for a drug-free delivery while still getting all of the medical monitoring (and intervention, if necessary) we also desire.

And I've met someone now who had an induction and made it through pain med-free, so it was good to hear that it can be done.

Reading your thoughts on hypnosis and unmedicated childbirth has been really helpful. Please keep 'em coming! I welcome any thoughts and experiences - whether it went well or not so well...and any tips you'd have on navigating childbirth for those of you who've been there, done that.


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Wednesday, August 22, 2012

First non-stress test was...not stressful!

I went in early this morning for my first non-stress test on the antepartum unit at the hospital. Somehow I was under the impression it would be an ultrasound, but it was not, was just monitoring of baby's movement and heartbeat while I laid on my left side. They said it could take anywhere between 20 minutes and 1 hour, depending on the baby's behavior.

Magpie passed with flying colors. I actually found the whole thing fairly relaxing and thought it was nice for me to get used to the monitoring...it will be good to have as many things as possible feel routine and downright boring before I actually get to labor and delivery so that I'm not feeling like I need to attend to anything but dealing with the labor itself when the time comes.

Will and I completed a Hypnobabies class recently and I think these weekly NSTs will be a great time to practice my hypnosis. Of course I need to practice a whole lot more than once a week, but it will be a good, dedicated time to do so. One of these days, maybe I'll blog about the class and preparation itself...I think it will definitely help when my "birthing time" arrives, but I don't know if it will be a complete panacea for all childbirth pain/discomfort...we shall see...we would like to do this birth thing unmedicated...or at least get the party well underway prior to receiving pain meds. Anything, including medical self-hypnosis than can help is most welcome.

Oh, and my blood pressure? 100/60 when they took it this AM. Funny how low it's been lately. Not bad for an advanced-in-her-years diabetic pregnant woman.

So today. The NST. Boring, boring, boring. Which is great. I laid there almost napping and Magpie boxed and kicked and her heart rate ranged from the 170s to the 150s.

And then I grabbed some breakfast and went to work. All good. We'll do it again next week (and the week after that, and the week after that...) just for fun.


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Tuesday, August 21, 2012

Get your terms straight!

So it turns out, I may be elderly, but despite what my ultrasound report says, I am no primigravida.

"elderly" = older than 35

"gravida" = number of pregnancies

(and "para" = number of births after 20 weeks)

In shorthand, I am a G7P0 (7 pregnancies, 0 births). A more detailed way to write it is G7P0060 (7 pregnancies, 0 term births, 0 preterm births, 6 "abortions" -spontaneous and elective counted the same, and 0 living children.

Also, when you've been pregnant more than once, you go from being a primigravida to a multigravida

However...I should officially be labeled an elderly GRAND multigravida (because "grand" signifies being pregnant 5 or more times. I'm a little like Michelle Duggar, only way less successful). 

So I suppose I'm an elderly grand multigravida with poor obstetrical history. 

Ah hem, just felt the need to clarify. Even if the "grand" makes the "elderly" sound even older than it does by itself...

If I'm going to be labeled insensitive medical labels, let's at least get them right, you know?

Big thanks to Shannon and My Two Lines for the endocrinology-related comments on the last post - very VERY helpful. I've found what I think is the original HAPO study from the New England Journal in 2008...and if I'm reading it right, my numbers are really not good. Which is what I thought - that my fasting numbers are too high. Shannon, as you suggested, I've been eating a cup of ice cream before bed (full fat low carb ice cream) and it's not helping (this morning's fasting was 99 after a cup of this ice cream right before bed last night)...ugh!

Hopefully my regular OB will be responsive when I see her next week. Or at least will agree to let me consult with an endocrinologist even if she thinks the numbers are no big deal.

It feels like we are so close! I am a pretty active coper, as you may have noticed. I am not about to get passive or sloppy now if there's anything I can do to help be sure we have a good outcome - with a live and healthy Magpie at the end of this.

Stay tuned.


P.S. I promise - promise! - to post a belly shot soon. And to update on the insanity that is our apartment as we try to prepare for the arrival of a little person...all without jinxing anything by erring in assuming we are having a baby. Tricky business, I tell you...

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Monday, August 20, 2012

Elderly primigravida? Here!

Who knew that "elderly primigravida" is the official term for advanced maternal age? It was printed on one of my ultrasound reports, along with other inspiring labels like "poor obstetrical history" and "preg via assisted reproductive technology."

Ah well...so I'm a granny-mom-to-be with a poor obstetrical history. Not exactly new news, and not how I planned things, but here we are. "Elderly" or not, I am so, so grateful - and still incredulous - to be here. Thrilled through to my core.

So this "elderly" first-time mom-to-be went in for her latest OB appointment today, 30 weeks, 2 days.

My OB is on vacation, so I chose to see the partner of hers I hadn't yet met. Her other partner was my OB for our first four pregnancies and miscarriages, so I feel plenty acquainted with him and know I would feel comfortable if he is on call when I am laboring.

But I wanted to check out the third guy. And phew! I really liked this other partner as well. He was very thorough and went over my entire chart with me, noted my history of Hodgkin's, noted the history of miscarriages, talked to me about what we'd done differently this pregnancy (lovenox, corticosteroids, IVIG, gluten-free for first trimester). We agreed together that much of it has probably been voodoo, but hey, voodoo or not, why mess with success?

My blood pressure looked good (108/65), and strangely I seem to have lost 3 lbs since my  last visit two and a half weeks ago. Which must be water weight or something because I'm definitely not calorie restricting - if anything, I'm on a much higher fat diet with this gestational diabetes.

The covering OB pointed out that Magpie's growth has been slowing (she's gone from the 41st %ile to the 25th %ile at the last growth scan). Although overall he said it's not that big of a change, and Will and I aren't big people, he wants to keep an eye on things to be sure her growth is not trending downward. He's scheduled another growth scan next week to check on her.

He also wants me to start non-stress tests this week, whereas my regular OB was planning to start them in my 32nd week. Fine by me. I want a safe and healthy baby - so more surveillance is just fine with me.

I was expecting to hear that my fasting blood glucose levels have been too high, since that has been my (and my new nutritionist's) opinion. Sometimes my fasting numbers have been in the 106ish range and they are never lower than the mid to high 90s). I've been doing everything I can to get them to go lower...but this OB said the numbers are still ok in his book. That was a surprise. We'll see what my regular OB thinks.

I have another appointment next week to see my regular OB, by my request....it's been 3 weeks since I saw her (when she told me I had GD)...and now that I'm officially high risk with the GD, I just don't want anything to fall through the cracks.

But so far so good-ish. This is one well-monitored little girl!


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Monday, August 13, 2012

Be still my beating heart

Twenty-nine weeks, two days here and all is well.

We had a fetal echocardiogram today, and everything checked out normally. I guess the gestational diabetes can cause a thickening of the heart wall (ugh), but Magpie doesn't appear to have that at this point, which is great. I'd had some lingering fears too because of my high vitamin E intake in the first trimester and its association with congenital cardiac defects...but again...no evidence of anything wrong. Yay!

Nice to get her checked though in any case, since there is no risk to checking. I wish she knew we were peeking in. Hi Magpie!

There are a few minor things that the pediatric cardiologists can't check yet because they should change after birth, but we will only worry about these if a pediatrician tells us something is concerning in the future. And these unlikely issues all sound like they are problems that are eminently fixable, which are the kind of problems we like to have if we're going to have any.

Fetal echo with doppler showing chambers, valves, and blood flow.

In other news, there is no news. I am feeling well overall and am being told now by the general public that I am "looking good" and "carrying well." (What does that mean?). Trying my darndest to control my blood sugars, mostly successfully, with a few hair-raising surprises (so far, for example, I have learned that Ethiopian food, with its bready injera is fine, but a couple of small tortillas with shrimp fajitas sends me over the glycemic edge. A huge chipotle vegetarian burrito is fine but a small Amy's bean and cheese burrito on a bed of salad is not....it's a bit befuddling.)  I saw a nutritionist last week who was fairly useless, so am on the lookout for another one. I promise to update if I learn anything worth sharing. 


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Monday, August 6, 2012

Magpie at 28 weeks...in 3D

We had an ultrasound today to check on the location of the placenta and to see how the baby is growing.

All good news (phew!)

My placenta is now 4.5 cm away from my cervix, so no more previa issues, thankfully.

We also checked the cervical length - long and closed. Yay!

And Ms. Magpie is measuring in the 25th percentile...I think they estimated her weight as 2.3 pounds. So...so far, no macrosomic baby here!

Right now, baby is head down and facing to my right side, but they said she can still move around quite a bit.

We met briefly with a maternal fetal medicine specialist after the scan to go over the results. All looks good he said. Will asked if we can keep the baby from getting too big by carefully controlling my diet and blood sugar levels. The doctor said unfortunately no. That the diet/glucose are the two factors we can control, but that there is evidence that the diabetic state itself can cause large for gestational age infants. Boo! (He said something about hyperinsulinema and amino acid secretion...but I didn't catch all of the details).

It's not the greatest picture...hopefully she won't be this lumpy in real life...but here is our first 3D image of Ms. Magpie. Oh my, I can't even process this. There is a little person inside of me. How did that ever happen?


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Sunday, August 5, 2012

Third trimester is here!

Wow! I can't believe we are 28 weeks and 1 day. We are in the third trimester!! 12 weeks maximum to go!

This may sound strange, especially to all those still in the trenches, but I really had not thought we would ever get here. As the IVFs stacked up and the failures and miscarriages mounted, it had begun to feel out of reach - pregnancy beyond 10 weeks, the second trimester a difficult to imagine fantasy, the third trimester not even in the realm of possibility. I think that a sense of futility started to really set in around IVF #5 and our fifth loss. I felt this pervasive sense of hopelessness about ever being able to get out of the situation we found ourselves in.

And here we are...despite everything still going strong. Definitely looking very pregnant now. I promise to try to post a picture later this week...I know many of you have been asking. It is unbelievable to be this pregnant. I try to savor every single moment.

Will and I have been far upstate on a little road trip with Moxie the Boxer since Thursday - I had to give a talk training others in my area of expertise. The talk went well and was well-received, so that was nice, and the setting was absolutely gorgeous. Moxie loved running around in the hills and spent a good amount of time trying to dig up rocks from the shallows of a lake we were staying near (one of her favorite activities).

Here is Moxie leaning up against tree all tuckered out after running her little white socks off during our trip!

In terms of pregnancy, Magpie kicks and squirms up a storm two or three times a day now. I can feel her at multiple places in my belly at once. She's definitely in there, and she doesn't feel so small anymore! She is making her presence known. I think I am having more Braxton Hicks contractions as well, but am not sure, and sometimes am feeling pain around my cervix/low down in my pelvis.

With my increasing size, sleep is getting a bit tougher. I am uncomfortable and must sleep on my side. Left side feels better than the right, but after awhile, my left ear, shoulder, and hip start to go numb and my right calf starts to cramp. At that point, I usually go to the bathroom (again) or at least haul myself over the other side. And it does feel like hauling. My goodness. I may have to invest in one of those long maternity pillows to see if that helps with my nighttime comfort. I have been trying to hold off. Our apartment (and bed) is small and these pillows seem so large...but if it would help, I'm pretty game at this point.

I've been very conscientious about testing my blood glucose levels since I found out about the gestational diabetes. Mostly they have been good, but there have been a couple of meals where the level was much higher than I anticipated. I'm meeting with a nutritionist Wednesday, so am trying to view the interim days between now and then as an information gathering time to learn about what my body can tolerate and what it has trouble with. The couple of times the blood level has been high I have panicked, imagining Magpie at that very moment swelling to huge proportions. Unrealistic perhaps but motivating to try to keep to what seems to work for my body and make sure to add in lots of fiber and some exercise whenever possible. It will be good to learn more about how to achieve this balance while getting in all of the nutrition she (and I) need.

That's about it here for today. We are headed back to NYC shortly. A relaxed Will, ever bigger Mo, and tired and dirty Moxie. Things are pretty good. We are so lucky.


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Wednesday, August 1, 2012

OB appointment 27 weeks 4 days: It's official

As expected, I have now been officially diagnosed as having gestational diabetes. I saw my OB this morning and despite the news, she was very upbeat (as always). She came bounding in to the room, calling out "Sugar girl!" Overall, she was very reassuring and encouraging, giving two hugs and several high fives. Lots of "OMG, you'll be 28 weeks on Saturday! You're basically in the third trimester!! Look at you! Everything is going to be fine!" I really don't know where she gets her energy from.

Interestingly, I have gained no weight in the past month. Don't know if that could be diabetes-related or not, but given my worry about getting huge, or Magpie being huge, I don't see it as a bad thing. I've certainly not been restricting my food intake. I was in the normal range for BMI before getting pregnant, and I've gained 18 pounds so far this pregnancy, which is an appropriate amount according to the calculators I have found online.

We listened to the baby on the doppler - her heart rate was in the 140s. And the OB measured my fundal height, but didn't tell me the measurement (and I didn't ask).

In terms of the gestational diabetes, the plan is for me to see a nutritionist for now. They also drew an A1C level to see how my glucose levels have been over the past three months. She wants me to monitor my blood levels fasting and 1 or 2 hours after each meal. If my diet is consistent and my levels are consistently low, she may drop some of the finger sticks. I am also supposed to see a nutritionist, pronto, to get advice on how to manage my diet. Once the OB heard what my blood levels have been at home, though, she said she was very reassured and that she suspects I will do quite well and be able to control things by watching my food choices.

She also said we will begin non-stress tests at 32 weeks to keep a close eye on the baby. She said that between the gestational diabetes and my coagulation issues, she will not let me go past dates, preferring to induce me if I get to 40 weeks with no baby in sight. Not what I will be hoping for, but I'm not really interested in going past dates either.

Here are the actual numbers from the 3 hour oral glucose challenge test (far right column). Interestingly, all of the lab values are lower than what my finger sticks were showing. Still really elevated, mind you (except for the fasting level), but lower. So that's good to take into account when I'm drawing my bloods and trying to make sense of the numbers going forward.


venipuncture lab values
Glucose load: Samples drawn after 100-gram glucose drink

Fasting (prior to glucose load)
< 95 mg/dL (5.3 mmol/L)
95-102 mg/dL
 88 mg/dL
1 hour after glucose load
< 180 mg/dL (10.0 mmol/L)
233 mg/dL
 219 mg/dL
2 hours after glucose load
< 155 mg/dL (8.6 mmol/L)
225 mg/dL
 199 mg/dL
3 hours after glucose load
< 140 mg/dL (7.8 mmol/L)
176-184 mg/dL
 145 mg/dL
Results interpretation
If TWO or more values meet or exceed the target level, gestational diabetes is diagnosed. 

So that's it for now. Still processing this new reality, but it seems like a very manageable one. It's a little bit of an ego blow - I'm usually such a good test taker! But I have to remember this isn't a test I could study for and pass. It's not up to me. It's my body and Magpie's placenta calling the shots here.

Thank you again for all of your comments and stories about your own situations - it's been an invaluable help and made me feel so much better about this!


One reason why we'll be keeping a close eye on things!

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