Friday, June 25, 2010

another appointment, 35 weeks 6 days

On Wednesday we only scored an 8/8 on the BPP. We didn’t get points for “fetal tone.” Otherwise, everything looks and sounds great; heart rate stayed between 140-150bpm, both during the BPP and later when the doctor used the Doppler. Baby girl had her hands under her chin, as usual. Though a bit later, she made a little fist.

She is definitely still a girl and growing well. Surprisingly she measured in the 47th percentile, smaller than before. Though as we all know, ultrasounds aren’t perfect, so I’m still guessing that she’ll be at least 8 ½ pounds. Her current estimated weight is 6-6 ½ pounds.

My usual doctor is out of town this week, so I saw one of her partners, who in addition to being a high-risk OB, has also done a fellowship in reproductive endocrinology. Needless to say, we spent at least half of the appointment discussing infertility and treatment, specifically for auto immune issues.

As it stands, we are scheduled to leave Dublin next summer, which wouldn’t be a big deal, except that we have two frozen embryos that need to be transferred. I want to make sure that if they should implant, wherever I go for follow up care (while in the U.S.) is capable and supportive of providing immune therapy, since obviously, it works. It turns out that the RE/OB I saw today is familiar with the Chicago program in which I had the famous “Chicago bloods” and offered to do some additional research and get back to me. Most of my test results were already in my chart and I told him that I would get additional information as well. All in all, a successful appointment.

a few additional pictures

Saturday, June 19, 2010

U.S. appointments 1, 2, and 3

I thought I should probably update the blog since it’s been a long time, too long, and I’ve had three appointments since my arrival, with another scheduled next week.

First, may I just say how nice it is to be back in the land of great medical care, very clean facilities, and specimen cups that are bigger than a sewing thimble. It’s amazing what you take for granted when it’s available all the time, and a normal way of life. I never thought I would miss these things.

appointment 1, 32 weeks 5 days

The staff was awesome and seemed genuinely glad to see me back. I gave my doctor the updates from the previous two months in Dublin, she ordered some blood work, went over my chart, and then we had the big talk.

induction or c-section
Having already spoken to several doctors, doing a lot of research, and weighing the pros and cons of both, it seems that going with a scheduled c-section is the best course of action. So, the OR is booked for JULY 15!!!! Just a week earlier than my original due date.

Back to the appointment, the doctor listened to the baby, then did a non-stress test. Much to my surprise, I was having contractions. I didn’t feel them, but the machine was definitely picking them up. The doctor said that the fact that I wasn’t feeling them was a good sign, but that I should take it easy, just to be safe. I was also told that my uterus was “irritable.” My ankles were a bit swollen, so I was ordered to keep my feet up. After the whirlwind move we’d just had, that sounded heavenly. Overall everything was great, including my weight and ever perfect BP.

appointment 2 and first Bio Physical Profile, 33 weeks 4 days

Keeping my feet up worked like a charm, swelling was down, BP and weight were again, perfect.

The Bio Physical Profile is a combination of an ultrasound and non-stress test. Apparently it’s fairly standard for high-risk pregnancy assessment. More info, here.
Baby girl had her hand up on her cheek during the ultrasound, took a few practice breaths, and arched her back several times, adorable! The non-stress test portion was easy enough and we scored a perfect 10/10 on our first BPP.

appointment 3 and second Bio Physical Profile, 34 weeks 4 days

My BP was still fine, though I had lost weight, so I was told to eat more. Will do.

My stubborn little girl was uncooperative during the ultrasound portion of the BPP and wouldn’t take a practice breath. The doctor spent a lot of time pressing on her, but no luck. I then went across the hall for the non-stress test. Baby girl’s heart rate was all over the place, though she was fairly inactive, so the nurse brought me ice water to drink in hopes of waking up the baby. It worked. My doctor was pleased with the results, but wanted to do another ultrasound to check for breathing again. She pushed on baby girl, trying to wake her up and make her angry so that she would take a breath. Twenty minutes later, she finally took two practice breaths and we passed, another score of 10/10.

Very sorry for the lack of pictures. I’ll remember to ask at my next appointment. I will say that she’s adorable and loves to have her hands up near her face.

Hope everyone is well. I finally moved into the hotel last week and should have more time to blog and catch up on other blogs!!

Tuesday, June 8, 2010

some people need a filter

I had been warned to expect comments, but really, nothing prepares you for the stupid things people say. I have been approached in stores, airports, and even by waitresses in restaurants. It seems that being pregnant invites conversation, wanted or not. Trust me, most of the time, it’s not.

Now, before I go on, I really don’t mind the well wishes, words of congratulations, or even a few questions; it’s the follow up that irritates me.

Always, always, always the first question. Everyone wants to know if it’s a boy or a girl. Fine. It’s a girl. A proper response is “congratulations, how wonderful, you must be so excited.” Anything else will lead me to believe you were raised in a barn, by wolves. I do not want to hear of your disappointment, do not want you to tell me that girls are harder to raise than boys, or that I might be surprised when the baby is born. Seriously? To the last one, I often feel like saying, huh, don’t think so, considering I’ve had over 20 ultrasounds, by 6 doctors (and a few techs), on at least 10 different ultrasound machines and in two countries. I think it’s safe to assume that we are having a girl, and we are THRILLED!

I’ve had people not only ask if I’m having twins, but also again with the “you might be surprised, there might be two”. I’ve not said it, but would love to inform the idiots that we had actually transferred two, one didn’t implant, and yeah, thanks for reminding me. A**.

Then there are the comments about my belly. One person insisted that I must be having a boy because of how I’m carrying the baby. Nope, it’s a girl. Followed by asking several times if I’m sure, see above. Not one week later someone else asked if I knew what I was having and when I answered a girl, was told that, “yes, you look like you’re carrying a girl.” Make up your minds people.

If you are a waitress taking my order in a restaurant, I do not want to know about your surprise pregnancy, how you told your boyfriend the news, or about your labor experience. I especially do not want you to return and share, in detail, your stories of morning sickness, during the salad course.

Then there was the little episode at the Chicago airport. I politely asked the man at the information desk where the closest Starbucks was located. He looked at me, then asked if I “should be going there?” The only response I could muster was that my crack dealer was fine with it. Now, I’m all about pregnant women being careful and taking precautions, but after 10ish hours of travel at 32 weeks, I’m fairly sure that my doctor would be okay with me having one caffeinated drink. I certainly don’t need the judgment from a man working at the information booth in an airport. Plus, as my mom pointed out, Starbucks has a lot of other things besides espresso. No need to be so quick to judge.

Okay, thanks for letting me vent.

The great fall of 2010, part 1

(This happened a few days after we moved to the new house. I waited to post until I had arrived in the U.S. and my mom could see that I am fine)

It all started with my grand idea of carrying just one more load of stuff up to the master bedroom before I went to bed. I knew I shouldn’t do it, could have asked for help, etc, etc. No, no, just one more pile of stuff. With both hands full, I started up the final staircase to our room when I tripped. Unfortunately I couldn’t drop anything in time, so no hands to break the fall. My full weight and force hit the edge of the stair, right on my abdomen. I was upset with myself for doing something stupid, that was 100% preventable, and quickly realized that a trip to the ER was the best thing to do. Particularly since ALL of the 20+ pregnancy books I own state that after any fall or jarring motion, a trip to the doctor/ hospital/ emergency room is in order. Unfortunately the health care providers I dealt with that night disagreed.

We arrived at the maternity hospital around 8:45pm and upon checking in, were told to go to the Fetal Assessment Unit, which is also the emergency department after normal hours. After sitting in the waiting area for several minutes, my usually, over the top, patient husband asked me if they knew why we were there and started to get up. I jumped up, walked to the desk, and politely explained the situation. I was then told that we had to wait like everyone else. The midwife on duty asked if I’d felt the baby move since the fall, I had not. Then she sat back and said “Welcome”, as if she were welcoming us to the spa. I was getting angrier by the second.

After several more minutes in the waiting area, the midwife appeared and took us back to the smallest exam room I’ve ever seen. She didn’t have my chart (which I had handed over upon arriving in the unit) and again asked if I had felt the baby move. No. She then had the nerve to ask what I wanted her to do. I calmly told her that I understood that the baby is well-protected, but I would appreciate it if she would check for a heartbeat, then an ultrasound to look at the fluid level and placenta. You would have thought I’d asked her to solve all of the world’s problems. I also requested that she call my doctor, which completely stumped her. I explained that he might want to know that one of his high-risk, “private” patients is in the hospital. The midwife said that the doctor on call would decide if she would call my doctor or not, when she “finally” saw me. She then left in a huff to find a Doppler. Now, I’m not one to panic and don’t get easily excited, but while she was gone, I all but insisted my husband find me a flight out of the country that night (as if that were possible). I was done dealing with the substandard health care and laid back attitudes in that department. As he was on the phone, the midwife returned and snapped at him to get off, as the phone would interfere with the Doppler; I didn’t have the energy to correct her. She was able to find the heartbeat, then asked me to give a urine sample, and off she went. I’m not an invalid, but at 31 weeks pregnant, she could have at least offered to help me off the exam table, especially since I had been lying down for 30+ minutes by that point.

When I returned from the restroom, a nurse stopped by with a fetal monitor to do a non-stress test. Progress, I thought. She strapped on the sensors, explained the machine and different colored lights to my husband, and disappeared. For the next 45 minutes we were left alone. The baby’s heartbeat would often disappear from the monitor, leading my husband to rearrange the sensors; not a peep from the staff.

Eventually the nurse returned and asked about Anti-D (Rhogam). Again, progress; at least they’d finally looked at my chart, saw that I am O-neg, and would need another dose of Anti-D. The nurse said that they would take blood, but I would need to return the following day for the shot. WHAT??? She asked if I was “happy with that?” Err, NO. Why would I be happy about making a second trip for the sole purpose of receiving an injection that EVERYONE knew I needed. Wouldn’t it be easier to just give me the shot while I was already there. Well of course not, because “that’s not how we do it”. She asked several more times if I was happy. I finally explained that we had just moved and that the next day was completely booked with appointments and workers (close to impossible to reschedule). She then had the nerve to ask me what was more important. Clearly my health and the baby’s health are paramount, but that certainly wasn’t the attitude we had received for the past several hours, so no, I was not happy that I had to cancel my day to return for a shot that they could have just as easily given to me that night.

Finally (2 ½ hours after we arrived) the doctor appeared, chart in hand. She was pleased with the non-stress test and offered to do an ultrasound. The midwife had also returned and took blood. Just what I wanted, Ms. Bad Attitude drawing my blood. For whatever reason though, she’d had a complete change of attitude. Perhaps she had read my chart, perhaps it was a divine intervention, who knows. She was cordial and professional, minus not cleaning the draw site with anything. As we left the room, my husband pointed out that my urine sample was sitting on the lid to the garbage bin. Huh, glad it was so important to get a urine sample. Yes, there was a lot of eye-rolling that night, and interesting discussions on what we have to look forward to in the U.S. due to the new health care bill (Another post, another time).

Bloods taken, we then moved to another room for the ultrasound. The doctor began by cooing over what a cute baby we have and pointing out her nose, chin, etc. While I appreciate the attempt, what I was most interested in was the fluid level and state of the placenta. Fortunately, everything was fine. The doctor left for several minutes, then returned to tell me that she had just spoken to my doctor. Yeah, I’m sure he was thrilled to be called at 11:45pm for an update on a patient that had arrived almost three hours before. She said that he was pleased with what had been done, that I didn’t need to be admitted overnight (thank goodness), that I should follow up the next day for the Anti-D injection, and that he would see me at my already scheduled appointment in a few days.

Around midnight it was finally time to go. I was told that my chart would be waiting for me the following day in the outpatient unit and that I should return around 1pm. As if it would be that easy....

The great fall of 2010, part 2

I spent the next morning on the phone canceling afternoon appointments, then made my way back to the hospital, arriving 15 minutes early for my injection. I attempted to check in at the front desk in the outpatient department and was told that they didn’t have my chart and that I should have it. Back and forth for 10 minutes, explaining that I had been in Fetal Assessment the previous night, still no chart. I was told to go down the hall and find a midwife. Fabulous, here we go again.

A very nice midwife approached me and after a few minutes of searching, found my chart. I was then handed over to a nurse who I found to be not only professional, but very pleasant. Good thing, because she had to break the news to me that the bloods taken the previous night were LOST. Lost as in never made it to the lab. Lost as in they couldn’t give me the injection until more blood was taken and then processed in the lab, which would take at least three hours. I asked if the blood work could be rushed. Blank stare at the word “rushed”, but at least an apology and promise that the blood would be taken to the lab and handed over directly.

After making a few phone calls to vent about the latest, I walked around the hospital, wondering if my plane ticket for the U.S. had been purchased; I was D.O.N.E. I arrived back in the outpatient unit and the wonderful nurse said that the blood work was back. She administered the injection then mentioned that I was welcome to go to Fetal Assessment for another ultrasound. I told her that after my experience the previous night, I would have to decline. She apologized, then offered to have the doctor in the outpatient unit do an ultrasound. I told her that I would really appreciate that and would find it very reassuring, particularly since we were heading into the weekend. A fabulous doctor soon appeared, READ the chart, asked questions, did an ultrasound, asked more questions, and made notes in the chart. ::blink, blink:: We had a nice conversation, she handed me my chart, and said that I should come back in if anything changes. What a difference! An attitude like that would have gone a million miles with me the night before.

To top off my annoyance and disappointment with the Fetal Assessment Unit, please notice the comments the midwife made in my chart.

Yes, that says, “parents anxious.” I’m also rolling my eyes about being seen “right away.” Clearly our definition of “right away” is very different.

Again, fortunately everything is fine. When I saw my doctor a few days later, we discussed the situation in Fetal Assessment and he wrote in my chart that if I'm admitted anywhere for anything, he's to be called immediately. I also learned that had I been brought in by ambulance, he would have been called right away because I'm a private patient. I certainly didn't think the fall was ambulance worthy, but at least I understand the system now. Things are just done differently overseas, very, very differently.