I had planned to write a 9-week entry right after writing my intro, but I have been laid up with a bad cold for over a week now, so I never got around to it. I'm feeling much better, but Tommy started coughing a lot this morning. The poor little guy! I know how miserable he must be feeling.
In my last entry I promised to go into the details of the beginning of this pregnancy so I'll get started on that now! In November I went on a trip to Michigan to visit my oldest sister and my grandparents and other relatives on my dad's side of the family. My sister hadn't seen Tommy yet. I planned my trip for just before Thanksgiving because I didn't want to deal with the crowds at Thanksgiving alone with a toddler. Tom stayed home and worked. I have taken four trips alone with Tommy to visit family and after getting home I declared that this was the LAST trip! I arrived on a Monday and flew back home the Monday before Thanksgiving. My parents arrived the Friday before I left and were staying through Thanksgiving so we got to see them too which was nice! Tommy just adores his Ahma and Wampa! We had a good time, but it is getting more difficult to travel with Tommy as he gets older. People can visit us from now on!
Going by LMP, I should have been fertile while I was away from my husband. I know my fertility signs well and did have fertile mucus while I was away. My period should have arrived on December 1, but it didn't. All I got was a very severe headache. I am usually extremely regular. I also had all the pre-period symptoms, slightly sore breasts, acne around my chin, cramping, and I had a horrid headache! I was thinking I was pregnant, but I had thought that the month before as well and wasted money on not one, but two pregnancy tests! (I had gotten a faint positive on one after 10 minutes, just like with Tommy so I took the second the next day). Finally I got what I thought was my period on December 6 late at night. This period was little lighter than normal, but I still had a medium flow for the first several days. Then it went on and off from heavy spotting to light bleeding. I still had this horrible headache and felt like a truck had hit me! I was tutoring extra because my students had big exams coming up, and I was finding it hard to stay awake as I tutored them! After eight days of this I decided my hormones must be completely screwed up so I made an appointment with my OB. The earliest they could fit me in would be December 28. I also decided to go into the lab to get a pregnancy test because I figured it would be the first thing the doctor would ask me, and I wanted to show that I had already ruled that out. A lab test is more accurate than the over-the-counter ones, and the lab test is free with my insurance.
I got blood drawn on Wednesday and called Thursday morning for the result, fully expecting it to be negative. The receptionist said "Its positive!" My only reply was "Then get me in to see the doctor NOW because I've been bleeding for over a week!" The receptionist asked when my LMP was and said that the doctor doesn't like to see patients until eight weeks and since I already had an appointment scheduled for December 28 I could just see him then. I couldn't believe her. What part of "I'm bleeding" did she not understand! Finally I got her to talk to the nurse and the nurse fit me in for the next Wednesday. To me that still wasn't acceptable! I actually didn't really want to be seen by the doctor, but I wanted to talk to him and get another hCG level drawn. I knew I had wanted to switch doctors anyway, but I just hadn't gotten around to doing this before I got pregnant. I called a few friends and got some midwife recommendations and called one up. She was wonderful. She talked to me about the bleeding and discussed various reasons including low progesterone. I have a very short luteal phase naturally and this is often caused by low progesterone so this was something that made sense to me. But this midwife doesn't accept my HMO insurance. She is on their PPO plan though. I called my husband's benefits department and explained the situation and they put me in touch with the insurance broker. I can switch to the PPO July 1. That was not good news!
I started bleeding heavier, possibly due to the stress, so I called my doctor's office again and demanded a call back. I knew there was little that could be done about the bleeding, but I also knew that a second hCG level would give me peace of mind and I needed him to order it. I also wanted a progesterone level drawn. He called back and was pretty unsympathetic saying that most likely I was miscarrying. I asked if I could come in for an appointment and he said that he would see me next Wednesday. I brought up the progesterone and he told me supplementation is a waste of money. He asked where I heard of it and I said I had spoken to another doctor. He then told me to just go see this other doctor. I told him that my insurance would only let me see him to which he replied in a harsh tone that I shouldn't be searching for another doctor! He then went on and on about how this was most likely a genetic mutation, just a sac of cells and not a baby and that if I started soaking a pad an hour that I could come into the office to complete the abortion. Needless to say I think this doctor cries for improvement in the area of bedside manner. I asked some more questions and he started raising his voice to me so finally I managed to speak through the tears and say, "I guess we don't have anything more to talk about then, thank you." And I hung up before he could get another word in.
The insurance broker had told me to call back if I couldn't get an appointment so I called her back. Again I didn't think I needed an actual appointment, but I did want to be taken seriously and treated with respect! She called the office on my behalf and tried to arrange an appointment for me with another doctor and they kept refusing to schedule me. She called the medical group and someone higher up finally got me an appointment at 5:30 that night with the "on call" doctor. When I got to the office I was told that my doctor didn't want me seeing any other doctor, even though there are eight in the practice, so he stayed late to see me that night! I couldn't believe it! I was ready to walk out the door, but Tom and I both felt like I should be seen.
When the doctor finally came in, before he even examined me, he lectured us for over half an hour about how I was miscarrying. How there was nothing that could be done to stop it and that we should just let Mother Nature take her course. He went on and on about how it wasn't a baby, just a sac of cells that had some kind of mutation and that is why I was bleeding and even if we could stop the miscarriage, we wouldn't want to because "who knows what kind of thing I could give birth to." (In the car on the way home Tom said he was tempted to say, "Wow, you mean she might give birth to . . . Spiderman!") At one point I stopped him and told him that we happen to believe that life begins at conception and that we would happily accept any baby that God blesses us with. Sharing our beliefs with him only made him change his tune in one way; he went on and on about how it was in God's plan that this pregnancy was aborting instead of saying it was Mother Nature's plan.
Finally after all this lecturing, he examined me. My cervix was basically closed, but the blood was definitely coming from my uterus. He then brought in the ultrasound machine and did a vaginal ultrasound. I had had one done at six weeks with Tommy so I was familiar with what we should be seeing at this point. I had assumed that we conceived on November 20 when I came home from vacation. The only other possible date was November 24. These dates would put me at about five and a half weeks (three and a half weeks post conception). Nothing showed on the ultrasound. He was commenting on all the negatives saying things like, "There's no sac; we should see a sac by now." And then he examined to make sure it wasn't a tubal, and there was no evidence of that either. I asked, "Isn't that a thick lining?" to which he replied, yes, very thick actually. I remembered that my lining was extremely thick with Tommy as well. I had bled for one day which is why he had done a six-week ultrasound and back then he had mentioned that a lining that thick was good.
When he was done he declared that he was 95% sure that I was miscarrying, and it would be just a matter of days before I expelled the tissue. This didn't make sense to me. If I were miscarrying, I would expect clots or piece of tissue and lots of cramps. I have been bleeding for eight days and had few if any cramps, and it was all very runny blood. I was also bleeding less not more. It worried me, but deep in my mind I just knew I wasn't miscarrying and I was not going to let myself accept this! He wanted to order another hCG level and would continue to order them until they were back at zero. I asked him to humor me and please order a progesterone level as well, and after more lecturing on his part he finally agreed, but said that no matter what the number was he wouldn't treat me with supplemental progesterone.
The next day, Friday, I went in to get the hCG done (they had to be 48 hours apart). I was still bleeding and not looking forward to having to wait until Monday to get results. Why do these things always happen over weekends? Monday came around and I called the office. The receptionist refused to give me the results and said the doctor would call me when he had a chance. A few hours went by, and still no call so I called back. This time I was told the computer system was down and that I had to wait longer. At 4:30 I called again and all the computers were still down. I called the lab and got the same line. I called the main medical group number and spoke with a supervisor at the off-site lab who also told me all the computers were down and that they didn't have the hard copies of the reports. This was insane! Finally she explained that they had the hard copies, but they were already shipped off-site and it would be at least a day before they got them, and even after that it would take longer to try to locate my result. I was livid when I got off the phone! This stress I'm sure wasn't doing good for the baby either!
Finally after hours my doctor's nurse calls and starts the conversation with "I have some bad news." Not the way to start off the conversation lady! It turns out that it didn't matter that the computers were down; the lab still hadn't even run my test! She apologized and said there was no excuse that it is a 24-hour turn around time on this test and they should have ran it Saturday morning. She promised to continue to check with the lab and call me as soon as she got result the next day. She also had me come in immediately for another hCG level.
I was shocked when at 8:30 in the morning Tuesday I got a call from my doctor. My first hCG level from Wednesday was only 41. They don't report the results on the quantitative hCG unless the doctor specifically requests it so he didn't get that number until that morning. A level of 41 means it is very early post conception, at the most 12-13 days past ovulation. So that was a good reason why nothing showed on the ultrasound! The second bit of good news was that in a little less than 48 hours my hCG went from 41 to 102! It's supposed to double every 48 hours in early pregnancy. That was an excellent increase. So this doctor that was just four days before telling me I was miscarrying now tells me that the pregnancy is fine and "don't worry about the bleeding." At this time I was still bleeding lightly and it was still bright red, not pink or brown. Red blood is always more worrisome. The only bad news is that my progesterone level was only 5.35. A good level at that point in pregnancy is 15 preferably 20. Anything below 12 is considered very bad, and 5 and less is an inevitable miscarriage! My hCG level from Monday was over 500; over a 5 fold increase from 72 hours before! So despite the poor progesterone levels the pregnancy was continuing.
I called and reported these numbers to the midwife. She scheduled an appointment to meet me, my free interview appointment, and also sent me to her lab for another hCG and progesterone level on Wednesday. These results came back in a timely manner. My hCG had risen to over 1000 so again they were doubling! My progesterone had also increased to 8.4 all on its own which was a good sign, but she still wanted me to go on supplement. The only bad thing is all the lab tests and prescriptions from the midwife are not covered by insurance. Each time I go for an hCG and progesterone level it costs me $100 and the progesterone cream is $200 for an 18-day supply! I need to stay on it until week 13 when the placenta has fully taken over progesterone production. I have to pay for the midwife out of pocket as well, but she hasn't charged me a cent yet. It looks like that house we want to save for will be put off even longer than it has been already!
Through all this good news the bleeding still hadn't stopped. It got less the weekend before Christmas, primarily just pinkish-red in the a.m., but on Christmas day I started cramping and bleeding more heavily again. The next day I talked to my doctor and he agreed to take another hCG level just to see if things were still going well. He still didn't want to see me until January 5. The bleeding on Christmas and occasionally before then would come right after I felt a twinge on one side of my uterus. I would get the pain and then bright red blood would come soon after. Before it had seemed to be a steady trickle of blood coming from my cervix, but now it was more specific. I spoke with the midwife and she said that is often a sign of a subchorionic hematoma, bleeding between the placenta and the uterine wall. About 50% of women with this condition miscarry, but as long as the hematoma is small and gets smaller in size there is little risk. It is something that shows clearly on an ultrasound and regular ultrasounds are done until they can see no more hematoma.
When the December 26 hCG level came back, it was 7397 so again an excellent doubling time! Those levels were such a relief to see! My midwife also ordered another progesterone level and that again was bad news. It went down from 8.4 to 8.0. But the baby seemed to be hanging in there!
The last bleeding I had was on January 2, I believe. I really can't remember the last day now. The last several days, it was mostly just pinkish blood when I wiped, not the red it had been before. In all I bled for four weeks. On January 5 we saw a beautiful little baby with a beating heart on the ultrasound! It was the best sight in the world. There was also no evidence of a hematoma. The only part I didn't like was the wonderful beside manor of my OB!
Oh, I almost forgot the whole conversation about the VBAC. When my doctor walked in for this appointment, he started going through all the first prenatal appointment questions. He confirmed that this was my second pregnancy and asked Tommy's birth date.
He said to himself "vaginal birth" and started checking off a box.
I said, "No, he was born by c-section."
The OB said, "Oh, and why was that?".
To which I replied, "You induced me two days before my due date . . ."
"Really? Hmm. Why did I do that?"
"Because I had a separated pubic symphysis, and you were worried that a large baby would further damage it."
"I was? And how large was he."
"9 pounds, 15 ounces"
He looked at Tommy with a smile. "What a bad little boy to grow so big. And you want a repeat cesarean, right?"
"No!"
"Why not? You know you have a 1 in 100 chance of a uterine rupture now that you have a scarred uterus and a rupture can get really nasty."
It only got better from there. First his statistics are so very wrong! The risk of uterine rupture is hardly more for a VBAC than for a woman who has never given birth. But mainly I couldn't believe he was asking me these questions. He had my chart right there, and he was the one who performed my c-section just 18 months before! I understand not remembering every patient, but he had my chart! He went on and on about how there was a trend toward VBAC in the 80's, but the trend has gone away from it in the 90's and he no longer likes to perform them. He also asked, "What makes you think you can deliver vaginally this time when you failed last time?" Oh gee, how encouraging! What happened to the whole idea that a c-section wasn't a woman's fault! What a way to make me feel better about my last birth. I wish I had remembered to bring up the fact that at my postpartum appointment five weeks after Tommy's birth, he walked in saying that he was sorry we couldn't get the baby out vaginally, but that it was this pregnancy and this baby, not anything fundamentally wrong with me that caused the c-section. He assured me that the next time I could have a vaginal birth. But here 18 months later he is telling me the exact opposite. All I can say is he's a real piece of work! I brought up that Tommy was posterior and he came back by saying that he was posterior because he was large. Large babies position themselves that way because there is more room. Every reason I gave for thinking I could deliver vaginally he shot down with a reply that was way off! Fortunately I have educated myself on birth and know that these claims of his are erroneous. I just wonder how many women go into second births as naïve as I went into the first and are fed poor advice like this!
Getting back to the good parts now. My due date is August 23. According to both the ultrasound and that first hCG levels I conceived on December 1, which means my husband has super sperm because the last time we had relations before then was November 24! It also means I ovulated two weeks late! Obviously this baby was meant to be. Tom and I are very religious as well and we feel that all the prayers from family and friends are what have gotten us this far in this pregnancy. We ourselves have been praying especially hard for the intercession of St. Gerard, patron saint of mothers and pregnant women, St. John Neumann, who is very popular with people who have ties to Philadelphia, and St. Philomena who is just an amazing saint! The night before our ultrasound after saying our evening prayers, Tom said that he knew everything would be fine. January 5, the day of our ultrasound, is the feast day of St. John Neumann!
So now onto this week's update! I have been debating between a home birth and a hospital birth. I know for sure I am not using this same OB! There are several certified nurse midwives (CNM) in the area who do home births or hospital births and some do both. The midwife I am seeing now only delivers at one hospital and never does home births. She used to be a labor and delivery nurse before she did her midwife training. She has been working at this hospital for over twenty years. Everyone I have talked to says that this hospital has a birthing center feel to it, and if you use this midwife they pretty much just leave you alone because she is so respected there. All the rooms are private for labor and delivery and the rest of your stay. I believe it is all in the same room. They have tubs with jacuzzi jets to labor in, and I also believe there are birth balls available in each room. Even though I have heard such good things about this midwife I am also hiring a doula for sure. I have started interviewing doulas and I will probably talk more about that in my next entry.
I met with the homebirth only midwife, but I really didn't feel a connection with her. I do like the idea of a homebirth, but my husband finally admitted he wasn't too excited about it. Maybe if this birth goes well, he will feel more open to it for the next baby! The third CNM in the area I have heard some not so good things about. My good friend had a horrible delivery with her and after talking to doulas in the area it seems that she is very quick to encourage interventions. Her back-up doctor seems to be called in a little premature in many cases and that almost always ends up being a c-section. I really want a VBAC so I have decided to not even interview this midwife. I most likely will go with the midwife who is currently treating me. I have my first "real" appointment with her on February 7, which I will unfortunately have to pay out of pocket for, but I plan on asking her a lot of questions that I didn't ask during our "interview" appointment. At that point I was so scared about miscarrying that I couldn't let myself think ahead to the birth and get my hopes up!
Another thing I like about this midwife is she is allowing me to use what some call a "shadow OB". As much as I dislike him, my insurance does cover my OB 100% so I will still be going to him for all of my prenatal appointments and get all my lab work and ultrasounds through him. This way the insurance will cover it all. I will see the midwife here and there and keep her updated by phone. This will minimize my out of pocket costs while still giving me good medical care. I have no doubt that my OB is competent; I just don't agree with his highly medical approach to birth and I obviously have issues with his bedside manner! I plan on going to all my appointments and behaving like a good little patient, and then when July 1 comes and my insurance switches from HMO to PPO, I'll drop him like a hot potato! I just hope he isn't reading this to get clued in beforehand!
How's week 10 of this pregnancy you might ask. Week 10 has pretty much stunk! I have been sick with this cold or flu thing, the migraines I got at about this time last pregnancy have arrived. I hate taking medication when pregnant, especially in the first trimester, but I have taken Tylenol several times this last week. I took some cold medicine in the middle of the night last week once as well. I just couldn't breathe or sleep. On top of all of this I still have morning sickness. It's not horrid like last pregnancy, but my sense of smell is just phenomenal! I smell the faintest hints of odors and just about everything I smell makes me dry heave. I don't throw up often; I just heave a whole lot. I am constantly hungry though, but nothing sounds good to eat. At least this cold has deadened my sense of smell a bit. Tom has been wonderful this past week. He has pretty much taken care of Tommy and let me rest when he isn't at work, and he even took Friday off so I could sleep in and then laze around the rest of the day. He's generally not the kind of guy to help around the house so it's been a nice treat! He even cooked dinner tonight. Of course I shouted out cooking instructions to him as I sat in here and typed.
The main problem I have been having this week is with Tommy. I'm not sure why he is doing it, but he keeps coughing then putting his fingers down his throat and gagging or worse making himself throw up! Right now Tom is on his hands and knees with the mini steam vac cleaning his latest contribution. I think he does this because it's a combination of discovering he can have control over something else on his body, and the fact that I'm gagging all day long as well! I go into heaves when I brush my teeth, and the smells when I do dishes or laundry set me off as well. And of course cleaning him up makes me throw up and that makes him try to throw up again. It has gotten really old fast! I don't know how to get through to his little 19-month-old brain that is not a fun game to play!
Other than the morning sickness and migraines I guess the pregnancy is going fairly well, and both of those I suppose are a good sign that things are ok. My nipples are also in extreme pain when Tommy nurses. He has always stopped eating solids when he is sick and all he has been doing all day today is nurse. I would limit him, but since he is sick I just can't bear to. Fortunately today has been one of the good days pain wise. Some days nursing hurts more than others. I'm also already experiencing the loosening of my pelvic area. My back has been hurting some and my lower back and pelvis crack and grind a lot at night when I move around trying to get comfortable. But these things are to be expected I guess.
I'm starting to worry a little bit if the baby is ok. I was on such a high and felt so pregnant right after the ultrasound, but it has been over three weeks now and fears are starting to creep in again. I'll see the OB in just four days and if he can't get the heartbeat on the Doppler I know he'll bring in the office ultrasound machine. I'm not really too worried, but I can't wait to get confirmation that all is well!
