Can't Believe I'm Almost There!

I am in my 37th week, now. It's hard to believe that the end is near (well, probably not that near; if this pregnancy follows my previous patterns, I have anywhere from 4 to 6 weeks left, but—I can see the finished line, you know?) I have most of my birth supplies, now; I still need to purchase a car seat (um, yeah. I should probably get on that, huh?) and a throw-away bottom sheet to put on the bed for D-Day, but other than that, I think I'm all set in that department. I bought a little boy and a little girl sleeper last week, so we'll see which one gets returned. My mother-in-law will be coming out, probably beginning of March, or so, and my mom will come a week or so after that. I'm kind of looking forward to getting some naps in, and having a few extra sets of hands to help out with the kids—I have been so tired lately, it's just really hard to get stuff done. I'm still waiting for nesting to kick in, and I'm afraid that I may just miss it this time. Which is kind of disappointing, because my house could really use a good scrubbing.

In other news, I'm trying to figure out what to do with my still-nursing-really-frequently toddler. I'm not planning to wean him, but he nurses waaaay more than my older two did by now, and I'm not sure that I'll be up to cluster-feeding a newborn, while my toddler throws a tantrum on the floor because I'm not cluster-feeding him, too. And bedtime is going to be a challenge if he doesn't at least partially night-wean soon (which he's showing no interest in even considering, right now). We may have to cut back a little, against his wishes. I don't know how that will work out, though. My four-year-old is down to one or two sessions a week, now, and only at bedtime, so I'm not terribly worried about her. I've been thinking of throwing her a weaning party to get her to finish up, but I'm not sure if she's completely ready, yet. She still asks for milkies fairly often at bedtime (our new rule is that she only gets it if it's not past bedtime). First-world problems, huh? I suppose we'll get it all figured out when the time comes that we have to. And I'll just have to not think about it until then.

Choice

Choice. Everybody talks about it like it's something we're entitled to, but the minute you try to actually choose something, everyone gets all up in your business and tells you that You can't do that! For instance, with all this bruhaha going on with the hospital goliath in our city, I am looking for a non-affiliated FP who can provide care for me for my pre-existing condition. I called a few places today (after having been sent to collections again, you could say that I am highly motivated). I spoke to one nurse who was supposed to take my medical history, and then give the info to the doctors in the practice, who would then decide if they can take on a new patient. So I gave her my information: my pre-existing condition, the fact that I'm currently pregnant (I made it very clear that I am not looking for prenatal care, or any pregnancy-related care), how I heard about their practice, when I'm due, and who my pregnancy care provider is. I told her that I was receiving care from a midwife and that we were planning a home birth.

I got a call later that afternoon telling me that because I have this condition and am choosing to home birth, they cannot provide any sort of medical care for me ("But best of luck with all of your future endeavors, etc., etc.,"). Seriously? Because they don't agree with my choice to home birth, they are not going to help me. Now, obviously, I know that choice goes both ways, and they're free to choose not to help me if they don't want to, but it's just a little aggravating that I'm never the one that gets to make any choices here. And it's not just with this. I mean, the whole reason we started home birthing in the first place was because I was given no choices my first pregnancy (there are standard-of-care protocols for people with my condition, and regardless of a person's individual situation, these protocols must never be deviated from, even if it puts the individual in danger, or causes poorer outcomes). I ended up with a c-section because the OB who insisted on inducing me at 37.5 weeks had the nurses turn the pitocin up so high that it sent my baby into fetal distress (more on that another time). Then, when I became pregnant with my second baby, none of the doctors in my area were willing to support my choice for a vbac. So I found a home birth midwife who would, and did it myself, thankyouverymuch. Which ended up being the awesomest thing ever.

During my third pregnancy, people pretty much left me alone, which was actually refreshing, and I was feeling pretty good about this whole choice thing.

Fast-forward to this pregnancy: the care provider that provided early prenatal care to me in my last pregnancy informed me that she was no longer able to provide prenatal care because I birth at home. "Take your business elsewhere, fool!" So then I called around to other care providers at the other goliath hospital system in town, and was told that I could only be seen by actual OBs; no NPs, no CNMs, no FPs. When I went into be seen for my first visit (which, ironically was with an NP, because everyone sees the NP first at this system), I was criticized for choosing home birth. Which, you know—I can handle criticism.

So, now, it's this. I can't choose my care provider. I can't choose home birth. I'm supposed to bow down and let everyone take care of me. Because, last I checked, people taking responsibility for their health is the best way to, you know, be healthy. But apparently, it's frowned upon in the medical community, and all doctors are spoiled brats who take their toys and go home unless you play their way.

At least, that's the way I choose to see it. Because, darn it, that's one choice they're making it easy for me to make.

Updates on That Which I Promised Not To Mention Any More

So we had that big, mid-term ultrasound yesterday, where they check baby all out, and you can see all of the bones and internal organs, and all of that fun stuff. Have you ever tried keeping three kids entertained while you peek at indiscernabletothem pictures of the baby in Mommy's tummy? Yeah, me neither. Candy works, though. I mean, I'm not all about giving my kids candy, but I've been known to do desperate things sometimes. So we settled them all in with candy, and checked out the baby's spine, brain stem, kidneys, fingers & toes, leg and arm bones, eye (sockets), umbilical cord, and, for daddy, gender.

So baby looks really good, which means I got to sit down with the doctor afterward and tell him, "thanks so much for the help; we'll take it from here." Which, he actually handled well. He told me that he was obligated by hospital policy to inform me that my decision to birth baby at home does not meet current standards of care ("But," he said, "You can obviously do whatevertheheck you want!"), which he documented, and then wished me luck in all of my future endeavors. And told me to get in touch if I needed anything else. So, overall, I have been fairly impressed with my interactions with this doctor. No hard-sell to birth at the hospital, or anything like that. I don't know if he just saw me as a hopeless cause (a woman walks into the office with three kids, two of whom have been born at home, you're not liable to get anywhere trying to convince her to go back to the horrors of hospital birth), or if he's just really a nice, easy-going doctor, but...I was actually mildly impressed. Which, you know, says a lot.

So baby is measuring a few days behind, but still well within normal range, which means that I may actually be pushing out a newborn instead of a full-sized toddler. Comforting news for my nether regions. My placenta is in a good position--toward the back, not near my previous c/s scar, not near the cervix, so that was very good news, too.

They tried to get one of those creepy 3-D ultrasounds of baby's face (am I the only one who totally gets weirded out by those?), but baby wouldn't move her hands away from face at all. Camera shy, apparently. Daddy got a peek at (her?) gender, but he's keeping it a secret because I don't want to know. Obviously, my use of the feminine pronoun will clue you in to my personal gender suspicion. But I could be totally wrong.

Our little addition: nicknamed Macadamia

A Little Too Much Help

So I got a phone call from the doctor's office on Thursday, telling me that they wanted me to start on antibiotics because of the results of my urinalysis (I had an appointment on Monday and had to pee in a cup for them while I was there). I assumed I had a UTI, so I called them back on Friday to find out more about it. Turns out that it's not a UTI. I tested positive for Group B Strep, so they wanted me to start on antibiotics to treat that. So I asked them why they were going to treat that now, when I'm only ten and a half weeks pregnant ("Isn't that something that you usually give abx during labor for?"). They said they wanted to treat it now, and then, of course, they would have me on abx during labor if my 36-week swab came back positive also.

So, first of all, I'm not going to be getting that 36-week swab because I stop seeing the doctor around 24 weeks, after I have the "big" ultrasound. And, if for some horrible reason, I did have to go have my baby at the hospital, I would not consent to abx during labor for gbs. The chances of my baby getting sick from it are small, and there is conflicting evidence as to whether abx actually help the baby, and, in the event that the baby does get sick, receiving abx during labor can make the gbs resistant to abx, thus increasing the risk that the baby will die. So there's that.

Also, gbs tends to colonize transiently. As in, I may test positive today, and negative tomorrow. So why would I subject myself and my nursing toddler to unnecessary antibiotics in my 11th week of pregnancy, with no apparent benefit?

When I thought it was a UTI, I asked the nurse which antibiotic they had prescribed. My husband is allergic to amoxicillin, and on the off chance that the baby has inherited his allergy, I don't feel comfortable taking that antibiotic while nursing. So then, I get a call back from them a little while later, and they told me that they decided to wait until next month (my next visit with the doctor), to treat the gbs. So it's obviously not all-fire important to treat it now, so why were they rushing me to the pharmacy to treat this right now!! if it's not that big of a deal?

Then, while I was on the phone with the nurse, she also pointed out that I'd had glucose in my urine, and asked if I'd been watching my blood sugars, and she said it in a very implicating way. And you know what is annoying about this? It's that when I really needed their help, they were all like, "Screw you, lady!" and now that I just want to go about my pregnancy, they're determined to get all up in my business. Well, I'm telling you now: butt out.

The Whole Saga

I was talking to a friend of mine on Facebook the other day--we've been talking about pregnancy and birth, and I've been complaining about all the frustrating experiences I've had this pregnancy. As I was composing my lengthy epistle in response to one of her notes, it struck me, that one of the reasons that I hate doctors (specifically obstetricians) so much is that they do not treat me, as their patient, with respect. And yet they demand respect (and obedience) from me.

For these last three of my four pregnancies thus far, I have planned to birth at home, but because I have some pre-existing conditions, I cannot use the services of a licensed midwife, and I have slightly increased risks for complications during the pregnancy and birth. I have found a lovely unlicensed midwife who assisted with my last birth, and will be assisting me again with this birth, but I like to get concurrent care with a doctor (my preference is a hospital-based CNM or a family-practice doctor, but none of those are ever allowed to provide any kind of care for me because of my pre-existing condition. Sucks.) through the middle of the second trimester. I like to have the "big" ultrasound around 24 weeks, and then, assuming all is well with baby (which is the point of the ultrasound), I switch to just seeing my home birth midwife.

But that first trimester and half, when I'm switching back and forth, is horrible! It is truly culture shock for me, to go from the woman-based care that my midwife provides, in which we spend time together, actually discuss my hopes and plans on an equal level, get to know each other, and build a relationship, to the provider-based care that the doctors provide, in which they expect me to get nekkid on the first visit, and lay on the little table with my nether regions exposed till they breeze into the room, shove their hands up my hoohaw, tell me I'm fat, ask me if I plan on having my tubes tied after this pregnancy, ask me (horrified) if I plan on birthing at home (because they absolutely cannot support such a dangerous practice!), and tell me that they would never have "let me" birth my last two babies vaginally, since they were so large. And then they whisk out of the room, confident that I have been properly subdued.

I have a passive-aggressive strategy that I use to avoid the nekkid thing, that, so far, has worked better than even I could have hoped. I leave my husband at home with the older two kids, and bring the fifteen-month-old by myself to the office. When the nurse tells me strip, I look at her, point to the baby, and say, I may have to put that off till my husband can come with me. At this point, the baby is usually yanking the paper off the little exam table, pulling cotton swabs out of the jars, opening the sterile instrument drawers, and causing no end of mischief, and my point is made quite nicely for me (although, I did have one nurse tell me that I'd have to talk to the doctor, to see if he'd "let" me put it off). I regret that I do not yet have the courage to just come out and say, "no," when they tell me to do something against my wishes.

This pregnancy has truly been a horror so far, regarding my run-ins with the local hospitals. It started last month, when I went to see the CNM who had provided my early prenatal care during my last pregnancy (I was grandfathered into her practice due to some truly providential circumstances). I was having symptoms of low progesterone, and was having trouble regulating it myself. Having a period every twenty days was a real wretch. So I go into her office, and she sits down and says, "Since you have your pre-existing condition, I am no longer permitted to provide any kind of medical care for you at all, per hospital policy. So we'll call this visit a consultation, and I'll send you out to the appointment desk to set something up with one of the obstetricians. Also, so you know, hospital policy also now forbids any care providers in our system to provide any prenatal care to home birthers. So don't bother coming back when you get pregnant." And that, along with a few side-swipes regarding my weight and how well (or not well) she thought I was managing my pre-existing condition, was pretty much the visit. I made the appointment with the obstetrician (although my better judgment was telling me to just forget it), and left. Fuming.

I got a call from this same CNM the next day saying that she'd talked to the obstetrician that I'd scheduled with, and she was just going to tell me to wait it out, lose weight, and try to get my pre-existing condition under control (even though I kept assuring them that I have it very well in hand), and maybe just go to the other hospital in town for help when I'm ready for it, since they have all my medical records pertaining to my pre-existing condition. In other words, "We don't want you. Go away and never come back." So I canceled the appointment with the obstetrician. And then I got an $81 bill from the hospital for the appointment in which I was told that they could provide no medical care for me. I'm fighting them about that right now. No way I'm paying for something that they could have just told me over the phone. /endvent

So I did my best to manage the progesterone issue myself, and somehow I ended up getting pregnant. Not sure how that happened. I mean, I know how it happened, but I don't know how I actually was able to get pregnant, with the progesterone deficiency. But I did. So I called about four different doctors the day I got my positive test to tell them that I had a progesterone deficiency with my last pregnancy, and could they please check my progesterone levels so I could get on a supplement if I needed it. No one called me back. For three days.

The day after my positive test, I started bleeding. I was pretty sure I was going to lose the baby at that point, because it wasn't the kind of bleeding that any pregnant woman wants to see, so I increased the amount of progesterone cream I was taking, started taking some herbs to help quell the flow, and I got myself to the walk-in clinic to try to get my progesterone levels checked. I pretty much cried on the phone with the hospital Ask-A-Nurse (I called to make sure I could visit the walk-in clinic for pregnancy stuff), and told her that I had called a bunch of doctors, and none of them called me back and I was bleeding, and I needed to get on progesterone, and *sob*. So the poor lady told me to stay on the line, and she called a bunch of doctors and found one who could see me, and who would start me on a progesterone supplement that very day. Bless that sweet angel, whoever she is.

So I took myself and my three kids to the walk-in clinic, and we waited for just about four hours to get my hcg levels tested (they don't test progesterone levels at the walk-in clinic, apparently). The doctor called me back and told me that I was either very early in my pregnancy (umm, yeah, like, nine days!) or I was miscarrying, and I needed to come back on Sunday to have my hcg levels drawn again.

So I picked up my progesterone, shoved one in at a gas station before I made the 60-mile trek home, and suffered through the weekend, not knowing if I was losing my little bean or not. When I got home, I looked at my progesterone package, and noticed that the doctor had prescribed 50mg of progesterone a day for me. With my last pregnancy (you know, the one in which they actually tested my levels?) they started me at 100mg, and raised it to 200mg after a second progesterone check. So I went ahead and took 100mg through the weekend, and figured I would call the doctor's office on Monday and explain my last protocol to them and ask them to check my levels and increase my prescription.

So Sunday, I head over to the walk-in clinic during morning church service, and have my hcg levels drawn again, and wait around for the results. My husband and the older kids met up with me and the baby after service was over, just in time for the results. They were rising, but they weren't doubling like they technically were supposed to be doing. The doctor was very optimistic (and very kindly complimented us on our kids!) and said that any rise was good news, but I left not knowing exactly whether to be relieved or to worry further. So, of course, I chose to worry. Because I am woman. Hear me roar.

Monday, I called the doctor and asked him to check my progesterone levels and raise my prescription (I was fairly sure that the bleeding was linked to my low progesterone, since it had been waning somewhat since I'd started on the vaginal suppositories (there, I said vaginal and suppositories on the internet. Again.), but it hadn't diminished completely yet, so I was mildly concerned about an ectopic pregnancy. Anyway, the nurse spoke to me and told me that they do not test progesterone (?!), only the fertility clinic does that, and 50mg is their protocol, so that is all they would give me. I tried to explain to her that they had actually, you know, tested my levels during my last pregnancy, and they were low enough that I was on a much, much higher protocol than 50mg, and I didn't want to miscarry. "Well," she said, "That's because you went through fertility last time [wha....??], but we don't do that at our clinic." So pretty much, it was tough beans for me. "Sucks if you miscarry, but we won't help you."

I was frustrated to the point of tears. I was not about to lessen the amount of progesterone I was taking, but I didn't know what other options I had. There are only two hospitals in our town, and one had thrown me out because I'm a homebirther, and the other one refused to provide the help that I needed to make this pregnancy work. I went to the internet, determined that I would go as far away as I needed to get what I needed. I found a small hospital an hour away in the next state over that was not only able to get me in with a doctor within two weeks, but faxed a prescription for 100mg daily of progesterone at that very moment, and said that the doctor would most likely check my levels if I asked him to. I didn't really give a heck if the doctor was a complete egomaniac--I had my progesterone taken care of for the time being, so I was temporarily appeased.

Meanwhile, the stingy-with-the-progesterone doc wanted me to come back in to have my hcg levels drawn again in two weeks to see if they were rising as they should. Not wanting to put all of my eggs in the same basket, I went ahead and kept all appointments with both doctors till I got a feel for how things were going to go. Somewhere in here, after nine days, the bleeding finally stopped.

My visit with the out-of-state doc went, well, pretty much as I expected. He was an egomaniac who told me that he would never have "let" me birth my last two children vaginally, given how large they were (ha! and you think I would have "let" you check their sizes at the end of my pregnancy? or that I would have "let" you cut me? Sucker!). He also told me that with my obviously uncontrolled pre-existing condition which caused my babies to be large, I should be in a larger hospital. Of course, I took exception to that, since my condition is very well controlled. I just happen to have big babies. Like my grandma. But no one really cares about my grandma. So we had a slight tense moment in which he didn't believe me and I didn't let him get away with that, but that passed, and he told me that he and I just weren't a good fit. "You are obviously a woman with very strong ideas about how things are and should be, and that's not a bad thing, necessarily, but I think you need to find another provider for prenatal care." Is that, like, a doctor's version of a compliment? Personally, I think the fact that I have three kids, had two home births, told him that I was considering a home birth this time around, and was wearing a skirt, made him think I was some kind of a religious nut that births at home on religious principle, instead of being a quasi-feminist who takes exception to doctors just having their way with me for their own convenience. And cutting my uterus open to remove my babies, because it's easier than waiting around for my babies to make their exit through the God-given hatch. So, yeah, we weren't a good fit. But he was very nice in agreeing to do an ultrasound to check on baby so we could rule out an ectopic pregnancy, and a follow-up ultrasound in a week, as well as prescribing the progesterone to me through twelve weeks. So all-in-all, I wasn't completely dismayed by the visit. Although, he did decline to check my progesterone level, since he wasn't going to be providing prenatal care.

My appointment for the hcg lab with the progesterone-stingy doc was the Monday following that appointment. I received a call the next day saying that my levels were over 11,000, which meant that they had been doubling well every two days since my last draw. A good sign, for sure. They wanted to schedule an ultrasound on Thursday of that week, so I went ahead and had that done, and cancelled the follow-up ultrasound with the out-of-state doctor. Baby was there, in my uterus, with a good strong heartbeat, so I was finally was able to breathe.

I am 7 weeks 3 days pregnant today, and as of yet, I still haven't had my progesterone tested. I am hoping that I didn't commit a fatal error by telling the out-of-state doc that I'd found a new care provider (I don't want to lose that progesterone prescription!). The nausea has been fairly frequent (although no throwing up, yet), and the exhaustion has been kicking my butt in a big way, so these are all very good signs. We will see what happens. If anyone ever again asks my why I home birth, though, I will send them to this post, and tell them it's because my midwife is the only care provider who has listened to me and respected me. Who else would I want to have assisting me during birth? Certainly not the asshats (sorry, Mom. It's the nicest word I have for them right now!) who have been giving me grief instead of prenatal care!

After This, I Promise I'll Move On

So I've been talking about Little Bean, mostly, these days, since, you know--that's mostly what I've been thinking about. I promise I'll try to find some other things to talk about, but I did want to mention that I got to see the heartbeat yesterday, pumping along strongly at 120 bpm. I was measuring one day short, but I don't think that's a problem. My dilemma now is whether or not to spend the extra $100 a month to get an additional 50mg of progesterone a day. I say this because one doctor prescribed 100mg daily, and one doctor prescribed 50mg daily, and I've been taking the 100mg, and ignoring the 50mg, but with my last baby, they had me on 200mg by this time, so I don't know if I should up my dose or not, since, you know, No One Will Actually Check My Levels! It's a dilemma. Especially since we're kind of cash-strapped right now as it is, with the new minivan purchase, and my insurance doesn't cover "formulary drugs."

On a slightly different note, I was extremely annoyed when I registered for my ultrasound appointment yesterday, and the registrar lady said, "Can we take a photo for your medical records?" As I was saying, "No, thank you!" (because it's not really any business of theirs what I look like. And I'm paranoid), she had her camera out and was snapping the picture. "It's something new they're requiring," she said, and that was that.

So why the heckity-heck did you ask my permission if I don't have an option to say "no?"

So now, somewhere linked with my medical file at that hospital, is a photo of me, scowling, with dark storm clouds gathering over my head, because some moron was taking a picture of me that I didn't consent to. Serves them right!

In Which I Experience More of the Same

Had an ultrasound in which we saw a sac and a yolk in what was presumed to be my uterus. Doc said that since he couldn't see a heartbeat, he couldn't conclusively say that mine is a pregnant uterus, but he wouldn't bet against it. So i go back a week from Monday to have a repeat ultrasound, in which this whole pregnancy will (I hope) be confirmed as healthy and firmly planted where it's supposed to be.

Incidentally, having a transvaginal ultrasound while holding a squirming 15-month-old on your chest takes amazing mommy skills.

In Which I Obsess Over the Future, and Worry About Things Which Cannot Be Controlled

Tomorrow is my first appointment with (any) doctor since that second pink line appeared on our family-growing test. Tomorrow, we will hopefully learn what has been causing all of these strange pregnancy symptoms, like, you know, the nine days of bleeding. And the weird twinges and tics. And the dizziness. And the slow-rising hcg levels. We will (I hope!) find out tomorrow if this baby is growing in my uterus, or--somewhere else. We'll (I hope) find out if my hcg levels are rising normally now or not. I am, quite honestly, worked up into a tizzy over it. I am trying to prepare myself for the most horrible news (there is no baby in there) or (there is a baby in your fallopian tube), but I am so very much hoping for the best news (here is your baby! Oh, wait! There are two of them! Haha. Just kidding. There's only one in there). I just wish I knew now what I will (I hope!) find out tomorrow.

Carpe Diem!

The bleeding has more or less stopped--I've had two days with only faint pink spotting in the morning when I was putting my progesterone suppository in (do I really need to justify my talking about suppositories on the internet by now?). I'm not sure if that's a good thing or a bad thing or a nothing, but  I'm glad to not be seeing it on a daily basis, anyway.

Unfortunately, I'm about 60% convinced that I am carrying an ectopic pregnancy--the bleeding and the slow-rising hcg levels are major symptoms. Of course, I could be wrong (and I really, really hope I am!), but I can't say I'll be surprised if it turns out badly.

I have been trying to focus on enjoying being pregnant right now--even if it's just for another week or two, I want to savor every moment! Pregnancy should not be wasted, even if it's cut short.

Waiting Around

Baby number 4 is kind of up in the air right now for us. My hcg levels are rising slower than normal (but still rising), and I've been having a lot of bleeding--the kind of bright red bleeding that freaks you out even though it never gets in your underwear (well, I said vagina on the internet, so it only follows that at some point I would talk about underwear, right?). It could be one of several things: a slow miscarriage, an ectopic pregnancy, something related to my low progesterone issue, or just random pregnancy bleeding that is happening for the sole purpose of making me turn prematurely gray. Obviously, we're hoping for option 4, or at worst, option 3, but we shall see. I am finding it difficult to think of myself as pregnant, or get excited about having a baby, when I don't know if it will stick. And waiting around to find out? Yeah. That's a big wretch.

Version 4.0 Coming March, 2013

Well, I can't say that with absolute certainty, since I haven't taken a test yet; but I am fairly sure. For all of you lovely people who chart, you can see my little implantation dip at 7 dpo (days past ovulation, for those of you who don't chart).

I had a teeny little bit of pink this morning when I went to the bathroom (yes, I'm putting that on the internet. At least I didn't say vagina. Oh. Wait.), but nothing came of it (I've been half-expecting my period, because I'm suffering from a progesterone deficiency, so my luteal phase has been between 6 and 7 days long). So the only other thing I can think of is--that we'll be needing a minivan before March of next year. Yay!

(Edit to Add:)
This new version has now been confirmed!