Saturday, October 18, 2008

25-26 weeks

Something really stressful happened at my last prenatal appointment (October 8, at 25w1d). It started out routine -- pee in a cup, blood pressure, weight...

My doctor came in and asked me about any symptoms. I told her that I still had the occasional tightening of my uterus, but nothing consistent and no vaginal bleeding to go along with it. I mentioned how it had been worse while riding the aforementioned bike in San Francisco (see below). She said that in general, she does not advocate bike riding during pregnancy as "you could get hit by a car" and because she's had a previous patient "flip over the handlebars and get hurt" while mountain biking. Well, OK... S and I don't even own our own bikes, and we have rented bikes exactly 2 times since we met 3.5 years ago, so I guess it won't be too hard for me to follow her advice.

Next, she proceeded to place the Doppler on my belly. Whoosh...whoosh...whoosh... a nice strong heartbeat.
But then: whoosh...whoosh.........whoosh.........whoosh.........whoosh.........whoosh..............whoosh............whoosh..................whoosh...whoosh...whoosh...whoosh
I could see wave of concern cross Dr. K's face. "Let's listen a little longer," she said.
Me: "The heartbeat showed down for a few seconds, didn't it?"
Dr. K: "Yes, but now it seems fine. It went into the 90s for a few seconds, and then came back up."
(It slows down a tiny bit, but not nearly as much as before.)
Whoosh..whoosh..whoosh..whoosh.. (for about 2 or 3 minutes)
Dr. K: "Well, everything seems OK. I think the baby probably just pinched her umbilical cord for a few seconds." (My face, I'm assuming, looks terrified.) "If you're really concerned, you could always go to Labor & Delivery and get monitored for a couple of hours."

At this point, I start to basically panic. As bad luck would have it, I have two patients scheduled for appointments that morning, starting in about 30 minutes. And afterwards, I am the consult attending at the VA, so I need to round on the inpatient service. Obviously, I could go to L&D if it's recommended or necessary, but it will require some major stress and inconvenience to others to make arrangements for someone else to cover these things for me.

I explain this to Dr. K, and she quickly back-pedals.
"I don't recommend that you go there; I think that everything is fine."
I try to negotiate a return to her office later for another heartbeat check... or maybe I'll go to L&D in the evening. My eyes fill with tears.
"No, I don't think you should. I wouldn't go there if it were me. Everything is fine. Let me get the ultrasound machine and let's take a look."

So, she got the ultrasound machine and we saw BabyGirl inside, head down for once, squirming and moving normally, heart appearing nice and fast and rhythmic, doing practice breathing with her diaphragm moving up and down.

And so I decided to NOT go to L&D. I wish Dr. K had never mentioned the words. My own rationale was somewhat like: 25w1d is way too early. If I got there, who knows, they might end up panicking and doing a C-section or something crazy. What else could they do if there really was a problem? Alternatively, they might order a bajillion more tests for me and BabyGirl. I know that would be SO scary. Somehow, I did believe that it was just a fluke and I didn't really want to be monitored and hear that again and just get more and more scared and worried. Did I spend the evening reading about decelerations and fetal heart monitoring?: ummmm, yes. But almost all of the info I could find referred to the perinatal period (ie during labor). And a decel lasts for minutes, not seconds. There's very little written, as far as I can find, about blips in heartrate that last for only a few seconds and which are noted at a random prenatal visit.

So, I've decided to trust Dr. K and trust BabyGirl and not worry about it. BabyGirl has been helping me out by being increasingly active over past week, so I know that she's OK in there. Just felt a kick, in fact! I know that Dr. K truly wasn't worried because our next visit is in November, at 29 weeks... 4 weeks from our last visit.

Between now and then, the only thing I need to do is take the 1 hour glucose tolerance test. I picked up the bottle of the orange stuff from the lab. For some reason, I was thinking it would be a small bottle, but that thing is pretty big! I guess I'll do it sometime next week.

I told a friend at work about the Scary Prenatal Visit, and she offered to bring me her "Doppler". It took her over a week to find it, and it's actually not a Doppler, but something called the "BebeSounds Prenatal Gift Set." As far as I can tell, this was probably popular right before people started buying and renting their own Dopplers for home use. It is basically a battery powered microphone that you put against your belly, and then you turn up the volume and listen with headphones. Honestly, I can't hear the baby's heart yet. However, the placenta (anterior) sounds like an approaching freight train. The instruction manual says that this machine works best in the 3rd trimester, so I'm not quite there yet anyway, and who knows if I'll ever be able to hear anything over the placenta. Also, it is highly dependent on the baby's position. BabyGirl gives me a lot of reassuring kicks while I try to listen, too. I love her so much already!! Today she is 26w4d old!


Lorrie said...

Sorry to hear of your stressful appointment, Sarah. I think you're absolutely right to trust your doctor. I'm sure everything is fine, but at the time, it can seem scary, huh? Keep us updated!

Jen said...

Oh my gosh! That is so scary!
I'm sure your doctor would tell you if she really thought something was wrong.
Definitely keep us updated, though.

Jill said...

Yikes! I'm sure I would be freaked out too. But, it sounds like you trust your doctor, so I'm sure she'd tell you if you needed to get monitored.

Glad she is a kicker! Hopefully she'll keep on giving Mommy lots of reasons to feel okay for the rest of your pregnancy.

Morrisa said...

Wow, I would be stressed out too. If it makes you feel any better though I have heard that before while listening with my doppler. I have also had a fetal echo where they spent plenty of time listening and examining baby's heart and all was well. I think it could be she is laying on her cord for a moment.

sara said...

Sorry about the scare- I totally agree with your feelings on this one as well! I hope it's the last time that you have to deal with that. I'm so glad to hear you're over 26 weeks and plugging right along :-)

You're completely right to ask why the vomiting. Both the OB, peri, and GI that have been following me feel it's due to uterine position (left unicornuate) and her increasing size creating a "reverse peristalsis" like action since it constantly contracts. At any given moment you can feel a rythmic like motion on my abdomen. That makes me feel like someone is constantly sqeezing my stomach. My IV has had D5 in it with some LR to help clear up some ketones since they found them. So we're trying to avoid doing anything else as much as possible. The PPN is also an option and the PICC would only be for IV access if they can't find anything else. They may do the PICC even if I don't need the PPN or TPN just since I don't have the best access anymore and they obviously wouldn't do a central line when they have the option of a PICC. They don't want to do anything not neccessary either - I think they are just preparing me in case stuff continues for days, you know? Also, on the off chance this continues for a few days after she is born - they were mostly not wanting be to go for an extended period without some decent IV access or nutritional source. But we all agree as long as I can keep PO intake of any sugar source and hang out with my dextrose in my IV (peripherally preferred of course) then we'll avoid any of those other things. Because I know I definitely don't want anything that isn't absolutely neccessary too :-)

sara said...

There is one other patient they had 6 months ago with a unicornuate uterus who had almost the same problem at the 33 week mark as well - she hung out for like 2 whole weeks on some broth and ginger ale and delivered okay later. But they feel maybe we have similar problems. Not all unicornuates have this bothers me to know why just as much. So thanks for asking - hope this helps. Sorry so long of rambling and I hope you are having a great weekend!