Friday, July 22, 2011

Week 36

Now at 36 weeks, we're looking at less than a week before we're considered full-term!  Wow...  There were times when this pregnancy felt like it was taking forever, but suddenly it seems like the end is right around the corner!

We had our last visit with the prenatologist Wednesday, and the news was pretty good.  The baby is estimated at 7 pounds 8 ounces and is measuring at slightly more than a week ahead.  He's measured a week ahead from the beginning, so this isn't bad news at all.  His abdomen is measuring a little big around, but not to a concerning extent.  The prenatologist's assessment: "He's a big baby, but in the normal range.  C-section is a possibility, but I consider you a candidate for vaginal delivery."  Honestly, that's a pretty great assessment!  I went into this knowing that a C-section is a more likely when the mother has diabetes, so to hear the prenatologist say I have a shot at a vaginal delivery feels like a triumph!

But the best part of visiting the prenatologist, other than hearing that the baby is healthy?  Getting to see the kid.

Aren't 4-D pictures just wild?  I bet when he's born, we'll be able to put this picture up next to him and tell that it's the same baby.

Diabetes in Pregnancy:

My prenatologist warned me that, after all the insulin increases you have to do during pregnancy, you often hit a point near the end when your needs suddenly decrease.  (Common knowledge medical opinion says it's due to the placenta breaking down, but my prenatologist thinks the baby is simply using more genergy/glucose at the end.)  I suspect I'm there.  I had a fairly bad low last night, and I seem to be struggling to keep my numbers up this morning.  Most (but not all) of my post-meal numbers are also lower.  If today continues to look that way, I'll be making some changes to my settings tomorrow.

Frustrating Pregnancy Stuff:

I went for so long with very few of those usual physical pregnancy complaints.  Now, I'm really catching up on the swelling!  My legs, ankles and feet have gotten worse and worse, with yesterday being so bad that I weighed in 13 pounds heavier at my OB's office than I had only 9 days ago!  The nurse practitioner says it was surely almost all from swelling.  I put my feet up higher and longer than usual last night and the difference was pretty significant in my feet and ankles, though my calves were still very swollen.  My feet probably won't swell much today since I stuffed them into compression socks and tennis shoes this morning, but I can already see my ankles growing despite the socks.

Sometimes in pregnancy, major swelling is also accompanied by other symptoms that point toward pre-eclampsia.  Luckily, I don't have either of the other two biggest indicators: High blood pressure and protein in my urine.  The doctor ordered some labs, including one that requires me to do the ever so fun 24-hour urine collection, to be absolutely sure.  I'm not too worried about the results, but I certainly don't mind making sure everything is OK.

Conflicting Opinions in Pregnancy:

Another frustration is contractions.  Ones I really don't even feel.  But when I go for my twice-weekly non stress tests, everything goes great except that I'm having contractions.  Sometimes it's just a scattered few, and that's not a big deal, but sometimes they're more regular or frequent.  A nurse mentioned to me that some doctors wouldn't consider even that a big deal, but my OB does.  Even though my cervix is closed and long (that means it's neither dilating nor thinning out in preparation for dilation), I've been given shots of brethine to stop the contractions a couple of times.

That. Stuff. Sucks.

The nurses warn you that it might make your heart race or make you feel out of breath.  It makes me feel way worse than that.  (I'm very sensitive to stimulants, and a nurse confirmed with me this morning that it acts very much like a stimulant.)  They also warn you that it can make blood sugar go high.  I could tell a difference with that, though it wasn't anything I couldn't keep a handle on.

But if I need to do something I don't like to keep my baby is safe and healthy, I'll do it.  Thing is... I have this gut instinct that I don't need the brethine, and that my body isn't doing anything it shouldn't do right now.  And brethine does come with some risks.  Using it to stop contractions is an off-label (though extremely common) use of the drug, and the FDA has recently added a label to it that warns against using it on pregnant women for an extended period of time.  So even though these shots are pretty short-term, I don't like them.

But my gut doesn't have a medical degree, or decades of obstetrical experience.  My gut only has "instinct."

Then I mentioned the brethine to my prenatologist, and he immediately shook his head and said, "No, they shouldn't be giving you brethine now.  Those contractions are normal.  They get your body ready for labor."  (This totally matched my own understanding of Braxton Hicks.)  I said that it seemed that regular contractions seemed to be what concerned my OB enough to give it to me.  Again, he shook his head.  "You're not feeling these contractions?  Trust me, you'll feel them if they're a problem."

OK, so now I have two conflicting medical opinions and a gut instinct to work with.  Oh, and fear.  What if I turned down brethine and the baby is born too early?  Or what if I accept the brethine and keep my body from getting ready in time for labor, or what if the drug has a direct negative effect on the baby?

I wound up deciding that today's NST would be the last one during which I would accept brethine for these contractions alone.  I told the nurse that if I had contractions, to express to my OB that I realllllly don't want to take it unless it's reallllly necessary.  I told this nurse, who has worked with me a lot, about the above conversation with my prenatologist and also that I'm really at the point where I feel like I should deny consent for the drug but am also hesitant to butt heads with the doctor who's going to deliver my baby.  The nurse said that would worry her, too.  As I watched the monitor, I saw a couple contractions... but they didn't seem at all regular.  The nurse took the sheets up to my doctor after the test had run long enough, and she came back down saying I could go.  "And I didn't tell her that you didn't want the brethine.  I said that your prenatologist had told you you shouldn't take it anymore."  It sounded like my OB didn't fully agree with that statement, but she was wasn't worried enough about the current contractions anyway.

That nurse is awesome.

And, though I plan to talk to my OB about it when I see her, the brethine might not be an issue anymore, anyway.  I'll be two days away from "full term" at my next test, and the nurse said she'd be surprised if I'm given it again at this point.

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