Monday, August 14, 2017


What a stupid, stupid day I have had. I knew today would not go my way when I awoke to find rain pouring from the sky.

Today was my first scheduled NST at 35 weeks at 10 am. I had to bring all the kids to my sister's house, which meant we had to leave home at 845. Really, we should have left at 830. I dropped the kids, gave a rundown of the schoolwork I sent along, and headed to the gas station because the van was out of stupid gasoline. I didn't have time to fill-up so I gave it about three gallons to get me there and back again. It was raining a deluge.

I get to the appointment about seven minutes late after having Dave call to tell them I was running a few minutes late. These appointments are not double booked because there is only one fetal monitoring room, but nonetheless it took them 30 minutes to call me back.

The nurse brings me back and asks if I have ever had an NST before. No. Is this my first baby? Why, no. She explains the procedure and then asks the loaded question: Did you have a good breakfast? Um, was I supposed to? "The test works better if baby has some glucose to work with." Nobody told me to eat well before coming. And I knew.

NB: I tend to have a low fasting glucose just like I tend to have low blood pressure. Nobody cares because all that matters is hypertension, diabetes, and a normal thyroid. I have a normal thyroid number so they all just shrug in my general direction. If this test relies on maternal glucose to goose the baby into proper performance, I knew right then this was not going to go well. Half a frozen sausage biscuit pair isn't going to go far. I was planning to eat for real after the appointment. You know, at 1030. IF SOMEONE HAD TOLD ME...

So she straps me all into a chair--mmm belly monitors, my favorite--assures me she will be monitoring our progress from her office over a baby monitor, and walks out of the room. Irony, there. Baby monitor. The pound, pound, pound of baby's heartbeat is being broadcast live over the air. I couldn't actually see the machine, but I guesstimated it to be around 150.

After some amount of time, she comes back into the room, looking vexed. She says baby is not responding appropriately so she takes this flashlight looking thing that vibrates and buzzes my belly with it two or three times before walking out of the room again. Pound. Pound. Pound. Move. Squirm. Pound.

More time passes. And I know. Eventually she comes back into the room, glances at the tape spit out by the machine and unceremoniously announces, "The baby has failed this test." Nice bedside manner, you have here. Don't try to soft pedal it. "You will have to have an ultrasound before you leave today. Go back to the waiting room and I'll see when Ultrasound can work you in" And then she utters the words that pretty much sum up the day. "I don't think anything is wrong, but we have to check." Of course.

Back to the waiting room, I go. It just so happens that the next ultrasound appointment is running late because of the rain. I get called back. Ultrasound nurse is a bit friendlier than NST nurse. She seems concerned. I tell her that if I had known I needed to eat a big breakfast for this test to function, I would have eaten better, but nobody told me. She says I don't need to apologize. I AM NOT APOLOGIZING. I am explaining the failure in communication WHICH IS IN NO WAY MY FAULT. Breathe, breathe. smile.

I climb onto the table. Good news! Baby is head down and has hair. Hurray. She measures all the things: heartrate (150bpm-called it), blood flow to the brain, breathing reflexes, limb movement, amniotic fluid. She announces that baby is passing the ultrasound with flying colors. Then she starts measuring baby for growth. And I know. Sigh. Let us all be shocked when she says baby is on the small side and she needs to discuss this with a doctor before I am allowed to leave. Of course. Except my doctor isn't in office on Mondays so ultrasound nurse, who I have only just met today, will discuss this issue with random OB in the office, who I have likely never met in order to decide whether I can leave.

I then deploy what I call the Grace defense. "My oldest was less than 6.5 pounds at birth and still is only in the single digit percentiles and barely weighs 70 pounds at 12 years old. That the baby might measure a little small is definitely within the realm of possibilities. We are a small people. My giant-sized daughter is only in the mid-30s in percentile." Her response: Sometimes it is just genetics, but we have to check to make sure. Of course.

Back into the waiting room, I go. By this point, I am starving. I had expected to be able to eat at least an hour prior. I think Ultrasound nurse forgets I am out there. Time passes. The door finally opens for her to call the next patient. She sees me sitting there and says, "Oh, the doctor said it was fine. You can go." Thank you very much.

It is now after 1230 and I. Am. Starving. I go to a restaurant, order too much food, eat it all down, and then feel bad for a good chunk of the day from eating too much, too fast. I have to drive home. Still pouring rain. There is a jack-knifed semi leaking diesel on the interstate blocking my way home because OF COURSE THERE IS. I get through that little traffic nightmare and have to stop and fill up the van again because I have burned up my three gallons from the morning and am now filling all the way up. I pull into my sister's driveway after 230. I am totally beat.

What a stupid, stupid day. This is why I am deeply skeptical of all this testing and interventions. At no point did I ever get the impression that any medical person I interacted with had any true concern about me or the baby. They all seemed to think everything was fine, as did I. But we sure as heck had to check a lot of boxes on our way. And I get to do it all again on Thursday when you will be sure I will eat more than one frozen sausage biscuit for redacted breakfast.

Saturday, August 12, 2017


Oh, hey! Another pregnancy post! I'll try to move on to other topics soon, but everyone loves a name post, right? You know how everybody knows those people who start dating and immediately start naming all their perspective children. I am not those people.  Most of ours have not been definitively named until transition is closing in.

I find naming children somewhat difficult. I think this difficulty is born of my given name, shared by half the girls born in the 70s. I feel almost completely disconnected from my name. It's more like a label than a name. One of the great mass of Jennifers. It doesn't feel personal or that it says anything particular about me. I did not want my own children to have the same disconnected experience from their own names. In practice this means I have gravitated towards more classic names and tried to avoid trendy names. It turns out all the other Jennifers feel the same way. (I tried, Olivia, I tried.)

I admit I am picky about names. I don't like a lot of them. I promise I love your kids' names whatever they are, but I cannot easily find names I love for my own kids. A name has to feel right to me and it is hard for me to describe what 'feels right' actually means. 

So now we are on our fifth child and our powers of naming are running low. This state of affairs is distressing to Grace. Almost every night at supper, she asks, "What are we going to name the new baby?" We all throw some suggestions around, but nothing seems to stick or feel right. Repeat again tomorrow night.

The current ex-utero children are named:
Grace Elizabeth
Olivia Rose
Samuel David
Marian Josephine.

The new baby is purported to be another girl. I tend to Englishy names, something Jane might name a character. So what do you think? What should we name the new baby? Help us, lest new baby end up being called Clare Annette.

Friday, August 4, 2017

Pregnancy This Time Around

Forgive me for pregnancy is on the brain. Your alternative is to hear about my housekeeping and homeschooling angst and I know you don't want that.

When I first seriously considered pregnancy again, my biggest fear was just being pregnant again. I wasn't worried about having another baby or where another might fit in this house or the implications for the car situation. I just really didn't want to be pregnant again. For months I longed for a surprise, a misreading of the chart, a margin that didn't really exist. That didn't happen. Instead we had to make the deliberate decision. I've never been so nervous in my life. Gah, what was I signing up for?

My fears mainly congregated around three main issues: nausea, heartburn, and pelvic pain.

My nausea has never risen to the level of HG, but it is debilitating to me. It comes on fast and knocks me low. The constant feeling of nausea for weeks and weeks leaves me almost worthless and everyone around me has to pick up the slack. Some people seem to be able to fight through this feeling to attain some level of functionality. I, for whatever reason, cannot.

The heartburn is more annoying than debilitating, but it comes on around the midpoint of pregnancy and is a ready companion until about 12 hours after birth. I have to sleep practically sitting up to keep the acid down through the night and pop Pepcid like candy with middlin' results.

My biggest fear, though, was the pelvic pain. I have struggled with pelvic instability since my second pregnancy. It was only slight that time and disappeared after birth, but set the stage for real pain later. It was especially terrible during my third pregnancy where I had trouble walking and standing and dressing myself. But again, it disappeared after birth. During my fourth pregnancy, the pelvic instability was not as bad as the previous time and I took proactive steps to rein it in by going to a chiropractor who specialized in pregnancy and doing stability exercises. In spite of these things, the pain lasted long after birth. Years after birth. I was truly afraid of permanently maiming myself with another pregnancy.

So how's it been?

The nausea came on fast and furious at 5 weeks along. I lasted about a week and then I decided this was dumb. Give me all the meds. I have never taken nausea meds during pregnancy before because I could not take a chance on the sleep inducing side effects while driving upwards of three hours a day. I might feel sick, but at least I was awake to drive. This time, I didn't have to worry about all that. I latched onto the Unisom/B6 combination. I slept long hours, but it did help. In retrospect, I probably could have and should have taken a higher dose. The meds functioned to take the edge off the nausea. It didn't completely disappear, but it gave me enough margin to eat in the morning and not spend the entire day retching.

The severity of the nausea also only lasted to about 12.5 weeks. I know that's when all the books say the nausea should end, but that has never, never, never been my experience. I usually have severe nausea through 16-18 weeks. It may have been the combination of the medicine and the sleep, but the 'I want to die' nausea portion of pregnancy was much shorter than usual.

Even though the nausea was a bit better, Dave was not prepared for how thoroughly the first half of pregnancy affects me. In the past, I would go off to work and he would carry on his normal duties at home. It's true I didn't help much when I got back home, but he already had meals and laundry covered so the functioning of the household didn't suffer too much from my stasis. This time all those were my jobs. He had to work all day and then come home and work all evening. The older girls had responsibilities they had never had before and didn't particularly care for. All while I held down the couch. It was rough to say the least.

A different experience with the nausea this time is the long tail. Usually I have hard nausea and then it leaves by around 20 weeks. This time mild nausea hangs on even to this day. I don't know if it is the meds or my age, but even now I am on a half pill of Unisom because every time I try to wean off of it, I get sick again. I wish I could stop taking it, but by this point I am just not willing to do withdrawal, if that's what it is, until after birth. No need to compound miseries.

The heartburn started this time earlier than ever. I tried intermittent Pepcid. I tried systematic Pepcid. I was still having breakthrough heartburn almost everyday no matter what I ate. After a bit of stubbornness, I finally asked the doctor about taking Prevacid. She gave the go ahead, and let me tell you, Prevacid is a freaking miracle. The acid is gone. GONE! I can lay down! I can drink water! I can eat food! It is a miracle. Now, you are only supposed to take it for fourteen days and it is supposed to last four months. I, on the other hand, have the heartburn return at about day 14.5 if I miss a pill so I am on constant Prevacid for the duration. I am not entirely comfortable with this, but I am also no longer willing to burn my throat with acid when it is avoidable.

Finally, the hips. I was extremely worried about the hips, but it really hasn't been a problem at all. I haven't been this comfortable hip-wise since my second pregnancy. I am now about 34 weeks and I haven't had to wear a support belt or anything. I feel a twinge in my left hip when I stand on that leg alone, but that's it. It is a really pleasant surprise. It is true it could all go down hill between now and the end and I could end up with a debility, but it looks good so far. I think I must be up and around more at home even though it feels like I sit a lot as opposed to spending all day in an office chair. Or maybe all those stability exercises did more good than I realized. Whatever it is, I'll take it.

A couple of things that I did not expect is anemia and an elevated heart rate. When the nausea died down a bit and the second half of pregnancy rolled around, I expected that burst of energy everyone talks about. It never showed up. Eventually I was diagnosed with mild anemia, but I had weeks and weeks of time when it seemed like I should be doing stuff, but getting off the couch was monumentally difficult. I started taking a Floradix once a day and eating a lot more red meat, and now I feel fairly normal, energy-wise, considering my age and it's the third trimester. I am disappointed I missed that magic window of productivity, but it is what it is.

Also my heart rate has been elevated for months. It's not high enough to trigger any medical concern, but it is really annoying and tiring. It feels like I have been up and around and active all while sitting in my very own chair. The constant pounding is a frustration. Coffee is totally out. I miss coffee. I cannot handle any morning caffeine. It sets me up for a bad day. I have to have enough protein at meals, otherwise carb heavy foods sets the pounding off again. I will be quite pleased when my heart rate goes back down to normal. Hovering in the 90s and lower 100s all the time is a drag. 

So there it is. The fears of the pregnancy were not entirely unfounded, but we survived while other issues I never worried about popped up. I am taking more medicine than I ever thought I would, but my patience for the "normal" aches and pains has been exhausted. Just six more weeks, right?

Wednesday, August 2, 2017

Pregnancy, AMA

When I last had a baby, I was 35 for the entire pregnancy. I met ACOG's technical definition of Advanced Maternal Age, but my OB never mentioned it. Later, at a yearly appointment, I asked her about it. She said that for someone with my medical history and pregnancy outcomes, she would not consider a pregnancy AMA until age 37 or 38 at the earliest.

As my husband and I discerned over the years about whether another pregnancy would be prudent, I always asked my doctor her opinion on my fitness for pregnancy at my yearly visit. She always was unfailingly positive. Someone with my history should not need to avoid pregnancy for medical reasons. As I crept up in age, she would caution that it might take longer than usual to get pregnant and my risk for miscarriage would be higher, but she strongly felt the odds were overwhelmingly in my favor.

Then we made the decision. It did not take longer than usual to get pregnant.

At the beginning of my pregnancy, while I was a spring chicken of 39, nothing much was different from a medical perspective than with my other pregnancies. My appointments were carried out in the same old way. I didn't have any extra appointments or screenings related to my age. I did have more ultrasounds, but that was due to ectopic concerns and later baby hiding from the doppler, but not my dotage.

In May at my regular appointment, my doctor made note of my 40th birthday in June. She said I should get a phone call from scheduling setting up my appointments for the rest of the pregnancy. I was not alarmed by either comment. I happened to get the phone call in a few days at a bad time. The nice woman on the phone said it wasn't a problem and she was just letting me know to expect a list of my third trimester appointments in the mail. Nothing prepared me for what was in that fat envelope when it arrived the next day.

Appointments. Oh, so many appointments. They had me scheduled for three appointments a week for the last seven weeks of pregnancy. Every week starting at the beginning of August, I was supposed to drive into Nashville for an ultrasound to check fluid and growth on one day plus a regular appointment and then drive back into town another day for a separate non-stress test. I was astounded. I went from being treated like a normal pregnant woman who had been encouraged to pursue a healthy pregnancy to one who it seemed they feared might have catastrophe strike if they didn't see me every few days.

Taken aback by this pile of appointments, I did some research to figure out why so many. (Let's be real, I asked people on FB and then did some other reading aside.) It turns out there is a higher risk of stillbirth in the last couple weeks of pregnancy for mothers over the age of 40. And I guess that's me now. I am frustrated by the notion that if I had had this baby in June instead of September, I likely would have been scheduled for almost none of this.

But the last couple of weeks of pregnancy is a far cry from the last two months. I have other things to consider besides tests being run out of an abundance of abundant caution. First is child care. Where am I to store the other children while I attend appointments that will carve three to four or more hours out of my day twice a week for seven weeks? The second is cost. Being the proud owner of a $5200 individual deductible before the insurance kicks in at a generous 50%, these tests will cost me upwards of $300-$400 a week. That's a pile of money. (How much does an NST cost? Anyone know? Not me.) I have no desire to spend that kind of money without a real reason to be doing it.

At my next appointment I talked to my doctor about my concerns. She explained the elevated stillbirth risks, but agreed that given my health and history, I could postpone these tests a few weeks without much concern from her. She wrote up the order to cancel two week's worth of appointments and I took that trusty piece of paper down to a scheduling nurse.

The scheduling nurse was beside herself. How did I manage to get the doctor to agree to cancel these appointments? Not your business, schedule nurse. She just wasn't too sure about this. I didn't ask your opinion, schedule nurse. She couldn't possibly reschedule a different appointment I had a conflict with because she was already pressing her luck by cancelling the other appointments. Show me your credentials and your understanding of my medical chart and then I might care what you have to say about this, schedule nurse.

I didn't really expect the scheduling nurse to be the source of friction on this topic, but there it is.

At my appointment earlier this week, I saw a different OB than my usual. My OB was on vacation and that's just the way the schedule worked this week. Whatever. My appointment was entirely normal. Appropriate weight gain. Good, which is to say low, blood pressure. Good fundal measurement. Strong heartbeat. This different OB might have used the word 'perfect' several times during the course of our five minutes together.

Then, apparently? something? I don't know?, she must have noticed that I was officially old on my chart. OLD, I tell you. After telling me how wonderful it all was, she then asked if I had an appointment scheduled with the high risk OB. Um, no? You just told me everything was perfect, repeatedly. Now I need the high risk OB? Then she asked if I had a growth scan ultrasound scheduled. Yes. When? In two weeks. Okay, good. We really need to get a growth scan on this baby. If you say so. My belly has grown since my last appointment and baby is kicking the fire out of me, but I guess we can't be too sure that baby actually grew. It's all a coincidence. I suspect my regular OB would not have been so jumpy.

So that's life with a really official AMA pregnancy. Everyone at the OB office thinks it's great, but they also think you might spontaneously combust. Stay tuned...

(Digression: I will be having this baby at the hospital this time. The midwife who lived five minutes away moved out of state. The other midwife I wanted to use couldn't guarantee her arrival within an hour. This is totally understandable. The number one medical concern in my pregnancies is unassisted delivery. If the midwife couldn't get here quickly enough, I'd run a high chance of delivering by myself. So the hospital it is. I know this means I will likely be induced. Meh. But it is what it is. The goal is no interstate deliveries.)