Due Date: Come and Gone!

We had a sonogram yesterday, Friday, June 15th, our due date. This is a standard procedure at the 40-week mark, and it's called a BPP (biophysical profile) to monitor fetal heart rate continuously for 20+ minutes, check the reflexes of the baby, measure amniotic fluid levels, etc.

According to measurements taken yesterday, the Bean is already 8 pounds, 8 ounces! The baby gains almost half a pound each week now.

The due date is the midpoint of the last 4 weeks of the pregnancy. Roughly 5% of pregnant women deliver on their due date according to Dr. Holden, and the rest come earlier or later. Senan (Emma's son) was born 5 days after his due date, Ben and I came after our due dates, and Bean is carrying on in the Renda tradition of being late.

It's funny to think I actually look forward to cramps and backaches. My parents and Michael ask "How are you feeling?" and I say "perfectly fine, unfortunately", and we all laugh. Ready to have the baby out now.

We saw the Bean's face and head even though it's down low. The radiologist said the Bean was making chewing/sucking motions. I hope that bodes well for breastfeeding attempts after the birth.

I find it emotional and difficult to look at our ultrasounds. We saw outlines of the external features, and the skeletal structure underneath, and he/she still looks like ET (!). I love the baby already whatever he'll/she'll look like, so I just want the radiologist to look on my behalf and tell me/us everything is ok. She said everything looked fine.

It is easy to get anxious at ultrasounds. Even though we had genetic testing and blood tests early in the pregnancy, there are a million other developmental issues that can happen along the way that can't be tested for in advance, that are unrelated to age and are out of the parents control (including things like cleft palate) so you find yourself shoving these worries to the back of your mind, hoping for the best, and watching the face of the radiologist very closely to insure he/she doesn't get a concerned look...

Last night, my parents and Michael and I walked to a restaurant in North Park Slope called the Chip Shop -- it's modeled directly on the UK Chip Shops and features meat pies, fish and chips, curry and chips, chips & butty, bangers & mash and more. We had great fish and chips and Michael tried a fried Mars Bar, which is a candy bar deep fried in batter (a donut!) covered in powder sugar. Heart attack on a plate. It reminded me of living in England.

We walked home and I had cramps for the rest of the evening, so we all went to bed optimistic that this might be real labor starting, but I fell asleep around midnight and woke up 8 hours later, so obviously it wasn't...

Today is my father's birthday! We were hoping the Bean would be born today, but unless something dramatic happens this afternoon, probably not. Mom made lamb chops for dinner, we had birthday cake and gave Dad a few presents. I'll post a picture here soon from our party of four (+1).

Above are two pictures from the two recent sonograms we've had - it shows the outline of Bean's head (June 15th), and one of Bean's feet (May 30th).

Weekly Checkup: No News & Weird Thing in Toilet... (Wednesday, June 13)

Vitals: 110/70
Weight: same as last week
Fetal heartbeat: good

We saw Dr. Holden today, and for the first time I was looking forward to him checking me out to see if I'm dilated (even though it hurts a bit). Was hoping that the cramping this week was a sign that things are moving along here. This is expected to be our last doctor visit before the birth.

He said I'm dilated ~2 centimeters and softer than last week, which are good signs but not necessarily indicators that we'll go into labor naturally soon, so I am a little disappointed. The cramps have diminished so doesn't seem like much is happening.

Our official due date is the day after tomorrow (Friday, June 15th). As per the discussion we had with Dr. Holden at last week's appointment, the latest we'll be allowed to wait for something to happen naturally will be next Thursday, June 21st. Since Dr. Holden is on duty next Tuesday, he recommended we formally book in to the hospital on Monday, and he'll deliver us either Monday or Tuesday (!). We can opt to wait until Thursday; the downside is we probably won't get Dr. Holden.

Michael and I would both like it if we went into labor naturally, so we're hoping something happens this weekend (but right now, it doesn't feel like much will happen...). We are scheduled to show up at Columbia Presbyterian next Monday at 6 a.m. eastern if nothing develops this weekend.

Dr. Holden said it would be normal to spot or cramp up after the appointment. After dinner, I went to the bathroom (pee), and found something weird in the toilet. Sort of light brown and scalloped... I called my Mom in and we both looked. Maybe mucous plug?
http://www.justmommies.com/articles/mucous-plug.shtml
Not sure, but hope that's what it was.

Some of the best laughs Michael and I have had this pregnancy have been around bathroom issues in the last trimester. One incident (#2) happened at the old apartment; and another incident (#1) happened at a recent doctor visit when I was trying to provide a urine sample. I'll write separate entries later with a warning up front in case anyone wants to be spared the bathroom humor. It's worth recording to me because it will capture at least two times Michael and I couldn't stop laughing recently. The closer the due date, the less the dignity...

Weekly check-up & Sonogram (May 30th)

Weight: Same as last week
Vitals: 120/70
Fetal heartbeat: 143-147 bpm (good)
Test result: Strep B - Negative (good!)

Michael and I met Dr. Eileen DeMarco today. She's nice -- very business-like. Felt the baby, confirmed head is down, said 'medium-sized' -- in the 7 pound range. Did an internal inspection -- said I'm starting to efface, but not dilated significantly. She mentioned she's on call on Fridays (June 15th is a Friday) but not the weekend of the 16th-17th, so it is a lottery in terms of which doctor will be on call when it's time to deliver.

The only thing on my mind was lack of movement. The Bean has been active every day for the past several weeks at many points throughout the day and night so that I've had no second thoughts about tracking fetal movement. Yesterday, I spent a good chunk of the day outdoors doing errands, and felt movement only twice, and none at night when I went to bed. This morning was very quiet -- no movement.

Dr. DeMarco said it's likely everything is ok, but indicated we should get a sonogram to check measurements and amniotic fluid levels to be safe. It's fairly routine to have a sonogram around week 38.

We were asked to stay and get the sonogram today, so Michael and I went to lunch and came back. The same radiologist who did our 19-week sonogram performed today's scan. Because the baby is big now, it was not easy to understand what was on the screen, and we couldn't tell what we were seeing. The radiologist said the baby looks fine: heartbeat, proportions and fluid levels all good and weight is 7 pounds 2 ounces based on the measurements! There was a good shot of a foot, so she printed that out for us to take home. I'll post it here once Michael gets home and we can scan it. She said we'll be fine and encouraged me to give the Bean a poke once in awhile if he/she has been dormant for a long time.

One thing I noticed: the radiologist referred to the Bean as 'him'!

37-Week Checkup (May 23, 2007)

Weight: 178 pounds
Vitals: 100/60
Fetal heartbeat: good

Dad left this morning after a two-week visit to assist us with making the move to the new condo. His help was a huge benefit to us, and we couldn't have gotten sorted so quickly without him. Thank you, Dad!

Michael and I went to the doctor appointment together. Melissa, the nurse, took weight, urine, blood pressure and listened for fetal heartbeat. Urine test was fine, and fetal heartbeat was good (we could see the baby moving while I was laying back on the table). Dr. Holden explained that he'd do a Strep B test and check my cervix for dilation and the position of the fetus. When he checked for dilation, it hurt a bit. He said the baby's head is way down, and I'm approximately one centimeter dilated. He also said the baby doesn't feel too big, and estimates it will be in the 7-pound range.

The baby could arrive anytime week 38 - 41, which is good news. It would be ideal if the Bean held off at least one more week so Michael and I can finish unpacking and get organized. We aren't ready for the baby yet... no place for baby to sleep, too many boxes in the bedroom and baby clothes not washed yet.

Dr. Holden said Strep B is present in all adults, but in about 20% of women, it is present in the vagina and poses a threat to the baby during birth -- the major risk is pneumonia in the newborn. If I test positive for Strep B, I'll receive antibiotics intravenously as soon as I check in to the hospital for delivery, and the baby will be held for 48 hours after birth for evaluation by a pediatrician to insure that the baby is not adversely affected. The worst case scenario (low probability but a possibility) is that baby develops a fever and gets sick, which typically requires a 2-week stay in the hospital. We'll get the Strep test results middle of next week.

-Called pediatricians in Brooklyn today and found several who are willing to take on a new patient. None were available to meet us before the due date, but said we could bring the Bean in within 3 days after birth and get started.

-Discovered the "R" subway line connects the stop nearest our condo (Prospect Ave) to 59th Street/5th Ave, which is the closest stop to Dr. Holden's office at the Eastside location. The ride takes about 65 minutes. It is nice to be able to stay on one train for the whole ride.

8-month Checkup (April 20, 2007)

Weight: 175 pounds (40+ pound gain since getting pregnant!)
Blood pressure: 110/70

I met Dr. Hadden today as part of a rotation every two weeks to meet all 5 doctors that take turns being on duty for the labor/delivery ward at Columbia Presbyterian. By doing this, whichever doctor is on duty in the labor/delivery ward and I will be somewhat familiar when the time comes to deliver.

Dr. Hadden looks as though he's in his early or mid-fifties and said he's been practicing for 25+ years. He said there's a 50 - 70% chance that Dr. Holden will help me deliver versus one of the other doctors.

I assumed this visit would be a handshake and brief conversation, but for each visit from now on (roughly every two weeks), I'll get a pregnancy checkup including urine test, weight, vitals and monitoring of the the baby's heartbeat.

The nurse found the Bean's heartbeat low on my belly on the left side, but as soon as the monitor tracked the heartbeat, the baby shifted and we couldn't hear it anymore. She moved the monitor and found the heartbeat again, but the Bean shifted and heartbeat went away again. Finally, she trained it near the center and we heard the heartbeat for several seconds. We both laughed. The nurse said she hasn't seen a baby shy away from the monitor in a long time -- the monitor makes a loud crackling noise, and the Bean doesn't like it.

Dr. Hadden measured my abdomen from pubic bone to fundus (top of uterus) and said I'm tracking at 32 weeks, in line with the other measurements taken over the past couple of months confirming mid-June for the due date. He felt my abdomen and said he could feel the Bean's head down near my pubic bone and back/butt up and to my right, all of which is normal.

His only warning to me at the appointment was to try not to gain any more weight. He said "Anything over 35 pounds is yours to keep" (meaning it will be harder to lose after the baby is born) and there's also a risk that if I gain more weight the baby will also get bigger, creating a harder labor situation. I'm embarrassed to write about this today, but am trying to be honest for the journal.

Attached is a picture from about 3 weeks ago (week 28)... [Demi Moore/Vanity Fair copy cat shot - Take 2]

Starting Baby Classes

BABY CPR
On Monday night this week, we went to a baby Cardio Pulmonary Resuscitation (CPR) class. The instructor was a senior RN named Fern Drillings who works in the Obstetrics ward at Columbia Presbyterian.

At the start of the class, the instructor asked everyone in the room to introduce themselves and share their due date or the age(s) of the child(ren) they have. There were roughly 26 people in the class -- many couples who are pregnant at various stages, some parents who've had children within the last 9 months, and at least 4 - 5 nannies, some who were there with their employers.

There was one woman in the class who is at the 38-week mark who looks the same size as me though I'm 31 weeks... and a couple of other women who are due in June who looked less 'large' than me, leading me to realize I am indeed on the 'biggish' side for this stage. So although it's a bummer when people in the office go "You're huge!", I realized they are right.

She gave us a brief overview of procedures to follow for a range of injuries or ailments that could affect infants and toddlers, ranging from burns and fevers to choking relief procedures and CPR.

CPR has evolved since I took a class 15 years ago. In the last five years, the health industry has updated the CPR protocol, and the good news is that the number of breaths and compressions is now the same for all ages.

Baby CPR differs from adult CPR now only in terms of the amount of pressure put on the sternum (chest) when doing compressions [for babies: two fingers only, pressing down 1/2 - 1 inch vs. for adults: using palms -- one over the other -- and pressing down 1-2 inches)].

The current CPR procedure for any age is:
1) Call 911
2) (Person lying on back) Tip head back to create clear airway passage
3) Check for indications of breathing (by listening/feeling for breath and watching chest)
4) Give 2 breaths - check that airway is clear (by looking for rising of the chest)
5) If airway is not clear, follow procedure to clear airway, and then proceed to CPR
6) If airway is clear, proceed with CPR:
2 breaths + 30 compressions
2 breaths + 30 compressions
(repeat until medical help arrives or person recovers consciousness and breathes on his/her own)

OBSTETRICS ANESTHESIA
Tonight Michael and I attended a free lecture on anesthesia and analgesic options available at Columbia Presbyterian, given by the Chief Anesthesiologist, Dr. Richard Smiley. He has a staff of seven Anesthesiologists and the eight of them rotate duty 24/7 and typically have 1-2 senior resident doctors in tow per anesthesiologist during each shift to perform or observe the procedures.

Fun fact: Dr. Smiley is the fourth Chief Anesthesiologist to lead the OB anesthesiology department at Columbia Presbyterian since Virginia Apgar - the most famous female physician of modern times - who pioneered the Apgar test for newborns. See here:
http://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_12.html
Dr. Smiley clearly enjoys his work -- his presentation was interspersed with pictures from a past sabbatical in Switzerland, a picture of his dog, and photos from a visit to a museum in France featuring the work of Volti, an Italian artist who made sculptures and works of art about women - especially pregnant women. Added bonus: free food and beverages were provided.

The trend now and the goal of the OB anesthesiologists is to provide analgesia (moderate pain relief while still enabling movement and sensation) vs anasthesia (complete numbness and loss of feeling - e.g. for surgery).

Dr. Smiley covered the pain relief options in great detail, including epidural, spinal block, IV, and the benefits, risks, side-effects and specific dosages and types of medication used.

More than 80% of women who give birth at Columbia Presbyterian opt for pain relief, and the majority get a combination spinal epidural (CSE) for which the patient can give themselves additional dosages to a controlled degree. The procedure involves the insertion of a soft catheter into the epidural area of the lower spine. The epidural catheter is taped to the back and stays in for several hours until delivery, and allows some degree of mobility though walking is not generally encouraged.

Michael enjoyed the presentation very much. I found it useful and learned a lot, but given my aversion to needles and the low (but possible) risks and side effects, I'd like to try and soldier through as long as I can without using an epidural. Have read many blogs online and many friends and colleagues have said "whatever you do, get the epidural!", and Columbia hospital statistics show that 85%+ of women who give birth at the hospital opt for pain relief, so it is very popular, and if I did pass it up, I'd be in a very small minority.

By the end of the lecture, the room was very hot and the topic made me feel queasy so I was glad to leave. We are both glad we attended; we'll be well-informed and reasonably prepared for whatever happens in June.

I spoke to my mom and learned she received anasthesia when I was born (either a spinal or epidural), and she said she got a painful headache afterward -- one of the side-effects of a spinal block, though they've recently been able to reduce the probability of a headache significantly.

19-Week Sonogram: The Bean is Jumping (Fri Jan 19)

We went for the 19-week ultrasound today at 1:30 pm. This is a standard test prescribed for all pregnancies to measure the development of the internal organs and bone structure of the baby.

We saw the spinal cord, bones in the arms, legs, hands and feet (10 toes), the four chambers of the heart (!), etc. The baby's arms were bent and hands were in front of its face a lot during the screening, so it was difficult to see the face. This is the second sonogram at which the radiologists commented that the baby is very active and so was difficult to measure! She asked if I had eaten just before the appointment (I hadn't). She also mentioned she felt a hardness on my left side and asked if I have a cyst or have had one in the past (I said no). She said it was nothing to worry about. I will investigate after the baby is born.

An ultrasound technician looked at the Bean from all angles, took measurements and said everything looked normal. The Chief Radiologist on staff followed up to check measurements and agreed that everything looks good. In total, we spent an hour in the ultrasound getting screened. The radiologist said the baby is still on track for a delivery date of June 15th (size-wise).

From the radiologist's point of view, everything is developing normally so they are not recommending the need for any follow-up. Since we elected not to find out the sex of the baby, the radiologists hid the screen for part of the examination.

Now that the baby is getting bigger and I've seen it moving, I'm more aware of having a baby inside (vs what had felt mostly like an unpredictable medical condition). Things have progressed smoothly so far, my bump is noticeable, and I'm more conscious now that everything I eat is feeding two of us.