Friday, July 16, 2010

Bumpdate 24 Weeks- And a rant.

First of all, my belly looks smaller than last week. Smaller, but pointy-er. Like the baby is not up in my stomach so much as down in my gut. Either way, the Nugget is all up in my organs. Particularly my diaphragm, which I am sure has been injured resulting in a hiatal hernia... hence all the heartburn. Thanks, kid:)

So, the good news: cervix is 2.6cm! And maybe I don't have to be high risk- just intermediate!

The bad news: my appointment sucked. Not that the doctor didn't tell me all that they know about my situation and discuss options given the various outcomes. He did. The problem is that that there is simply not much known about my particular situation. To be honest, most women who experience pre-term labor/delivery do so based on a few particular circumstances: pre-eclampsia/eclampsia (dangerously high blood pressure), trauma (injury of some sort that induces labor or causes a woman to be unable to continue carrying a child safely), drug abuse, or women who have a history of pre-term labor with or without cervical incompetence.

I do not fit any of those categories. The reason I am at a higher risk is because of the history of surgery I have had, including a major surgery on my cervix in August, 2009. There is no category for me. The number of women of childbearing age who have had the surgery I had last year and then gone on to conceive a child are few... un-studyable. Certainly, if anyone in the OB/GYN department at my institution has dealt with a woman with my history, they haven't told me or any of the other doctors (I always knew I was special.)

Since we can't really compare me to a similar group of people, we  really are in the dark about what to expect. At this point, things could go very wrong, very quickly... or not. My cervix could drastically shorten and open unexpectedly... and just as equally I could experience a failure of the cervix to open when it is supposed to! Or, things could be absolutely perfect for the rest of my pregnancy, and I could avoid the problem I had when I was pregnant with Abigail (low amniotic fluid) and have no complications from my clotting disorder. We just don't know. Which is terribly frustrating.

And which is why I was referred to the experts. Because while they don't know things- while they can't predict the future any more than you or I, they can certainly give an opinion. As a nurse and a doctor, John and I are rarely interested in opinions of health care providers, but in a situation like this, where he and I are both out of our element and where there is no "fact" available, we are looking for an educated opinion. That's really all I wanted.

And that is the one thing I didn't get.

I asked specific, reasonable questions and got crap for answers. The doctor continually stated that I should make the team aware of any "concerns", but when I asked how I should know when I to be "concerned," he gave me nothing. Are there any signs of a shortening cervix other than bloody discharge that I can look for at home? No, not really. Is there any way for me to tell if my contractions (which I have been having for weeks) are causing cervical change? Nope, although they can check me out if I go into the Labor and Deliver department. So how do I know when to be "concerned?" Well, just be aware of changes was the response that I got. Repeatedly I asked what kind of changes or what kind of symptoms I should look out for, and I got not a single objective measure. The doctor continually told me that if I "felt" different, I should be concerned... if things didn't seem "normal," I should call them.

Let me just rant for a moment...

1. I am pregnant. I "feel" differently all the time- literally from moment to moment. My feelings are volatile. Do you really want me to call you every time I "feel" different?

2. I am not sure I know what a "normal" pregnancy is supposed to "feel" like. In many ways, Abigail's pregnancy was so much more difficult than this pregnancy- I was vomiting constantly, more exhausted than I am now, and never once had a painful contraction until I was in active labor. This pregnancy has had shortness of breath, chest pain, intense contractions, heartburn, and very little vomiting- as well as off-the-charts levels of stress. Are either of those a "normal" pregnancy?

3. Why is he putting everything on me, as if it's my job to know what is "normal" in pregnancy? And why can't he give me any objective rather than subjective measures to guide my decision-making? We don't tell diabetics to go to the ER if they "feel" abnormal, we tell them to check their blood sugar and come to the ER if it is above or below certain numbers. We don't tell people to avoid their blood pressure medication if their heart rate is below normal- we tell them to avoid it if their heart rate is less than 60 (or 55, or 50 or whatever) beats per minute. So why am I being given subjective terms like "normal" and "feel."

4. I am all about trusting my gut- as a nurse, I do it frequently. But when there is a baby in my gut, I don't think my gut is very reliable.

5. Do you have any idea how stressful it is for me to think that if something were to happen- if something were to go wrong, it would be because I had a messed up sense of how I was supposed to "feel" and whether the way I felt was "normal"? I HAVE ENOUGH MOTHER-GUILT. I DON'T NEED ANYONE ADDING CIRCUMSTANCES THAT WOULD ONLY SERVE TO INCREASE MY GUILT LEVEL!

End rant.

So, not the most fulfilling doctor's appointment. We will meet back with my intermediate risk doctors next week and hopefully get a better idea of what we should be doing/not doing/monitoring for, etc...

On the other hand, the high risk doctor thought it would be okay to return the the "honeymooning" that John and I were missing out on:) Now, if only my stress level wasn't through the roof, John might be a happy husband!

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