Voices - updated

I had posted this almost exactly a year ago. At the time, I never actually thought I'd be where I am, 12 weeks pregnant with my 4th baby.


Heart and Desire: You know you want to, just admit it. Think how much fun it would be!

Logic and Reason: I'm not so sure, but you're probably right, another baby would be cute and cuddly, but there's no way. No way.

HD: I want another baby.

LR: No I don't.

HD: I don't believe you.

LR: Well, I should.

HD: But, I don't.

LR: How can I not believe me, we're are the same person.

HD: This is true, but I don't believe you.

LR: We sound crazy, arguing like this. I think that makes me crazy in some way. I'm not sure of the diagnosis. Maybe we should consult Dr. Sister, the psychiatrist to diagnose my issue.

HD: Yeah, I guess having conversations and arguing with myself is kind of crazy.

LR: Yep.

HD: But, now that we've established that we are completely nuts, lets get back to the argument...why not another baby.

LR: Well, for starters, just no, and kids are expensive and the older they get, the more expensive they will become.

HD: Well, I guess there is that.

LR: Plus, I can't get anything done now with 3 kids, let alone another baby. Can you imagine that chaos?!

HD: After you have 3 kids running around, what's a 4th going to do? I already can mulit-task like a mad woman, plus by the time another would come around, I'll have 2 kids off in school and Isaiah will be close to going too.

LR: Right, but there's the expense and managing everyone's schedule...all the field trips, parent-teacher conferences, school activities, etc. Yeah, let's throw in a newborn, and more sleepless nights, exclusive breastfeeding, etc again. I'm still not getting a full nights sleep now.

HD: But, Isaiah is doing much better lately. So yeah I'll be tired, but what else is new? Would I really know what to do with more than enough sleep? Plus, don't I just want to experience being pregnant one more time?

LR: Not really. I mean, well, maybe. The middle part is kinda cool. Feeling movement, seeing that positive pregnancy test, seeing the sonogram. But the morning sickness sucks, and I had preterm contractions this last time.

HD: But they never really caused a problem, remember? And isn't there no better moment in the world than meeting your baby at delivery?

LR: Yeah, that is pretty cool, but remember, I've had 2 c-sections...that means there isn't a chance at a VBAC. Yeah, yeah, I could push for a VBAC, quote all the stats about the unlikelihood of complications, but come on, this area is very VBAC unfriendly, and I'd be too nervous.

HD: It would be your second labor, so in theory, you could go too quickly to be sectioned. The c-section wasn't so bad. I know it sucked recovering and the pain, but do you really remember that now? And does it make any difference now that Isaiah wasn't a vaginal delivery?

LR: No, it doesn't matter, and you're right, I can't really remember how much it sucked after the c/s, but I know it did.

HD: So if I really didn't want another, wouldn't I feel done? Do I feel done? I don't really feel done. Wouldn't either Husband or I have been "fixed"?

LR: Well, yeah, I do sort of feel like another would be okay, in theory, but there's so much more than that. The idea is nice, but money is an issue. Room in the house is an issue. The kids each have their own room now, if I had another, someone would have to share a room. I am in an old house that requires constant upkeep and major fixes, and we can't keep up now. I've yet to get out into the yard and pick up sticks, weed the landscaping, etc. Oh, and there's only 1 1/2 baths! What if number 4 is a girl! That would be an issue with the number of bathrooms we have

HD: So what if the yard isn't perfect. And so what if they have to share a room? The house is big enough. Plus, I work weekends for great pay. Things are going great now. And by the time the kids are older, maybe you'll have the basement finished and a bathroom down there for the boys. And how long will we live here, really?

LR: That's a big maybe on the house renovations or moving. I don't want to make a big decision based on a list of maybes. Plus I don't want to work weekend nights forever.

HD: But what do I want to do? Do I want to work dayshift? Do I want to work another job?

LR: Well, no. For the most part, weekend nights are working pretty darn good. There are some kinks, but not as many as there would be if I worked a normal shift.

HD: I rest my point on that.

LR: I think I'm just being nostalgic because Isaiah is getting older and not so much of a baby anymore. I think I'm just a little sad to think there won't be anymore babies, that once he's done breastfeeding, I'll never breastfeed again.

HD: Maybe there is some nostalgia because Isaiah is getting older. Maybe some of that is desire for another baby. So just think about it. Another pregnancy, another baby, another toddler, another child. Plus, my kids are so smart and cute.

LR: Yeah, but every mother thinks their kids are the most awesome. And I've already have been blessed more than I deserve. Three happy, healthy kids. I feel trying again would be tempting fate. Haven't I been blessed enough? Wouldn't it be greedy wanting just one more? What if the next time, I actually have bad preterm labor and have to be off or deliver early?

HD: I can understand that. I have been blessed, but again, I have 3 great kids. Wouldn't one more just add to it?

LR: I don't know. I'm not sure the family would be so thrilled, just because they would worry about us. We did have a hell of a time Isaiah's first year, and it's still a bit of a struggle managing everything. It would just be more chaotic with another. Remember all the arguments and fighting Husband and I did? I don't want to go through that again.

HD: We worked things out, didn't we? We have a strong relationship and we can get through anything. I know the family would be thrilled. They may worry for a bit, but that's what families do. And what's more chaos but more happiness?! Things would work out fine, and I know it. Just think about it. Husband had kinda tried to test the waters to see how I felt about another. I think he just waiting to hear, yeah, why not one more. Think about it. Plus I'm not talking about doing it anytime soon. In a few years, maybe even when Isaiah is about to go to kindergarten

LR: But I'll be "advanced maternal age" by that point!

HD: So?

LR: So? So there is an increased risk at that point.

HD: Lots of women have babies after 35. I've even seen women as old as 50 have a baby

LR: Yeah, well, that's them

HD: Just think about it, okay?

LR: Okay, I'll think about it, but I make no commitments.

HD: I know you'll cave, you always cave to me.

LR: I know, but we'll see.

HD: Yes, we will.


I guess the heart won! Everything just seems to have fallen into place, in all aspects. We didn't wait until Isaiah was in kindergarten, but the timing is perfect, and I'm NOT old enough for advanced maternal age! Although the heart won this arguement, logic and reason did have some demands that were all met. I guess everyone is a winner.
(should really proofread better, I am NOT advanced maternal age, like I had previously typed in error!)

This is Why A Change is Needed

It is no surprise to anyone when I say there needs to be a change in they way healthcare is managed. It is no different in obstetrics. The rules, regulations set by the hospitals that are there to help "protect" moms and babies sometimes get in the way of providing humane care. I know that docs, nurses, hospitals really are out to provide safe competent care, but sometimes we forget how the patients feel and we are too quick to jump to a surgical delivery if things aren't running on schedule, or in our attempt to provide good care, we start that cascade of interventions that can lead to c-section. Induction - pitocin - AROM at only 2 cm and no change from the start of the pitocin - epidural - crank the pitocin - internal monitoring - temp - infection - antibiotics - failure to progress - c-section. Elizabeth wrote this about her two birth experiences. Her first birth experience was a c-section for breech. Her second, a VBAC. And while breech is a legitimate reason for a c-section, it doesn't change how a woman feels. We get involved in the process of prepping, draping, counting, etc., that we forget that here is a mother who wants her baby. Mom is taken alone to the OR, waiting for her partner to join her in a sea of strangers. The baby is born and she is frequently last to hold her, then the baby is taken away to the nursery while the surgery is finished and mom waits longer to see her baby. And she feels she isn't taking part in the birth, that she isn't doing what she should and sometimes feels her body failed her. She has not failed, it is the system. And some c-sections for "failed induction" or "large baby", are they really necessary? Some people might say "at least after a VBAC, she is healed". I'm not sure I agree with that. The mother doesn't forget her experience. Yes, while she was able to "prove" to herself, to others that her body does in fact work, that doesn't erase the feelings, the scars from a c-section.

Healthy Baby, Part I

C-Section. IV, cold arm. Surgery. Sign the waiver, "Potential fatality." Hairnet. Yellow Tummy and Razor. Crying. Alone. Where is my husband? Cold. Numb. Can you feel this? Helpless. Fear. Fear of pain. What if something goes wrong? Out of my hands. Nauseated. Relief he’s here. But he can’t help me. Sterile curtain. Waiting. Don’t cut yet. Cutting, pulling, pressure. Suction. Tugging. TUGGING. My bottom half is on a roller coaster. Throw up or pass out. Gurgle. Cry! Relief. Cry! I want to help. There he is, there he goes. Where is he going? I can’t go. Tubes, sucking, screaming, crying. Flashes of pictures. Anger. At least he’s there with him. They must be hurting him. He is scared. I am already not doing my job. I should be with him. He’s leaving. Why? Go with him, leave me. He needs someone. Waiting. Waiting. Terrible waiting. Counting. Why are they counting? Wish I could see something. Anything. Who is even down there? It’s all wrong. I feel wet, numb, and cold, but strangely hot. Surreal and bizarre. Finally, I get to go. In a stupor. They will bring him, I think. I don’t know anymore. Thirsty. So thirsty. I need something. Ice chips. High. Losing time. Looking at the clock. Waiting, sleeping? Clock again. How long? Nurse on the phone. She is there, but I’m not. I am unaware. I’m a pest. I need again. Husband here. Camera. There’s my baby on the camera. Everyone has met him but me. Rejection. Resentment. Finally rolling outta here. He’s beautiful, Liz! I wouldn’t know. He’s here somewhere, I guess. There he is, on the other side of the glass. He is lonely. He has surrendered to sleep. I have surrendered. Acceptance. Rationalization. Buzzed. Hot. Sweaty. Thirsty. Don’t let anyone else hold him before me, okay? Please? Are you ready to see him? Oh God, please let me have him now,
my
Healthy Baby.


Healthy Baby, Part II

Pain wakes me. An owl outside the window. Sleep. Small pain. “I think I’m in labor.” Excitement. Anticipation. Try to rest. I’m up. Must eat. Must shower. Pause to breathe. Ah, shower. Eat and drink. Nightgown. Relax, there is no rush. I like to stand. He holds me and we breathe together. Goosebumps. Clock. They are getting closer. Time to go. Favorite blanket. Waiting outside in 50 degrees, exhilarating. Hugs. There is no rush! It will be a while, I know. Long car ride. Closed eyes, music on the radio. Good songs. We arrive. Welcome! No IV or EFM here. Sanctuary. Toast and morning TV. Joking around. Bathroom. My body is working. Stand and breathe, time. Serious. I need the shower. Come with me. I hold the wall. This is working. Need to get out. I must give in, not try to escape. Bed. Try to rest. Lying down hurts worse. O.J. Vomit. Heating pad. Wet rag. Nice. Is it slowing? Shower will help again. No, stay out this time. Holding friend the wall. Swaying. Moaning, who cares? Is this really working? There is a balloon in there. Wow. That is truly amazing! I get out and he comes. Dry me off. I felt it! I’m happy. Hot. Wall. Focus. Pain. Tense. Don’t get tense! Pain. PAIN. Don’t touch me. My thoughts are consumed by my body’s work. Concentration. Ow! Obscenities. Try different positions, but don’t want to move. Vomit again. They are close. It has taken over. Sit on the bed. Why am I pushing? POP! Warm and wet. It’s not clear. Oh, God! Panic. I knew it! Can’t go NOW! He dresses me. I cry. I feel stuck. Ambulance. Lay down. NO! I need drugs! No, I really do! I need help. I scream. I am pushing. Don’t push. I’m not! It just is. Complete. I already knew that, somehow. Gurney. No shame. Too much pain. Pushing. They will help. Sirens, honking. Eyes closed. Talking. Where is he? He’s there in the cab. He tells me he’s here. Love! Laying down is horrible. Familiar voice. I can push now. They help. A woman tells me, this is normal. Relief. I can do this. They will not cut me this time! Push through the pain. I’m working. Feel his head. Wrinkly. Amazing. Thrilled, but not done. It’s warm and numb, I’m tearing. He’s here. Don’t you dare take him! He is just over there. He is looking for me. They bring him. He is wet and messy. I’m not worried. I worked. I birthed. He is here and the pain is already forgotten. I’m a healthy woman alongside
my
Healthy Baby.


Birth should be more like Part 2. I don't really need to say more. Elizabeth's writing is honest, and very emotional. Now, I know that not everyone who has a c-section is affected this way, my experiences were good as far as c-sections go, but how many women are traumatized by their c-section experience? Just one is unacceptable, and there are probably more women than we realize. Something needs to change. We need to remember that the patient on the table is a person, a new mother, and while it is important to make sure that the sterile field remains sterile and that all instruments and sponges are accounted for, we need to remember the person. The national c-section rate is unacceptably high, and we need to work to figure out how to bring that number down. VBAC's shouldn't be an unattainable goal, it should be encouraged. Too few people are given the opportunity to do what Elizabeth was able to do...to participate fully in her birth, to allow her body to do what it was meant to do. We need to remember that a due date is an estimated day of delivery, not an expiration date. We need fewer scheduled elective inductions, less interventions for moms with healthy babies, more patience, intermittent monitoring, freedom to move around in labor. And for those who do have/need a c-section, things need to change. I have been working with our processes to change how we manage c-sections. It's not much, but it's a start. The partners are now allowed to come back with mom while the spinal is placed. We are working on keeping baby in the OR...all assessments can be done there, baby can go with mom to recovery and that way mom doesn't feel quite as disconnected. We aren't using the arm straps (thank God) so mom's hands are free to touch and hold her baby. Like I said, it's a start. And to Elizabeth, thank you for being a voice for women out there who are affected negatively by their c-section, and for sharing your moving VBAC story.

I want to be boringly normal

All I think any pregnant woman wants is to be "normal". No extra testing, no worries, no complications. I know that's all I wanted. I had finally relaxed and started to enjoy this pregnancy when Wham! no longer am I "normal". Last Friday, they redrew my CBC because my platelets were low. They were 139 and the low end of normal was 140. I figured it was a fluke and it'd be all good. The office nurse called to tell me they had dropped more - to 127 and that Doc wants to redraw again in 2 weeks. If they are still low, or drop further, they will refer me to a hematologist and maternal-fetal medicine. WTH!?!? Ok, give me someone with low platelets a little further on and I understand, but at 11 weeks? I've never had an issue with my bloodwork before. Like most nurses I know, I hit up the internet (which I DO NOT recommend) and of course I had myself self-diagnosed with something like leukemia, lymphoma, lupus, etc., because that's what Dr. Google came up with. I know, I know, I do know better than to do that, but, I know just enough about medicine to be dangerous to myself. The only thing off on my labwork was my platelets. Everything else was fine, as was my CMP and liver enzymes. It's a good thing Sister is a doctor. I'm sure she was shaking her head at me (would be well justified) and she found some information on gestational thrombocytopenia. Apparently 8% of a pregnancies are affected by this, and the majority of the time it is benign and it resolves within days of delivery. She also reassured me that if I did have something more serious, like leukemia, there would be other lab values that would be off and I'd probably have some type of symptoms. And since I just had a CBC done last August which was fine, this is probably brought on by this pregnancy. I have no symptoms, I'm not covered in bruises, my gums and nose aren't bleeding, and I'm no more pale than usual. Of course, I won't know anything for sure until after my next round of bloodwork comes back and I meet with the hematologist. I've taken care of women with very low platelets and they had taken steriods throughout their pregnancy to try and get them up. Sometimes it worked, sometimes it didn't work enough and they had to labor without an epidural (and they wanted one). So one of my concerns, should this just be gestational thrombocytopenia, is that my platelets are high enough for me to get a spinal. The literature says they just need to be above 50, but the anesthesiologists I work with won't do it if it's under 80-90, depending on who is doing it. We'll see. I'm jumping to conclusions, but again, I'm a nurse, I'm not a good patient. I want answers when I can't have them at this moment. Until my next appointment, I'm going to try and forget about this, and just be patient...it's going to be a long 2 weeks.

11 weeks

I love comparing the size of a growing fetus to fruit. At 11 weeks, my baby apparantly is the size of a fig. I'm glad the picture includes a comparison to a quarter because I hate to admit, I've never eaten a fig or held a fig. It is amazing to me that this little person is that small, but my waistline looks much larger. Since this is my 5th ride on the pregnancy rollercoaster, I think my stomach got puffy at conception. Later this week, I'll be having the first of a series of maternity shots taken by a coworker. She is also a photographer and wants to do a pregnancy series. Here's a link to see an example of what we'll be doing, starting now on through post-partum. I don't think I can do naked...I've agreed to a strategically placed fabric or short loose cotton shorts to cover my lady bits. But, here you go, the first in the bump shots, starting at 11 weeks. Already the little bugger is taking up my lower abdomen quite nicely...but I can still wear my jeans, who cares if I need a rubberband to hold the button together!

Here's more information about those maternity pics and here. I really wish I had had maternity pictures taken with my first two kids...you can't go back once they're born and have them done. It really is a special time you will want to remember. And this is a fabulous way to commemorate that time.

Pseudocyesis - False Pregnancy

For the second time in my career as a labor and delivery nurse, I took care of a woman who said she was 28 weeks pregnant...but wasn't actually pregnant. She had everyone fooled. She came in by ambulance with several complaints and the only one OB related was abdominal pain. She wasn't happy to have been brought up to OB because she said she wasn't worried about the baby because she just had a sonogram a week ago and that he was moving all over the place. So I get to work to verify that she was fine obstetrically, but I was unable to find fetal hearttones. She was a larger woman, but appeared obviously pregnant. Her t-shirt appeared wet from leaking colostrum and when I did Leopold's, it felt like her baby was lying towards her left side. I grab a doppler, and again try to find the baby. No luck, but it sounds like there is movement in her abdomen. Generally, when you use a doppler to locate FHT's on a non-pregnant woman, or a woman with a fetal demise, you can hear her bowels moving, but it's pretty quiet. It really sounded like there was movement in there. I had 2 other people try - something I don't normally do because if I can't find FHT's, you worry it's a demise and all it does is stress the patient and the OB needs to come in. But I was sure I was hearing fetal movement. None of us had any luck. The patient didn't seem concerned because she said they have a hard time in the office, too. After trying for quite awhile, I call the city call OB (her OB doesn't practice at Hospital). He orders a OB sono to confirm the pregnancy is fine. At this point, I jokingly said to my coworkers "Maybe she isn't pregnant". But boy, was I surprised when the sono tech looked up and said "I don't see a pregnancy. I'll use the transvaginal to get a better look." Nope, nothing. Never was pregnant. No baby, no yolk sac, fetal pole, no nothing. Not even a large cyst. I wondered if maybe she had delivered recently and something happened and the baby died and she didn't tell anyone, but based on the report, it didn't appear she had been pregnant anytime recently. Not sure how they can tell that, but I'm not a sonographer. I felt pretty dumb because I really didn't think it was possible she wasn't pregnant. She had a large gravid-appearing abdomen, appeared to be leaking colostrum. And she insisted that she had a sonogram a week ago and everything is fine and then said "My babies never show up on the sonogram and they are fine". Complete denial. I believe she was the first case of pseudocyesis that I've seen. (The other case was someone who obviously knew she wasn't pregnant and she never let us evaluate her before she left AMA.) This woman was convinced she was pregnant and believed so whole heartedly that she appeared pregnant, had hormonal changes that cause colostrum to form and as for the "fetal movement", she must have some crazy gas in there. The "mass" was probably stool, hopefully nothing more serious. A couple times, I've felt gas moving around in my bowels that seriously felt like a baby running it's leg across my abdomen, when I was not pregnant. It was very eerie. I discharged her to the ER and I hope she sees a psychiatrist. We will be extra vigilant in the next few months with infant safety. People who claim they are pregnant but are not are at risk of trying to kidnap a baby. I'm still a bit in awe. I don't know what is going on in her life that she would claim to be pregnant, but I hope she gets the help that she needs.

Everything is perfect! Nice healthy, strong heartbeat! I didn't get any good pictures because the sono machine the nurse practioner used was an older one and the picture was really grainy...plus she isn't a sono tech. But I can relax, and I may be able to find the heartbeat with the doppler at work because my uterus is above my pubic bone. So life is good, I can relax and quit driving Husband nuts with my worry!

Appointment of Truth

Today I have my second appointment and check on the baby. I think I'm more anxious about this appointment than I was with the first...I think because of what happened last time. We saw a healthy heartbeat, but if we would have checked the second appointment (when they normally don't) I would have known it was gone. Plus, the last couple days, I've had periods of cramping, no bleeding, but cramping. It actually woke me up the other night and kept me up for a couple hours. I'll admit, I started fixating on it so that just added to my anxiety. Yeah, yeah, I know cramping can be normal, but that's how it started with the m/c. So that's got me more worked up than I was before. If there is a heartbeat today, I'll be able to relax and not be crazed. I hate how insanely neurotic I am with this pregnancy! I just don't know how I'll handle losing another one. And I've only m/c'd once, I just can't imagine how people relax who have had multiple m/c's. I do know that nothing is a guarantee. I could see a heartbeat today and it be gone tomorrow, at 28 weeks or 40 weeks. But the likelihood is much less. If today goes well, I'll be able to look past next week and maybe start planning for bringing a baby home in October. I'll keep you posted.