Friday, July 27, 2007

"Lesion" update

I had a midwife's appointment yesterday so I asked her to look at my cervix. Yes, I specifically said "please take a look at my cervix." She waaay over-apologized and over-warned as she greased up her speculum and inserted it, leading A. to believe that pelvic exams are painful (which, for me at least, they are not). And she saw... nothing. Nada. Zip. No "lesions." Well, she did see a Nabothian cyst, which she described as like a whitehead on my cervix.

She rolled her eyes at the emergency doctors, their diagnosis of lesions, and their insistence on me making sure I got follow-up care. I don't know; I really liked the doctors, though since they have to be such generalists I don't expect them to be particular experts on cervical changes in pregnancy. So it turns out all my extensive googling into possible causes of cervical lesions, and endometriosis, was for nought. At least if I had had endo, I would have been in good company.

We did some quick follow-up on my quad screen (screen negative for everything), and my ultrasound. The only thing she noted about the ultrasound was that it shows I have an anterior placenta. An anterior placenta is totally normal, though it can make fetal movement a little less noticeable, and there is a very small amount of evidence indicating that an anterior placenta may be associated with a posterior presentation. I guess I'll have to be pretty vigilant about following the posture recommendations at Spinning Babies.

I asked her if the ultrasound said anything about dates. She told me, but didn't seem happy about telling me. I found that slightly annoying. It turns out the ultrasound would recommend a due date six days before the one I have according to LMP. So, of course, I (and she) are choosing to ignore this. However, if it had recommended a later date, even by a few days, I would have asked the official EDD to be changed. It annoyed me that she seemed to think I didn't have the knowledge to interpret this data, and so didn't want to tell me at all.

She also recommended that we try to make appointments with other midwives in the practice. I thought I was seeing the same person (for every appointment but my first) on purpose. Apparently not. I'm glad she made that recommendation since I'm beginning to get frustrated with her. If there is anything I hate, it is being condescended to. Not that she's so bad I wouldn't trust her to help me birth a baby; she seems very hands off and relaxed, which I like.

Monday, July 23, 2007

Not as upbeat as it should be

Friday was 20 weeks. I had a post planned; it was going to marvel at how normally everything has been going this pregnancy. It was going to go into some detail on the screening ultrasound: the two kidneys, the heart with four chambers, A. getting teary, etc. It was going to discuss how in my opinion 20 weeks is not halfway through the pregnancy, since 1. Most first-time mothers go well after their "due dates" and 2. The pregnancy didn't really start at the beginning of my last menstrual period.

Instead of posting, I spent five hours in an emergency room on the other side of the country.

I was on a two-week long trip visiting a distant university. I helped run a workshop in my field for a few days and then was working with some colleagues on the project that's funding my postdoc position.

Two days before I was to fly home, I had a lovely dinner out at an Indian restaurant with my ex-boyfriend and his newly pregnant wife. I adore Indian food, but it makes me gassy. While waking the next morning, I had a ginormous fart. Really, an excellent fart. But during the fart, I also felt some liquid moving through my vagina. I'm not sure if my readers are familiar with this phenomenon; I certainly am. Whenever I get my period my farts do a lot of the work of getting the blood moving downwards.

Anyway, I figured it was just that extra cervical fluid so helpfully provided by pregnancy. But I'm your standard paranoid pregnant person, so without opening my eyes, I slipped a finger inside my vagina to gather some liquid and wiped it off on the white motel sheet next to me (oh yes, housekeeping loves me). I half-lifted my sleep mask and opened one eye.

Brown. What? Mask comes off, other eye opens, and I stare at the sheet. There's a clear brown fingerprint. I'm immediately up and into the bathroom, wiping myself vigorously and checking the colour and origin. There is no doubt that my vagina is leaking dark brown liquid.

I called my midwife's office back home and the nurse told me to go to the E.R.

They saw me very quickly, but then they wanted to monitor me for my initially high blood pressure (See the previous post, re white-coat hypertension) and then the OB/GYN department took 3 hours responding to a request for a consult.

Also there was a bit of confusion over my dates. I told them I was exactly twenty weeks. Twenty weeks is the borderline for whether they'll see you in the E.R. or send you to L & D for continuous fetal monitoring. Then the nurse brought out one of those wheels and told me I was nineteen weeks. I told her I was pretty sure I was twenty, but I wasn't going to argue with her when she decided she knew better. I spent the time waiting for the doctor double-checking my math (March 2+140 days=March 142=April 111=May 81=June 50=July 20. See? 20 weeks). Then the doctor came and did it on his PDA, and got the same answer I had. But they decided to see me in the E.R. anyway since I was there and right on the border.

They did an ultrasound and everything was fine, which I already mostly knew because I can feel fetal movement pretty frequently. Then they did a pelvic exam. The doctor saw two lesions on my cervix. To me, lesion is a somewhat frightening word. I associate it with bad things, like AIDS and cancer. However, it appears that it's medical speak for "damage" or "something looks a little funny." He asked about a pap smear: I had one in February and it was normal. He also asked about STDs; I was checked for all the common ones at the beginning of the pregnancy and they were all negative.

When the OB/GYN consult came back, it was suggested I might have endometriosis on my cervix. I have no idea how they came up with that; my googling indicates that cervical endometriosis is relatively uncommon. I haven't really had any symptoms of endo, although in retrospect I do have somewhat painful periods.

I didn't get a definitive diagnosis; they told me to follow up with my own care providers. I called my midwife's office today and lengthened my appointment; they gave me the last appointment of the day this Thursday. I'm worried that I should have instead gotten an appointment with the OB, since I'm not sure if midwives are trained to look at abnormal cervices.

The worst part was sitting there for 5 hours without food. I left as soon as I got up; I didn't have breakfast. I was smart enough to grab an apple on the way out and ate that in the waiting room. They asked me early on if I was lightheaded; good thing they didn't ask later. You don't leave pregnant women for 5 hours without food! The other bad part was poor A. back home. I sent him a quick e-mail (followed by a brief msn conversation) telling him I was going to the E.R. for vaginal bleeding; he didn't hear from me until almost 6 hours later.

Sunday, July 1, 2007

Pregnancy update

  • I'm still pregnant. 17 weeks now. I had a midwife appointment the other day, and there is still a heartbeat present. I used to scoff at people who bought home doppler ultrasounds. I know the American Institute of Ultrasound in Medicine is not a big fan of ultrasounds for other than indicated medical reasons, and I thought that people who disregarded such advice for their own reassurance were foolhardy at worst, merely silly at best. I'm not running out to buy a Doppler, but I now have much more sympathy for the people who do. Four weeks is a long time to wait between live-fetus checks. Especially when one is a big research-slut, aware of many of the things that can go wrong in a pregnancy at any point. But next week is the screening ultrasound, and fairly soon I expect to start feeling fetal movement on a regular basis. So this four weeks might just be the longest period I've had to go not being quite sure if there's a real live fetus in there.
  • I'm not showing. I bought my first baby item last week: a Maya Wrap sling. I found it on craigslist. Plain black, my size (but not A.'s), with instructional DVD, and within short biking distance. Perfect. The couple I bought it from have a six-week old daughter who hates the sling. The father said to me "I hope... whoever you're buying this for... enjoys it!" So I guess, even when my behaviour indicates I could be pregnant, I don't look it. The midwife also mentioned me not showing. I told her A. can tell, when I'm naked. Apparently having one's husband think one looks pregnant while naked does not officially count as "showing."
  • I have a definite case of white coat syndrome. Except that it's not doctors (or midwives) who necessarily freak me out. It's receptionists and nurses. I've always had a pretty significant social anxiety disorder (yes, professionally diagnosed), and it tends to be worse with "counter people" (retail workers, receptionists) and low-level authorities like nurses. I breathe deeply in the elevator while A. pats my arm, check in with the receptionists (whom I hate, for a combination of rational and irrational reasons), fiddle clumsily with the label for the urine sample I brought along, try to calm myself while flipping through a magazine in the waiting room, quickly get called by a nurse (since my midwife seems to do her appointments on time, and I refuse to show up any time either than exactly 5 minutes before my appointment), follow the (feared, but not hated) nurse into the exam room, and immediately get my blood pressure taken. High, of course. This time I got the midwife to take it at the end of the exam as well, at which point it was comfortably in the normal range. I'm worried that they'll want to induce me later for PIH, which will really just be social anxiety. Maybe I can convince them to let me take my own readings over 24 hours before they make any decisions.
  • I'm gaining weight like crazy. It worries me. If I continue gaining at this rate, I will gain 50 lbs over the course of the pregnancy.
  • We asked the midwife if she knew any Bradley instructors. She mentioned a couple of names, that A. had already found in his research. She also said that she liked them because they didn't make their clients "hostile." She described the "hostility" as "vestigial." A. was impressed with her choice of vocabulary. I was slightly disturbed by her dismissal of the consumer-education portion of the classes. It seems she measures an instructor by their tendency to have complacent students. I guess I shouldn't expect any differently, since she would be on the receiving end of the "hostility." I think she thinks it's no longer needed since she and her colleagues no longer routinely shave their patients, give enemas, separate the parents, etc. But I'm still worried about other decisions: to not have an IV, to eat and drink, to delay cord cutting, and to have the baby never ever leave the room.
  • A. finds me extra-sexy when I'm pregnant. He told me he's even finding himself attracted to other pregnant women, which hasn't been a factor for him before. I'm enjoying the attention, since I have the typical worries about how pregnancy is changing my body.
  • I still haven't told my boss I'm pregnant, and only one labmate knows. I figure the boss should be first. She's been out of town for a few weeks. I may have to tell her at a workshop we have out-of-town in about a week. I'm nervous. She does not like children. She's always felt, I think, that I've been one of the few people she can confide in about her dislike of children, and her annoyance when events she has to attend turn out to be child-centred. On the other hand, I know she strongly identifies as a feminist, and I don't think she's going to try to make my life hell for choosing motherhood. She knows that it's much easier for men to choose fatherhood at this stage (or any) in their careers, and I know that her sense of fairness will win out in the end.