The other shoe

While neglecting this blog the last couple weeks, what we haven't been writing about is how this pregnancy has now shifted from extremely healthy and extremely low-risk (although not necessarily easy, see the nose incident and that persistent morning sickness) to a moderately risky one necessitating pretty vigorous medical management. Great. We all know how much I love doctors.

The short story is that over about the last two weeks we've determined that I have developed a not-so-common (but not necessarily so uncommon) liver problem specific to pregnancy, with relatively conclusive labs coming back yesterday morning. I'm not going to name it, because expectant parents read here and you have enough to worry about; you don't a new tempting scary link. I promise, if you really need it, you can find out more than you ever wanted to know starting with the info here, but really, don't look it up unless you have good cause.

In addition to the most insane skin itching I've ever felt in my entire life, which was our tipoff that something was really wrong, this condition comes with substantial increases in scary stuff like pre-term labor, stillbirth, fetal distress and some other stuff. As near as we can tell, the real risk is to the baby, while the risk on my end is primarily completely losing my mind due to being up all night itching and itching and itching. The risks to the baby are minimized (to the point of being nearly eliminated) with medication, sufficient monitoring to make sure things are OK in there, and most effectively, early delivery at about 37 weeks.

Especially given that we've been earnestly planning our home birth, encouraged in our plans by that super-healthy pregnancy I was having, this is extremely unwelcome news. I'm at 34 weeks now. We will most likely have a baby in 3 weeks if not sooner. We had thought we were on more like the 6 to 8 weeks schedule, especially since for first pregnancies, the babies like to come a little late.

Obviously there are plenty of worse late-term complications out there. Even though moderately risky and unpleasant, this one doesn't seem to represent a huge hazard to the baby as long as we do what we need to do. I get that. I really do. But I'm still not happy about it.

We do at least now get some payoff for my putting up with those pesky back-up OB appointments. I was able to get labs through quickly without having to futz around to find a doctor willing to take me this late in the game, and even though I have a general distrust of doctors (oh, except my father, sorry Dad), for a host of reasons, some good and some not, I do at least like this OB, and count her among the "good ones." She was willing to be unofficial back-up for my midwife at a time when that is really not at all politically expedient in this area. She also seems to have a good grasp of what actually is and isn't evidence based in obstetrics. At my appointment this morning, she was extremely reassuring and is handling the transfer of care appropriately and respectfully. I feel like we're in good hands, even if it's not where we want to be.

We had been considering switching from this local back-up hospital to one a long drive south with a better c-section rate, but with our midwife's encouragement, we'll be staying with the local hospital, not only for continuity of care and to avoid the stress of traveling so far for monitoring, but also for the safety of having the hospital close in case of pre-term labor. Our midwife will also be continuing to work with us, but now in a labor support role. We trust her. She's been smart about all of this, encouraging testing at the right time and supporting appropriate transfer of care to a more medical approach. We'll be glad to have her there.

I suppose now we have to figure out what to do with those nice boxes of birth supplies out on our porch. Does anyone need a lot of chux, vinyl table cloths or drinking straws?