Readiness Update

We're long overdue for an update, but you won't get anything profound. It's all bullets around here.

• First, Gail is having super pumping success. She is a total milk machine. She cleared 5 ounces pumping yesterday and gets a few mL more every day. See the graph above of her output since day 2 of pumping. It may not be the exponential growth in supply she was hoping for, but that would have been a bit much. We're perfectly happy with some nice solid linear growth. We already have a freezer stash and we don't even have an infant yet. Those straight moms are going to hate me...
• We had a goal of getting a (much reduced) "No really, this has to be done before the baby" list done by Friday, and we succeeded. We actually set up the crib and changing table, washed clothes and diapers, and decided that we didn't actually need to have that garage sale.
  
• The hospital bag is actually finally packed, despite many false starts and a giant meltdown on both of our parts once it was actually ready to go. Something about packing the bag meant this was really happening, both in terms of birthing at a hospital, and in terms of the "wait-a-second-we-really-are-having-a-baby-%^&(*&^" realization.
  
• Constant monitoring of this kiddo continues to show that he is A-OK in there. A fancy ultrasound last week and the (perhaps more accurate) estimate of our midwife have put my worries that the baby might be too small to rest.
• Our midwife, and the doula we had lined up for home (who know each other and have worked together before) are totally up for a trip to the hospital, so we'll still have much of the birth support we hoped for. I'm trying not to worry about what the nurses will think when we show up with extra people (though at least we won't have extra family around cluttering up the room and misbehaving).
  
• We're hopeful that the extra support helps Gail do what she needs to take care of herself during the birth (like, say, eating and maybe even sleeping). We've been warned by our vast array of care-providers to be prepared for a long haul, and during Leigh's birth (itself a very long haul) I did not do a good job of taking care of myself, partially because we should have lined up more support. Gail's job has gotten harder now that we've moved locations.
• Grandma is on deck for Leigh duty while we're busy birthing. She's been hosting Leigh overnight one night a week for the last month or so (and has done a couple 48 hour stretches in the past) so they should be good to go. (Yes, we do know how lucky we are).
  

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?

Body snatchers

At our first official midwife prenatal visit today (as opposed to our earlier consult in which we mostly talked logistics), after being totally prepped that it was unlikely at 9 1/2 weeks, we...drumroll please...heard the heartbeat over the doppler (just barely, underneath the very loud whooshing of a placenta). Holy **** people. Someone is in there!

Meet the midwife

Last Friday we had our first consult with our probable home-birth midwife. She was the "second" midwife at Leigh's birth, and provided a much needed calming influence during that rather arduous journey. Leigh's birth story merits it's own post (or two or three), but the very simplified story is that after planning for a home birth, two solid nights of beautiful but grueling labor for Gail at home, we transferred to the back-up hospital and Leigh was able to make her appearance with intervention but without surgery. It was both astounding and frightening. This particular midwife had a great way of supporting me as I was supporting Gail. She was supporting Gail also of course, but her presence was what kept me hanging on and able to be present for Gail during that long second night of labor. I'm not always a particularly easy person to support, and am extremely sensitive to the moods and emotions of other folks, for good or ill, so we consider this a pretty good indication that I might actually listen and respond to her during a labor, and that she would calm me down instead of ratcheting me up.

The consult contained both good news and bad news.

Good news:
1) She'd be thrilled to work with us.

2) We can afford her.

3) She has office hours close by our home (important, since we don't drive).

4) We'll probably get some insurance coverage (never guaranteed with a home birth, but probable and she's had some success with my insurer).

Bad news:

1) She has plans to be out of town (on the OTHER coast) for 2-3 days just after the due date. We're thinking we may try to meet the probable back-up midwife to make sure we feel comfortable with her. The back-up midwife will also probably be our "second" midwife at the birth if preferred midwife is in town, so we'll be meeting her anyway, and we know she and our midwife have compatible styles. But we do still need to think on it.

2) The medical back-up situation for local home birth midwives has seriously gone south since Leigh's birth. For Leigh, we were able to have all labs done at a local hospital/birth center, and to transfer directly into labor and delivery where they knew our situation and had access to our records. It was overall fairly smooth, the hospital treated us well, and we were able to receive hospital midwife care as opposed to whatever random OB was on call (which is what happens if you transfer through an emergency room without a pre-existing back up relationship). Things have changed dramatically though in the last few years, and at the moment, the only practice willing to provide official back-up is over an hours drive south, which is obviously too far for an emergency transfer (but isn't too far for going way post-date, say, and needing a ultrasound, or induction). This practice has something like a 7% C-section rate, so it would be worth the (rental car) drive, particularly if we end up needing induction. Otherwise, for labs or a last minute emergency transfer (like we had with Leigh), we need to cobble things together. I'll be consulting with an OB who I've heard is sometimes supportive of home birth at the most probable emergency transfer hospital. If she was willing to do some labs and minimal OB care, at least the hospital would have my records. If that fails, I may go through my family doc for labs (who is affiliated with a different hospital) and either have labs transferred or just hand carry them if we transfer. In any case, any emergency transfer will be through an emergency room to whichever OB is on call, but that seems to just be the lay of the land these days. I hadn't realized how spoiled we were last time.

There is also a "big meeting" with one of the most wonderful miwife-supportive OBs in the area who is apparently lobbying her hospital to be able to provide back-up in November, so maybe the situation will change. Who knows. We have close midwife friends, and have been peripheral to this world for long enough to pick up that back-up situations change, based on all kinds of things you can't predict. Even with this less than ideal situation, I'd still feel safer starting at home (for both me, the baby, Gail and Leigh for that matter) than setting foot initially in any hospital or birth center, given our state's 33.3% C-section rate, not to mention my (admittedly slightly unreasonable) discomfort with medical situations.