Sunday, June 03, 2007

Update on the Monsters

It's been a very busy week at work. I'm trying to get all the loose ends on my projects wrapped up so that my replacement can just step in with the new projects rather than dealing with all the ridiculous minutiae of the rest. Don't know how successful I'll be, but meanwhile, it's keeping me quite busy.

On Tuesday, I faxed a request to my OB's office to send all my OB & Prenatal records to the perinatology practice. It's the chicken's way out, but it works. On Thursday, I saw the perinatologist. The ultrasound took a very long time, but we got a great look at the babies. They measured the head circumference, belly circumference (I'm sure there's a technical term for that, but I'm not sure what it would be), femur length and heart rate for each of the babies. The appointment was when I was 17w, 1d and they measured 17w 2d, 17w 0d and 17w 0d. They all measured six ounces, which seems astoundingly small to me: they're the size of tuna cans. I have 18 ounces of baby in me! My cervix is still doing fine, though I did note that it has shortened slightly, but it's still within a fine range, which makes me happy.

Then the doctor came in and took a look. Apparently my cervix tilts a bit, which made the original measurements a little sketchy, so they remeasured and the doctor was satisfied. She asked if I was still being followed by the OB practice and I said, "funny you should mention that..." So I explained the weirdness I'd gotten when I'd brought it up in person, and I told her I'd been back and forth about it and was very torn, but felt more comfortable just having one set of doctors so I've asked that my records be transferred over to them. No problem, she said. They're very comfortable handling triplets themselves... it tends to be their preference, and it seems to be easier on the patients, since they're in the office so often anyway that another set of appointments becomes cumbersome. So after she'd gotten a look at all the sonogram pictures ("Wow, these babies look great!") she told me that I could go ahead and get dressed and come chat in her office. What? Talk to a doctor while fully clothed? I'm not sure I know HOW to do that!

We chatted for a bit in her office and pulled out a calendar to guesstimate an arrival time-ish for the babies. The perinatology practice gets most of their triplets to 34 weeks and rarely lets any triplet moms go past 34 weeks. I hit 34 weeks on September 26th (erev Succos) which is the day before my mother's birthday. Mostly I want to avoid my foster-son's birthday if possible, which should be easy, failing an emergency, because it's a Sunday this year. The doctor isn't concerned about me taking 2 prenatals a day yet... she said unless my blood work shows that I'm anemic (I'm not yet, but it's likely to happen at some point), she's not worried. She'd rather not double the vitamin because it could exacerbate constipation (a pregnancy symptom I've been lucky enough to avoid so far and I'd like to keep it that way!).

I mentioned that I feel a little guilty for not... how do I put this?... not finding more joy in the pregnancy experience. I'm incredibly grateful to be pregnant. I am looking forward to meeting my babies. I am blessed in so many ways, I don't even know how to begin expressing it. But I could do without the endless nausea (yeah, that hasn't stopped). I could do without the terminal exhaustion (that second-trimester energy burst? It's a myth). I could live without the stress, the previa, the contractions (nope, those aren't gone either), the random pains, the heartburn, the worry, and the migraines. And the doctor's answer? "I did mine one at a time, twice, and I must say, I'm not a fan of pregnancy. I love my children, but I could have done without all the pregnancy yuck." So you know? I feel a little less guilty. That being said, the pregnancy thing? It's pretty nifty. And there are times, even now, that I'm surprised how good I do feel.

I go back in two weeks for a prenatal appointment (my first with this office) to set up my "prenatal chart" -- whatever that is. They'll also do a cervix check, which they'll do at EVERY appointment (seriously? most women graduate from the RE's office never to see a transvaginal ultrasound transducer again... me? it is still my life!). And they're going to do at least part of the detailed anatomy scan. The doctor was worried that I'd be too uncomfortable to lay down through all three of the babies in a row for the detailed anatomy scan, so she figured if we could get at least one or two this time, then we can get the rest at the next appointment. So that's pretty nifty. I'm expecting it to be about a three-hour appointment. Holy cow. It will be a wonder if I ever get any work done again at this rate with all these marathon appointments.

Today I called the doctor-on-call at the perinatologist's office, because I've been having these pretty uncomfortable menstrual-like cramps sort of rhythmically throughout the day. They aren't painful, exactly, but they've gotten worse through the day and they're very uncomfortable and I've had a bit of very light spotting. I never really know what the threshold is on calling the doctor. I hate to be an alarmist, but on the other hand, I can't tell anymore where that line is. Anyway, it was a doctor I don't know and she was both completely reassuring and unhelpful at the same time. Basically she said that it's just as hard for them as doctors on the other end of the phone to know where the line is, too. And she said that I could come in if I'm that uncomfortable, or I can stay home. Or I can wait a couple hours and see how it goes (that's what I've decided to do). Spotting in early pregnancy, she says, can be very normal. Early pregnancy? Heck, I'm half-way through this pregnancy! Ahem. And don't tell me about early pregnancy spotting. I know from early pregnancy bleeding. That's what I do. But I haven't had much in the way of spotting at all for five weeks. Besides, it's not the spotting that's freaking me out. Well, I'm not even particularly freaked out. But it's not the spotting that prompted me to call. It's the cramping. The very rhythmic, tightening/cramping that seems to be getting worse in the day. But that can be normal too, she says. Except when it isn't. Which is why she suggests coming in to be evaluated if it doesn't get better in a couple hours. So while that's completely unhelpful, it's very reassuring to know that no serious red-flags went off in the doctor's head to make her say, "Oh my gosh, get thee to the doctor's office NOW!"

The only really frustrating thing was that since my records haven't officially transferred over from the OB's office yet, she's worried about stepping on toes, and she'd rather it go through them with the perinatology practice consulting. But I don't want that. It's my care. One of the reasons I wanted to transfer my care is that I have zero concerns about the perinatologist communicating their findings down to my OB, but I have some questions about whether there's really two-way communication here. Will the OB really communicate it back up? And if I've made it clear I want my care transferred over as soon as possible, is there any benefit to not just proceeding as if my records really had been transferred over?


Anyway, my thoughts at this point are to just hang tight and if it doesn't get worse I won't go in. If it gets better or stays the same, I'll just hang out here and go to sleep. Sleep is good.

Update: I did end up going to the hospital last night because the cramping/tightness got much more uncomfortable, much more frequent, and much more intense. I was instructed to go to triage at labor and delivery. The perinatologist said she'd call ahead and let them know I was coming and that she'd also call the OB practice and let them know so that they could see me. I expressed my concerns about my care being done through the OB, but she calmed me down about that. She said that since they have more of my records and background, they were in a better position to evaluate my condition. However, she said, since she was the physician initiating my care at the hospital, she would definitely be in the loop with whatever happened**.

However, when I got to labor and delivery, they sent me to the ER, because they won't see me until I get to 20 weeks. The irony is that I'm pretty sure this is because they generally don't use fetal monitors before then because the uterus isn't big enough. Well.... my uterus is big enough. Anyway, I've been to the ER enough to know that I did NOT want to go to the ER right then. But on the other hand, I had gone to the hospital for a reason. Three and a half hours and one sonogram later, the babies were declared healthy. They were measuring 17w4days, 17w3days, and 18w1day. (I think that last one was a mis-measurement, because, honestly? That's a BIG jump from last Thursday when it measured 17w0d). They all had good heartbeats (149, 139, 144). My cervix was fine (I didn't hear the measurement). I was sent home feeling stupid and sheepish.

Today I'm supposed to follow up with the perinatologist, even though I feel even dumber now. Except... that cramping? Getting worse! I imagine it's just everything stretching out, which would make sense, except it's so... rhythmic. When I was trying to decide whether to call the perinatologist or not, I called a doctor-friend of mine (who has five children of her own) and asked whether she thought I should go in and described what was happening and she said, "You're having contractions. It's probably not a big deal, but why should you spend all night worrying?" I'll tell you why. Because I would have gotten more sleep, that's why. Still, it was the right thing to do. I just wish I'd been 2 weeks and 3 days further along so I could have gotten into L&D, where I would have been monitored for an hour and sent home. Then I might have felt stupid, but I would have been asleep well before midnight instead of closer to 2am.

**One of my main concerns, which led to my ultimate decision to leave the OB's office, was that while I have absolute confidence that the perinatologist will communicate 100% of their findings with the OB, I don't have the same level of confidence that the OB will communicate everything up to the perinatologist.


Anonymous said...

Hoping that the cramping and spotting are nothing more than an annoyance.

I don't think you should feel the least bit guilty about not finding lots of joy in this. I don't know if I could with the shock, fear, appointments etc.

BTW, how are the migraines?

Rachel Inbar said...

About enjoying the pregnancy, I think it's really hard with multiples. With one, when it's moving, you know everything's OK, but with more than one, you always worry about the other(s).

I have twins, one was on the left and one on the right, but she was lying kind of transverse, behind the one on the left, so I never felt her move and would always worry about her (though I didn't know it was a girl until she was born).

Then again, maybe it's not even a multiple thing, maybe it's any pregnancy that is higher risk - because you have to let go of the fear in order to really enjoy it...

Monica said...

I don't particularly enjoy being pregnant with just one baby either -- it's the ending up with a baby (or babies) part that's wonderful. Seems to me that your feelings are more than normal. You really are dealing with a lot. I'm glad that things are progressing so well though and hope that the cramping and spotting go away pronto!

Jody said...

I'll leave aside the pregnancy emotions for now, because it's such a huge topic, and hard to know how to handle. (But the short version of what I might write is, don't bury this issue, because ... well, just DO NOT. We'll talk, okay?)

I'm exceedingly reassured that your peri practice sounds so experienced, but I have to say, you should just be going to get checked every time something like this happens again. Just Go. Seriously.

And at some point, fight to have the contractions monitored, because even my very good practice was sure I'd "know the difference" and didn't believe I could be contracting every minute without noticing. And yet -- I was.

Ah, the trans-vag U/Ss. You WOULD think you'd get to leave them behind, wouldn't you.

Erin said...

Your practice sounds wonderful and very reassuring. I'm glad that you'll be able to see them exclusively and that you feel comfortable with them. Ugh to constant cervix checks, though!

In Search of Morning Sickness said...

The cramping sounds scary! I think going to the hospital was the right thing! I hate how long ER's take, though. LOL at the "chickens way out" with your records. It works, right?!

suzanne said...

well gosh...i hope those contraction will stop and give you some sort of relief. and about your OB/perinatologist..well, i think your last paragraphed said it perfectly. gotta LOVE those trans/vag cervical checks! at least we get to see our babies every week, which many mom's don't have the pleasure of doing!

The Town Criers said...

Always better safe than sorry. Go in any time you're worried--better to waste four hours now than ever have regrets. I had a bunch of extra appointments. I just didn't want to leave anything to chance.

Carol said...

hmm, sounds like contractions to me. did they not put you on a monitor to check out the contractions? I would think you definitely need that.

I hope you get it resolved. good luck.