Tuesday, April 24, 2007

Elbows and feet?

He or she moved a lot today, all day. This is a new phase of sensation when the Bean moves. In February and March, the movements were brief - like a punch or kick from inside, but my belly felt like a big water balloon and it wasn't clear where the baby was or what was going on. Now, when I run my hands over my belly, the overall shape has often changed, and sometimes its possible to feel small lumps sticking out, usually near the belly button. It's unclear if the lump is a knee, elbow or foot, but if if I gently press it, it moves away! It's apparent the baby is getting bigger, and there's less room inside, so when he/she moves, we can see shapes slide from one side to another. Michael and I laugh a lot now when looking at the belly after meals, and are amazed by the movements.

People ask when I'm due now, and say "You must be ready to have the baby... Aren't you fed up with being so big?" I haven't gotten to the point where I'm physically uncomfortable yet. My walk has become more awkward (penguin-like), and my pelvis gets stiff after sitting for long periods of time, but it's not uncomfortable.

I'll be glad when the baby arrives so that we can both see it and watch it, and I can retire anxieties about what's happening 'inside'. We're both very excited about the Bean's arrival.

Saturday, April 21, 2007

8-month Checkup (April 20, 2007)

Weight: 175 pounds (40+ pound gain since getting pregnant!)
Blood pressure: 110/70

I met Dr. Hadden today as part of a rotation every two weeks to meet all 5 doctors that take turns being on duty for the labor/delivery ward at Columbia Presbyterian. By doing this, whichever doctor is on duty in the labor/delivery ward and I will be somewhat familiar when the time comes to deliver.

Dr. Hadden looks as though he's in his early or mid-fifties and said he's been practicing for 25+ years. He said there's a 50 - 70% chance that Dr. Holden will help me deliver versus one of the other doctors.

I assumed this visit would be a handshake and brief conversation, but for each visit from now on (roughly every two weeks), I'll get a pregnancy checkup including urine test, weight, vitals and monitoring of the the baby's heartbeat.

The nurse found the Bean's heartbeat low on my belly on the left side, but as soon as the monitor tracked the heartbeat, the baby shifted and we couldn't hear it anymore. She moved the monitor and found the heartbeat again, but the Bean shifted and heartbeat went away again. Finally, she trained it near the center and we heard the heartbeat for several seconds. We both laughed. The nurse said she hasn't seen a baby shy away from the monitor in a long time -- the monitor makes a loud crackling noise, and the Bean doesn't like it.

Dr. Hadden measured my abdomen from pubic bone to fundus (top of uterus) and said I'm tracking at 32 weeks, in line with the other measurements taken over the past couple of months confirming mid-June for the due date. He felt my abdomen and said he could feel the Bean's head down near my pubic bone and back/butt up and to my right, all of which is normal.

His only warning to me at the appointment was to try not to gain any more weight. He said "Anything over 35 pounds is yours to keep" (meaning it will be harder to lose after the baby is born) and there's also a risk that if I gain more weight the baby will also get bigger, creating a harder labor situation. I'm embarrassed to write about this today, but am trying to be honest for the journal.

Attached is a picture from about 3 weeks ago (week 28)... [Demi Moore/Vanity Fair copy cat shot - Take 2]

Wednesday, April 18, 2007

Starting Baby Classes

On Monday night this week, we went to a baby Cardio Pulmonary Resuscitation (CPR) class. The instructor was a senior RN named Fern Drillings who works in the Obstetrics ward at Columbia Presbyterian.

At the start of the class, the instructor asked everyone in the room to introduce themselves and share their due date or the age(s) of the child(ren) they have. There were roughly 26 people in the class -- many couples who are pregnant at various stages, some parents who've had children within the last 9 months, and at least 4 - 5 nannies, some who were there with their employers.

There was one woman in the class who is at the 38-week mark who looks the same size as me though I'm 31 weeks... and a couple of other women who are due in June who looked less 'large' than me, leading me to realize I am indeed on the 'biggish' side for this stage. So although it's a bummer when people in the office go "You're huge!", I realized they are right.

She gave us a brief overview of procedures to follow for a range of injuries or ailments that could affect infants and toddlers, ranging from burns and fevers to choking relief procedures and CPR.

CPR has evolved since I took a class 15 years ago. In the last five years, the health industry has updated the CPR protocol, and the good news is that the number of breaths and compressions is now the same for all ages.

Baby CPR differs from adult CPR now only in terms of the amount of pressure put on the sternum (chest) when doing compressions [for babies: two fingers only, pressing down 1/2 - 1 inch vs. for adults: using palms -- one over the other -- and pressing down 1-2 inches)].

The current CPR procedure for any age is:
1) Call 911
2) (Person lying on back) Tip head back to create clear airway passage
3) Check for indications of breathing (by listening/feeling for breath and watching chest)
4) Give 2 breaths - check that airway is clear (by looking for rising of the chest)
5) If airway is not clear, follow procedure to clear airway, and then proceed to CPR
6) If airway is clear, proceed with CPR:
2 breaths + 30 compressions
2 breaths + 30 compressions
(repeat until medical help arrives or person recovers consciousness and breathes on his/her own)

Tonight Michael and I attended a free lecture on anesthesia and analgesic options available at Columbia Presbyterian, given by the Chief Anesthesiologist, Dr. Richard Smiley. He has a staff of seven Anesthesiologists and the eight of them rotate duty 24/7 and typically have 1-2 senior resident doctors in tow per anesthesiologist during each shift to perform or observe the procedures.

Fun fact: Dr. Smiley is the fourth Chief Anesthesiologist to lead the OB anesthesiology department at Columbia Presbyterian since Virginia Apgar - the most famous female physician of modern times - who pioneered the Apgar test for newborns. See here:
Dr. Smiley clearly enjoys his work -- his presentation was interspersed with pictures from a past sabbatical in Switzerland, a picture of his dog, and photos from a visit to a museum in France featuring the work of Volti, an Italian artist who made sculptures and works of art about women - especially pregnant women. Added bonus: free food and beverages were provided.

The trend now and the goal of the OB anesthesiologists is to provide analgesia (moderate pain relief while still enabling movement and sensation) vs anasthesia (complete numbness and loss of feeling - e.g. for surgery).

Dr. Smiley covered the pain relief options in great detail, including epidural, spinal block, IV, and the benefits, risks, side-effects and specific dosages and types of medication used.

More than 80% of women who give birth at Columbia Presbyterian opt for pain relief, and the majority get a combination spinal epidural (CSE) for which the patient can give themselves additional dosages to a controlled degree. The procedure involves the insertion of a soft catheter into the epidural area of the lower spine. The epidural catheter is taped to the back and stays in for several hours until delivery, and allows some degree of mobility though walking is not generally encouraged.

Michael enjoyed the presentation very much. I found it useful and learned a lot, but given my aversion to needles and the low (but possible) risks and side effects, I'd like to try and soldier through as long as I can without using an epidural. Have read many blogs online and many friends and colleagues have said "whatever you do, get the epidural!", and Columbia hospital statistics show that 85%+ of women who give birth at the hospital opt for pain relief, so it is very popular, and if I did pass it up, I'd be in a very small minority.

By the end of the lecture, the room was very hot and the topic made me feel queasy so I was glad to leave. We are both glad we attended; we'll be well-informed and reasonably prepared for whatever happens in June.

I spoke to my mom and learned she received anasthesia when I was born (either a spinal or epidural), and she said she got a painful headache afterward -- one of the side-effects of a spinal block, though they've recently been able to reduce the probability of a headache significantly.

Saturday, April 14, 2007

Pictures - 31 weeks along

Bean is moving a lot and because he/she is bigger (approximately 15 inches in length and 3 pounds...), it's easier to see and feel movements. I used to feel the occasional sharp kick (or punch?), but now it's possible to see turns and shifts in position. Bumps move across my belly and the whole shape changes, etc.

We bought a denim Bugaboo stroller a few weeks ago and it arrived this week. Michael assembled it today and it was fun to wheel around the apartment and take our photos with it. Nice ride for the Bean!

Here are pictures.

Saturday, April 7, 2007

Flight Travel While Pregnant

I went on a 1.5-week business trip to California two weeks ago. After checking in at JFK airport, I went through security. My purse and all its contents, computer bag, and luggage all cleared the x-ray machine without any special check or inspection. I then walked through the sensor and cleared without any problems, but the TSA agent asked me to step in a glass box and wait to be checked again.

I waited in the glass box for 15 minutes until a female agent came into the area who could perform the search. Another 10 or 15 minutes of time passed before I was asked to leave the box, and it coincided with the arrival of a second female agent. The two female agents asked me to step into a private office, where I removed my shoes, got scanned with a wand, and then physically frisked. I asked why I was getting searched, and they said that a heightened security alert was in play highlighting the risk of women travelers who may appear to be pregnant but could be disguising explosives or other illegal substances in fake bumps. I asked why I had to wait in the box for so long, and they said that any pregnant woman who gets checked will be checked in a private office, which requires two female officers -- one to perform the search, and the other to witness.

Once I was released and went to the gate, I learned that my flight had departed already. I asked about getting on the next flight 2 hours later, and was assured that there would be no problem getting a seat even though I was on standby status. However, when the next flight arrived and all the passengers had boarded, I still hadn't been called to get on the plane. I went to the agents, and they told me the flight was full, and that I would need to wait for the next flight (3 hours later).

At this point, the day was shaping up to be a bust and I started crying (hormones!). The agent took pity on me and I got the last seat on the flight. They held the plane and allowed me to board before it took off. Although I wish I'd been able to avoid crying, it probably helped my case.

When I landed in San Francisco, I dug around the bottom of my purse to retrieve my itinerary for the car rental, and discovered a 6" steak knife. I've been taking a knife to the office to cut apples and pears for snacks, and forgot to remove it that morning before leaving for the airport. The steak knife cleared the security check at JFK with no notice, and I was allowed to carry it onto the plane... Don't worry about the serrated-edge knife in her purse; let's make sure that belly is bona fide!

On the weekend, I took a shuttle flight from San Francisco to Santa Barbara to visit my parents for two days. On the flight from Santa Barbara back to San Francisco, I was seated in an exit row. When the flight attendant noticed my shape, she asked me to switch seats with another passenger so that I was no longer in an exit row. He didn't seem to mind, since it was an aisle seat just one row ahead of his original seat, and I didn't mind either.

Done with airline travel for now until the Bean arrives.

7-month Checkup (April 4, 2007)

Weight: 173 pounds, a 36-pound gain since the start of the pregnancy (!)
Blood pressure: 110/70

The fun news at this appointment is that Dr. Holden and his wife had their 2nd child - a girl - on Saturday (Mar 31st). He and his wife have a 2-year old boy too. We asked him how he and his wife got to the hospital, and he said they took a taxi -- same strategy as for their first child. He also said that another doctor delivered the baby; Dr. Holden was there as a husband/father only. He said his wife doesn't like getting advice from him when she's pregnant, which was funny.

This appointment went quickly. We listened to the Bean's heartbeat and it sounded good. The monitor that the nurse used this session did not provide a digital readout of the number of beats per minute, so I am not able to record that data for this entry, but in general, the Bean's heart rate is faster than mine.

He said I look good, all signs are good, and we can keep on truckin. Because Dr. Holden is part of a team of 6 doctors that takes turns being on call at nights and on weekends, I will meet each of the other doctors every couple of weeks so that regardless of who is on call when the Bean finally arrives, the doctor who assists will not be a complete stranger if the time comes and Dr. Holden is not available.

I received a shot of Rhogam in the rear end to prevent any blood incompatibility issues with the Bean, and then we all went back to work.