38 Weeks!

I am 38 weeks and 2 days pregnant today, which is just absolutely madness. A friend’s sister, who was due one week before me, had her baby a few nights ago, and even though I am very pregnant and living in a house full of baby things, it still boggles my mind that there could be a baby here at any moment.

For anyone even remotely interested, here’s the third trimester belly progress:
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(In addition to being photos of some random internet stranger’s belly, which are by nature not interesting, I know these pictures are boring because I’m wearing the same thing in all of them. However, that was intentional, because I figured it would be easier to track changes this way. So, sorry, everyone.)

To look at me, it would appear that not much has happened in the last week or so. However, I feel like I am suddenly enormous. That pelvic pain I bragged about not yet experiencing in my previous post is here in full force, making my lower back and inner thighs feel like I’ve spent several days riding a galloping horse. I always thinking about food, but too full to eat anything. I am also totally exhausted. I haven’t officially started maternity leave from my PhD program, because I figure I might as well wait until the baby is born, considering I can very easily do my work from home, but my brain is basically already on a time out. It took me two full days to write an embarrassingly short project proposal, even though I able to crib most of the material from other things I’d already written. Luckily, I’d managed to get a lot done before I became useless because useless I most certainly am.

My PhD project, when it eventually starts really happening and isn’t just a bunch of stuff I tell people I will be doing someday, will focus on childbirth intervention, so I’ve spent many, many months researching maternal health care and childbirth and all its various outcomes. What I’ve found, for the most part, is that as wonderful as modern medicine has been to women giving birth (like, say, in its insistence that people wash their hands before attending laboring mothers), in many ways, processes that might be better left to proceed on their own are often too actively managed. (As an example, there’s the “cascade of interventions,” which is labor induction -> electronic fetal monitoring to watch the effects of medically induced contractions -> mothers laying on their backs in bed -> more intense pain -> epidurals -> the slowing of labor -> fetal distress and/or failure to progress -> caesarean section.) I had a lot of big feelings about this overmedicalization of childbirth when I drafted my PhD proposal, long before I found myself pregnant. Doctors are too pushy, medicine is too incentivized, nature has been abandoned in an effort to keep schedules or avoid lawsuits. And I still think those things. (To be fair, this isn’t just some earth-mother hippie crap being howled at the moon. Statistically speaking, the cascade of intervention is very, very real.)

However, what has been really interesting about doing this research while facing my own childbirth experience is discovering that as a pregnant woman, I will do anything to ensure my baby is healthy. I can intellectualize the medicalization of nature as a product of hospital care as much as I want, but I’ve learned that if a professional with an ultrasound wand tells me something might be wrong, I will drive home in hysterics and spend the next three hours on Google, working myself into a panic and vowing to consent to anything to make it better.

Those aren’t two opposing thoughts – in fact, in most of the theory I’ve read, that’s how medicalization works. Doctors and hospitals apply techniques to make childbirth more efficient/more scheduled/ostensibly “safer,” and mothers trust their care providers and consent to them.

It’s just been very eye-opening to experience it myself.

For the first 32 weeks of the pregnancy, I saw the same midwife practicing out of a medical practice near my house. At each of my relatively rare and low-key visits, she would test my urine, take my blood pressure, and then do a fundal height measurement using a tape measure. For the uninitiated, the fundal height is the distance from the top of a pregnant woman’s uterus to her pubic bone. This measurement in centimeters should, conveniently, mirror the number of weeks pregnant a woman is – a woman who is 26 weeks pregnant should measure on (or around) 26 cm. At all of my appointments, I was measuring spot on. At 24 weeks, I was 24 cm. At 28 weeks, I was 27.75 cm. At 31 weeks, I was 31 cm.

And then I moved to another city and had to transfer to another midwife. In the five days between my last appointment with my previous midwife and my first appointment with my new one, the baby turned from head-down to transverse, meaning he was now laying horizontally across my belly as opposed to vertically along it.

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I went from the long belly on the left to the short, stubby belly on the right. I didn’t think much of it, until the new midwife whipped out her tape measure and measured my nearly-32-week-belly at 27 cm. She immediately made me an appointment for a growth ultrasound, because measuring five weeks behind (even by super high-tech tape measure) could be a sign of a growth-restricted baby without enough amniotic fluid.

Now, as a person who knows too much about pregnancy and childbirth due to having had my super dweeb face in journal articles and books for nearly a year, I completely flipped out. In addition to taking me out of a midwife’s low-risk care and placing me into higher-risk “consultant” (doctor) care, this new potential amniotic fluid issue put me at risk of being harangued into an induction, as fears about a baby’s size and amniotic fluid levels are one of the most common reasons labors are induced. Cue the crying in the car on the way home, the drinking of tons of liters of water a day in an attempt to up my fluid levels, and the crawling around on my hands and knees to try to turn the baby.

A week and a half later, when I had the growth scan, the baby was head down again and measured in the 60th percentile for growth, which was lovely. However, the total amount of amniotic fluid measured via ultrasound was 8.2cm, which was still cause for alarm, as the “normal” range is about 8-18cm. I was hovering right at the low range of normal. My new hospital consultant wrote “low AF at 5% at USS” (low amniotic fluid at the 5th percentile at ultrasound) under a giant “ALERT! Please indicate risk:” label on the inside of my maternity notes, and told me she wanted me back for another scan in two weeks. That was great.

Two panicky weeks later, at my second growth ultrasound, the amniotic fluid was up to 11.8cm, which was firmly normal. In addition, the baby now measured in the 90th percentile for growth. In fact, the ultrasound tech thought the baby might be growing too big – she took the femoral length measurement four times because she thought she was making mistakes. The baby that was once thought to be too small was now almost off the charts.

Despite the incredible hulking baby, I passed the growth scan with flying colors and am no longer high risk.

I hope it goes without saying that I am, of course, very happy and grateful that everything ended up being fine. It was, however, really bizarre to know that the difference in fundal height measurements between midwives was entirely due to the turning of the baby and the admittedly insanely subjective tape measure method, and still feel totally nuts when I was sent for extra ultrasounds. I thought that there was something horribly wrong with the pregnancy because of a tape measure.

On one hand, it’s nice to know that the people taking care of us are proactive. I have had nothing but wonderful interactions with everyone, and I don’t think any of the extra tests were done to make me nervous or take advantage. However, on the other hand, it was unnerving to find myself ready and willing to submit to any intervention possible (I would have been completely on board with an elective c section, for example, if it meant combating growth restriction, which shocked me, given what I know about pre-term caesareans), when the methods pointing me in those directions should be approached with caution.

The extra growth scans illuminated to me that childbirth interventions are notoriously difficult to manage and are more often than not used based on evidence that is subjective at best. For all the actual problems that are addressed by them, there are hundreds of others that are caused by them. (I lucked out because in my case, the only issues the extra scans caused were emotional.) At the risk of sounding super naive and having to eat these words after I have the baby, my WARNING ALERT SMALL BABY EXTRA SCAN experience has only solidified my desire to try to have as few interventions as possible during the birth.

We’ll see how that goes.

P.S.: I’ve been writing and editing this post for 24 hours and I still feel like it makes no sense. There was a point in here somewhere, guys, but like I said above, MY BRAIN IS ON VACATION AND I JUST CAN’T.

20 Weeks.

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On Thursday, when I was exactly 20 weeks pregnant, I had my 20-week anomaly scan. According to the ultrasound technician, the little bub is measuring totally normally and was very cooperative. (This is something this very same tech said to me at the 12-week ultrasound, so I think it means I’m guaranteed to have a very well behaved child for the rest of my life. A GIRL CAN DREAM.)

We got to see its brains and its kidneys and its ten little fingers wiggling around. In the photo above, it’s basically dancing a contortionist jig, with its arms all over the place and its legs up over its head. When this photo was taken, the tech asked us, “So, looking at this, who does it take after?” prompting a sex joke from The Boyfriend, which the very English technician then pretended not to have totally set up for him.

At various times throughout the scan, as the baby moved around and we saw bits of facial bone and dark shadows, it really did look like most of the terrifying online ultrasound photos my mother and aunt tried to convince me were fake, so I win. THEY ARE REAL.

We also found out what the little bub is, and as much as I want to tell everyone I know on any and all social media platforms, I am keeping my huge mouth closed about that until I go home for my mom’s Most Epic Baby Shower In History. I’m also kinda in love with the idea that the people who might get me gifts (because that is so not an expectation) will have to do it without knowing what the gender is. This kid will love cupcakes and dinosaurs no matter what its genitalia is!

Maybe I’ll have that printed on a t-shirt and make Baby wear it on the first day of kindergarten.

It’s A…Human!

On Monday January 12th, the one year anniversary of my move to England, I had my first ultrasound, which was firm confirmation that another huge life-changing event is on the horizon.

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IT’S A BABY.

I’m getting my health care through the NHS, so I have the benefit of not needing to pay for private insurance, which, as a US citizen, is a little bit like living in opposite land. However, because I’m not paying for the health care, the experience has been different than what it might have been if I were in the states. For example, I met with both a general practitioner and a midwife before the 12-week scan I had on Monday, and neither of those medical professionals confirmed the pregnancy (through urine or blood). I also wasn’t offered an early ultrasound (at around 8 weeks), like I might have been in I was back in California. So, for the first three months, until I saw the little babe kicking around on the ultrasound screen this week, I could have basically been making the entire thing up like a hysterical crazy person and no one would have been the wiser, myself included.

As a notoriously high-strung individual, it was really strange for me to have very little medical intervention during a time when all I wanted was as much reassurance as possible. Thankfully, I have my midwife’s cell phone number – that poor woman probably hates me.

As I understand it, because there is very little that can be done in the first three months of pregnancy, the ethos here is to just let it happen. It’s all very c’est la vie.

That was very, very difficult for me.

Additionally, the NHS keeps sending me totally vague and absolutely terrifying text messages as my various blood test results are received by my doctor’s office. Nothing says peace of mind like getting a text at 4:55pm that reads, “Your test results are now available. Contact your GP as soon as possible.” So fun trying to frantically contact a health center administrator in the last five minutes before the office closes. Fortunately, as of now, all results are normal.

In England, prenatal care – and often, birth itself – is managed by full trained, highly educated midwives, not OB/GYNs. I think this is excellent, because in theory, it should cut down on the amount of unnecessary intervention suggested to women as they prepare to have babies. That being said, the strangest thing that’s happened thus far occurred during my “booking in” appointment, the first time I met my midwife. We went through family ancestries and histories, I told her my height and weight, she took my blood pressure, and then after this extensive testing, she deemed me “low-risk” and advised me to have my baby at home.

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WHAT.

As an American, this casual suggestion was similar to hearing a nurse tell me that I look pretty competent so I should just handle the stitches myself. For years, I’ve harbored some obnoxious ideas about how medicalized pregnancy and birth can be in the United States, so I absolutely appreciate living in a place that treats this like a natural process, and not a terrible disease. However, having a midwife use 30 minutes of conversation to determine that I wouldn’t need any medical help was a teensy bit surprising, even for a liberal granola nutcase like me.

Luckily, the options are basically endless here, so as of now, I’ve decided to use a birth center inside a hospital, staffed with only midwives, but an elevator ride away from some serious surgeons, just in case. I’ve read that for a home birth to be truly effective as an experience (and also, I guess, as a way of getting an 8 pound human being out of your body), you have to be relaxed. I, queen of the tightly wound, would not fare well with a potentially life-threatening situation intentionally scheduled away from a hospital.

Luckily, I am slightly less anxious now, as I’ve got four photos of our tiny martial artist and I know it exists. However, now that I know this is for real, I am ramping up tons of anxiety about making sure I don’t screw it up.

I’m such a well-adjusted human being. It’s just amazing.