Tag-Archive for » medicine «

Oct
29

I have half-completed my quest to be stuck with at least two more needles. As both a preggo and an asthmatic, I’m meet two qualifications for being high risk and for requiring the shot, rather than the nasal spray. But finding the vaccine has been a bit of a pain in the butt. I see a midwife at a birth center, so they don’t have the vaccine, so they refer me to my GP. My GP doesn’t have any of either type and isn’t expecting to get any in, so they refer me to the local health department. The local health department has suspended all public health clinic vaccinations due to lack of vaccine, so they refer me to my GP or OB. The OB group that is handling my ultrasounds hasn’t been able to get any for the workers and doubts that they’ll be able to get any in for patients, so they refer me to my GP. You may see the dilemma. To make matters worse, I’d like to find the single dose, since I’d prefer fewer preservatives.

Fortunately, Jason was able to able to find a local grocery pharmacy that had the seasonal flu vaccine in single dose. So that’s been accomplished. They don’t know that they’re going to get any H1N1 vaccine, however. The nurse at the maternal fetal medicine who returned my results suggested that Snohomish County might be running clinics this weekend. So I plan to trek about a 45-min drive north to Snohomish County to get the H1N1 vaccine there.

And yeah, those results were all good. Blood tests combined with the ultrasound puts me at very low risk for any detectable chromosomal abnormalities (1 in 11,000 for Downs and 1 in 22,000 for the other trisomies). Whoohoo!

Oct
23

There hasn’t been a lot to report the past few weeks other than being nauseated every day and have headaches most of them as well. But today you get something worthwhile: an ultrasound report.

We headed to the maternal fetal center for the ultrasound and first blood test in the combitest. It tests for risk of Down Syndrome, a couple other trisomies, some severe abnormalities, and so on.

The center had a whole host of small little ultrasound rooms, with cute lighting that looked like stars on the ceiling. The sonographer came in after a little while, goo’ed up my belly, and began the wanding. We saw the little alien quite clearly right away, and it was positioned quite nicely to start taking measurements on nuchal transparency. The baby stayed mostly well positioned, but moved around a fair amount, stretching out, swinging limbs, and spinning on the axis of the spine.

The sonographer went on to measure blood flow around the bladder (which was pretty awesome to see), measured length, looked at the heartbeat (171bmp), checked arms and hands and legs and toes, looked at the nasal bridge, showed up all kinds of little bits. The ‘crown to rump’ length was 6.87cm, putting gestational age at 13.0 weeks, rather than the 12.5 weeks I ought to be, but ultrasounds aren’t exactly the most reliable at precision.

It was cool, but weird. I think that’s the operative work for most of this – weird. Since I don’t still feel pregnant outside of feeling sick.

Sep
23

Oh, well, I still have to turn it in, but we have completed our current quest to interview providers. (Yes, yes, blatant WoW reference. It just seemed appropriate.)

Today was the Puget Sound Midwifery and Birth Center, in Kirkland. They are two blocks away from Evergreen Hospital, which makes it even closer than the Eastside Birth Center is to their backup hospital. They operate three birthing rooms, shared by two sets of three midwives who work as a group. We had an interview with one of the three who would be in the group that I would be with, the Lake Washington Midwives. We saw Sunita, who is also a naturopathic doctor, so I’m not sure if she should have a Dr. in front of her name or not.

The facility was easy to get to, and inviting. They had a library of books on conception, pregnancy, childbirth, and early childhood/parenting in the waiting room – and I mean something like 15 (short) shelves of books. We did the ‘interview’ in one of the birthing suites, as they tend to do their prenatal appointments there. She had a very personable style, while answering questions, and went over most of the same stuff we’d been asking, sometimes answering questions before I even got to them. They have a low transfer rate, and most of their in-labor transfers are done for maternal exhaustion. They have a very low episiotomy rate, as well. She noted that they can do sterile water injections, but her experience is that they tend to be more irritating than painful, and she has been trained in TENS and uses it on occasion, but doesn’t use it often. Like the other birth center, when I asked about how they tend to manage coping with pain there, she pointed towards the tub (and they do birth in the tub as well). (Yes, “how do you, a birth center, manage pain and discomfort in labor” is a totally leading question trying to get at the mindset they have during the process, but that’s kind of the point of the interview.)

She was the first person who asked us, after she answered all of our questions, to tell her a little about ourselves. And she had a good hearty laugh (along with appropriate sarcastic response!) to Jason’s “Well, we tend to be pretty analytical people.” She even helped answer the “why are hospitals so anti-water birth”; her opinion being that it has a lot to do with provider convenience, since tub births are a little hard on them (hard tub sides and all) and there isn’t much in the way of visual access during one.

At the end of our visit, she showed us a little tour of the place. One of the birthing rooms was in use for a labor, and the other one was in use for an appointment, but the other provider (and patient) was fine with us checking in. Turned out to work perfectly, as the other midwife in the room was one of the other people on the team that I would see. And when we walked out into the hallway, I got to meet the third (who immediately said “wow, you look familiar” after I introduced myself). They all seemed quite friendly, and warm.

Really, that’s the impression I got from the whole place – a warm, inclusive welcome. Very homey, if not entirely in decoration (there’s only so much you can do with that who “homey hotely” setting), then very much in spirit.

This leaves me torn. I understand the “Oh! We have to be in a hospital because something could go horribly wrong and it’ll be awful if we’re not at a hospital” emotional reaction, but I also know that it is a primarily culturally ingrained irrational fear. There are certainly benefits to be had being in a hospital! But there are risks from every intervention, which is also closer at hand, and more likely to be used, in a hospital, not to mention just being able to be really comfortable and trusting of EVERYONE in the room.

I’m going to be sleeping on it, but I definitely have a preference in mind. 🙂

Sep
16

Last night, we toured Evergreen Hospital in Kirkland (~20 min away), and did a meet-and-greet with the nurse-midwives who practice there today. Let’s just say that making this decision won’t be easy.

The guide who did the tour of Evergreen was a short, older lady with… the most annoying habit of talking in short sentences, making the last two words sound crucial, and talking slowly. And the way she talked to the little two or three year old that was with us… UGH! It made it a little hard to focus on the tour, but as Jason said – over time, you kinda warmed to her, or at least uncooled towards her. It was the first maternity ward I liked the layout of, oddly enough. The rooms were nice enough, had a decent amount of space, various supplemental birthing supplies (ball, squat bar, jacuzzi tub, rocking chair, even birthing stool, I think). She talked a fair amount about the support for natural childbirths, one-on-one nursing (they try to keep you with one single nurse during each shift), their openness to avoiding interventions if not warranted, and even talked about the vaccination waiver process. (I’m not planning on not vaccinating this kid; don’t worry. I’m not so fond of giving a DPT, Hep B, and Hep A vaccine all at once withing 24 hours of the stress of birth. While I have much more research to do on this front, I’m of a mind to try to space the three out over the first month or so. We’ll see.)

This morning, we met with one of the five nurse-midwives at the Center for Women’s Health at Evergreen (not to be confused with the Evergreen Women’s Health Center, aside from the fact I confuse them every single time). She was an interesting combination of very patient (we were there for 40 minutes, asking questions, after all), and medically efficient. It’s a combination that I think I like. I was disappointed to hear they don’t do vaginal breech delivery, as I’m a little annoyed at the reduced care available because people aren’t trained. (Seriously, lack of training and experience is the biggest reason breeches aren’t delivered vaginally. In *some* breech presentations, it’s not more risky to do a vaginal birth, if the provider is trained. But, no one trains them anymore. Sigh!) But I was pleased about the discussion over various methods of version in the case of a breech. And I was pleased with her response to my question on episiotomies, which was somewhat vague in the “depends significantly on the woman” but she discussed the other methods they use to avoid them focusing on giving the baby’s head plenty of time to do the stretching naturally, and finished by saying that in her 15 years of midwifery practice, she’s probably done about that many ‘routine’ episiotomies.

As an final irony, the assistant at the chiropractor’s office I go to mentioned that she used to work in the birth center that we’ll be interviewing at next week, and she thinks I would really like two of the midwives in the group of three I’m interviewing with. She doesn’t know the third, because she left before the new midwife came in, who also happens to be the person we’ll be interviewing with. And, she knew the midwife at the birth center we already interviewed, and suspects I’ll take to the other midwives better. Definitely a small world!

So, this all leaves me very uncertain where I want to give birth and who I want for a provider. Evergreen falls into the “acceptable” category, and Jason does like the immediate proximity to emergency facilities (though I’d add that the other birth center is literally two blocks from the maternity center). The main differences are the environment – can I find myself just as relaxed in a hospital? – and only the birth centers offer water birth. And when it comes down to these two relatively small differences (as far as I know now, without having given birth, anyway), I suspect it will strongly come down to who do I mesh the best with.

The decision has gotten difficult!

Sep
13

We toured Valley Medical Center today. It was difficult to navigate, for one (we ended up in the pediatric area first, only to head upstairs to the birth center). The tour was ok, the rooms were ok, but neither of us felt it lived up the expectations we had. The rooms were a little bigger, but felt a little more cluttered. They didn’t move people from a delivery room to a mom&baby room, but they didn’t appear to have telemetry for monitoring. The person giving the tour we had couldn’t really say much about policy mandated interventions, other than they usually go with the doctor’s preference, and that people coming in should probably have something written up if there are fairly standard things that they don’t want.

So, still leaning towards the birthing center.

Sep
12

I admit, I went into the tour of Overlake with a significant bias – they don’t have CNM’s, they don’t always get the best reviews, and they just seemed unfriendly to a non-allopathic approach. I further admit, however, that my biases were not entirely met.

We got to see a labor room, and then a mom&baby room, though in the middle of our discussion in the labor room, a nurse came in to say they needed the room asap. 🙂 It was reasonably nice – the lights were adjustable (presumably during stage 1 labor, not so up-to-your-control during stage 2), the bed had lots of configurations (including being able to add a squat bar), they had birthing balls, and had telemetry on monitoring if necessary (but they do an awful lot of monitoring). But it was most definitely a hospital, with rooms that weren’t cramped but were definitely not spacious, a door in front of the tub (which was in the bathroom), and a bunch of machinery to watch you. I have to admit, the stack of twenty widescreens mounted to the wall displaying fetal monitors with two nurses behind the desk there to watch them… a little impersonal, and a little “metrics” heavy.

But they seemed open to all kinds of delivery choices (even non-medically necessary elective cesarean, which I might be of the opinion is a little too open minded), roomed mom and baby together, tried starting nursing immediately after birth, and other friendly options. They don’t limit both food and liquid after starting active labor, but do generally limit to liquids only, and definitely do limit to liquids only if induced.

So, all in all, not the place I would choose to deliver off hand, but I don’t feel worried about ending up there in an emergency transfer either.

Though, I have to admit, I felt really strange being the only woman not showing. I’m at seven weeks, and … well… don’t really look pregnant. Everyone else was at least 32 weeks. Weird!

Sep
11

We had our first “interview” with a prospective provider. It was at a birth center nearby. We came in with a list of 39 questions, spent an hour there, and came out with a DVD of births they’ve done. One of the two midwives in the practice was our contact for the day, and she showed up around the birth suite, which is attached to her husband’s chiropractic clinic. It was nice, if a bit hotel-y. (Definitely not hospital-y, however, and had lots of room for moving around. It also answered one question I had always had about tub births – there was a shower immediately on the other side of the shower for cleaning up.)

We chatted for a while, asked about what they tend to do for coping mechanisms (movement, tub, herbs, willing to use TENS), if the same person would be with me the whole time (yes), what the do for transfers (non-emergency to one hospital, emergency to the other), got a feel for what those transfers tend to be like, how they avoid conflicts (careful planning and a bit of luck), and got an idea of how they do prenatal care and postnatal care (all regular tests offered, but not required). And how much it tends to cost (not cheap at nearly $5k, but cheaper than hospital, and totally covered by insurance).

The woman we talked to was nice, but I haven’t figured out if it’s a good personality fit. The only thing that I really noticed is that she talked a lot, rapidly. Heavens knows I do that too, and more so when I’m nervous, so I’m not saying it was all bad, but I think that’s the only reason it wasn’t a quick “meeting of the minds”.

We stopped by Whole Foods afterwards, and picked up some food so that I could have the oddity I decided would be tolerated well by my stomach – a BLT. It was gluten-free bread, nitrate/nitrite-free bacon, and organic tomatoes and lettuce, even healthy mayo. And it was good. 🙂 I might make another one tomorrow.

Sep
09

I’m still not particularly nauseated, but I still have pretty much zero interest in food. I haven’t felt this not-hungry since the last time I had the flu. Of course, I have to eat, or I feel shitty… GAH! At the moment, the only things I can count on are guava or mango juice, and avocados. I’m eating at least one avocado a day. ‘Cause I know that’ll not play funny with my stomach.

In other news, Jason’s finished reading the Ina May Gaskin book I asked him to read, and I’m really glad he took the time to read it and think about why he initially preferred a hospital setting, as he is saying now that he’s just fine with a birth center. Not only was there the “why do I have faith in them doing a good job with labor when I don’t trust them to be intelligent for simpler things?” but he realized that all of the conditions I’m dealing with going into this (fibromyalgia, depression, restless leg, vulvar vestibultis, chronic migraines) – while everyone agrees do not put me at greater risk during the pregnancy or birth – are themselves best dealt with by relaxation, calm, warmth, and patience. And I’m not likely to find a great mix of all that in a hospital with different nurses and doctors coming and going, and bright lights and lots of directions.

Don’t get me wrong – we are going to be touring hospitals! All three in the area. If complications arise during the pregnancy, I want to not have to start over from scratch when evaluating places to go. There’s a small, but by no means close to zero, chance that even if we want to go for a birth center, I’ll end up in a hospital instead. If we get to make that decision before the birth, I want to go to a hospital I’m most comfortable with. (And if there’s an emergency transfer, just get me to the closest one!)

But I feel better about us at least being on the same page with what we’d like to work towards.

Sep
08

Seriously… 10 hours of sleep, and I only get up because my body can’t sleep any more, despite it’s desires to do so. I’m ok with being mostly unproductive during these weeks, but the wanting to sleep and not being able to is annoying. Of course, so is the complete and total lack of appetite, despite the distinct need (via nausea and fatigue) to do exactly that. So… Summary of the first trimester so far? Distinct internal conflict.

I’ve always been sensitive to smell, and this has just increased that – as expected. Jason finished the steps for the car yesterday (as in finish/waterproof), and the garage REEKS of finish. Like, I can get so far as opening the door before pulling it shut. VILE! I’m happy food hasn’t smelled that bad, but the thought of some textures (mayonnaise, for instance) – BLECH!

And, today I started the search for a provider. Make that, “today I started banging my head against a dumber-than-usual brick wall”. Ok, ok – I’ll grant you that I have high expectations, and I’ll grant you that they may not be reasonable. But it doesn’t seem to me too hard to fathom that I might want to meet a potential provider and determine whether or not I feel comfortable with their philosophic approach to pregnancy and birth – BEFORE becoming their patient.

In a normal world, you want a new doctor, and you don’t generally interview. References from friends and family (maybe the internet) is standard, but you generally do a trial-by-fire type of evaluation, and dump them in favor of a new doctor if you don’t like their service. Well… It’s a little harder when you have about seven months to evaluate them, and less and less chance of being *able* to safely switch providers the longer you evaluate them. Not to mention that this person may (or may not!) play a vital role in one of the most important moments of your life. I want to know the person before I agree to a service agreement (essentially).

But NONE of the OB’s I tried calling, and only some of the CNM’s (certified nurse midwives) attached to hospitals do meet & greets. Both birthing centers threw an hour long (free) appointment at me, encouraging me to get a feel for the place first, and even suggesting a couple of hospital-attending CNM’s if their facilities end up not being a good fit for Jason and I. I REALLY want to try to be impartial, particularly as I know Jason has a preference for a hospital (and we have a tour set up for the first of three hospitals we’re going to check out), but the service levels and approaches are making it hard to remain free of too much bias.

The thing is – I’m a female. No matter what else I’ve done in my life, my body was bred for this purpose – to grow and birth another person. It’s what the human race does; we fuck, we birth. I am not in some sort of precarious medical condition that needs to be mitigated every step of the way. This is the job my body was supposed to do, and while I may need support and observation going through the process, I do not need to be managed. I’m not sick – I’m just pregnant.

Sep
07

Zomg, it’s a “husband post”!

So, thus far- Tiffany is sleeping a lot.  We’re trying to get some cleaning and purging done to get prepared for the push to baby-safe the house and make a nursery materialize in here somewhere.  And we should set up the tripod somewhere so that we can start constructing the time-lapse photography!

I’ve found that, not surprisingly, I’ve fallen into the typical male pattern of prenatal care opinion, and the assumption that we should have an OB and give birth in a proper hospital, etc. – even though I’m totally open to the general concept of a midwife and the notion that a comforting and relaxing environment for the mother is really important.  What is surprising to me is that I’ve managed to cling to this faith in western medicine when it comes to obstetrics when I don’t have faith in them to manage most general health issues.  Don’t get me wrong, doctors have a good deal of value, but most of what I’ve encountered in the medical profession is diagnosis by flowchart and treatment by pharmaceuticals with annoying side-effects.  Still, the what-if’s of the whole process make me want to mitigate any potential problems.  It will be interesting to see how our hospital tours and midwife interviews and all of that go.

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