Week 35 Midwife Appt

January 15, 2009 at 7:42 am (Baby Stuff) (, , , , , )

During my pregnancy, I have put on approximately 40 pounds.  This is about 10-15 lbs more than I hoped, although I’m not terribly concerned; I figure if I’d kept up the gym routine rather than dropping it sometime around November (whoops!) I’d be closer to my ‘ideal’ number.  Again, honestly, I don’t really care about the weight I put on so long as my baby comes out healthy and at a normal size, but it’s obviously on my mind nonetheless.

I had a midwife appointment yesterday, and when I weighed myself I showed as 6 lbs heavier than two weeks ago.  Thinking this had to be a mistake, I went and peed (trace protein in my urine, which has happened at about 75% of my appointments but isn’t a cause for concern unless accompanied by some other symptoms) — as if peeing is going to make me shed a few pounds?  Weighed myself after — still 6 extra lbs.  I know Maia didn’t grow that damned much, so I’m going to blame the fact that I’ve been eating Gardetto’s like they’re going out of style.  My mom sent me a case of twelve bags for my birthday, which is one of the best birthday presents ever, but I’m not doing very good at portioning them.

Anyhow, we met with Sarah today.  She always says I have a “neat” bump, which makes me smile.  When she was checking Maia’s position, though, she slid her hands around and said, “I think she’s kinda curled around with her back close to yours” — then somehow STUCK HER HANDS INTO MY STOMACH AND TOUCHED MY SPINE.  I mean, I didn’t see how she did it, but since it felt like that’s what she did, that’s my story and I’m sticking to it.  Then Maia flopped around as if just as disturbed as her mother, and continued flopping as Sarah tried to take her heartbeat.  I’m pretty sure this little girl has more attitude than her mommy and daddy combined already…

Then we learned about all the fun gynecological exams I’ve got coming up.  No, really.  Within my next appointment or two, I get to do vaginal and anal swabs of myself to see if I’m a carrier of some sort of bowel bacteria that is entirely harmless to adults (40% of women carry it, and the bacteria comes and goes so that’s why they check at the end of pregnancy rather than earlier) but can, if spread to the baby during the birth process, cause her to get sick.  Inconvenient type sick, not deadly type sick.  If I do carry it, I’ll be prescribed some anti-biotics to prevent that from happening.  But seriously, I get to swab my own butt.  That’s pretty special, and by “special” I mean “I deserve some hot chocolate afterwards”.

There’s also something they call a  “stretch and sweep” (aka a membrane sweep), which they routinely perform from 38 weeks onwards.  Sarah says it is not effective at inducing labour in and of itself unless your body is READY to give birth.  I feel like I need to ask more questions because I can’t remember why she said they do it, I just accepted it as part of their normal routine.  Also, I mean, it’s kinda cringe-worthy to think about how much a pap smear pisses me off and makes me uncomfortable for days, and I’m going to be welcoming someone’s goddamned FINGER caressing my cervix?  Sarah was giggling about how sometimes the cervix can be hard to find before the woman enters labour, because of how it is shaped and the position of the baby’s head, and I have to admit that the thought of lying there spread-eagled with a midwife’s fingers in my coochie trying to squiggle around the back of my baby’s head just to poke my cervix actually made me laugh.  I swear there’s something wrong with me.  Maybe it was the look on Chris’ face that was so hilarious.

After this appointment, we headed over to the hospital to register in their maternity ward.  We did let them know we’re planning a homebirth and that my OHIP doesn’t kick in until March 16th, but just in case we have to head to that hospital they’ve got all my relevant information about allergies / preferences / medical history and whatnot.  Something I found interesting is that for a “visitor” to the country, a hospital stay — not including any doctor’s fees, and who knew that a doctor charges separately from the hospital charge? — is $2500 a day.  For an “uninsured resident” (me), it’s $900 a day.  I just thought that it was really interesting (and cool) that, even though there’s only a 90 day window in which a resident is uninsured, there’s a special billing classification for us.

In other, semi-related news, I slept on the couch last night and slept through the entire night.  This is as opposed to sleeping in bed, where I wake up at least three times (and pee).  I really hate not sleeping next to my husband, but if crashing on the couch where my back is better supported (and I get lots of puppy love!) ends up helping me sleep through the night, I’m not going to argue with it.

My father-in-law is visiting today.  I don’t know what time and I don’t know if I’m cooking for us or if we’ll be going out to eat or what.  He is so much like Chris though — they’re both so laid-back about making plans, late anywhere they go, and not very organized at home — that I’m not terribly worried about either impressing or disappointing him.  Our apartment isn’t spotless?  Big deal, neither is his.

Chris mentioned today that he feels weird about being the only man at the birth (two midwives, my mom, his mom should all be there with us) and was like “I should invite my dad or brother to come.”  I’m pretty sure he was joking, but just to be sure, I let him know in no uncertain terms that such a thing is not happening. I love his dad and brother, but seriously, I don’t think that welcoming them into my labour and delivery is a step in our relationship that needs to be taken.  He was smirking the whole time though, so I’m pretty sure he’s aware of that.

Today is one month til my due date!  It’s crazy how the time has flown by.

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8 Comments

  1. Gala said,

    Sometimes don’t you just wish Chris was somewhere else??? I mean discussing your hemarhoids…anal swabs…Is nothing Sacred??? LOL
    Never heard of the membrane sweep, though it does sound like a good thing to try before induction.
    Sorry about the Gardetto’s…wonder if they make a “lite” variety??:)

  2. Ms. Core said,

    OK, lots of comments for you!

    First, off Strep B culture is no big thang! They barely even enter your anus with the swab. And neither are the cervical exams AND you can decline them before 40 weeks if you want. What difference does it really make? IF you go into labor, you go into labor, right?

    Second, not to sound like your momma but the last 6 pounds are likely water. And I am guessing the Gardetto’s are salty? I have noticed a huge difference when I watch my salt consumption in the swelling in my feet. Takes a few days for your body to adjust though so you might not see it at first if you change your diet.

    Lastly, stripping your membranes (or sweeping, or rimming) is NOTHING like a pap. What they are doing is separating your cervix from your aminiotic sac by forcing their finger in there. Not to scare you but is it not pleasant. It really can’t be done until you are dilated sufficiently for the midwife to get a finger in there which is what I think you mean by them not finding your cervix. Supposedly mechanical irritation of the cervix can start the prostagladin release which will start to help dilate the cervix.
    I have only found one study about it and it showed that when midwives did it after 38 weeks their patients were less likely to go past term and there were no harmful effects that they found in the study. I can send it your way if you want to see it. Anyway, hasnt worked for me yet…might have him do it again tomorrow though.

    Glad you found a sleep position that worked for you, it is so, so important to sleep at the end. Makes a world of difference in your attitude.

    That’s all for now!

  3. Maria said,

    Group B strep is no biggie. It does generally require an IV during labor. I had it with my second.

    Having your membranes stripped does NOT have to be routine. And if you end up GBS positive many midwives are against doing it in case it could shove that bacteria up into babyland. Do some research on the membrane sweeping thing, to some it counts as “intervention” and if you strongly desire to let Maia do her own thing you are completely allowed to ask that they refrain from doing it. (And if you are uncomfortable with pelvic exams you might want to forgo just based on your own comfort.)

  4. J.C said,

    All this stuff makes me cringe. None of that is routine over here – in fact the first time I had a midwife go anywhere near down there was when I was 4cms dilated, in heavy labour – then again at 7cm, then when they were convinced I wasn’t right that her head was right there ready to come out and it was…
    Glad the couch is working for you! Couches rock like that lol, good luck with everything.

  5. Gala said,

    Now that I have read more about the sweeping thing, I would tell them to back off! Let Maia come when she wants. I definantly wouldn’t let them do it until 40+weeks.

  6. ck said,

    When my first daughter was born her pediatrician didn’t do rounds at the hospital I delivered at, so the staff pediatrician checked her out. It turned out that while the our insurance told me that they covered the hospital, what they meant was that the covered the BUILDING not the DOCTORS. WTF? I had no idea they weren’t a packaged deal – I’d never spent time in a hospital before. You are so lucky to find that out before you give birth and not after. Finding that out one-month postpartum was awful. (Clearly I’m still bitter about it. Which is healthy…)

  7. Tatiana said,

    They do make a Gardetto’s Lite, but I mean… that’s kinda like eating fat-free cheese… it’s just not natural! I am going to go with Ms Core here and say it’s all water weight from eating too much salt 😉

    And yeah, the midwife did explain that GSB is no biggie, just something to pop some antibiotics for, but it still makes me laugh… NOTHING IS SACRED when you are bringing a life into this world I guess!

    I’ll ask more questions about the sweeping at my next appointment, but right now I do feel pretty okay with it. I’m sure it’ll be very uncomfortable 😦 and probably make me cry 😦 and I might be like “CHRIS THIS IS ONE OF THOSE THINGS YOU DO NOT WANT TO BE IN THE ROOM FOR”, but, if it’s something that may help me not go too far over term, I’m open to it… at this moment. I would like to see that report :] It’s not like she’s gonna do it and I’m gonna go into labour immediately, so far as I understand.

  8. Ms. Core said,

    You won’t cry, don’t worry. And Chris won’t actually see anything except maybe some bloody mucus afterwards. Have him hold your hand. Here is the abstract from the article I told you about:

    Obstet Gynecol. 1996 Jun;87(6):927-31. Stripping of membranes as a safe method to reduce prolonged pregnancies.Berghella V, Rogers RA, Lescale K. Department of Obstetrics and Gynecology, New York Downtown Hospital, New York, USA.

    OBJECTIVE: To evaluate weekly stripping of membranes at term to determine its safety and effectiveness in reducing the incidence of prolonged and postterm pregnancies. METHODS: One hundred forty-two pregnant women with certain gestational dates were randomly selected to receive, starting at 38 weeks, either weekly stripping of membranes (73 patients) or weekly gentle cervical examinations (69 patients). RESULTS: Women who received stripping had earlier delivery (8.2 versus 12.2 days; P < .005) and less incidence of delivery at 41 weeks or greater (three versus 13 patients; P < .01). The reduction remained consistent for favorable and unfavorable Bishop scores, and for nulliparas and multiparas. Only three subjects in the study delivered at 42 weeks or greater. No woman reported rupture of membranes after stripping. CONCLUSION: Stripping of membranes is a safe method to reduce the incidence of prolonged pregnancies and the length of term gestations. Larger trials on populations with a higher incidence of postterm pregnancies are needed to evaluate its efficacy in reducing the incidence of postterm pregnancies.

    Poking around a little more there more recent research that suggests that there is no effect but they started at 39 weeks and the good news is that there were no complications found. Here is the abstract:

    Gynecol Obstet Invest. 2006;62(1):41-4. Epub 2006 Mar 3. Effect of membrane sweeping at term pregnancy on duration of pregnancy and labor induction: a randomized trial. Kashanian M, Akbarian A, Baradaran H, Samiee MM. Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Tehran, Iran. maryamkashanian@yahoo.com

    AIM: To evaluate the efficacy of sweeping of fetal membranes for induction of labor in uncomplicated term pregnancies. METHODS: A randomized controlled trial was performed in 122 pregnant women beyond 39 weeks of gestation with no complications. The women were assigned to have their membranes swept or not (controls) for labor induction. The main outcome measures included duration of pregnancy and possible complications of sweeping of membranes, including rupture of membranes, postpartum infections, and vaginal bleeding. RESULTS: Twenty-one patients did not give birth in our hospital and were, therefore, excluded from the study; 101 women completed the study (51 patients in the control group and 50 women in the study group). There were no statistically significant differences in maternal age, parity, birth weight, and Bishop score in the two groups. The mean interval between sweeping (stripping) and vaginal examination until delivery was 7.7 +/- (SD) 6.9 and 7.1 +/- 5.6 days in the sweeping and in the control group, respectively (p = 0.61). Of the 101 pregnant women, only 6 patients had premature rupture of membranes (2 in the sweeping group and 4 in the control group). There were no statistically significant differences between these individuals (p = 0.68). Significant vaginal bleeding was not observed in the two groups. Meconium-stained amniotic fluid was seen in 13 women: 8 in the sweeping group and 5 in the control group. There were no statistically significant differences among the women who had meconium-stained fluid in case and control groups (p = 0.39). There were no differences between women who had puerperal fever (3 in the sweeping group and 2 in the control group; p = 0.68). 12 of the 101 women (6 in each group) had cesarean section performed, but there was no difference between the two groups. CONCLUSION: Sweeping of membranes at 39 weeks of gestation has no significant clinical effect on the duration of pregnancy. 2006 S. Karger AG, Basel

    Finally there is a study that is even more recent but I can’t find the original article to see if the study power was greater or when they actually did it (what week) but here is the URL that summarizes it (the link on the page to the original article is dead):

    http://birthing-options.suite101.com/article.cfm/stripping_membanes

    They found a slightly higher incidence of membrane rupture prior to labor onset but it doesn’t say when the membrane break occured after the procedure. So there may be some slight risk and it may do nothing. I would definitely hold off until at least week 38 when there is no doubt baby’s lungs are mature but after that I say go for it!

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