24 Week Prenatal Appointment (and Ultrasound!)

Well last Thursday we headed to the 24 week prenatal appointment. We were scheduled for another ultrasound, just because the tech wasn't able to find our son's kidneys, although she wasn't concerned because she could see that his bladder was full. It was really nice to get to see him again...and I think the tech liked it too, because I doubt she gets much opportunity to ultrasound older babies like ours, she was playing around and showing us different effects that the machine could do with colors of blood flow, etc. Pretty neat.

I got the feeling that we were spying on him - you know, almost like peeping toms - he had no idea we were watching him, yet we saw his every move while hidden away. It was neat to see him, but almost I felt we were watching too long to be respectful of his quiet space.

So after that I got weighed (6lb gain), gave a urine sample, and then Cora had to go potty, so I took her. The nurse waited, and when we were finished with the diapering/pottying we all went back to wait for Dr. F.

We didn't have to wait too long for the doctor, but while we did Cora and I played a game while she sat next to her daddy - I had her touch her nose, her toes, wiggle her arms, clap her hands, wiggle daddy's ears, touch daddy's elbow . . . and so on. She really enjoyed that game, and it was nice to see how responsive she can be when she wants to be!

I like having her along at the prenatal visits, because I think it's good to have her there so she can be more aware of what is going on. I just think it's going to take her by surprise when she all of a sudden has a little baby brother taking up mommy and daddy's time that I want her to be as informed beforehand as possible. However, she is so darn cute, she distracts the doctor! Instead of talking about baby and pregnancy stuff, he ooohs and aaaahs over our toddler, who is admittedly very adorable, but, well, let's focus!

I carefully described to the doctor about how I've been having a pain in my pubic area, and then began noticing the veins on my right leg all the way down were dark and purple and sore.....and he just kept nodding his head. The diagnosis? Varicose veins, and he blamed Cora! He said that the pregnancy symptoms like that just keep getting worse with each pregnancy, and while my veins were stressed the first time, they are actually becoming problematic now. It's not causing me real trouble, just annoying. Nothing really can be done about them, but I hope they go away after our son is born.

And then I asked him some questions about the birth. "How might this second delivery be different than the first time?" His answer was that typically, second time moms have shorter labors, and the pushing phase is much shorter, sometimes only 3 pushes and the baby is out. (I hope this is the case!)

My real reason for questioning him about this is because of my strong desire in labor and delivery that as long as my health and my baby’s health is good, it is EXTREMELY important to me that my body is allowed to labor on its own time. This means no artificial rupture of membranes (breaking the water) to accelerate or start labor, allowing me to begin pushing when I feel the urge, and allowing me to push as strongly or as gently as I feel necessary – no “coached” pushing.

So, I described what I remembered of Cora's birth, how I became fully dilated around 3pm, and the nurse suggested I begin pushing, although I had no sensation or urge to push, but I pushed anyway because she insisted. Cora was born at around 5pm, and I had a second degree tear. My gut tells me that had I waited to push until I had a strong urge to push, that I may not have torn as badly, or at all. Of that whole birth, the one dark spot about it was healing from that tear - it took WEEKS before I could comfortably sit, MONTHS after that it was still scary to even consider intimacy with my husband (thankfully, this did eventually resolve itself as I healed, but things were painful for a long time). Essentially, this time I want to try to do EVERYTHING I can do avoid tearing, and one of the main things I'm wanting is to be in control of the pushing phase as long as baby is doing well.

Dr. F couldn't remember if I'd had an epidural (can't blame him....how many babies does he deliver in a year?) so I reminded him that I had not, and actually hadn't had any drugs whatsoever. I fully intend to go this way again, since I think it is healthiest and safest for my baby. I asked him if the "urge to push" was something most women feel, and he honestly could not answer me, because he said that MOST of the women that birth with him have epidurals, so even if they had the urge to push, they wouldn't feel it anyway due to the epidural. Of course, he disagreed that my tear had anything to do with when or how hard I pushed (I didn't argue with him, but I just KNOW in my heart that it had an effect) but he did say he was fine with waiting to push until I felt ready. So, he agreed with me about letting me push when I want/how I want, but then got up, shook mine and my husband's hands, and left. (I think he was afraid of what else I would ask!)

So, I guess the conversation went well, in that he agreed to allow me to do pushing my way this time, but it bothers me that he is so unfamiliar with unmedicated birth. When our daughter was born, our nurse and the neonatal nurse both said that mine was the first unmedicated birth they had attended in nearly 30 years!!!!! But I am concerned that neither the OB's at that practice, nor the nurses in the hospital they work in have actual experience helping a laboring woman who is not medicated. I would feel much more confident if they were used to using other comfort measures beyond drugs in the IV, or an epidural in the spine. Our nurse with Cora was helpful and offered some suggestions, but I am quite concerned that the next nurse we get may not be quite so willing to help with an unmedicated birth.

Based on the severity of the pain involved in my tear, I truly do want to attempt everything possible to protect my perineum from further damage. Mother-led pushing, allowing labor to begin on it's own, warm compresses, baths, massage oil, perineal counter pressure applied by me as our son's head begins to emerge.....ANYTHING at all possible to minimize the damage to this very sensitive area. I wish so badly that I could go back to the first birth and employ all of these countermeasures - then at least I would know that I had tried everything I could to avoid tearing, and that it was just going to happen.

If you are pregnant for the first time, I would urge you to take your perineum seriously, and work with your care provider to protect yourself as much as possible from birth injuries. I believe that tearing is likely unavoidable in many cases, but yet there are still measures that can be taken to lessen the damage done.