Anesthetist

The early morning appointment with the anesthetist passed without much to comment on, although Chris and I definitely agreed that when I asked him whether a student would be administering the spinal block on Monday, a disgusted look passed his face that said, “Do you know how many years of study I’ve had to do before I could even give someone an aspirin?”. What actually came out of his mouth was, “Maybe in a third world country!!!!”

This made me muse on how the different medical specialists have their different bedside manners. Here’s my experience to date:

Endocrinologists: supreme scientists that like to mutter under their breath when reviewing blood test results. Any questioning of their judgement is met by haughty snorting.

Obstetricians: wonderful, kind, patient people. When I’ve asked painfully naive questions of obstetricians (my most memorable one was when I asked Sue whether I would be sharing a room when in labour) they give gentle, forgiving, smiles of reassurance. They also like to joke around a lot. The obstetrician that performed my ECV said, “This isn’t a very scientific procedure, there’s lots of massaging and pushing,” to which I replied, “Yes, and thank god for that, because if it was more scientific it would probably involve needles or scalpels.”

Midwives: the ne plus ultra of caring down-to-earthness. Many of them are “earth mother” types, more than willing to cuddle you, pat you, and above all, be reassuring and calming. Many also have a hint of matter-of-fact sobriety, a sort of “I know this is new for you, but I’ve done five of these already today.”

Receptionists (not really medical specialists, but still…): devils in disguise. Be nothing but passive, compliant and apologetic around these people or they will make your lives hell. Their particular tendency is to have loud conversations that the entire waiting room can hear, complaining bitterly about how stupid the patients are.

I wonder if I’ll rack up any more specialities before the end of next week? Pediatricians? Lactation consultants?

 – Sarah

4 days to go…!

We had our weekly visit with the obstetrician today. The baby is still breech, and everything is set for our Monday c-section. She filled in quite a few details for us: I’ll probably be in hosptial for 5 days (which is longer than I thought), and she explained that I’d get to see, kiss and touch the baby right away, but I won’t be able to hold her, until after I’ve been sewn up (ewwwwww). The baby (and Chris) will be taken off to the labour ward soon after the birth to be weighed and for her health to be checked. After that we’ll all meet up in recovery, where I will be monitored, and then we go up to the postnatal ward. She got us to fill out some paperwork, and then we had to go to the pre-admissions department in the hospital. The only thing we don’t know is when the whole business is going to happen on Monday. We won’t find out until they compile the operating list, which will be available tomorrow afternoon. All I know is that I’m third in line.

Unfortunately, I have to go back to pre-admissions tomorrow at 8am to meet up with the anesthetist. I’d been hoping for a few appointment-free days (and more to the point, days when I wouldn’t have to while away the hours in a waiting room), but that doesn’t appear to be happening.

Mission: impossible

The ECV was unsucessful. But the good news is that it wasn’t painful or traumatic, and I know that both the doctor and I gave it our best shot.

The frustrating thing was that the obstetrician got the baby out of the pelvic cavity and turned about 90% of the way within the first 30 seconds of the procedure, but she just wouldn’t budge for the last bit. The obstetrician, a wonderful man with a very reassuring and kind manner, had prepped me that there are “babies that turn and babies that don’t”. I could tell that he thought I had “a turner”, because he gave it 4 attempts before giving it up.  He tried turning her 3 times clockwise, and once anticlockwise.

Was it painful? It’s really hard to explain what it was like, but I would say that it was more scary than painful. The whole hospital check-in procedure, where you’re waiting in a room with sick people being rushed through on beds with doctors shouting medical jargon, isn’t exactly calming. I was hooked up to a drip so that they could administer ventolin, a muscle relaxant, which made me shake and feel very jittery. There was a lot of pressure and pushing, and there were a couple of times when it felt genuinely painful (I think it was my kidneys). The worst thing about it was fighting my natural feelings of protectivity. I found that when someone is pushing on your stomach and you’re 9 months pregnant, it’s really hard not to punch them in the face, or at least yell “Back off!” I had Chris sitting next to me the whole time, stroking my head, and telling me to relax and breathe, which was wonderful. I also had an incredibly lovely midwife sitting next to me telling me when I was tensing up and to remind me to breathe slowly.

It was a very emotional experience getting so close, but not actually making it. Afterwards I felt absolutely sure that there wasn’t much else I could’ve done, and I felt sure that the doctor had tried his best. But it’s still disappointing knowing that a c-section has become almost inevitable. I understand that it’s not impossible that the baby might turn, but it’s a very slim possibility. I’m still continuing with the bells and the weird exercises, just in case. But most likely, our little girl is going to be born next Monday by c-section.

Titan

I’ve known for a while that the timestamp on my blog has been a little wonky, and I just found out the reason why: posts are being published by Greenwich Mean Time (and date). I’ve finally found the place to change the setting to my local time (Sydney), so hopefully that’ll make things a lot clearer.

I don’t have much in the way of updates other than to say that we got our car yesterday afternoon! We’ve Chris has got a few things to arrange, such as the insurance, fixing the wing mirror, parking permits, etc., but it feels fantastic to have this problem sorted out, especially before the baby comes. Our old car, Bessie, is getting picked up today by the salvage company. What’s our new car going to be named? That one came easily…. we’ve named her “Titan”.

Breech clinic

This is just a quick update to say that everything went well this morning at the hospital. I eventually got through on the phone to the department that handles breech presentations, and they said I had to be there by 9.15am. We got ready really quickly, zoomed off and arrived with plenty of time to spare. There was quite a bit of waiting around, but then I got to see a midwife who confirmed that baby is still definitely in breech position (all those crazy exercises and pelvic rocking I’ve been trying out in the last few days have not worked to turn her around). The midwife was a lovely woman, explained all the risks with the procedure, and said that part of their risk management strategy was giving me a full ultrasound. Because I didn’t have an ultrasound booked (I didn’t know I needed to book separately), she personally took me down to the ultrasound area and strong-armed them into scanning me right there and then (even though there were other patients waiting). The ultrasound seemed to go really well. The baby is approximately 3.8 kilos in size, which isn’t too big for the ECV. Also, everything is in proportion (she doesn’t have an excessively large head or anything), which also increases our chances of a sucessful procedure.  There’s still a good amount of amiotic fluid, also, and the placenta is nice and high (low is bad). In terms of position, she had one leg folded up, and one leg curled down. It’s hard to visualise such gymnastics, apparently our girl is “bendy”. They call this a “partial frank/complete breech”. The midwife told me that I have a 30-40% chance of success tomorrow, given this information.

Tomorrow I’m to arrive at the hospital about midday. The whole thing is going to take 3-4 hours, but the actual procedure will only be 5-10 minutes. They will give me a drip for administering a muscle relaxant, and they will be doing an ECG/cardiac monitoring of both me and the baby. If I don’t feel comfortable at any time, they’ll stop the procedure. Anyway, I feel excited about all of this – hopefully there’ll be a good outcome. If there isn’t, then I know I’ve done everything I can.

Some good news!

We have a car! Our car broker brought around an absolutely fantastic car on Friday, which we test drove and immediately fell in love with. It’s a 2000 Mitsubishi Verada, which is a much larger car than we thought we would end up with (it’s a 3.5 litre engine!) We fell in love with what a nice, comfortable car it is to drive, the safety features, and the price. Here’s a picture of a similar one that I found on an auto web site (ours is dark blue, like the one in the picture). I was a bit dazzled by the powerful car stereo (with steering wheel controls), the digital climate control that keeps the temperature specified (most cars I’ve seen in Australia have a dial for Cold and Hot, not a digital input that acclimatises when you have windows or doors open), the electronic seat positioning system, the ABS breaks, airbags galore, etc, etc. The truth is, we’re buying the car because it’s available at a price that’s too good to be true. Our broker got it from a wholesaler who would’ve sold it to a dealer who would have detailed it and fixed the wing mirror (the only thing that needs fixing) and probably would’ve put it on the market for $14,000. We got it for $8,250. I think that for us, it’s a bit unreal. Driving this car makes us feel like flying first class: we’re not worthy of such luxury. I mean, we have been driving a 1985 Subaru with a saggy headliner and a glove box that won’t close! We don’t actually have the car yet; Chris will probably pick it up on Monday, depending on what happens with the hospital appointments. I’m so excited!!!

Finding out about the car has been really nice, and has helped to counterbalance all the other worries about the breech birth. The latest update is that on Friday morning the obstetrician who is going to perform the ECV (turning of the baby) called to say that he’d booked me in for a Tuesday early afternoon appointment. He then told me that I should also come to the hospital for a “breech clinic” on Monday, where they’d talk to me about breech presentations, I’d sign the consent forms, and then they’d give me an ultrasound to determine the position and size of the baby, and the amount of amniotic fluid (these can all be factors in determining likely successful outcome of the ECV and also why there’s a breech in the first place). He told me that I had to phone to book in for the breech clinic (can you tell that I’m brewing up another story here?). Well for the rest of Friday I called the phone numbers he gave me every half an hour, left countless messages that were never returned, and yet not getting hold of a human being. It was so utterly frustrating. What am I supposed to do??? I’m really hoping that someone will be there on Monday morning to tell me when & where I should go.

In other news, I talked to my doula on the phone yesterday and told her about the breech birth. I have some mixed feelings about her reactions. She told me that there was a lot I could do to encourage the baby to turn, and gave me lots of good advice, some of which sounds very dubious, like wearing bells in my knickers (the theory being that the baby will move towards the bells). I was, however, a little upset that she said that the ECV was invasive and should be avoided if possible. I realise that she has a very anti-interventionist philosophy, but I feel very reassured that the procedure is not invasive as she has put it. My obstetrician gave me this booklet with all the evidence supporting the procedure, and clearly outlined the risks. The main risk is going into labour, which would mean an emergency cesarean. But this risk is not all that high, because you have a baby monitor on you during the procedure so that they can monitor the baby’s heart beat. If there’s any distress at all, they stop. (If you want to know more about the ECV here’s a good summary). My big problem with what she said is that I don’t really want to hear anything right now that suggests I’m doing something dangerous to the baby. I have plenty of anxiety and worries without feeling a lot of guilt and insecurity about what to do.

She also told me that that baby might be breech because I’m feeling overprotective towards her, that I need to “let go” and let her move into position. This sounds like classic new age “blame the victim” mumbo jumbo, of the sort that has cancer patients being told that they somehow caused their disease. It’s true, the baby and I did go through a trauma when we had the car accident, but I don’t want to hear that I might be perpetuating that trauma. I can confidently say that doing my best to be positive and proactive and do what I can to get me and the baby out of this situation safely.

Some of you might be wondering whether I might be better off without her, considering how I feel. I’ve definitely thought about this, but still feel pretty clear about what I need her for. I would still really like her support if the baby turns and I go into labour. I think that she has an important role in the labour for keeping me positive and encouraged. So I’m going to continue for now, but I’m also going to try to be clear when she’s saying things that upset me.

Some disappointing news

We had our weekly obstetrician’s appointment yesterday. Unfortunately, the baby is definitely in breech position (head up, bottom down). We don’t know when it happened, but since the Emergency Room doctor picked it up, and the week before the baby’s head was engaged and down, it was around the time of the accident. This basically means that my chance of having a cesarean has dramatically increased, which is hugely disappointing. I’m going into hospital in the next week (probably next Wednesday) have a procedure called an External Cephalic Version (ECV), which is where they try to turn the baby to a head-down position by manually applying external pressure to my abdomen. It’s my best shot at this stage to have a natural birth. But the chances aren’t incredibly high – Dr Jacobs gave me a pamphlet explaining that ECV has about a 40% success rate, but she privately told me that my chances are probably smaller than that. The baby’s position is really unusual: she has her legs apart and splayed from one side of my abdomen to the other. If she was tightly curled up she would be in a better turning position.

If the ECV doesn’t work? For me, almost certainly a cesarean. In fact, they’ve booked me in for one around my due date. The same booklet she gave me explained that approximately 7% of breech babies born by vaginal breech delivery died or had a serious illness (e.g. Cerebral Palsy). My situation is even more complicated by the position of the baby and by the fact that this is my first birth. In a way, knowing these statistics has made me feel a bit better. This whole thing isn’t a sport, it’s about me and the baby coming out of it safely.

Nevertheless, it’s hugely disappointing that this has happened. It’s also frustrating that the labour ward and antenatal midwives didn’t pick it up (in fact they assured me that the baby was head down) because if I’d known earlier I would’ve had a better chance of the ECV working. The later in the pregnancy you have it, the less chance of success you have. But I can’t think about that, there’s no point stressing about last week, I just have to focus on the next big thing. 

An update

First of all, thanks everyone for your support over the last few days. It’s certainly been a challenging time, but I’m happy to report that the last few days have been a lot better. On Friday we picked up a rental car for a week. The insurance company says that they’ll pay for part of the rental, but either way, it’s been really great having a car to get around and do things, like go to the supermarket. Also on Friday we got in touch with the car broker who bought our first car. He understood our situation really well and said that he would spend the next few days looking hard for a new car. It’s so great using someone like this – we haven’t got the faintest idea of what makes a good car, and aren’t particularly savvy when it comes to dealing with car people. Whereas he’s an mechanic, knows the market really well, and is really great at haggling with car dealers to get a good price. He said that he would be in touch within a couple of days.

Also, I drove to the supermarket yesterday, which very much felt like I was getting back on the horse. Or staring down the bull. Or whatever metaphor you like to mean “doing something very scary”. I had decided it was necessary to do this because I didn’t want it to become a huge mental block. I also didn’t want the first time I drove again to be when we have the baby in the back seat. Basically, the journey was was fine. The world has become a lot more chaotic and unpredictable since last Wednesday. I have to admit to driving like a granny, being very cautious, and being very tentative at intersections. I kept expecting cars to come flying out of nowhere. But nothing untoward happened, and it was really reassuring to have it go so well.

As for the progress of the pregnancy, things have been fine. The baby has been squirming a lot. Last night when we were watching TV she got the hiccups really badly. Chris had tears in his eyes as he felt them through my belly. Last night painful braxton hicks contractions woke me up several times. I did have the fleeting thought that maybe labour was coming on, but nothing happened, and I went back to sleep. So who knows? Maybe it’ll be a few days or a few weeks?

Car accident

As if we don’t have enough drama in our lives, on Wednesday evening we got into a car accident. Fortunately I am writing this post from the safety and comfort of home, so you can be reassured that I am okay, so is the baby, and so is Chris. But I did have to spend Tuesday night in the hospital, our car has been written off/need to buy a new one, and we’ve got a lot of financial hassles!

It all started yesterday when I picked Chris up after work. I was driving along in rush hour traffic, and suddenly another car pulled out from a side street. I could see the back of the woman’s head and she was not looking in my direction, so I squeezed on the breaks, and she plowed into the front left hand passenger side of the car. Our car was pushed sideways, but did not swing around. The next few moments were a bit of a blur, but the other driver and Chris drove our cars into a nearby parking lot, by which stage the police and ambulance had arrived. I was feeling very shaken up, but thought that I was perfectly fine. But I felt a lot of tightness in my low abdomen, and was worried about the baby. Because the obstetrician had told me about the head being down, I was worried that the seat belt might have hurt her after we got pushed sideways.

The ambulance got to the emergency ward and told me their protocol is to treat the mother first, then the baby. They took blood, ran some tests, got me into a hospital gown, and were fortunately able to say that they baby appeared to be doing well and that I was fine. They got out the ultrasound machine to check the baby, but the emergency room doctor was pretty inept. He kept saying, “I don’t know what I’m doing here” and couldn’t find the heart beat. I was actually relieved that he told me he didn’t know what he was doing, otherwise I would’ve been freaked out! The most disturbing thing is that he thought the baby had moved around head up (i.e. into breech position), which would’ve meant the baby had been really traumatised.

They then transferred me to the Labour Ward where the midwife had a feel around and said, “That’s not a head, that’s a big squishy bottom!” The baby hadn’t moved around! What a huge relief! She also told me that the head was “way down in the pelvis”. They also performed more complete foetal monitoring: they used two external belts strapped around my middle, one to measure the baby’s moves, one to measure mine. They took more blood, and called my obstetrician about what she wanted them to do next (I might’ve been able to go home, or she might’ve asked to keep me there for more testing). My ob wanted me to stay overnight for further monitoring, so they moved me up to the antenatal ward.

Now I have to say that despite the fact that everyone in the hospital was incredibly reassuring and lovely and nice to me, it was a huge disappointment to have to stay there. Hospitals are alienating, scary places. I had a really nice room to myself, but I didn’t have anything with me other than the clothes I was wearing that day. The bed was hard, there were weird beeping noises all night, and there was a lot of light in my room from the lights on in the hallway. Chris found a nearby newsagent to buy me the newspaper and some trashy gossip magazines to take my mind off everything, and he left to deal with the car. By this stage is was 10.30pm or so anyway.

I didn’t sleep much. The baby moved around, but I also had these new, stronger, more painful braxton hicks contractions that I’d never felt before. It was scary: I didn’t know what to do, I was worried that I was going into labour by myself, and every time I closed my eyes I kept hearing the screech of tires and the thud of the impact. The midwife came to check on me in the morning and I told her about the contractions, and she was really lovely. She reassured me that if I was going into labour I’d be fine (I’m now over the 37 week mark, so full term, and as she put it, “I’d only be missing out on a few more stretch marks”.) From my limited experience, health professionals in hospitals are really wonderful, caring people who are really good at being reassuring, matter-of-fact, and down to earth. Chris arrived at 7.30am to find me having a cup of tea and eating the worst breakfast I’d had in a long time. Hey, I wasn’t expecting much, but then I got the microwaved english muffin.

More waiting around ensued, punctuated by more checking and monitoring. Finally the midwife said that they were waiting around for some final bloodtest results, which wouldn’t be getting there until 2pm. At that point, I’m unashamed to say that I begged to be allowed to go home. She called my obstetrician, who agreed to let me go, and the midwife explained that if the blood tests were irregular they’d re-admit me. Fortunately, that hasn’t happened, so it’s all good!

It was great to be home, but we had a lot of hassles in the afternoon. Chris spent all afternoon on the phone with the insurance company, the tow-truck drivers, the mechanics and the police. I’ll save writing a lengthy narrative about it but will explain where we’re at. Our car has been “written off’” by the mechanic (which means that it would cost more to fix than the cost of the car), but the insurance company will not pay out until they assess it themselves, which will happen next week. The car is outside our apartment building currently. We’ve had to pay the tow company about $500 for the tow charges, some of which we may be able to get back from the insurance. We’ll probably get a pittance for the car – probably less than $1000 because of its age (1985 subaru). So now we have no car, and needing to get a new one urgently, and with very little money to buy one. We’ve decided to borrow money off family (thanks family!) to get a new car, because it’s unimaginable trying to get by without a car with the new baby.

Anyway, it’s all bad timing, it’s stressful worrying about money, how I’m going to get around when so heavily pregnant, the logistics of getting to the hospital when I go into labour, but I’m fully aware that it could be a lot worse. I’m hugely relieved that we’re all safe.

Preparations…

Chris and I had a fairly busy weekend, with lots of catching up with friends. We had a fabulous brunch with Tom, Michelle and Beth at our favourite Sydney cafe (Cafe Sopra) on Saturday. On Sunday we went to a brunch at Fran and Mike’s house, then met up with Raewyn and Jen at the art gallery and caught a movie in the auditorium (Miyasaki’s “My Neighbour Totoro”), then Raewyn came home with us for tea. What with all the favorite cafes and catching up with old friends, it seems like we’re living as people who are about to be deprived of their liberty! I keep thinking, “Is this the last time I’ll see X before the baby comes?” and “Is this the last movie I’m going to see on the big screen for the next X months?”

I guess it’s all part of “pre-baby” mental preparation. We’ve also been preparing in other ways. Tomorrow we’re going to Ikea to buy a change table, which is the last of the essential items we need for the baby. My nesting instinct has also been in overdrive, and I’ve been doing lots of things, like, cleaning the freezer out, sorting out and relabeling everything in the bathroom cabinets. (Don’t worry, I’ve surprised myself!)

One exciting thing to report: our medical insurance kicked in on March 11th (yesterday), which is a relief. It means that we’re now covered for hospital charges associated with the labour. It’s a complicated situation: even though I’m giving birth in a public hospital there are still substantial out-of-pocket charges for accommodation and theatre fees, partly due to the fact that I have my own obstetrician, so are technically a private patient in a public hospital. If you want to know more about public/private health care in Australia, I applaud your tenacity.