19-2-2009 - My first pregnancy: 34 weeks till birth

My mood while writing this blog: happy

The first 34 weeks can be read in another blog entry.....

• 34 weeks 5 days - Had an appointment with the obstetrician today! He said that he will let me go all the way to 40 weeks because my glucose numbers have been excellent and my baby is perfectly sized for gestation. He reached that conclusion by palpating my abdomen and feeling the bubs size and position of head. Bub is in the Right Occipit Posterier (ROP) position at the moment , facing my left hip. He said that bub's head was at 3/5th's above the brim. See diagram above for explanations. Which means that if bubs head is 5 fingers wide from jaw line to top of head, three finger widths of the head is still above my symphysis pubis, and two have already dropped into my pelvis - referred to as relation to brim. Once bubs head gets to only 2/5th's above it means the head is fully engaged in the pelvis, and 0/5th's above means none of the head is above the pelvic brim and can be palpated because babies head is actually coming out. Measuring fifths is more accurate than internal exams because they can show the babies head moulding - and this is a distortion of the skull length when the pelvis is tight and there will be trouble fitting it through, so sometimes practitioners can mistake skull moulding for further progress if they don't measure the fifths as above the pelvic brim as well. As well as moulding, another issue can be that bubs head protrudes above the mothers pubis symphysis instead of sitting flush. This can also indicate Cephalic disproportion or CPD of the head can spell trouble. So at 3/5th's above the brim I am not far from being fully engaged which explains the pressure and frequent urination, stabbing sensations and constant braxton hicks. My cervix still needs to shorten another centimetre to really get things going, to below at least 2 cm's to ensure success with induction methods. This shortening should happen in the coming weeks. He also recommended lots of sex to try to go on my own and avoid an induction. Hubby will be very happy with that recommendation! That is what got me into this mess, but I guess it is good to try rather than wait for the synthetic prostoglandin gels made from animal semen! I will also try walking as I think gravity is what has been bringing on more intense braxton hicks contractions and discomfort, so I assume these are helping to move it all downwards. Not sure about all the others measures I've read. Nipple stimulation doesn't really appeal to me, and evening primrose oil, castor oil, black and blue cohosh, and red raspberry leaves seem a bit short of empirical evidence, but that doesn't mean they don't work! There is also discussion about spicy food and consuming lots of pineapple both of which I like, but doing the later hard when you are monitoring blood glucose and eating low GI. The obstetrician assured me that he will measure me against the 'Bishop Score' before deciding to induce or not so that is great news! Today's CTG was normal with bub having a good baseline rate between 120 and 140 bpm, nice variability and some accelerations. One contraction was picked up in the CTG of moderate strength. The midwife noted on the printout that I had a small amount of pain when that happened. I asked what level real labour contractions get to in this test, and she said 100 and 120. Mine got to 80, so I'm on my way to feeling what it might be like. (Only with a lot more pain when the real ones occur). (I'm not sure of the units of measurements for uterine contractions, will find out.) My hubby is so excited now, reading my pregnancy books and checking with me to see that I know things. He is so cute! And I feel like a kid in junior school counting down the days to Christmas or my first ever overseas trip, except the anticipation is ten times greater than those events! I am probably more obsessed about this special event as I was about our wedding! We are starting to improve our home and get the room ready for bub as well. All on track!
• 35 weeks 2 days - Today I researched the use of a Partograph in labour. It is fascinating. It records how the mothers cervix is dilating, how the babies head is descending through her pelvis, details of her contractions and times. The World Health Organisation (WHO) has set the transition from 'Latent/Early labor phase' to the 'Active labour phase' when the cervix is dilated to 4cm. This means that once the cervix is there, it is presumed that in real labour 90% of mothers cervixes will dilate at a rate of 1cm an hour and they wont cross the Alert line. Ten percent cross the Alert line which tells practioners when to be especially careful about their decisions. If nothing more happens after another 4 hours then they cross the Action line. This line tells practioners they must intervene and do something. Only 3 out of 100 mothers don't progress enough in labour and cross the action line. Action normally means an oxytocin drip or emergency caeserean. Studies show that about 30% of primigravidas cross the Alert line and only 10% of multiprimas cross it.
• 36 weeks 1 day - Another ultrasound today and they estimated bub to be at 6 lbs 3 Oz (2874 grams), which puts bubs about a week ahead for average weight estimates which has been the same since week 19 and the amniotic fluid index (AFI) was at 12cm which is still fine. I'm sorry to say that I don't have much faith in these ultrasounds as today's technician measured our bubs head at the size they said it was 3 weeks ago! So either these ultrasounds are frought with error or my babies head is going down like a balloon! Last week the obstetrician said bubba was perfect size on palpation, and told me not to worry too much about the ultrasound stats. Since he has been delivering babies for over 35 years in our town I trust his expertise. I am over all of the visits to the hospital, I just can't wait for the big day. Still don't know how long they will let me go - definately not longer than 40 weeks but it would be so nice to have a date! I wanted to go as close to 40 weeks as possible for bub, but I don't know If I can bare it! Will find out next Wednesday if I can have an induction date booked. Pelvic pain is unbearable at times. I can't lift my legs to put my underpants on as there is too much groin pain - Symphisis Pubis disorder (SPD) I believe. I also the occasional nerve pain shooting through the buttocks - I think that is the pressure on my sacrum illiac joint. It feels like my ovaries are being squashed and the Braxton Hicks are ridiculous at times. I have had about 30 in three hours tonight. And I keep getting this tender / swollen / irritated sensation coming from the cervix/bladder area which I think is from the constant direct pressure. On apositive note I have had no rib pain or high kicking, or breathlessness, indigestion or heartburn which are common at this stage, so perhaps my bub has just been low the whole time. My cervix is shortening/effacing very slowly - they look at it in the ultrasounds, and I have so far gone from 49mm at 19 weeks to 36mm at 34 weeks, to 30mm today - so it's on the move at least! It also looked like it was funneling slightly at bubs end by about 1cm, so thats a start. But pretty closed still. I am maintaining my blood sugars on a low dose of insulin, but couldn't do that without the insulin. I pray that this GD goes when bub arrives! Injecting 4 times a day and monitoring sugars for 7 times a day is starting to wear pretty thin on me! I am so ready now. Better pack my bags tommorrow. The countdown is on!
• 36 weeks 3 days - bubba is very responsive to my night time sleeping position and keeps turning from side to side with me so that gravity puts bubs spine closer to the bed because of its shape and weight. I can tell where bubs spine is because of the firmness and the hiccups that keep switching each day from my left to right lower belly. Must be making his or herself dizzy in there switching from side to side. Hopefully bub is not doing some full circle work or that cord is going to be around that little neck! Bubba is in the cephalic (head down) position, but alternates between LOP and ROP (left or right occiput posterier) . The occiput is the bony part at the back of the skull, and in labour this should turn to face my pube so that bub is delivered in the anterior position facing my perineum. Posterier labours (face up) are very difficult and take a lot longer because bub has to work the anterior turn into he whole process, or if bub cant turn anterier the diameter of the head being stretched back is greater as it tries to move through the pelvis.. So I have started looking at Optimal fetal positioning (OFP) techniques to get this little blighter to turn face down. I also read that it is easier for them to turn anterior ( face down) from the LOP (facing my right hip, than ROP facing my left hip, must be the shape of my organs that restrict the right side. So some OFP techiques I am trying are sitting forward rather than slouching on the sofa, sitting with good posture with knees below the pelvis, sitting backwards on a dining room chair and leaning into the back of the chair with legs lowered, swivelling my hips on my fit ball, really anything that encourages bubs spine to fall in the curvature of my hanging belly. So we'll see what position eventuates in the coming weeks. It really makes a difference though, I can get bub to the LOP position if I sleep the whole night on my left side. Now just have to get bub into the anterior position and hay presto well be ready to descend through that pelvis. Mild swelling in my ankles and increasing blood pressure means more frequent visits now.
• 36 weeks 7 days - I was negative for Group B Strep, and still don't have any positive antibodies in my blood. - Yippee! Finally some good news. Maybe that means my bub has the same negative blood type as me. Or perhaps it is just that there has not been any exchange between us yet, so no doubt I'll get another preventative Rhogam injection at birth. My bub is at -2 station so nearly engaged, The obstetrician said that he thought it was on the final descent now! So no more bouncing! Bubba is facing sideways (laterally) (ROL - Right Occiput Lateral) which isn't far from the final turn to anterior (ROA - face down) to get the right part/diametre of the skull through that pelvis! My bub turns from side to side each day. Bub can't make up its mind which way to make the final journey. And it could still all change to a difficult birthing postion, but looking good at this stage. I found an awesome study last night that has some correlatation between bub's presentation (into the pelvis) left or right with whether a baby will be left or right handed. Bubbas that like to lay LOL or LOP (head down with their spines facing mums left hip are more likely to have preference for using the right hand at 19 weeks of age, and bubbas that are ROL or ROP were more likely to be lefties at 19 weeks of age. Interestingly in this study more girls laid LOP/LOL and more boys laid ROP/ROL. I wonder if my bub will be a lefty or righty? I went to pick up the car baby capsule today. Tommorrow I am finally going to pack that hospital bag. I have been procrastinating on this for a while, and to make matters worse we are half way through painting the nursery and our master bedroom. If it happened now the house would be a mess. So I'm eagerly waiting for that supposed nesting instinct to kick in.
• 37 weeks 1 day - Reading the 'you are considered full - term now' on the 37 weeks page are such sweet words. I thought this time would never arrive. Been checking the site weekly and sometimes daily since week 7! I have insulin dependant GD, and had it drummed into me that I was high risk and would be induced at 38 weeks. I had a little bit of grief, saying goodbye to the natural minimally intervened pregnancy and birth I wanted. For a lot of my profession I have spent long periods leading people in the bush with minimal equipment, living really simply, studying Australian indigenous ways of living. Very free, Just living the experience. Always thought I never needed much help with things. Never went to the doctors, been pretty healthy. But since 26 weeks I've been to hospital nearly 3 times a week for this and that. Diet control, blood glucose monitoring 7 times a day, injecting insulin 4 times a day, tests, ultrasounds, recording a food diary, palpations for fetal growth, NST's/CTG's, unterine contractions strength, fetal heart rates, urine analysis everyday for presence of glucose, ketones and protein, swabs, blood tests. All very scientific, measured quantified and ordered. It has run my life. This fed a need in me to research 'the science' of pregnancy and birth. It has been fascinating. But I can't help feeling like it has all been taken out of my hands. So a week from the 'medically necessary' induction date at 38 weeks, they say everything is great and you'll be going to at least 40 weeks. And I'm a little dissapointed for me but happy for bub. We are blessed to have the medical knowledge and facilities we have in Western modern times. But I do wish I was in control of my pregnancy and my body. I feel like I have lost touch with something that should be so natural - lost confidence with my role in the the whole process. Wish that baby would decide what the right time was, and go to that point whether that is 38 or 42 weeks.. Will I know what to do in labour based on how I feel? Or will I have doctors, tests, and drugs making me do it? Will I have the science of it playing over and over in my mind? Have the knowledge and fear interfering with the natural hormone production that should be working for me? I am already thinking about how I'd like my second pregnancy to be. Data and test free and relaxed at home! Knoweldge is powerful, but it also takes so much away from the actual experience of just being able to feel ones way through pregnancy and birth as women all over the world still do in countries that dont have access to medical care - giving birth under a tree in a field, in a dimly lit hut,. My friends think I am crazy for feeling like this. A little philosophical today, I know.
• 37 weeks 5 days - Had a doctors appointment this morning and monitoring. The CTG, BP, and urine are all normal and swelling in ankles is gone too!. Today's doctor was great. She said we better get a move on as I'm almost 38 weeks. This has contradicted information from my last two appointments. So on Thursday after my ultrasound appointment I will have my first review and assessment which includes a vaginal exam and an induction will be booked pending these results for either next week or earlier (over the weekend) if there are any issues. Hubby and I are so relieved to finally have some notice either way about something happening. Looks like bub might just make it to nearly 39 weeks! I wonder what bubs weight estimate will be on Thursday? I wonder what the induction path will be like? Prostin gel? Ruptured membranes? Syntocin (Oxytocin) drip? A strange calm has come over me with this news, as I sit in my messy house with so much still to do. We almost have finished the nursery, except last night the light fitting fell from the ceiling so now we need an electrician - as if to say - no you are not ready yet. It would be really funny if I went into labour on my own before the induction! Either way it is going to happen! , Hospital bags check, birth plan check, baby names list check, people notification list check, list on what to do as a parent after the birth - no idea about that one. Better start shifting my mindset from pregnant lady to mother and parent.
• 38 weeks - 1 day - Intense frontal contractions this morning and a desire for frequent bowel movements! The pain is like intense stitches right across the front of my lower belly and was difficult to seperate them as the belly remained as tight as a bowling ball for pretty much the whole time. I estimated the break between them at about 4 minutes. Could be more serious Braxtons, or early labour. Pretty painful - so I wonder what real labour will be like for me. These lasted all together for 4 hours. How exciting! Hubby and I went and had our 38 week ultrasound and the news was fantastic - growth measurements are all normal which is a relief for a GD mum! Currently estimated at 3283 grams (or 7 lbs 3 oz, and growth pattern has been about 200 grams a fortnight for the last month, so the final fortnight should see an additional 200 grams at 40 weeks, making bub - drum roll please......................... about 3662 grams at birth or 8 lbs 1 oz. Of course - these estimates can be out by as much as one and a half pounds or between 6.5lbs and 9.5lbs - what a frightening variance) So I won't know until I push bub out what the end product is. I do feel though, that if my GD had no been picked up and managed with diet and insulin that I could be having a much bigger baby! My dad was nearly eleven pounds so big babies are in my genes on one side. Bubba is currently in the LOL position (left occiput lateral position - facing my right hip) and this is the most common presentation in the final stages of pregnancy. The umbilcal cord looks like it is fully around the neck - the ultrasound today showed the cord blood flow pulsating around bub's neck, but it was dfifficult to see if it had looped or whether it just circled once. There is no point getting alarmed about this as there is nothing that can be done except monitoring and that shows no fetal stress. Today's CTG showed some awesome contractions at full strength coming at every 5-6 minutes. But I had no pain with these compared to this mornings ones. Bubba's heart rate was at about 135bpm, a nice baseline with good variability after I drank some chilled water. The heart rate increased a minute or two before each contraction - as though bubba can sense before they happen. My awesome midwife and resident had spoken to my obstetrician and hospital registrar, and they will let me plod along for another two weeks, happy with my management of the GD and insulin. The plan keep changing! So I get to see if my body does the work before a scheduled induction near my due date. My mother is coming from the other side of Australia this weekend - a little early, but no doubt she will get me moving until I go into labour in the deli section of our local supermarket! Better carry that jar of pickles in my bag to drop - just in case the waters break in public! A little more nesting time for me. Everything is looking great!

• Hubby admiring our handywork in our nursery

  Can't believe we finished before bub arrived!

• Later the same night - Ha ha - It's night time here in Southern Australia at the bottom of the world and my painful contractions from this morning are back. Estimated at between 10 to 5 minutes apart, but my uterus is so tight and sore it is hard to time the length of each. I know when they start but don't know when they end! It's been happening for over 3 hours. Hope this is actually doing something and doesn't go on for weeks. Pretty painful! I'm like Charlie in the Chocolate Factory searchng for that golden ticket, every time I take a wee. Will there be something?????? No mucus plug or discharge for me yet. (if before labour at all) Bring it on I say - want to beat that induction date on the 11th March, which is also my wedding anniversary!
• At right: Finally finished our nursery!! Phewwwww!!
• 38 weeks 5 days - an ouch ouch ouch vaginal exam including a cervix stretch, OMG. Torture torture torture!!!!! I nearly hit the roof of the office. There must be a better way than this! If I can't handle the pain of this what on earth is labour going to be like? If this doesn't get things moving - then induction is scheduled to started Monday afternoon, 3 days short of 40 weeks not bad fora GD mum. This might mean a wedding anniversay baby. How funny is that! Hopefully my hubby will now never have a reason to forget our wedding anniversary. The doc said cervix was soft, but still at 3cm long and not dilated. A good place to be for a first timer, and induction likely to be successful. Imagine if bub came before it? That would be super. Swelling in legs and ankles is hideous! Will I ever be able to fit into my shoes again?
• 38 weeks 6 days - I saw the 'blob of snot' today! 24 hours after the cervix stretch! Slightly brownish, small tiinge of pink and then clear. I heard that it can be clear, yellow, orange, pink, brown or green! Hardly the colours of the rainbow! Could be the plug or part of it. How exciting. Minor cramps again in lower abdomen, severe braxton hicks at night that tell me the bladder needs emptying. Bowel movements more frequent. Swelling is up again - today it is in the hands for the first time. Seeing all of the babies being born to women on ths site that I have shared the journey with since week 7 when I joined is quite surreal. Soon I will be looking at my own little cherub!
• 39 weeks - More of the 'blob of snot' today! Mmmmmmm, just delightful! Never been so excited to see this kind of stuff in my undies! No cramps today, just continued Braxtons that have become such a part of my day and night that I might actually miss them when it is all over! Wish my abdominal muscles could flex like that! Had a few of those terrible stab stab nerve pains in the cervix area too! Another appointment in the morning for fetal monitoring - and induction to commence on Monday in less than 4 days!! So So excited!!!. My mum is here now, and of course we cannot stop talking about everything pregnancy, birth and baby related! Tonight she tried the old wives tale with the needle and thread dangling over my tummy. Three times it spun in circles indicating a girl. She did it on hubby and it did not spin around or rock from side to side. Fascinating! I don't believe in those tales but that was quite freaky!
• 39 weeks 4 days - dear friends, our little love, Avery Joseph came into our world at 1.09am on Tuesday the 11th of March - our wedding anniversay, gd insulin mum bub weighed 7.14lb (3240grams), 3 days short of 40 weeks! Went in as first timer for the prostin gel with an almost closed cervix still at 2cm long/effaced, thinking it would take a day or two, had the gel, sent hubby home for the night and within two hours was on a painful contractions roll that would send me to the floor to cope and I had him 3 hours later. So from 1cm to 10cm in 3 hours, hubby missed the first 2 hours of active labour at home, then when he arrived I had 1 hour of intense pressure and pleads for pain meds, but was told not long, and then 9 minutes pushing! Birthed on a matress on floor. Unbelievable. Birth story on Avery's own page. Hospital stay for 2 days as had some issues with breast attachment. Home now. Coming to terms with mummying and breastfeeding. But have posted some picks in my photo album. When I look at him I think my life has really only just begun, Enjoy your pregnancy journey! Ciao bellas.