I've Moved!

My new blog is called Reflections from a Global Nomad, in order to acknowledge that we no longer live in Maadi and that we are, in fact, global nomads, not staying in one place longer than two or three years. Please join me at http://DeborahReflections.blogspot.com

Monday, May 31, 2010

Pregnancy Update

It's been a couple of weeks since I last posted anything here--sorry about that. I'd like to say it's because things have been busy, but ... it isn't. It's because I've been so tired that I really haven't been doing much to write about. But there has been a little going on with the pregnancy, so I decided to update you about that anyway.

At my regular prenatal appointment a week and a half ago, my nurse asked all the standard questions, including "Have you been experiencing any pain?" The short answer to that question this time was yes, although there was nothing that I thought was unusual or problematic. However, it's always safer to report it all and let the doctor decide, so that's what I did. I was right about the hip and thigh pain that I've been experiencing for over a month now--that's normal, and it's normal for it to be worse at night than during the day. But that isn't the only pain I've experienced. I've also experienced a little bit of abdominal pain, mostly when I'm wiggling around in bed at night trying to get comfortable or when I reach for something on the top shelf in my kitchen cabinets. This pain also struck me as normal--after all, my abdominal muscles are under a lot of strain right now, so it makes sense to me that any use or stretching of them may be enough to push them over the edge into soreness or even a momentary acute pain. My nurse practitioner largely agreed with me, but she looked a little doubtful. She said that pain like that was unusual, and unusual is a little concerning, so she wanted me to go see a local OB just to make sure everything was okay.

We made that trip last week. Long story short, everything is fine. There is no indication that anything at all is wrong, other than that I may be a little dehydrated. Both my nurse practitioner and the OB emphasized that, especially now that I've started having a few Braxton Hicks pressure waves, which can be magnified by dehydration. The OB, Dr. Nevine, also recommended that I start taking Cal-Mag, a calcium supplement, in addition to the prenatal vitamins that I was already taking. That made sense to me, as I regularly realize that I've gone all day without eating or drinking much of anything that has a lot of calcium in it--I try so hard to make sure that I drink enough water (which means that I often drink nothing but water, drink it constantly even when I'm not thirsty, and still end up with signs of dehydration) that I don't drink much milk.

Dr. Nevine also palpated my abdomen and informed me that Alexa currently is transverse. That means that she's lying across my abdomen; instead of being head up (fully breech) or head down (in the proper birthing position), her head is on one side and she's lying against my cervix. It isn't a problem at this point; most babies turn sometime between weeks 32 and 38, and I'm just now at week 31. She'll probably turn into the proper birthing position on her own, but if she doesn't, my OB in the States may be able to turn her manually later on. I actually was happy to hear that she's transverse, just because that's how I felt like she was laying. It would have been disconcerting to be told that she was up-and-down when I could have sworn that I felt her more side-to-side. But it will be nice when she gets herself into the birthing position--if she were to stay transverse until time for her birth, that would be an automatic cesarian section, which I'd much rather avoid.

In other pregnancy news, I've started doing a home study course for natural childbirth. It's a 5-week course with weekly reading and daily practice. I have not been good about doing the practice, which is why I'm not keeping to the 5-week schedule so well--I keep realizing that it's time to read another lesson but I haven't done my practicing. The course I'm using is Hypnobabies. I was very skeptical of it at first, and I'm still skeptical of some of its claims, but overall I think it will be a good method for me. I don't think of it as self-hypnosis (although it turns out that there actually is some research out there indicating that people can be trained to use self-hypnosis for effective pain relief) so much as I think of it as teaching myself not to be afraid of childbirth and to relax deeply.

The idea is that fear causes the release of adrenaline and increased muscle tension. Increased muscle tension can stall labor, as the uterine muscle fibers that have kept the cervix closed during pregnancy tense up and refuse to be drawn out of the way by the uterine muscle fibers that are trying to open the cervix for birth. Increased muscle tension causes the experience of pain as these muscles work against each other. So it's important for a woman not only to not be afraid, but to be able to relax deliberately in order to minimize muscle tension and allow her body to birth with as little resistance as possible, which should minimize the pain she experiences as well.

Some claim that using self-hypnosis effectively leads to completely pain-free birth, but I don't expect that--although the course is trying hard to get me to expect it. I am, however, working to teach myself to expect a birth that is calm and manageable--one during which I will be able to use the relaxation cues I've learned in order to help my body relax. That's what the daily practice is all about--they call it learning self-hypnosis; I call it conditioning my body to relax in the presence of certain cues. I don't do the practice as often as I should, though, because apparently my body already relaxes in the presence of those cues--I keep falling asleep! I don't expect that to be an issue during my birthing time, so I do need to teach myself to relax in the presence of those cues while not falling asleep.

Oh, and if you've noticed some oddities in my vocabulary, it isn't just you. Part of the Hypnobabies method for reducing fear involves changing the way we think about certain things by changing the words we use to describe them. "Contractions" become "pressure waves," an equally accurate descriptor without the associations with pain that most people have. "Labor" becomes "my birthing time," again because so many associate labor with pain. I forget the other vocabulary changes that I'm supposed to be making, although there is one that may or may not be a Hypnobabies thing, but I've read it from several midwives and doulas: the word "delivery" is a little demeaning to mothers as it currently is used with regard to childbirth.

"Who will deliver your baby?" That makes it sound like the doctor is doing all the work--and making all the decisions--and the mom is just along for the ride. Midwives and doulas tend to talk instead about a medical professional attending the birth or catching the baby (although sometimes, depending on parental preferences, the doctor attends and the father catches), and the mother is the one who is birthing her baby. This change in terminology linguistically gives control to the mother, rather than to the birth attendant, at least to the extent that anyone can control birth. I like this terminology better than the traditional "delivery" terminology. After all, do I really want to use the same word for childbirth that I use when the pizza shows up at my door?

I think that's it for the pregnancy updates, other than one kind of amusing story. Alexa had been kicking me fairly regularly, although not all the time by any means. Then suddenly she stopped kicking me more than a couple of times a day. I started to get worried and mentioned it to Jeff. Within an hour, Alexa was kicking me constantly--four or more times in the first 15 or 20 minutes. Now it may be that frequently sometimes, less at other times, and none at all if I'm moving around a lot (probably rocking her to sleep), but it never gets to the point anymore where I even consider worrying before she goes into a frenzy of movement. It's almost as if she understood me tell Jeff that I was worried--I know she hears everything I say now, although understanding is unlikely--and she's determined not to worry me again.

Okay, that's really it. Hopefully it won't be two weeks again before I post something, but no guarantees. Right now my time is being spent sleeping, chasing Cleo away from the speakers (she's taken to licking them), and getting ready to head back to the States before too long. Speaking of those speakers ... gotta go!

Monday, May 10, 2010

Window Into the Womb

Modern technology is truly amazing. I don't often take the time to appreciate it, but sometimes I'm hit with the realization of just how awesome modern technology is--the ability to see and hear events that are occurring on the other side of the world, or right in front of us but so small that our eyes can't discern them; the ability to record and play back images of all kinds; even the ability to cool an entire residence to a comfortable temperature when it feels like a furnace outside (an ability for which I am becoming increasingly grateful as summer approaches!).

I am in even greater awe of the intricacy and majesty of God's creations for which He did not use human minds and hands as His tools--rugged mountains, beautiful meadows, delicately balanced ecosystems.

And then there are those times when modern technology and God's creation intersect. The ingenuity of man--enabled by God--allows us to see a side of God's creation that wasn't possible a century ago, a decade ago, or in some cases, a year ago. Those times truly fill me with wonder.

The most striking examples of those times recently have occurred as I'm lying in an exam room looking at a large screen mounted on the wall opposite me--staring in awe at my daughter as she rests, squirms, and hiccups inside me.

During this pregnancy, Jeff and I have had an opportunity that I doubt we'll have with any future pregnancies--the opportunity to watch as our daughter grows and matures before her birth. Most of these ultrasounds were obtained for less than desirable reasons, as you'll read, but the result is spectacular. So join me now as I offer you a glimpse through the window into the womb ...

The picture above was taken on 12 December 2009, when I was around six weeks along (around four weeks once you realize that the first two weeks of pregnancy are before ovulation even occurs!). We had an early ultrasound because of the cramping and bleeding that I was experiencing, which raised fears of an ectopic pregnancy. The purpose of this ultrasound wasn't actually to see the baby--that was impossible at this point--but to see the gestational sac and determine where it had implanted. The gestational sac is labeled on the above image as "GS," and as you can see, it was located within the uterus, much to our relief.

This next picture was taken on 20 December 2009, at almost 8 weeks. Because of my symptoms, my medical providers wanted to see evidence that the baby was still alive before they began any routine prenatal care. During this ultrasound, we saw the baby--I think they called her an embryo at that point--and the characteristic flutter that indicates the beating of a developing heart. The baby is the light spot inside the black area, with the two plus signs indicating her length. Although this ultrasound was just over one week later than the first, that one week plus the benefits of more sensitive equipment enabled us to go from "no baby" to "baby," albeit "tiny tiny baby." And there is no way I can describe the joy and relief of seeing the rhythmic flutter that showed that our baby was alive.

This picture was taken on 24 January 2010, at almost 13 weeks. We had this ultrasound because we wanted nucal translucency screening. This early screening gives a good indication of several possible problems with the baby--we knew that we would have this child even if she had problems, but we also knew that if that were the case, we would need time to prepare ourselves for the arrival of a special needs baby. So we opted for the screening. The opportunity for another ultrasound was a bonus! It was during this ultrasound that we first heard Alexa's heart beat and saw her move. You can see in the picture above that she definitely looks more baby-like here, with a recognizable head and body. We also saw her little arms and legs waving as she maneuvered--her high activity level during this ultrasound had me comparing her to a jumping bean.

For this next one, I just had to show you two pictures. These were taken on 30 January 2010, at almost 14 weeks. We discovered after having the previous ultrasound taken that the hospital where we had been referred for that couldn't actually do the nucal translucency screening. They did the ultrasound but they didn't draw the blood or presumably have the connections to send the blood for testing. So we went to a different clinic, repeated the ultrasound, and had the blood drawn and shipped to the UK--or maybe it was Germany; I don't remember--for testing. The results eventually came back that there was little likelihood that the baby had any of the disorders that this test detects, and we were able to see our daughter in 3D for the first time. These are my two favorite pictures. The top one shows Alexa's big head, her face, and her little body, all facing left. I like how she appears to be praying. The bottom one--my all-time favorite--shows Alexa facing us. I'm not sure if the structure on the left is the placenta or what, but I love how it appears to cradle her as she rests comfortably against it.

I just had to show you two from this one as well. These sonograms were taken on 17 March 2010, around 20 weeks. This is the ultrasound that most people get, in which they find out the baby's gender. Our daughter was being modest that day. The doctor told us that he was "almost certain" that she was a girl, but his voice and body language was a little less confident than I would have found assuring. She wouldn't show us "the goods" that day, but she did let us get a couple of pictures of her face. In the top picture, you can make out her eyes, nose, and mouth as she lies on her back. You also can see her arms and legs, but she has a leg or foot strategically placed. The bottom picture had Jeff making cracks about Skeletor for a while. I admit it--I didn't get offended and even joined in the Skeletor comments some; it's an apt description of how her face appears in that picture!

Okay, I admit it--this picture also was taken on 17 March. We had our last ultrasound on 5 May 2010, just last week, at around 27 weeks. There was no medical reason for this ultrasound. We wanted confirmation on the gender, and when the doctor suggested another ultrasound, we saw no reason to decline. We also were hoping for a nice view of Alexa's face, since it should have a little more fat on it now and look more like a baby than a skeleton. However, she absolutely did not cooperate with that. The picture above shows a side view of the position that she stayed in pretty much the whole time. Her legs are up, in a pike position, so that her legs and feet cover her face. We can't even get a side view of her face because her arms were blocking it. During this most recent ultrasound, we didn't even get this view. We got the view that showed us her backside and the backs of her legs, hiding her face. I don't feel comfortable posting that picture online, because her backside is clearly discernible, and even though she is still in the womb, a lady is entitled to her modesty. She did shift position just enough for the doctor to say that she is definitely a girl--either that or he's "imagining things," in his words. He seemed confident enough this time to reassure me that all of our cute baby girl clothes will be put to good use. (Although I did wake up two mornings later from a dream in which our little girl turned out to be a boy who had to go nameless for several days because we hadn't picked out a boy's name.)

So there you have it--a sampling of the glimpses we've been given of Alexa's development so far. I don't think we'll have any more ultrasounds, unless something unexpected happens, so these will be the last pictures of her until her birth. It looks like the curtains have closed on the window, to take the analogy too far :) But I always will be grateful that during this, our first pregnancy, we were able to watch as our baby developed from a tiny bean-shaped embryo into a full-fledged baby.