Tuesday, Feb. 28th
I got back last night from Oklahoma City. It was a great four day trip to refocus and reset my mind. I really enjoyed seeing all of my co-workers and it did a world of good to be solely an employee for a few days...not a mother, not a wife, not a patient. I did nothing other than sit in meeting, rest and sleep. Every time I called Rob, he was in a great mood-- just loving every minute with Rachel. He did not lash out at me once, much different than my trip to Florida last year. I could breathe and not worry for the first time in a long time. Rob has been absolutely wonderful; he came home early from work on Thursday last week so I could get done some packing and last minute things. He has been helpful and supportive. I feel like I have a partner and an ally. I am thinking that the reduced anxiety level can only help this baby. I went to the PDC today and had good results... 3.3 s/d ratio (normal), 138 heart beat, 12 cm amniotic fluid. Everything was great. Dr. Carr suggested that I use some guided imagery or meditation to help the baby grown. I am enough of a tree hugger to believe in that... so that is exactly what I am going to do!

Thursday, Feb. 23rd

This is definitely one of those weeks when I do not feel ahead of the game. Too much to do and too little time to do it. Not to mention, these doctor's appointments add to the existing stress of being a working mother and wife. I went to my first diagnostic appointment at Ob-Gyn Associates on Tuesday. I had a 9 am appointment but was not seen until 11 am.... sitting in the waiting with my anxieties brewing. The tech who performed the non-stress test fumbled around and could not pick up the baby's heart beat easily, so that was frustrating. Then, I had the Doppler ultrasound where the tech found the s/d ratios to be high and the amniotic fluid to be low. Afterwards, I saw my doctor who realized she forgot to do the biophysical profile. At this point, I was visibly upset. The doctor suggested that I continue to be seen at the PDC because this set up at Ob-Gyn Associates was not working for me. I agreed! I finally got out of there at 11:45 am. Half  my day was gone.

Today, I went back to PDC for my appointment at 8:15 and got out of there just a little after 9:00 am. Much better!!! Everything was pretty much fine. Amniotic fluid was up to 9 1/2 cm (7 cm on Tuesday), baby's heartbeat was 145,  baby has a full bladder which is a good indication that it is being nourished, the s/d ratios was okay. They did it 6 times--- 5 were normal and one was elevated, but nothing to be concerned about. Whew!

Friday, Feb. 17, 2012

Quick post while I am running out the door...
I had a early morning appointment at PDC today before taking a trip to PA.
Everything was GREAT! The baby is 2 lbs, 11 oz. at 3% percentile. The baby was supposed to gain 200 grams over the last 2 weeks, instead there was a 300 gram gain. Thrilled. (Granted, I wish the baby was above the 10% percentile then I could stop with all these tests!!!) The Doppler was normal, 3.4 s/d ratio, in fact very normal. Everything else was a-okay including amniotic fluid, heartbeat, etc. The doctor today was the head of the program and again, I expressed my concerns about "too much testing" for a constitutionally small baby. She said that I have to stick to the program and wait it out:(

Feb. 14, 2012--- Valentine's Day
What a great day! I had my Doppler ultrasound this morning and it was very good, probably one of the best. The s/d ratio was 3.3 (anything above 4.19 is too high). I met with Dr. Carr afterwards. He is my favorite doctor because he seems realistic-optimistic. He explains the tests thoroughly and talks to you as if you are an intelligent human being with feelings! (Imagine that!) He told me that baby's bladder is full which is a good indication that the baby is healthy. If the baby is being compromised, then the resources go to the heart and brain and other bodily functions lower than the heart are suppressed. The full bladder shows the lower part of the body is working and the top half is being nourished. Additionally, the amniotic fluid was nearly 12 cm, that is very good. The heartbeat was 140, healthy & strong.

Afterwards, I went to OB-GYN Associates to meet with my doctor and meet with one of the midwives. I believe my doctor is a nervous nellie after talking with her on the phone on Monday. She was nervous about the high s/d ratios on Friday and wanted to intervene i.e. bed rest, hospitalization or deliver the baby. On the other hand, when I met with the midwife it felt like I was finally speaking to someone who speaks my language. She is going to talk about gentle c-section at the Doctor's Round table Meeting on Wednesday. I am praying they will get on board! Hope is eternal.

Friday, Feb. 10th
Just came back from the PDC.... a little upset that the doppler ultrasound showed the s/d ratio as high.
It was 4.3; it should have been 4.1... so it is too terribly bad. Everything else was fine including the biophysical profile, non-stress stress, etc.

I met my new doctor yesterday... she is no Dr. Magee. She was no aware of gentle c-sections which was very disheartening. I thought OB-GYN Associates was on board for gentle c-sections, so I am going to need to dig a little deeper on this one.

Tuesday, Feb 7, 2012
Last week, I said good bye to Dr. Susanna Magee who is Family Doctor with OB privileges that delivers at Memorial Hospital. It was extremely difficult to transfer my care out of her practice to a more "standard" ob/gyn. I have been feeling blue since then...knowing all of this is a reality. My baby dreams are not going to come true; instead I am on the path of a high risk pregnancy and all that "defensive" medicine can offer and the "midwifery model" cannot. It's a sad realization.

Today's appointment went well, nothing remarkable. The baby's heartbeat was 145 bpm; 3.13 was the s/d pressure, and everything looked fine.

I asked the doctor after my ultrasound if he could tell me how many babies who have similar diagnosis of IUGR end of the following categories

• Are delivered full term at 39-40 weeks
• Are delivered early at 36-37 weeks
• Are micro-preemies; under 3 lbs
• Fetal death occurs

He said that he rarely sees fetal death at the stage unless there is some other significant underlying issue; especially in the metropolitan area with a major medical center available. He told me not to worry about this baby being a micro-preemie since I am into my 3rd trimester. And then the conversation got interesting.. I asked him about the babies who are delivered between 36-40 weeks. He said most of them are "constitutionally" small.  That begged the question in my mind that I needed to ask "If that is the case then, where does legitimate medicine end and "defensive" medicine begin, if these babies are just small?" He said obsectrictics is very much defensive medicine especially high risk ob medicine because they cannot see the baby, the only can see the mother. That's why so much testing is used. I asked what the reasons why someone would deliver at 36 weeks and why 39 weeks instead of 40 weeks. He said 36 weeks delivery happens when there is low fluid, the umbilical cord pressure is unfavorable or there is a significant problem with growth. We talked about my "dreams" of VBAC and bring this baby to full term at 40 weeks. He said they may let me go beyond 39 weeks with additional monitoring. That was the answer that I wanted to hear... so I guess all is well that ends well.

(I will always wonder, "I know that Rachel loves me but how much more would she love me if she was born vaginally instead of a c-section?")

Came to the realization that this baby will have over 70 ultrasounds over the pregnancy.  I am feeling blue, frustrated and sad that I am a patient not a pregnant woman.

Jan. 31st and Feb 3rd
Tuesday's ultrasounds were non-eventful. The baby's heartbeat was 145 and the Doppler ultrasound was normal at 3.3 s/d.

Friday has been on my mind since it included a growth ultrasound. The growth ultrasound showed that baby is 2 lbs. 1 oz. (the baby should be 2 lbs, 8 oz.) and 1% on the growth curve. Certainly not the worst information but I had hoped it would be better. On a more positive note, the baby grew 2 cm which is what the doctors had hoped. The heartbeat was 144 and the Doppler ultrasound was 3.2 (the new threshold is 4.3 & below as normal). The doctor said I can remain pregnant as long as the Doppler ultrasounds are normal (in other words, becoming lower). After the ultrasounds, I went to say goodbye to Dr. Magee. It was my last appointment with her. I am so brokenhearted over it. I believe with every fiber of my being, she is singlehanding changing the face of maternal health care in Rhode Island. She is amazing. What other doctor would call you on New Year's Day just to see how you are doing? I have to the realitization that I cannot have this baby at Memorial and will have the baby at Women & Infants. When I was there in November visiting a friend who had a baby, I had a panic attack at Women & Infants. That place fills me with anxiety. I decided that I do not want the High Risk Docs as my OB; I need to be with a group that has a midwifery-model of care. There are not many good choices. The best that I have come up with Ob/Gyn Associates. As I left Dr. Magee's office, these words were running through my head... Why don't I deserve a better birth? I had hoped for better than what happened with Rachel and instead, I am in a worst situation. I need to re-frame the situation in my head--- preception is reality and I need to make the best of it.