Midwife visit, 32w6d

[judecorp]

So I had an appointment with The Midwife I Love today. But even TMIL doesn't help when things seem so ambiguous. I just want some answers, dang it!

For starters, I have been having weird BP. I have always been really close to 110/60 before I got knocked up, and was a firm 120/70 for a long while in pregnancy. Then for whatever reason I went from 124/64 to 130/64 to now 130something/60something. So for whatever reason my systolic BP keeps going up while my diastolic BP is totally rock on normal. And TMIL has no suggestions or answers, but now "we have to watch it." I don't want to watch it. I want to have normal BP again. Abnormal BP = threatened inductions = don't want to go there.

And then of course there is measuring time. Two weeks ago I met with a different midwife and AGAIN asked if I was too small, and she said I was measuring 29 weeks which was perfect for 30 weeks. I go in today a day shy of 33 weeks and my measurement? 29.5cm. WTF? So I once again ask if I should be concerned or whatever, and TMIL says 1) that I have grown 6cm in the 6 weeks since I saw her last (which means I have always measured so behind and she never told me) and 2) that I measured 28cm last time, even though I am /sure/ I was told 29. She basically gives me the "I'm sure everything is fine," brush off, and asks me if I want another ultrasound. No, I don't WANT another ultrasound, but I want to know if I /should/ get another ultrasound. She's the professional, I'm just the dumbass who is always told she is SO SMALL and stuff. So I say no to the ultrasound and ask her, "Do you think I'm having a small baby?" She says no. How does she know? This is the same person that seems to think that nearly 4cm behind is no big deal.

On the plus side, baby was head down today, back on my left side, foot firmly planted in my lower right side (ow). She says this is not likely to change and kid SHOULD be head down for the duration. So now I guess I can't blame my small side on transverse baby.

I know that TTC and pregnancy are all about "giving up control" and "letting nature take its course" and all of that hippie crap, but I just want some sort of straight info on the BP and the belly size. That's all. Bleh.

Comments

[cappucinogrrl.livejournal.com]

I'm sure it's nothing to worry about, but if you're concerned, maybe you should talk to somebody else, just to feel better about it.

[judecorp.livejournal.com]

Problem is I don't know who else to talk to. I mean, we're trying to deliver in this total rural hospital/birth center and there is (that we know of) one practice that delivers there. I guess I could ask to talk to one of the OBs in the practice, but I have never met them.

Bleh.

When I talk to people who have had kids, I either get the "It's fine, don't worry" or "Go get a growth scan now" answers... so they balance each other out.

[siercia]

I would generally fall into the "it's fine, don't worry" camp, but if this is worrying you so much, then I think you should go get a growth scan. If it turns out to be nothing, you can relax and enjoy the last few weeks of your pregnancy. If it turns out to be something, you can deal with it and fix it if you can, and also be comforted by the thought that you *did* do all that you could, if it turns out to be something.

It's easy for the doctors to say it's nothing - they have the experience to know that in 99.X% of cases like your's where they baby seems fine by most external markers, the baby really IS fine. That's what they're resting on in being calm about things. If you feel like you want to check up on things, then you should.

Also, if I were you, I'd want an ultrasound to verify the bean's osition, so you don't get an unplesant surprise while you're in labor (especially if you get induced).

[judecorp.livejournal.com]

I agree on all counts. I wasn't sure if I wanted another ultrasound but in the end I'm glad we went this morning.

In fact, kid is not just a little head down, but is SO head down that the chick had to seriously grind my pelvis to measure head circumference! (Ouch.) So I seem to be good on that front!

[siercia]

I'm glad to hear you went. It's definitely good to put your mind at ease. Did you get an all clear, or are they analyzing the data and letting you know?

And I'm getting RSVPs for the shower! We're going to have such a fun time!

[judecorp.livejournal.com]

They're a little weird about results. The ultrasound tech person is IN the office with the midwives, but technically reports to different people (perinatologists who analyze the pictures, I think). So the tech is awesome about saying what she sees (she doesn't play dumb) but there isn't an "official" word. And usually we don't get "official" word unless we ask... because our office tends to be a "no news is good news" kind of place and only gets in touch if there's a problem.

But I am assuming (if our lost twin ultrasound is any indication) that if the tech found something really concerning, she would have stepped out and found and OB or midwife who could talk with us immediately. Which she didn't. So I'm guessing it's all good.

[marshmelococoa.livejournal.com]

Measurements are guidelines. As long as you're still growing, I think you're fine. And belly growth doesn't always coincide with weight gain either. The only sure way to tell - and it's not even 100% accurate - is the ultrasound. THOSE measurements, while not 100% accurate, are more definitive than from the outside.

Your BP will fluctuate with pregnancy. I think as long as you're in a normalish range, you're ok. Your BP can change in 20 minutes time too - just the anxiety of rushing to the appointment or needing to pee can change it! ;)

Remember that most of all, you feel great. You are growing, you're being monitored, and the baby is moving around in there. Keep up with checking those movements and as long as your BP doesn't move into an abnormal place or you don't suddenly stop growing or lose size, then you're fine. And sometimes these things are gradual and some times they just happen over a day or two. Just continue to take good care of yourself, drink plenty of water and get as much sleep as you can.

Not much longer to go!

[keelamonster.livejournal.com]

what she said about most of that stuff.

1--the baby is growing. it's not the absolute number that's important as the growth curve over time. You've always measured a little bit small, and that's fine as long as you're growing the way you're supposed to be. Which you apparently are.

2--the baby is moving and kicking and doing all the things she's supposed to do. At this point there are 4 things that should make you go to the hospital (I hope she told you these): heavy bleeding like a period (not spotting after an exam), leaking fluid or a gush of fluid, contractions that are at least 5 an hour for more than 2 hours and if the baby stops moving. If she stops moving, then you drink a big ole glass of water, lie down on your left side and count the kicks. if it's less than 5 in half an hour, go to the hospital. Other than that, you shouldn't worry about your size.

As to the blood pressure: a jump in your blood pressure is concerning. But it's even more concerning if you're having swelling or headaches with it. if you have a LOT of swelling in your hands and feet (not the regular, hey my shoes are a bit tight but most of my rings still fit) or if you start having headaches, go to the clinic or to the OB department at your hospital.

Yes, she should watch it and if it makes you feel better, go and get it checked again in a week or so. Also, you can get it checked at the pharmacy or the firestation, and it should be back down. I would be surprised if you didn't have white coat hypertension, with all the anxiety you have associated with your pregnancy, so check it outside of the doctor's office from time to time.

It's okay to feel anxious and worried. You're pregnant. You're not wrong for feeling anxious and worried. When it becomes a problem is when the anxiety overtakes your whole ability to live your life.

She just doesn't want to freak you out by saying "i want to watch your BP" because most people go home and assume they're dying. You're one of those crazy ones that wants all the data, the good and the bad stuff, so you can feel like no one is hiding anything from you.

[judecorp.livejournal.com]

The BP is baffling to me. I don't think it's white coat hypertension because I previously got good reads in the office. BUT, we have a home machine that is consistently giving me really good readings. Now I'm concerned that our home machine is wrong. I suppose I will have to go to the pharmacy or grocery store and try to "break the tie." (You can get your BP checked at the fire station? Are you serious??!?!?!)

My concern isn't being small, it's going up 0.5cm in 2 weeks. Because that's a slow in growth for me, and that makes me nervous, ESPECIALLY when the kid has FINALLY gotten into a good head-down (ish) position that is supposed to be better on the measurements than transverse.

I don't have any swelling. None. That's why when my BP came back at 130 two weeks ago, I didn't care. I can still wear rings and all of my shoes. I still have dainty ankles. I can sit all day without puffing up. I don't get headaches. But I don't understand why it is getting higher and higher, or why our home machine is consistently giving me 110ish readings while I get 130s there.

I don't know that anxiety is keeping me from living my life... but I do know that it is impacting my ability to enjoy being pregnant. And that sucks, because I /want/ to enjoy being pregnant. I don't want to think about friends of ours who last year went through an eerily similar process and had a post-date baby that weighed 5lb with a lot of placental complications they didn't know about.

[keelamonster.livejournal.com]

Sure, those all make sense, and of course you're anxious. I don't think it's keeping you from living your life.

Here's my recommendation (or what I would tell you if you were my patient): go get your BP checked elsewhere when you're feeling sort of calm and cool about it. Don't doubt your machine just because it's lower than in the office. I'd trust it since most machines are pretty reliable (they don't want to deal with the whole 'we sold you a piece of shit that told you you were fine right up until you had your stroke' lawsuit business, frankly.

If it's fine at the pharmacy or whatever (and yes, you can get your BP checked anywhere they have EMS type services, since they all know how to do it there), then don't sweat the BP so much. And yay for the no swelling or headaches.

As to the growth, keep in mind now that she's head down, she may actually also be lower in your belly and pelvis. That can affect where she'll measure out. No, she's not in the birth canal just yet, but she's headed that way.

What I would tell you as my friend and after my own pregnancy: any time they say "do you want another ultrasound?" say yes. I mean, a) you get more pictures of the pumpkin and 2) you get to see for real that you have plenty of fluid in there, the placenta looks good and healthy and that she's growing.

Also, the midwife or doctor can try and measure out how big the baby will be with Leopold's maneuvers (where they feel how and where she is) but it's really imprecise. The ultrasound is not foolproof, but the OB I trained under was talking about guesstimating the size of a child without ultrasound and he told a patient of his in Alaska that she'd have a 5 pound baby. And her baby was 5 pounds. And then there was also a 5 pound twin, too. So if you want to know an approximate size of the peanut, just let them scan you. If that's what you need to confirm it's all okay and let you enjoy your pregnancy, then do it.

Honestly, I do think you have a little more anxiety every time you go in there, because you feel like you're not getting all the answers you want and that maybe a contributing factor to your higher BP in the office that's okay at home.

I totally understand your frustration, but the truth is that if she were really concerned, she'd be acting concerned about the growth and the blood pressure. She wouldn't be blowing you off. Again, aside from just caring about you and wanting you to have a healthy pregnancy and a healthy baby, she probably doesn't want a lawsuit.

[judecorp.livejournal.com]

Thank you for writing everything.

We ended up deciding to go and take a quick peek. Aside from feeling better, we got to see the kid again. That's fun, just like you say. I appreciate you saying that.

The midwife was actually MUCH more explanatory and reassuring to Jen on the phone. I guess something in the way Jen says things as opposed to me sends a different message. She apparently didn't get the vibe that I was too concerned. So that was good.

Thanks again!

[judecorp.livejournal.com]

See, I was cool with that, too - that growing bit. But I /know/ I was told 29cm two weeks ago, not 28. I know. And to go from 29 to 29.5 in two weeks is a little scary to me. Especially when the kid moved to a more favorable position for measuring.

My BP doesn't seem to be fluctuating in their office. It seems to be going up. We have a home BP machine (well, it's Jen's) and whenever I take my BP at home it is totally normal... but now I don't know if maybe the machine is faulty? How can the two be so different? I will have to "break the tie" at the pharmacy or grocery store. But 130s is not in the normalish range, not when 140 is considered hypertensive. *sigh*

I just want to know if my kid is big enough. That's all. I don't want to be surprised with a 4lb baby at full term, you know?

[aminahfiddler.livejournal.com]

Ever heard of White coat syndrome? I have it. I have high blood pressure, I've had it since I was in my 20's. Moderate high not HIGH. I've been off and on meds for 25 years. I'm on now and unless I loose every single pound I want to loose and am in perfect shape I won't be going off it. But, at home with my monitor on my sofa and on my meds. It's fine. It's always higher at the doctor's office. Sometimes it's how they hold your arm. Sometimes it's because the moment you sit down they take it. Sometimes it's because you've just asked a stressful question or for me, it's just 'coz I"m there and I KNOW they are going to tell me bad news.

I take my bp on a regular basis at home. In different situations and stressed and not stressed times. I write it down and take it to the doctor's office with me. That plus the reading they get at the office is a much better indicator of what's going on.

If you're worried go out and buy a cuff and take it a home. Or just hit the local stores that have a monitor and take it from time to time. It will make you feel much better.

[judecorp.livejournal.com]

I have been using Jen's BP machine at home too and it always gives me good readings (like 110/70)... so I don't know if it's not reading me accurately, because it seems like a big discrepancy. I guess I can just keep checking and see what happens. *shrug* I don't /feel/ nervous when I go in there but I suppose it could be happening.

My midwife told me NOT to go to the pharmacy/store to check as those machines are usually not calibrated correctly and give incorrect readings. No idea, though.

[meglett.livejournal.com]

NOT wanting to be alarmist, but hope had some similar issues.

BP: i agree with PP that the fluctation is normal, and that since you are still within acceptable range, try not not worry too much. (easier said than done, i know) does the MW take the BP? or someone else? at our OB's practice, the nurse-in-training did it, so by the end of the pregnancy, we had cycled through several NITs. one in particular, the one we had in the last several months, was a terrible BP-taker. really. she was awkward about it, and at every appointment seemed to not really know what she was doing. and that corresponded with hope's rising BP numbers....maybe a coincidence, but while i do believe her BP was increasing, we had doubts at the legitimacy of the recorded numbers.

belly growth: i don't have much assvice here, and again agree with PP that as long as you're continuing to grow, things seem good. BUT....this is another area that retrospectively hope and i wonder about. for maybe the last 10 weeks, hope came in small, and OB wasn't concerned, so neither were we, mostly. she could be a little forgetful, and so a few times she thought there was CM growth, when really it was the same as the previous appt. we never called her on it, i don't think....or if we did, she assured us it was all good. but with the placenta issues and quinn's size, we wonder now if we just didn't miss the signs. if we do this again, we'll be much more advocating and pro-active about things like this--so i am sorry you didn't get a reliable or useful response from the MW, but i am glad you repeatedly said something.

i am so not trying to say your concerns=unavoidable monumental problems. i honestly think you're probably just fine, and wouldn't lie about that. but i just wanted to share about the similar experiences....

[judecorp.livejournal.com]

I know. All I can think about is Quinn. I mean, the whole time I was sitting there I wanted to say, "But you don't know! I know these people!!" and then my midwife would roll her eyes because she always assumes that when I say, 'I know people,' I mean, 'I read too many stories on the internet.' Seriously. Once I said I was concerned (shoot this was 2-3 months ago?) that everyone was bigger than I was... and she said, "Stop looking at pictures on the internet." I was like, "THESE ARE REAL PEOPLE!!!"

You guys had an abruption, right? Were there more placenta problems than that? Sorry for bringing up bad memories.

[sunshyne72.livejournal.com]

Well, not sure if this will make you feel better, but I watched my cousin go from small little bump to BIG ol' watermelon in a very short period of time around that last month or so--she has the stretchmarks to prove it. She is a very thin person and always has been but she had a good size healthy little guy in the end. Don't lose faith and if you're nervous maybe get another consultation.

[judecorp.livejournal.com]

Apparently my kid is just really good at being crammed into a small space. She's like the houdini of fetuses. She's all jammed in there and is actually a decent size. (We went and got checked today.)

Thanks for the calming wishes!

[judecorp.livejournal.com]

We went for the u/s today. I don't think they're getting an accurate measure of my fundus because my uterus is tipped. The u/s tech today said the kid's butt is WAY higher than I have been measuring... so that was interesting.

Thanks for your perspective, you WERE small for twins. WOW! And they were good sized kids, too.

xoxo

[kcmedc.livejournal.com]

HUGS...it sucks to be a new mom sometimes.Jude don't worry. Really. Keelamonster is exactly correct and just to give you a story like yours, When I was preggo with the second one, I didn't show until May (she was born in August) and I didn't even measure right until the last week of July. Kayci was 6lbs 8oz and had no problems what so ever. And the blood pressure thing, also had fluctuations with the boy. As long as there's no swelling, you're fine. Hugs hang in there, it's ok to be frustrated and scared.

[judecorp.livejournal.com]

It DOES suck to be a new mom. I feel like I should write a book about everything they tell you (that you shouldn't listen to) and everything they DON'T tell you (that they should). I honestly was SO naive and had no idea pregnancy was this nervewracking!! This has been a crazy ride!!

Thanks for commenting!

[fatfeistyfemme.livejournal.com]

so many things to worry about. I can't even imagine it. Sending you good, calm, restful energy.

[judecorp.livejournal.com]

Dude, being knocked up is HARD. I had no idea.

[estrange.livejournal.com]

I hate doctors, they never say the same things. Girls are usually a little smaller I think.

[judecorp.livejournal.com]

Yeah, it looks like our little peanut is on the smaller side - estimated at the 49th percentile which is a-okay with me. She's just really stuffed into my tiny belly, I guess! :)

[mayna.livejournal.com]

If it worries you a lot, then I say go for the ultrasound. If it was ME, even with hearing all the "you're fine" stories, and I was still worried, and they offered me an ultrasound that I didn't have to pay out of pocket for to make sure everything was fine... I would do it. Heck, I did that with Greg... had an ultrasound at 16 weeks (ish), doctor did a quick once over and said I was fine, and couldn't determine the gender... I was worried because he DIDN'T say "oh look, see 4 chambers in the heart, and his head is measuring 16 weeks, yadda yadda", just a "baby's fine" and didn't appear to look all that hard. So we paid for an ultrasound at 23 weeks because I wanted to find out the sex anyway. There is something to be said for easing your worries if you can.

I think different practitioners measure differently, too. The measuring tape being just a smidgen different can make the whole measurement different. Same thing with measuring the baby's length (after they're born that is), if the doctor and nurse both do it, you'll probably end up with 2 different measurements.

As for the BP... no idea. Mine is usually like 110/55 and when I'm preggo goes up to 120/80 and doesn't seem to fluctuate much as far as I remember (I'd have to look at my chart).

[judecorp.livejournal.com]

We ended up deciding to get the ultrasound. I think it was the right choice for us. No, I wasn't "convinced" that something was wrong but I didn't want to spend 7+ weeks wondering "what if."

I don't know what's up with the BP either. At home on Jen's machine I get pretty consistent 110/70. And at the midwife I'm 130/64? Weird.

[mayna.livejournal.com]

Exactly... it can't be good for your blood pressure to sit and worry about "what if" for 7 weeks, when doing an ultrasound will give you the scoop. And ultrasounds aren't invasive like amniocenteses are. I would've done the same thing.

[amyura.livejournal.com]

Even my highly-interventionist MEDwife-in-crunchy-clothing said that as long as you're constantly growing, if you're a few cm "behind" it's not that big a deal. It would be a problem if you weren't growing.

[judecorp.livejournal.com]

I know that in my head. I do. I mean, I tell myself that all the time. It just caught me off-guard to hear that I have been 3cm+ behind all along, when I have been asking about size all that time.

Thanks.

[sassywoman.livejournal.com]

From what I understand about BP (which was little before having problems during my pregnancy) the bottom number is the most important. So ... if that stays low and your top number doesn't get much higher I think you'll be just fine.

Coming from someone who had PIH you can manage if it were to happen that you would develop an issue and have to be induced. I wasn't thrilled to be induced and end up with a c-section but the bottom line was we got Emma out safely.

Try not to worry (I know this is not realistic) and just think back to where you were last year and how this kind of worrying is better then worrying if you'll ever be pregnant.

I'm thinking of you and praying every night that you and baby August will be a-ok!!!

[judecorp.livejournal.com]

I have heard, too, that the bottom number is the most important. It's just weird that my top number is so bizarre! I don't understand it. I have never seen one number go up but not the other. I guess I am a freak of nature.

I know you weren't thrilled to have an induction or a c, and I know that if it is best for my baby I will do it, just like you did. I just... well, I'm sure you understand. I just really want to NOT have one! :)

Can't you just come and visit already? I like you so much!!

[sassywoman.livejournal.com]

Aww... you are so sweet. I really think we're going to make the trip next summer. :) And yes... I totally understand about not wanting an induction or a c-section. Not the best scenario at all!

[judecorp.livejournal.com]

I can't wait until you make your trip!