Welcome To This World...

During the last few weeks of my pregnancy, Myrtle and a few others asked if I had become so uncomfortable that I reached that point of being nearly desperate to get the baby out. I was still enjoying the pregnancy so much, even at the end, that I never felt such an urgency. Until the very last day. My carpel tunnel syndrome was in full rage. Performing the simplest task induced agony and on a few occasions brought me to tears. I felt so pathetic. Other women would be experiencing labour pains on the day before their baby's arrival. I was crippled by pains in my hands. How lame.

I was amazed at how much we got done and were able to cross off our 'to do list'. Although I pushed to get most tasks accomplished on Friday and Saturday, so that we could enjoy a leisurely Sunday and last day baby free, it didn't exactly happen as we were still working right up until we went to bed, which was probably a good thing. My case ended up getting moved to 9:30, which was also to our benefit as someone correctly predicted, we didn't get much sleep. Tyler stayed by my side for the entire night. It was so hard to believe this day had finally arrived. My transfer was just before Halloween and I delivered after the 4th of July. I was pregnant through Thanksgiving, Christmas, New Year's Day, Easter, and Memorial Day. My pregnancy extended through the Australian Open, French Open, Wimbledon and the Women's World Cup. That's a long duration.

I had come to terms mentally with a C/section, but it's not really possible to prepare physically, even when you know what to expect. The anesthetist was awesome and she got my spinal in on the first try. The warm and heavy sensation in my legs was weird, but not unpleasant. For some reason, when she placed the wedge under my right shoulder, a sense of panic took hold. I'm not sure if claustrophobia is the correct term, but it reminded me of the anxiety during my MRI. I was very aware that I couldn't move and people would be doing things to me. I wanted to bail. I changed my mind, I would rather take my chance with an induction and potential blood bath of a delivery, just so I could have some control. Yet, I knew I would end up back in this OR, only it would be an emergency case and instead of everyone enjoying pleasant banter as they prepped me, there would be a frantic sense of urgency. I thought about asking for some Ati.van, but realised it's probably not recommended as some would go to the baby. I was considering going under general, but then Husband was brought into the room and he sat beside me. I wanted to remain awake so I could share this experience with him.

The occlusion drape was stretched very high. "It's like you're playing tents as a kid..." the anesthesiologist joked. I couldn't see anything that was going on. I held Husband's hand and closed my eyes as I went through the procedure in my mind as soon as I heard my OB announce to the anesthesiologist that she was making her incision. Skin incision done. Knife back to the OR tech, Bovie to slice through the subcutaneous layer. Stop to cauterise any bleeding vessels... Identify and open the fascia. Place the retractors to protect the bladder. Knife for the uterine incision, work through the lower segment. Bandage scissors to extend the uterine incision. Break the amniotic sac...

Then I sensed the pressure on my abdomen as they worked to delivery my baby. I was in a state of sensory deprivation except for my hearing. I heard a crying sound. It was a loud penetrating wail. A sound that I'll never forget. "That's our baby!" I said to Husband, "That's our baby crying!" My own eyes were weepy. As his hand was still in mine, I felt all the stress and tension that he had been carrying for nine months leave his body. The empty shampoo bottle that he refused to throw away because he used the last amount on the day of our beta test. The pregnancy related webpages on his phone that he refused to delete as he didn't want to tempt fate. It all went away. I know it would only be a matter of time before he would find new sources of stress, but for that moment; it was gone.

First Family Photo

They invited him to look at the baby to announce the gender. Although it was concealed by his mask, I could tell he had a big smile on his face. "Kate is here." He informed me. Wait... "Does that mean what I think it does?" I asked. "Yes, Jane. A girl." (I would later learn that he also double checked with the pediatrician before he was sure she was a girl) Truth be told, I may have had a heads up. I didn't share this with anyone, but at my very last scan, the tech may have slipped. As I was sharing how baby had been flipping in and out of the transverse position, the tech noted, "Well, hopefully she or he!" she quickly added "will stay head down...." The look on her face was more telling than her words. Yet, I still wasn't completely convinced, so it truly was a surprise.

Yes, It's a Girl!

Husband accompanied Kate to the nursery and I closed my eyes until the surgery was complete. My OB described that the placenta was very low and the only way I could have had a vaginal delivery would have been if her head were fully engaged and would have applied pressure to tamponade the placenta. She was relieved that the blood loss was much less than expected, but commented that my placenta was very "sticky". So perhaps even without the marginal previa, I could have ended up in the OR needing a  D+C and transfusion after the delivery. I'm so glad not to have that drama, as I was able to meet Kate in the recovery room right away. The nurse placed her on me and she lifted her head as if to look around before latching on straight away. The nurse was quite impressed. I felt rather proud. That's our girl.

I knew that I loved her from that first moment, but it would take some time before I appreciated just what that love felt like. She was still a stranger. I couldn't believe that she was mine. Each day the bond grows stronger, but what really makes my heart melt is seeing how much Husband loves her. Fatherhood suits him perfectly.

The recovery from the C/section was much easier than I anticipated. I was able to just use Motrin for pain relief and I no longer needed any meds by post-op day #4. Getting in and out of the hospital bed was tough, but not nearly as excruciating as getting in and out of the car. Upon bringing her home, I let out the first string of expletives in front of my daughter.

Could.Not.Resist.this onesie 

Here's my 'I've experienced this once, so now I'm an expert' words of advice for anyone with an upcoming delivery: do not accept any visitors in the hospital. Some people actually wanted to come to visit on the day of my surgery. It was easy to say "No" as I was groggy and puking every 20 minutes. However the next day, once I had my IV removed and could tolerate PO liquids and foods, I felt back to my old self and I expected to act that way.  I almost didn't feel that I should be in a hospital. My parents arrived around 2 in the afternoon, and after they each had a chance to hold her, I continued her feeding schedule under a modesty cover. Since Kate latched so effectively, I didn't pay as much attention to her latch, and I wasn't hand expressing some colostrum to encourage her, as the nurses had suggested. As a result, I had a baby who spent the day exerting much effort, only to get very little colostrum in return, which made for a very fussy baby and a baby who lost 9% of her weight and we needed to start formula with a Supplemental Nursing System (SNS). I hadn't pushed fluids as aggressively as I should have been. I felt guilty, so the next day, I was determined not to let anything affect the baby's feeding efforts. However, I thought I saw a window of opportunity to feed her before my parents arrived in the afternoon, so I decided to wake her to feed. Huge mistake. She was so pissed off that she didn't want anything to do with feeding and refused to latch. We were regressing. Now I had a baby who was on the bubble of losing too much weight, who wouldn't feed and I realised that she hadn't had a wet diaper since the night shift.  Meanwhile, my mother was trying to talk to me about her friend's son's drug problem. The nurses had suggested that I try to pump some colostrum for the SNS. One of husband's (male) hockey friends was going to try to stop by that day. It was time to put up the Do Not Disturb sign. I told Husband to cancel any visitors and he came up with a clever rouse to take my parents on a walk to Starbucks, so I could have the room to myself to pump. I know everyone will be anxious to see the baby, but your recovery time needs to be for you and your baby. Entertaining my parents was distracting my focus from Kate and taking care of myself. As there isn't an established routine, it's hard to anticipate when would be a good time for visitors and since modesty and privacy are important to me, I didn't want any guests walking in while I was nursing or pumping.

I can't say enough about how amazing the postpartum nurses were. Our LA friends, who delivered via Caesarean a few months ago, encouraged us to take advantage of the extended hospital stay by asking lots of questions. The nurses shared many tricks and tips, and tried to install confidence that we would manage as we embarked upon this adventure called parenting.

Home. We are going... 

Pregnancy Reflections

Sometimes I'll catch a glimpse of myself in the mirror, and I'll think 'who is that pregnant woman?' I'm still in a state of disbelief that after so many years of not wanting to become pregnant, and then not being able to get pregnant when I wanted to, that the reflection is actually me. More so, I'm amazed at how much I've enjoyed being pregnant and how much I've cherished this opportunity. Once we were seemingly out of the woods with the accreta scare, and the potential for life threatening complications were no longer making us question if we shouldn't have pushed things and should have accepted that we weren't meant to have any babies grown in my uterus, we could finally embrace the pregnancy and almost appreciate that we may have a little baby in our arms at the end of this all. By week 27-28, Jate became very active and I felt myself wanting to savor every kick and every hiccup. I could already appreciate a sense of nostalgia. I am going to miss being pregnant.

Although I won't say never, the probability is very high that this will be our one and only pregnancy. If we're fortunate enough to have a healthy mother and healthy baby from this experience, we don't want to tempt fate again. I hate the thought of going through the uncertainty of another transfer, an agnosiging beta wait, and all the lurking potenial obsetrical complications we could face after making it through the first trimester. Not to mention, we're not getting any younger. We won't officially make any decisions regarding our embryos for another year or two, but I already decided my post partum contraception will be Nex.planon. I was an IUD user for 10 years, but if my ute makes it to the end, I'm going to give her a well deserved rest. Plus, Nex.planon inhibits ovulation. After spending three years determining when or if I was ovulating, I don't want to ovulate at all for the next three years.

I managed to make it to the third trimester before wearing any formal maternity clothes, although I had picked up a few larger sized items and some stretchy material skirts by the time I hit twenty-four weeks. I had always vowed that I would never wear maternity jeans with the large stretch panel, so I managed to make do with a Bella band, even though it is essentially the same look. I shopped conseignment stores for a few maternity dresses and tops, but I did go to a proper maternity boutique to get one new dress. I felt a bit smug at the check out, as the woman at the till next to me had filled three shopping bags and she was barely at the half way point. So far, I've managed to escape any stretch marks, thanks to the genetics from my mother and a European cream not available in the United States. I had purchased some when we first started trying to conceive, because I had to be prepared, and my prediction came true that it expired by the time I was actually pregnant. It would cost over $160 to purchase through Ama.zon.com, but Husband procured a few bottles for less than £20 while he was in England. Apart from my pre-Thanksgiving irrestible desire for Tater Tots, I haven't had any food cravings and my appetite has been pretty normal. As of 34 weeks, my weight gain was around 23ish pounds, although it could vary by 2-3 pounds depending on my swelling, but it stayed in that range until the end. I've been trying not to obsess (too much). I had wanted to keep the total gain closer to 20 pounds than 25 pounds, and it became frustrating as my weight kept increasing depsite maintaining approximately the same caloric intake. My OB appointments felt like a reverse Weight Watchers weigh-in. Myrtle had gained 15 pounds by the time she was 18 weeks and was up 35 pounds by 32 weeks, so I imagine she must have been between 40-45 total gain by the time she delivered. I know it's not a competetion, but I'm winning in at least one category.

Since the early weeks of my pregnancy, I've had some nights with interrupted sleep. It's the middle of the night and I'm wide awake. Recently, I've been getting up and trying to do something productive, so I can somewhat adjust to being functional at night. I'm still fairly comfortable while sleeping, and I find that I'm actually able to sleep on my back. It makes me silently chuckle when women present for their first visit and are concerned about sleeping on their backs. Overall, my energy level is rather high and I don't feel too fatigued. I feel very fortunate that I don't have any aches or pains. From my own experience,  I have become more convinved about the benefits of exercise during pregnancy. It seems to follow the 'body at rest, stays at rest and a body in motion stays in motion' philosophy. I feel that if I were less active, I would be much more stiff and seized up.

I do miss running and I hate that I have to delete the many emails I receive for local races and events. I had wanted to continue running and had planned to run a half marathon at 16 weeks, but I developed plantar fascitis. My running shoes were long overdue to be replaced, but I had many races in November and December, and I didn't want to run with new shoes. I had also changed my pronation due to the pregnancy and the combination of those factors wrecked my feet. Since the main treatment for plantar fascitis is rest, I figured this would be the best time. I also really miss my ankles. I don't know why, but I was naive enough to think that I was going to be immune to the swelling effects and I was devidtated on the day that I looked down and saw that I had cankles. I had to banish my favourite pair of Mary Janes to the back of my closet as I discovered that it was not a good idea to wear any shoes with a strap. I purchased a pair of basic Easy Spirit black flats which are made of a very comfortable stretchy material. Still, my lower extremities look like baggettes stuffed into shoes. Husband has commented that my ankles look very similiar to Tyler's paws. I was offended, but his observation is pretty accurate.

I have loved not knowing the baby's gender. So many people have said to me "Oh, I don't know how you can do that! I'm way too impatient!" Honestly, I'm still not anxious at all to find out. I supposed I'm applying a bit of the Monster at the End of the Book tactic, which is the longer I hold out on knowing, the longer I can hope for a girl. I honestly have no inclination either way. Sometimes I've had a certain feeling or vibe from some of my patients that has lead to an accurate guess, but I have no speculation on my own baby. There seems to be an almost 50/50 split between the conjectures of my patients, staff and friends. I've been running scenarios through my mind where I hear my OB declare "it's a girl!" or "it's a boy" just to try to prepare myself. Oddly, I've had two dreams where they baby was born, and we still didn't know the gender.

So far, there have been no significant labour signs or symptoms. Although, I'm a bit embarassed to say that I'm not entirely sure. It's been ages since I used to sit an palpate a labouring patient's contractions. Some times I'll feel a vague sensation of tightness or hardening, but I can't tell if it's just Jate moving about. I've decided it's akin to determining if a woman had an orgasm: if you have to ask, the answer is probably 'no'. My cervix has not been able to be checked due to the low lying placenta, but I've felt some odd twinges toward my vagina, so it may be effacing a bit.

Best moments of the pregnancy? There have been so many, which is why I'm going to miss being pregnant so much. The highlights definately include seeing the smile on Husband's face when Misery announced that my beta was 175. Watching the vivid and dark test line appear on the First Response Early Pregnancy Test. Making my mother cry when she first looked at the ultrasound photo. Receiving an email from my Dad celebrating each week, often with a silly poem that he wrote. Feeling the clumsy thud that announced Jate's presence for the first time. Noticing that Jate seem to kick more often while I would be listening to the fetal heartbeat for one of my patents. While the 25 minutes inside the MRI machine, was not a highlight, receive the news that I looked to be clear on an acreta certainly was. Planning and decorating the nursery was quite a bit of fun. I ordered so much online, it felt like Christmas as so many parcels arrived on our doorstep. My aunt and cousin hosted a baby celebration event, which is not to be confused with a baby shower. While I was so thankful for their efforts, I was quite nervous as my aunt is one of the most disorganised and infocused people I know. I arrived earlier than instructed as I figured we'd have to help with food prep and other arrangements. When I walked through the door, my aunt announced that everything was under control, thanks to a special helper. My mother flew out for a surprise visit. I was so thrilled to see her and was so relieved as I knew the party would go off without a hitch. (My mother did state that she had to crack the whip to make sure all tasks were being done). The event was a perfect celebration with friends who have supported us through the disappointment of every failed cycle to the triumph of a pregnancy that might finally produce a baby.

Most of all, I've loved sharing all this with Husband. I'll especially miss lying in bed at night with his hand on the bump to appreciate Jate moving about. I love the way he talks to the baby as I love seeing how excited he is about becoming a father. He caught me bump smuggling one day and commented, "It's such a beautiful sight. It's something I thought I'd never see." Neither did I. It's been such a privledge to experience this pregnancy. Perhaps, I've enjoyed a deeper appreciation after infertility and pregnancy loss.

The Final Verdict

I remember watching the episode of The Office when Pam returns after having her first baby. "How was maternity leave?" she repeats the question asked by the never seen nor heard interviewer. "Oh, it rocked. It rocked my ass off." It has only been one week, but so far, my leave has been rocking my ass off.

I felt oddly emotional as I headed into my last day. I wondered what it would feel like to wake up on Monday morning and not have to go into work. I didn't get to have that experience until Tuesday as I had a 9:00 fetal monitoring with Co-worker on Monday morning. It was as if it were just a regular day. Except I got to wear open toed shoes and I had my swim suit on under my clothes as I planned to attend the noon swim class. During my last week, I scanned myself on a daily basis to confirm Jate's position. He/she was head down on Monday and Tuesday, flipped transverse on Wednesday, and was back to cephalic on Friday (I checked twice that day). I suspected baby was transverse again on Sunday night, which Co-Worker confirmed on Monday morning. Interestingly, in the complete oppositie direction from Wednesday. I felt so defeated. I was now 37 and a half weeks. 97% of babies are head down by 37 weeks. Once again, I was in rare minority. I hated having one more issue. One more potentially complicating factor. Okay, I get it. I suck at pregnancy. I really, really suck at pregnancy. Husband had started to become alarmed after doing a Google search on transverse position. He also tried to bribe baby to turn head down by promising him or her a kitten. I left my appointment to go swimming, which was my first time in the pool in almost two months. While we were doing our kicking drills, I felt a flipping sensation inside. Jate went head down again and has stayed in that position. I've been palpating myself somewhat obsessively to confirm. At least once an hour.

"One of these things is not like the others..."

My final ultrasound to assess my placenta was scheduled for Thursday morning. I wanted to be prepared in case the perinatologist advised me to be delivered the next day. I completed my necessary errands. I prepared some meals to put in our chest freezer. I gathered items to bring to the hospital, although I haven't yet packed them into a suitcase. (For a great list of what to pack, check out this post from Climbing the Pomegranate Tree) It wasn't all work, as Husband suggested that I should spend at least part of the day with my feet up. Wimbledon! The Women's World Cup! Don't mind if I do! I couldn't have planned the timing of this leave any better! It has dramatically reduced the swelling in my ankles. My feet are still a bit puffy, but I lost two pounds, which I'm pretty sure was all water weight. At times, I felt a bit guilty. If I'm able to swim, cook and run important errands such as getting my bits waxed and squeezing in a pedicure, then I should be able to work. Although the swelling has improved in my feet, it's become worse in my hands and I have carpal tunnel syndrome. I feel that I would struggle performing certain procedures. At least, that's what I keep telling myself.

Tyler has been keeping me company during my feet up time.

I had been counting down the days until this scan, as it would finally once and for all, answer the questions that had been on everyone's mind for the past twenty weeks. What would be the mode of delivery and when? I was less concerned about the mode of delivery and more curious about the when. I know how selfish this sounds, but I was really hoping for an extension that would grant me some more days of this wonderful leave. I think I have to also acknowledge that I'm freaking out a bit as we may have an actual baby really soon. Despite the pregnancy and preparing the nursery, it hit me when Husband installed the car seat and we took it to the Police Station to be insepcted. I'm driving around with a car seat in my car! Are we really ready for this? We know that this baby is going to change our lives as we know it, but how are we going to react to this change?

The technician must have obtained at least twenty measurements of my placenta and the furthest distance she could measure from the os to the placental edge was 1.8 cm. It would need to be more than 2.0 cm to permit a vaginal delivery. Jate's head was pretty high while she was taking the transabdominal measurements, but the head was more engaged during the transvaginal scan. As the head moved lower in the pelvis, it brought the placenta closer to the cervix. Half a centimeter to be precise. That seemed to seal the deal. A vaginal delivery was just not in the cards for me. I'm okay with this. Quite at peace with it, in fact. Even if the placenta had moved enough, I had decided that I would request a C/section rather than an induction if I didn't go into spontaneous labour.

The Perinatologist was detained at the hosptial and wouldn't be back until the afternoon. I was waiting for his phone call while everyone who knew we would be receiving news was texting and emailing me for an update. He called after 5:30. As he still hadn't left the hospital, he didn't have a chance to look at my images. I reported the findings as well as the recent issues with Jate's presentation and a summary of my blood pressure readings. As long as my blood pressure is within range and baby stays head down, I can schedule my C/section at 39 weeks and 4 days. My maternal side is so happy that Jate will be delivered after 39 weeks. Selfishly, I'm happy about having another week to myself. The doctor offered that we could do one more scan on the day of my Caesarean and if the placenta has moved enough, then we could convert to an induction. NO THANK YOU!

Although, it brought such a sense of relief to have this decision made and to finally have it scheduled, I had to admit to myself that I would proabably always be jealous of Myrtle and the fact that she was able to experience the wonder and beauty and all the glory of a natural vaginal birth. As I filled her in on the details, I asked if her husband slept at the hospital. (I told Husband that he can sleep at home, so at least one of us gets a good night sleep) "I think he did." she replied "We were both so tired as I was up the entire night while I was in labour..." I realised this was my opening for a C/section Women are Smug moment: "Yeah, I was offered if we wanted our case to be at 7:30 or 12:00, and I chose the noon time slot, so we'll have one last morning to sleep in..."

2015 Challenge Update #3

After the drywall work was done, things began to move quickly with our projects. The weekend after Memorial Day, Husband and I painted the garage. Yes, we took the easy way out and painted the ceiling and wall the same colour...

Husband installed motion sensor activated ceiling lights, as well as several new outlets in the garage and he re-organised the electrical panel. When the city inspector came to evaluate, he thought things looked good and admitted that he forgot his tester. "Here, use mine" Husband offered. The inspector commented that good contractors seem to want to show off their work. Personally, I think Husband was that kid in class who reminded the teacher if she forgot to assign homework.

Next, we had a professional Epoxy treatment to the floor. 

Before...

And After!

The next "fun" project was installing the storage unit, but at last we could move the contents of our garage out of our house.

Finally, the garage doors were installed! 

There are still a few projects left to do, such as painting the doors in then next 30 days per HOA regulations, but fortunately, we'll have my dad here to help. Most importantly, we have a functional garage in time for baby's arrival! 

...and They Have a Plan.

Last year, while I was preparing for my maintenance of certification exam, I came across this practise question in a review textbook:

1. The patient asks you about birth plans during her initial prenatal visit and inquirers as to your attitudes toward pregnant couples who wish to participate in decision making for the conduct of labour and delivery. How would you respond?

A. Birth plans are not a good idea; usually something goes wrong and the couple is disappointed
B. Birth plans are not a good idea; they frequently lead to unresolved guilt to the couple
C. Birth plans should be avoided; perinatal morbidity and mortality are usually increased
D. Birth plans are an excellent idea; everything always goes according to plan
E. Birth plans are a good idea; they involve the couple in the planning for the baby's delivery and can be an important part of the prenatal, postnatal and postpartum care

Here is a situation where I would argue that you have to read the questions carefully. If they are asking, 'what is the best answer?', then obviously they are leading you to select choice 'E'. However if the question were phrased 'what is the correct answer?', then I would go with choice 'A'. When I was working on Labour and Delivery, the majority of my patients were young girls for whom nothing about their pregnancies nor births were planned. However, there is something about the body at that age that is conducive to giving birth. Many of my patients had the all natural, unmedicated, intervention free vaginal births that the older patients on the floor desperately wanted. I always detected a sense of slight annoyance whenever one of the nurses was caring for a patient with a birth plan, but more so, the universal consensus from the nurses, to the midwives and obstetricians, to the anaesthesiologists and the OR techs, is that the more detailed the birth plan, the more likely the delivery would end up as a Cesarean. Even the Unit Clerk would ask about booking an OR if a patient handed her a 5 page birth plan upon her admission.

My thoughts on birth plans is that they can lead the couple to focus too much on the process and not the outcome and too often, disappointment is expressed when things didn't go according to plan. When Myrtle recounted her birth story, she described that she starting feeling cramping and uncomfortable around 11 PM. She went to bed and woke up around 5 the next morning and could tell she was contracting. She walked around her tiny condo for an hour and as the contractions picked up, they decided to go to the hospital. She was 5 cm upon her arrival and little Myrtle was born via a Vacuum Assisted Vaginal Delivery at 11:45 AM on her due date. Barely 12 hours of labour. Most of my patients and my infertile jealous self could only dream about having a delivery so perfect. Yet to Myrtle, there was one flaw. "I had to have an episiotomy, which I did not want." she complained. Oh, for fuck's sake Myrtle. It's not like you're at the deli and you're telling the guy behind the counter that you don't want pickles on your sandwich. I wanted to say these words to her, but as little Myrtle was in the Newborn ICU with breathing issues, I held my tongue.

Co-worker is the only patient I know who had a birth plan that went according to plan right to the letter. She drafted it right after learning she was having twins; 'I want a C/section'. Prior to learning of my placenta issues, my birth plan would have been 'let's just see how things go...' which has really become the approach for the since the discovery of the previa. As the placenta had moved past the os by 32 weeks, I no longer needed to be delivered between 36 and 37 weeks, but it still hadn't moved enough to allow for a vaginal delivery. So we had yet another follow up at 35 weeks and 5 days. The placenta was now 1.5 cm away from the os. It needs to be 2.0 cm to permit a vaginal attempt. The perinatologist that I usually see was on vacation, so of course, the one filling in offered a completely different opinion. He suggested re-scanning at 38 weeks to allow the placenta a little more time to move, and if it does, and as long as my blood pressure is controlled and the resistance index of the umbilical artery is normal, then I could go to 39 and a half weeks before he would induce. (The original perinate recommended delivery between 38 and 39 weeks due to my chronic hypertension).

So the latest birth strategery looks like this: If the follow up scan at 38 weeks indicates that the placenta has not moved enough, then we'll schedule my C/section the following week. If it has cleared 2 cm, then we'll induce at 39 weeks and 4 days, if I don't go into spontaneous labour before then. Hopefully not on July 4th. The petty aspect of my birth plan is that I desparetly want to avoid a 4th of July baby out of consideration for my English in-laws. It just feels like it would be very in-your-face to have their grandchild born on such an American holiday. Husband and I have discussing the pros and cons of each option. At times, the suggestion of a vaginal delivery makes me wishful for the conveniences of a scheduled C/section and most importantly, the opportunity to have my stomach muscles reapproximated. Other times, I feel that since we've come so far from a possible accreta and potential hysterectomy, then I sort of owe it to myself to try to avoid any major surgery by attempting a vaginal delivery. There are a few awkward logistical issues. My parents booked their flights when we thought I'd be delivery early and the baby would be 2 weeks at the time of their arrival. Now there is a chance they could arrive a week before the baby. Additionally, as we have been anticipating a Caesarean delivery, we've been factoring 8 weeks disability. My actual return date (not the one assigned to me by the DS) is predicated upon our trip back east at the end of October. If I have a vaginal delivery, it will be more costly as I'll only get 6 weeks leave and will have to take two weeks unpaid. Just as I was reflecting how shitty it is that women have take this into account with delivery decisions, Husband cheerfully piped in, "Best case scenario: you go to 39 weeks and 4 days, but ended up needing a C/section anyway!' Sometimes it's amazing how such simple concepts can rule the male mind...

So now that we've established a p-l-a-n, it's going to invite the Universe to fuck with it. The first potential variable is my blood pressure. It has been so good, I've almost been back in denial on whether or not I really have chronic hypertension. I tested myself by taking my Labetalol a few hours late and obtaining a reading. It was creeping up to 132/88. Sorry Jane, it's the real deal. I also know my well controlled blood pressure doesn't provide too much reassurance as I've seen patients go from zero to full blown severe pre-eclampsia in a day, if not, within hours. The other variable is Jate himself or herself, who won't stay head down. I suppose the former gymnast in me should be proud that he/she is essentially doing cartwheels in my uterus. At my twice weekly NST appoinments we've seen the head on the left side, the right upper side, cephalic presentation for the perinatologist, and most recently spine down transverse with the head on the right lower side. It's been like Mark Twain's description of the weather in New England; just wait a few minutes and it will change. I feel a little more encouraged as baby can spontaneously vert into a cephalic position and I've been doing the Forward Leaning Inversion and Breech Tilt, which is supposed to help with a transverse baby. I've been trying to determine the position, but it's hard to do Leopold's maneuvers on yourself as your hands are at the wrong angle. When a transverse presentation is confirmed, it feels as if I have something sitting across my lap, and I have much more pressure on my bladder when baby is cephalic. Transverse presentation is a little more frustrating to manage than a breech. If an external version is to be attempted, then an induction should follow immediately if successful as transverse babies are more likely to vert back than a breech. It's also recommended to deliver between 38 and 39 weeks as there's a higher risk for cord prolapse if spontaneous rupture of membranes occurs.

Alas, we wait and see. I still have no idea when, how or why I'll be delivered...

If you leave, don't leave now...

Sadly, I'm old enough to remember when Bill Clinton signed the Federal Medical Leave Act (FMLA) into law, and it was considered a legislative victory and represented progress for women's rights. Twenty plus years later, it's widely recognised that FMLA protection is rather inadequate as it only secures one's job while he or she takes twelve weeks of unpaid leave after the birth or a baby, adoption or need to care for an ill family member. Additionally, FMLA is rather restrictive as one must be a full time salaried employee for at least one year at a company with more than 50 employees  in order to even qualify. It is projected that 40% of employees are not even eligible for FMLA protection. Last Week Tonight with John Oliver recently broadcast a brilliant piece on the shitty state of maternity leave in the United States, and he featured some clips from the opposition to FMLA, which sound so familiar. There were claims that it would "cost jobs" and it was a "suffocating regulation being shoved down the throats of businesses and families" (from a female Congresswoman). Tom Delay, who many will remember was indicted on charges of conspiracy to violate election laws among other dodgy allegations, claimed the bill was "unfair, invasive, anti-business, anti-growth and deathly expensive". Yet less than 10% of business expressed any negative effects about complying with FMLA mandates. California broke ground in 2002 with the introduction of a Paid Family Leave, which provides partial pay for six weeks and is financed through payroll taxes. Over 90% of California businesses report a 'positive' or 'neutral' impact of the paid leave. As John Oliver describes, "It's like having an ice hockey game on at a bar. It's not bothering anyone and some people are actually really into it."

When I first spoke with the Disability Specialist (DS), I took note that she seemed reluctant to offer any information and only replied to specific questions. It would seem that she were just lazy or incompetent, but now I appreciate that she is a very diligent employee who has probably been trained to be evasive. She wouldn't tell me how much leave I could take, only that it would depend on my eligibility, which couldn't be determined until I submitted my request. I was instructed to apply for my leave 30 days before the intended date. As my latest ultrasound had revealed that my placenta is moving and my delivery date could be pushed out, I emailed the Disability Specialist to ask if it would be better to file 30 days before the earliest possible date of my leave and then change the date as needed. She never wrote back to me and as my office manager kept asking if she should open my schedule for another week, I decided to say 'fuck it' and planned to file a week later with the hope that I would need to change the date and would create extra work for the DS. At last when it was 30 days before my intended last day, I clicked on the weblink that the DS had sent me so that I could sumbit my request online. I couldn't get passed the first page before the site crashed. Repeatedly. I tried calling the 800 number that was listed, but after waiting on hold for twenty minutes, I had to leave a message. I called again and waited for another 20 minutes to no avail. When I didn't hear back from anyone at the end of the day, I called the DS and received her voicemail. I left a pissy message indicating that I did not want to have to work past my intended stop date and did not want to have to take unpaid leave just because her department didn't have their act together.

The following Monday, I finally reached the DS. There was no mention of my prior messages or email. She took my information started the process of my leave application. Two days later, I received a formal letter from her. According to my paperwork, I was approved to take six weeks off from my delivery date. She had already slated my return to work date, which was exactly six weeks to the day from my original due date. As that date falls on a Thursday, I would be expected to return on a Friday. As in 'don't be cheek enough to think you can take one more day and restart on a Monday...' The icing on the cake? She mentioned that I could use my PTO time, but according to her records, I had zero hours of stored PTO to apply. Cue freak-out from an emotional, hormonal pregnant woman.

I just couldn't escape the feeling that I would get screwed over by the process. I am a hard working, tax paying citizen who has never had to use the system, let alone have any idea how to work or manipulate it. One of our affiliate offices hired a new doctor who was about 4 or 5 months pregnant when she started working. She only took 6 weeks off,  as she wasn't eligible for California benefits since she hadn't been an employed state resident long enough. I've been a full time employed resident of California for the past 8 years and I have all the receipts to prove that I've paid my taxes. I realise that she has to put something down for my return date, and it was probably arbitrary, but it's hard to believe that when you're looking at an official looking document that also states how you can be penalised if you don't return to work on your anticipated date. Still it felt insulting. As if this was all the time I was allowed to take, six measly weeks, which I know is a reality for many new mothers. She was proposing that I take the shortest possible time as I needed to get my ass back to work right away. What was so aggravating, is that thanks to my cousin, I am aware of the paid leave options provided by the state of California. Why was she seemingly so reluctant to let me know my leave options? FMLA allows me to take up to 12 weeks. I wondered how many employees wouldn't challenge this letter and would only take 6 weeks off. She doesn't actually work for our company, so there is no benefit if I take less leave, which is financed by payroll taxes and does not accrue costs our company. Actually they probably save money as they're not paying my salary while I'm out, although they lose the income generated from my productivity. Maybe she was offered some incentive to screw me over.

I sent her another email and I revealed that I had a family member who is a Human Resources director and had discussed my leave options, including California's Paid Family Leave. Her simple response: "that's a different leave. You'll apply for that when your disability leave finishes". I wanted to write back to ask when or if she even planned to discuss this leave with me and why any mention of it was omitted from the forms in my 'Leave Packet'. I sat on my hands to prevent myself from writing such a message. Firstly I figured that she would just reference the extremely vague and confusing handbook that can be downloaded from the company's intranet. Secondly, until everything is complete, it's probably best not to completely piss her off. I emailed the Bean Counter to inform her of my intended leave, which included my Pregnancy Disability Leave, Paid Family Leave and my 4 weeks of PTO, which I knew were available to me. Much to my surprise, the Bean Counter actually asked the DS to remove the arbitrary return date as she did not want my schedule to be opened, which could lead to booking erroneous appointments for patients.

The California disability leave also allows pregnant women to start their leave four weeks prior to the due date. I've always held a certain admiration for women who work up until their due date. One of my colleagues in Connecticut started contracting as she finished seeing patients in the afternoon session. We hooked her up to the office monitor and she finished her charting while banging out contractions every 3-4 minutes. Once she was done, she walked over to Labour and Delivery to be admitted and her baby was born later that night. Over the past few weeks, I've developed an apprehension as I leave the office each night. If I had to be taken out of work, how many tasks would I be leaving for others to finish? Thus, it's become a push not to leave anything for the next day. All my billing, results reconciliation and other correspondence must be complete each night. I realised that it would actually be less disruptive and less of an imposition to my colleagues to have a set end date, even if it does mean starting my leave earlier. Additionally, there really is no benefit to working longer, except that it's more time get paid on your full salary than partial disability pay. I've heard some patients say "I'd rather work up to the due date to be able to take more time off after the baby is born", but the four weeks prior to the due take is a 'take it of leave' it proposition. You can't apply it to the leave after the baby is born. My new mantra; don't be a hero. It's better to leave on your terms.

It's funny how over a year ago, I was longing to be able to take a maternity leave as I was starting to feel burnt out. As my work load has been much more reasonable, I no longer feel such a need to escape. Since I entered the work force, I've never taken longer than two weeks off at any given time. I fear I'll lose a little of my identity during my leave. I'll miss my patients. I wonder how many office policies and procedures will change while I'm gone. I wonder how rusty and out of sorts I'm going to feel after four months off. Mostly, I wonder how lonely it's going to feel going back to work without Jate. I've grown accustom to his or her company.

Welcome to the Jungle...

Husband sacrificed his home office to create a nursery for Jate. I had a small desk that I kept in our guest room, which I didn't really use. We moved Husband's work space into the guest room, and moved my desk into the living room, which means I have to keep it presentable. We decided not to change the paint colour in the room. When we first bought the house, we hired a professional colourist to select a colour scheme for the entire house. This particular paint, is actually in the grey family, but looks blue in the room. More so, the name of the paint colour is "Husky Grey" which connects to my Connecticut roots.

This is the photo that inspired the jungle theme. Many years ago, I spotted it at the Embarcadero craft market, and even though I didn't think I would want to have a child at that time, I decided that I would want this photo in the nursery. I bought some other prints from the artist, so I was able to track down her email address and made arrangements to order this photo.

The crib was provided by my cousins, although we purchased a new mattress. It was used by both of their boys and had been stored in their garage for the past few months. We cleaned it with some Chl.orox wipes and a Mr Clean Magic Eraser, which really does have magical powers. I don't think the crib has been this clean since they first took it out of the box. It took Tyler all of two seconds to find his way into the crib...

What do you mean this is not my room?

The glider will go into this corner. The baby supply store has signs indicating that they offer a plethora of fabric and colour choices, but they don't state that a custom order takes at least twelve weeks to receive. Twelve weeks! That's almost an entire trimester! We'll move the bassinet (also offered from my cousins) into our room once the baby arrives. I thought the bassinet seemed a little flimsy, but it has been used by four other infants, so that's a good indicator of quality control. Someone else has offered to test out the bassinet for us.                

The end table/book holder was a random Internet find. Does anyone remember the significance of that book?

When we thought we might be facing a pre-term delivery and NICU stay, Husband wanted to wait until baby was born before purchasing any furniture for the nursery. I convinced him to take a leap of faith, which was a good idea, as I tried to order this changing table from Ama.zon, only to discover that it was backordered for weeks. Fortunately, I found it at Way.fair for almost half the price! Score!

We're going to try cloth diapering through a local service. I was cloth diapered and I felt proud that my parents were so environmentally conscious, until my mother explained that it was really because they were poor. We found that the cost of using a diaper service is about the same as using disposables, but the other advantage of using a service is that their washing process uses less energy and less water than cleaning the nappies yourself. Husband has been busy practicing his technique.

I tried to find a simple mirror as I was going to stencil some animal designs on it, but in my search, I came across this mirror from P.ier1 and I decided that I had to have it. Unfortunately, it was also backordered, but I had a saleswoman at a local store track one down for me and secure the sale price! Not only does it compliment the colours in the room and is an interesting decorative piece, I love how it captures the reflection of the tree design and other pictures in the room. It took us nearly three hours just to hang the mirror and the pictures. Really glad we didn't put this off until after the baby's arrival...

The final detail was a small little basket for toys. I made the lining myself. I wanted to place the stuffed animals on a small shelf, but it would impede opening the closet door, so on the floor they sit...

It was a lot of fun to put the nursery together and we hope Jate likes his or her room. The jungle theme not only works well from a gender neutral standpoint, but 'welcome to the jungle' seems to be a good metaphor for parenthood...