Monday, August 31, 2009

Another day, another copay

We had another checkup with our doctor/midwife practice that once again showed how personal medicine is, despite all the science behind it.

We've always been happy with our practice--although we were a bit disappointed with our initial midwife on our last trip to the hospital--in large part because they work with us rather than on us. When pregnant with 3B, Mama was concerned about how much weight she was gaining, and each doctor or midwife--it's a large collaborative practice--had a different opinion. While that shows that there's no absolute correct answer, it's also a bit unsettling.

Then we had an appointment with Dr. G, one of the founding doctors, who explained it this way, "Pregnancy is a natural event with a broad normal range. All we do is ensure that you're within that normal range. If you go out of that range, we talk to you about it." Then he patted his paunch and said, "Besides, it's not becoming for a man of my shape to be telling you that you're gaining too much weight."

In a nutshell, they're honest, modest and they trust us to be intelligent adults.

Today our appointment was with one of the original two midwives, and she was the same as Dr. G, with a mellow manner, and like most of the folks in the practice, she got it. She gets who we are and what we're about, so when we went over our history of appointments and I told her that we want to give baby girl at least as long as her brother had to come out on her own, I didn't need to say anything else. The midwife took it from there and set us up.

See, after our checkup last week, we were supposed to schedule an inducement appointment. But the midwife recommended we come in this Tuesday or Wednesday, which would be just 9 or 10 days after baby girl's due date, and we wanted to give her at least as much time as 3B had to be late, so that she could come on her own, if at all possible. The midwife understood us, but as a matter of course recommended only going 10 days past our due date before inducing.

Her concern was multifold:

  • the placenta gets old and stops producing as much fluid and oxygen as the baby needs
  • labor is stressful and that combined with low oxygen could make baby's heartbeat fluctuate more than normal during labor
  • everyone in the room will know that we're more than 10 days late, which makes them more likely to cut labor short and suggest a c-section
Her feeling was that inducing at 10 days gave us a better chance of a vaginal delivery than of an unplanned c-section.

Giving us the benefit of the doubt, she scheduled us for tests--non-stress test and amniotic fluid index, for you OB geeks out there--on Friday, to determine how comfy baby girl is in Mama. We passed with flying colors, so there's no hurry to get baby girl out--from her perspective, although Mama has a slightly different take on it. Just in case, they had us book another round of tests on Tuesday, to ensure nothing's changed.

Today we got to experience one of the joys of a collaborative practice--seeing the range of opinions among practitioners. After going over the last week's history with today's midwife, and explaining how we were aiming to give baby girl as much time as possible, we left it up to the midwife to recommend a course of action.

She recommended that she strip Mama's membranes, which we were planning to have her do, confirmed that tomorrow's tests are a good idea and told us that next time we came in, we'd have to see a doctor, because "they're kind of sticky about some of their rules." However, she continued, she would pick her doctor, looking for one who's laid back. She found him, even though he's at another of their office locations, and so that's where we're going on Wednesday. This other office isn't too far from our house, so it's not inconvenient.

While we were celebrating our ability to let baby girl schedule her own delivery, however, we were also realizing that this meant there is no definite end in site for Mama. She'd been counting on scheduling an inducement appointment today, so walking out without one left her, once again, hanging.

So this is where we are--still pregnant, with a calendar full of appointments. I think part of the reason they schedule so many appointments when you're past due is to ensure the mother is doing her share of walking. In fact, today's appointment was one floor up from the regular office, which was probably just to get Mama to walk up the two flights of stairs...which she did two at a time.

Is she kidding? Just watching her do that made a vein pop out in my neck. Oi!

At some point we'll have to bite the bullet and schedule an inducement. Perhaps when we do, baby girl will respond the same way her brother did--by finally deciding to come out and see what this world is all about before being pushed out. It's a trait he has to this day--he'd much rather do something himself, even something he finds laborious, than have someone do it for him. And yes, we do exploit this Achilles heel for all it's worth.

While we wait, we remind ourselves that this is a natural event with an end date and we take comfort in the words of our midwife: "They do all eventually come out. I read that in a book somewhere."

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  1. HA! I love that quote from your midwife!

    I can't even imagine how Mama is feeling right now. Know that we're sending labor vibes your way and that little lady better get a move on--we want to meet her!!!

  2. She was full of good stories about being a Vietnam vet, having a kid who was a Green Beret and is now a tax law attorney, and so on.

    Thanks for the vibes. We're anxious to meet her too.

  3. I think the other reason for all the appointments is so that you will already be at the office when she goes into labor.

    She is already living up to that name we suggested for her... if she did not come, she would have been induced out... 2 weeks late!!

    Sending contraction vibes your way. I hope to see her by Thanksgiving.

  4. It must be nice in Mama's belly. Your kids don't seem to wanna leave!

    Hang in there, Mama! I know you must be ready to meet this little girl, and stop sharing your space! (...which makes me think...Look: two people CAN occupy the same space at the same time!)

  5. Anonymous4:25 PM

    See, this is practice for all the superheroic patience parents need later in life....

    Eh, stripping membranes -- maybe helpful, but never fun.

    Hang in there! They all do come out eventually.