Recent Appointments

It's been awhile since I've been able to sit at my computer without interruptions. Today was supposed to be that time for me, but as it stands now, I have an ill husband in bed and a non-napping toddler wanting attention. So...we'll see how far I get. The goal for this post is to record notes from my last couple of visits with doctors before things get any more muddled in my brain...

On November 10 I had a regular monthly OB visit, which lasted about an hour as the doctor took her time with me, asked questions, and really listened when I shared about my experiences at the university hospital. She also encouraged me to send feedback about the NICU doctor to the medical center's Patient Services office, which is on my mental to-do list but honestly just hasn't happened yet. 

Other than that, the biggest things I remember about this visit were the doctor's recommendations for the following:

1. She thinks that I should go ahead and transfer my regular OB care to the university medical center staff once I reach 32 weeks. (The decision to remain at the military health clinic for my regular check-ups was entirely up to me...if I wanted to transfer to UNMC sooner, I could certainly do that. The convenience and more personal feel of the military clinic were the biggest factors for me, as it is twice the distance to UNMC.)

2. Given my past birth history and Verity's overall good health (considering), she believes I'm a good candidate for delivering vaginally as opposed to planning a C-section. In her opinion, even if Verity is in a breech position at the time of her birth, that alone would not need to be a factor in our delivery options.

3. She also advised continued monitoring of Verity's growth via ultrasound, something recommended and covered by Tricare (our military healthcare). This was a pleasant surprise to me, as our last ultrasound had seemed to have a note of finality about it--I wasn't given the option to make a return appointment, and since they had seen Verity's heart and profile clearly (unlike the first ultrasound), I assumed that since no one said anything to me about scheduling another appointment, then obviously we were done with ultrasounds. Looking back, I can't help but wonder if the doctor who had evaluated the pictures felt continued monitoring was unnecessary...? I can't say for sure, but I had the distinct impression during our two meetings with her that she was rather negative about continuing the pregnancy and the chances for Verity's survival. 

At any rate, the military clinic staff set up the appointment for an ultrasound that would be about 4 weeks after our last one, which ended up being November 23. Since my parents were in town for Thanksgiving, my mom and Charis went with me for this one, and we joined Ted plus my dad and the rest of the kids on base for a squadron open house after we were finished.

Verity at 26 weeks

This appointment was a very quick screening and included getting to see Verity's sweet little face in 3D! After the images were recorded, I met with a different doctor than before. (I was pleased to learn that my doctor from the military clinic had requested for me to see someone different this time!) We learned first of all that while nothing else seems to be showing up as potential problems at this point, Verity is still very small, only in the 7th percentile...and that is with a later due date than my original one. Our initial due date was based on LMP, giving us February 16. After some early concerns--long before we had any idea about the Trisomy 18--I ended up having two internal ultrasounds about a week or two apart that seemed to agree with each other on a February 25 due date, based solely on the gestational development at the time. The doctors have not adjusted the due date since, even after the diagnosis, so we are basing everything on February 25. I'm not sure how adjusting it would affect her percentile...either way she would be pretty teeny.

Verity at 26 weeks, 3D. Can you see her right ear, eye, nose, and mouth?!

Dr. N is very kind and gentle and also took time with me to discuss some things no one had yet asked or told me about. For example, he asked how "aggressive" we wanted to be during the pregnancy itself. This part was a little confusing at first, but after asking some questions, I think the gist of what he wanted to know was how frequently we would like ultrasound monitoring. With any other baby measuring less than the 10th percentile, they would typically recommend ultrasounds every 2 weeks. That sounded exhausting to me. 

And then he explained that some couples choose to intervene with early C-sections based on any alarming ultrasound findings, even if taking the baby early wouldn't affect the outcome. I suppose one could certainly ask the question: how do we KNOW the outcome wouldn't be affected? But at this point...Verity looks good. She doesn't have heart issues or other organs affected like some T18 babies. I don't see that going in twice a month is going to be any more beneficial than once a month (which the doctor seemed to agree with, even though he made it very clear that it was our decision). So our next ultrasound will be on December 20. 

Finally, without me having said anything about delivery options, the doctor spent some time on that topic as well, and when I told him what the military doctor had told me (about us being a good candidate for vaginal delivery), he nodded in agreement. This was encouraging for me, as he affirmed my desire to not bring further harm but that if things were looking well for us both during labor, then we wouldn't necessarily need to go in planning a C-section. Certainly if it looks like that will be the only way to deliver her alive, we will definitely go that route. Now that I have heard from two compassionate doctors--two medical professionals who respect our desire to do the best we can with and for Verity, who affirm that they and all involved will give whatever support and help is needed for her during and after her arrival--I'm feeling at peace right now with not assuming we MUST do a C-section. I may learn more information down the road to indicate we need to change the plan, but it's comforting in a strange way to have a birth "plan" of sorts that fairly well resembles our previous births: natural delivery if possible, meds if necessary, C-section if necessary. (I've never had a C-section and only managed to do 3 of our 8 kids' births without any medicine whatsoever.)

With reaching 27 weeks tomorrow even by the later due date, I suppose that means we are officially in the final trimester. Only God knows what will happen between now and her arrival!

And...by the way...for the inquiring minds who want to know, this post was written with many interruptions, but some bread and butter went a long way, as did a session of reading new library books!