Last week I had my third midwife appointment, and I admit I walked in with my “tail between my legs” as some might say, because so much of the midwifery care model revolves around nutrition and I had been rather indulgent over Christmas. Sarah laughed and said she never expected anything different from her pregnant mamas and I felt happy to move on to other subjects. As with all of my appointments she measured my blood pressure (97/72 if you are wondering), checked the baby’s heartbeat with a doppler (136 bpm), and I stepped on the scale to see the number 190.6, which meant a gain of 8 lbs since my last visit. I tested my urine and saw elevated leukocytes, but I have no burning during urination or kidney pain so it doesn’t seem to be an infection. I was diagnosed with Interstitial Cystitis about 7 years ago and some reading on message boards has me thinking that it’s possible my elevated leukocyte level can be explained by that condition. Sarah also noted that elevated leukocytes can occur because of vaginal discharge that has come in contact with the urethra (and is excreted with the urine), and anyone who has been pregnant or is pregnant currently has probably experienced that lovely pregnancy side effect as well.
At my last appointment I asked about heartburn, swelling, rapid weight gain, and gestational diabetes. My heartburn has been tolerable (still avoiding Tums, although a reader named Lala has me thinking that acid inhibitors like Zantac and Prilosec are the harmful ones to avoid and not Tums) and I’m mostly combating it when it appears by drinking extra water. The swelling stopped as soon as I got my carb intake under control and started focusing on high protein levels in my diet, and although my weight gain hasn’t slowed down much, at least it hasn’t increased, right? RIGHT? Gestational diabetes… let’s save that one for a bit later as it still depresses me to talk about it.
The only question I had this time around concerned an ugly rash I’ve developed on my legs (see iphone documentation here), but since I don’t have it anywhere on my body it doesn’t seem likely that it would be pups. It doesn’t itch, burn, or hurt, just looks rather atrocious and so I’m planning on making a dermatologist appointment soon.
Sarah said that my blood test results had revealed I am RH-Negative (most people are RH-Positive so I guess you could say I’m “special” in this way), which in very clinical terms means I don’t have a protein called the RH factor on the surface of my red blood cells. If That Husband is RH-Positive then my chances of having an RH-Positive baby are about 70 percent. When baby and I have a different RH Status it can mean trouble. If my blood mixes with baby’s blood I will start producing antibodies that could be harmful for future fetuses as it increases the risk of developing Hemolytic disease. If That Husband is RH-Negative I have nothing to worry about, as I’ll be having all of my babies with him and we’ll keep producing RH-Negative babies each time so he is going to get tested since I’m hoping I don’t have to get the shot!
There are many who will say “I had the shot and it was no big deal.” First, it is a big deal to me, shots are always a big deal. When I had surgery on my back you know what I was most concerned about? Paralysis? Someone cutting me open and poking around near my spinal cord? Nope. I was almost hysterical when they had to put the needle in my hand to get the IV started. Second, even if our insurance pays for it, shots still cost money. It costs the insurance money, which costs the employer providing us the coverage money, which costs us money. I’d like to avoid contributing to the mountain of unnecessary and expensive medical procedures if I can. Third, though the complications are rare there is still the possibility that an allergic reaction could happen or that it could adversely affect the developing fetus. I’d like to avoid any interventions possible as long as I feel assured that such avoidance will do more harm than good for both baby and myself. It is my understanding that for most women seeing OB/GYNs the shot is administered automatically if the woman is found to be tested as RH-Negative, with no testing being done on the father, a practice I deeply disagree with. Yet again another great reason for me to be working with a midwife rather than a doctor!
The shot commonly given to pregnant women is called the Rhogham shot. If I choose to have the shot it will be offered at 28 weeks, but I will be having it at 30. The shot is only good for 12 weeks, which means it will “expire” at the 40 week mark, and since I intend on taking this pregnancy all the way through until 42 weeks if baby decides to cook a little bit longer I’m going to have the injection a bit later than usual to cover me all the way through the full gestation period. I’ll also have a second shot within 72 of hours of any event that could cause my blood to mix with baby’s including miscarriage, stillbirth, bodily trauma (such as a car accident), or labor/birth. The little bit of research I’ve done indidcates that the FDA banned the use of mercury in the Rhogam shot in 2001, and as almost 9 years have gone by I doubt there are still contaminated doses sitting at the doctor’s office. Even so, I’ll be asking lots of questions before the shot is administered to ensure that the dose is mercury-free. If the doctor’s office can’t leave me feeling assured that the shot I’m being given is mercury free I’ll be asking for a dose of WhinRho SDF instead.
Last but not least (this post has become impressively long!), we talked about the gestational diabetes test once again. A quick note on the difference between the midwifery approach to GD and the medical approach to GD. I’ve lamented many times in the past that I think I will have to get the test, and many people have spoken up to assure me that the test isn’t that bad and that it is nothing to worry about. I agree, the test in and of itself is not a big deal and I don’t really have an issue with it. The reason why I would like to avoid it if at all possible is due to the midwifery care model. In the world of US medicine, procedures such as the glucose tolerance test are done on ALL women, regardless of their personal health or history. Thus, the test becomes “no big deal” because everyone does it. With the midwifery care model, the test is only administered to those women who are exhibiting warning signs and actually need it. Thus, being told I need to take the test is very bad news for me because it means that my midwife, who has personally cared for hundreds of pregnant women, suspects that it might be an issue for me. I think the subject of gestational diabetes needs it’s own post, but the biggest reason why I am hoping that the results are very, very, negative is that very, very positive results could mean a transfer out of the care of my midwife and the sad, sad news that I will be denied my much desired home birth.
I’m taking the test on the 21st of January, which means that beginning a week from now I’m going to be focusing on making sure I have the BEST DIET EVER. I don’t want to deal with anything close to a false positive. The only positive thing I can say about taking the test? I don’t have to drink the awful orange drink! Midwives administer the test a little differently than a doctors office and I’ll write about the whole experience in my post about Midwife Appointment 4.
Overall though, I’m doing great, feeling great, and according to you kind friends (thank you thank you thank you) I’m looking pretty great as well.
*I am not a doctor (duh), and it’s quite possible that this perception I have developed regarding the administration of the GD test is inaccurate, but my current understanding is that all women seeing an OB/GYN in the US are subjected to this procedure as part of the routine that has developed in regards to prenatal care.