Fourth midwife visit.
Dec. 8th, 2004 08:45 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
rivkaI went to the midwife today for my 23-week appointment. (I know that's a weird number, but they start visits at 8 weeks and then want you to come in every 5 weeks.)
Everything looks just great. The baby's heartbeat is strong and regular. My blood pressure is 108/62, which is fine, I don't have any swelling in my hands and feet, and I don't seem to be spilling any sugar or protein. She tested for anemia because of my problems with dizziness and shortness of breath, and my hemoglobin came back 13.6 - which is excellent. (Normal for a woman who isn't pregnant is 12.1-15.1, and normal for a pregnant woman is 11-12.) I guess all the red meat I've been eating has really paid off.
She thinks the shortness of breath is normal pregnancy stuff, and the dizziness is probably related to low blood sugar. She recommended that I have three snacks a day, avoid too much sugar at once, and eat protein at every meal and snack - so now I have to think of lots of easy high-protein snacks. It's too bad I'm trying to avoid deli meats (because of listeria) - otherwise that would be a great option. There's only so much cheese you can eat.
I am still two pounds under my pre-pregnancy weight, which has me a little worried. The midwife says I'm just slow getting started with my weight gain, and predicted that sometime in the next month I will start being ravenously hungry all the time and my weight will take care of itself. She's not at all concerned.
We spent some time talking about post-partum depression. I'm probably at higher risk, because I've had two mild depressive episodes before and because my sister had real trouble with it. Both of those things are predisposing factors. I wanted to know if there's anything I can do to reduce my chances of developing PPD after the baby is born. She said that the most important thing is to make sure I have a strong support system in place - including help with the baby, having someone else to do the cooking and housework, making sure I have opportunities to leave the house without the baby, and possibly joining a new mother's group. She also said that I might want to consider using formula for one night feeding, even though otherwise I'll be exclusively breastfeeding, because PPD is strongly linked to sleep deprivation. Finally, she gave me the name of a psychiatrist who regularly works with their practice and suggested that I might want to meet him before the baby is born, so that if problems arise I will already know who to go to for help. She tried to impress upon me the importance of being willing to take antidepressants if necessary, even if I'm nursing - I told her that, as a psychologist, I know enough about the potential developmental impact of having a depressed mother that I will be perfectly willing to take whatever medications are necessary.
Some of this seems like it might be more than is necessary, but I feel better knowing that all the bases will be covered.
I go back at 28 weeks - the beginning of my third trimester. (Isn't that a terrifying concept?) That's also about the time I get more labwork done, including a glucose tolerance test (for gestational diabetes) and a Rhogam shot (because the baby and I are probably Rh-incompatible). They're also going to test for thyroid problems because there's a family history and because it can cause complications - but she said that's just a precaution, because if I were *very* hypothyroid then I probably wouldn't have been able to get or stay pregnant.
I continue to be very, very impressed with my midwife practice. This visit was 45 minutes long, and I had all the time in the world to ask questions and get them answered. We've now met all three of the midwives, and although I still have a favorite, I will be perfectly happy to have any of them attend our birth.
And of course, I am also very impressed with the Li'l Critter and her stellar health and behavior. What a fine baby we're going to have!
Everything looks just great. The baby's heartbeat is strong and regular. My blood pressure is 108/62, which is fine, I don't have any swelling in my hands and feet, and I don't seem to be spilling any sugar or protein. She tested for anemia because of my problems with dizziness and shortness of breath, and my hemoglobin came back 13.6 - which is excellent. (Normal for a woman who isn't pregnant is 12.1-15.1, and normal for a pregnant woman is 11-12.) I guess all the red meat I've been eating has really paid off.
She thinks the shortness of breath is normal pregnancy stuff, and the dizziness is probably related to low blood sugar. She recommended that I have three snacks a day, avoid too much sugar at once, and eat protein at every meal and snack - so now I have to think of lots of easy high-protein snacks. It's too bad I'm trying to avoid deli meats (because of listeria) - otherwise that would be a great option. There's only so much cheese you can eat.
I am still two pounds under my pre-pregnancy weight, which has me a little worried. The midwife says I'm just slow getting started with my weight gain, and predicted that sometime in the next month I will start being ravenously hungry all the time and my weight will take care of itself. She's not at all concerned.
We spent some time talking about post-partum depression. I'm probably at higher risk, because I've had two mild depressive episodes before and because my sister had real trouble with it. Both of those things are predisposing factors. I wanted to know if there's anything I can do to reduce my chances of developing PPD after the baby is born. She said that the most important thing is to make sure I have a strong support system in place - including help with the baby, having someone else to do the cooking and housework, making sure I have opportunities to leave the house without the baby, and possibly joining a new mother's group. She also said that I might want to consider using formula for one night feeding, even though otherwise I'll be exclusively breastfeeding, because PPD is strongly linked to sleep deprivation. Finally, she gave me the name of a psychiatrist who regularly works with their practice and suggested that I might want to meet him before the baby is born, so that if problems arise I will already know who to go to for help. She tried to impress upon me the importance of being willing to take antidepressants if necessary, even if I'm nursing - I told her that, as a psychologist, I know enough about the potential developmental impact of having a depressed mother that I will be perfectly willing to take whatever medications are necessary.
Some of this seems like it might be more than is necessary, but I feel better knowing that all the bases will be covered.
I go back at 28 weeks - the beginning of my third trimester. (Isn't that a terrifying concept?) That's also about the time I get more labwork done, including a glucose tolerance test (for gestational diabetes) and a Rhogam shot (because the baby and I are probably Rh-incompatible). They're also going to test for thyroid problems because there's a family history and because it can cause complications - but she said that's just a precaution, because if I were *very* hypothyroid then I probably wouldn't have been able to get or stay pregnant.
I continue to be very, very impressed with my midwife practice. This visit was 45 minutes long, and I had all the time in the world to ask questions and get them answered. We've now met all three of the midwives, and although I still have a favorite, I will be perfectly happy to have any of them attend our birth.
And of course, I am also very impressed with the Li'l Critter and her stellar health and behavior. What a fine baby we're going to have!
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no subject
Date: 2004-12-08 05:58 pm (UTC)I'm very happy to hear everything is going so well and that your midwife practice is so right for you.
Beef Jerky
Date: 2004-12-08 06:10 pm (UTC)no subject
Date: 2004-12-11 10:35 am (UTC)Also, making your own beef jerky if you're so inclined is very easy (assuming you have or can borrow a dehydrator).
no subject
Date: 2004-12-08 06:05 pm (UTC)no subject
Date: 2004-12-08 06:11 pm (UTC)no subject
Date: 2004-12-08 09:02 pm (UTC)She simultaneously made it sound like PPD was something completely normal to experience, and like it was something to be taken very seriously. And I liked that, when I told her I thought I was at higher risk, she said matter-of-factly, "You probably are." I'm used to being soothed or minimized in situations like that.
no subject
Date: 2004-12-09 09:57 am (UTC)Would it be taking unfair advantage of your status as a professional to ask "What developmental impact of having a depressed mother?" I've been coming to realize more and more lately what a huge difference it makes in David and Kathy's development and functioning that I am feeling and functioning better, and it's nice to hear that the literatire supports the idea that me taking care of myself is important.
no subject
Date: 2004-12-10 07:14 am (UTC)Here's (http://www.cps.ca/english/statements/PP/pp04-03.htm) an excellent general discussion. I like it because it goes well beyond infancy (most research on depressed mothers looks at post-partum depression, for obvious reasons) to consider depressed mothers of school-aged children and adolescents.
I am encouraged that you're viewing this through the lens of "taking care of myself is important," and not in a guilty way. Depression is not the depressed person's fault, and negative developmental effects on a depressed person's children aren't that person's fault either. It's also the case that children are surprisingly robust, and can't easily be "spoiled" by parental difficulties even if temporary negative effects do occur.
no subject
Date: 2004-12-10 07:35 am (UTC)no subject
Date: 2004-12-08 06:16 pm (UTC)Seriously, though, if you have access to any sort of gourmet cheese vendor, this could be a great opportunity to try little bits and pieces of exotic new cheeses!
I've developed wonky blood sugar without even being pregnant, and I find that small quantities of the following nibbles (in addition to cheese) keep things pretty well in check.
* Nuts. It doesn't take many. Unsalted almonds are especially good for you - lots of calcium.
* Nut butter (peanut, cashew, almond) or tahini on whole-meal crackers.
* Hummous, preferably home-made, with crunchy raw vegetable dippers
* Sunflower seeds.
* Edamame.
* Beef jerky.
* Smoked salmon (the nice, hard-smoked PNW sort)
* Other smoked fish. An outfit in Tillamook makes a smoked tuna jerky that's to die for.
* Leftover ham or roast beef (cook it yourself and slice/package/refrigerate promptly so you don't have to worry about the listeria issue).
I'm so glad things are going well for you and your Critter!
no subject
Date: 2004-12-08 07:15 pm (UTC)K. [but of course you should eat things you like to eat. Should you want advice on cheeses you can have it, natch]
no subject
Date: 2004-12-08 07:20 pm (UTC)Sadly, blue cheeses, soft cheeses like Brie, and raw-milk cheeses are also off the menu. That rules out a lot of tasty options.
Smoked fish is a good idea. I'll have to see what they have at Whole Foods. I'm not eating tuna (except for, possibly, canned light tuna - ick) because of mercury, but smoked trout is a good possibility.
We looked at some hummus at the store, and were surprised to see that the protein content listed on the nutrition label is very, very low. You found that it worked okay to control your blood sugar, though?
no subject
Date: 2004-12-08 11:30 pm (UTC)Unlike you, of course, IANA doctor. (-:
no subject
Date: 2004-12-08 11:31 pm (UTC)no subject
Date: 2004-12-09 07:49 am (UTC)no subject
Date: 2004-12-09 08:45 am (UTC)no subject
Date: 2004-12-09 05:31 pm (UTC)*eyelash batting*
I mean, I'd have to save it until after delivery, but...
no subject
Date: 2004-12-09 05:38 pm (UTC)You can still bat your cute li'l eyelashes at me, though. (-:
no subject
Date: 2004-12-08 06:42 pm (UTC)Excellent news for all of you!
The terrifying third trimester begins by being poked full of holes
Date: 2004-12-08 08:34 pm (UTC)I had been warned that the glucose stuff was disgusting and horrible - but I didn't think it was so bad. Tasted just like orange pop to me - not even too extra-sweet. When I commented on that, the medical assistant said it used to be a lot worse, and more the consistency of maple syrup. I do drink pop somewhat regularly, so that probably helped my tolerance level. Once or twice in the hour I was waiting to go downstairs for the blood draw, I felt like my heart was racing slightly, but nothing serious, and not for more than a minute or two.
And the Rhogam - well, it's just a standard shot, really. They do it in your "hip" (i.e. pick a butt cheek). That spot is not even sore now, 10 hours later.
no subject
Date: 2004-12-08 08:58 pm (UTC)http://www.dooce.com/index.html
An excellent blog - she has been struggling with PPD since her daughter was born 10 months ago, and has kept a thorough and painfully honest journal throughout. She also writes lots of fun, interesting, and thoughtful things as well.
Squick warning!
Date: 2004-12-09 05:39 am (UTC)When I was trying to do the increase protein snack thing, I went through a phase of making a ton of cauliflower cheese on a Sunday and freezing it in individual portions to eat for supper with ham. Also, you can put cheese into pretty much any soup. (Well, not miso soup...)
On formula overnight -- it's also endlessly possible to express for overnight. If you express some at the end of each feed, probably by bedtime you'll have enough for the deep-night feed. OTOH, this means messing about with sterilizers and pumps all the time, which some people think ends up being more trouble than waking up and feeding.
Now the squicky bit -- some people say that eating your placenta can help for PPD. I didn't do this and I don't know anyone who did, but I've read about it and some people swear by it. Though I have to say anyone who is up for that might not be the type to get depressed anyway. But other mammals certainly do it.
Re: Squick warning!
Date: 2004-12-09 06:13 am (UTC)Re: Squick warning!
Date: 2004-12-09 05:29 pm (UTC)Honestly? I wouldn't care if some people said that eating your placenta would help you walk on water. I just can't imagine doing it.
Re: Squick warning!
Date: 2004-12-09 05:41 pm (UTC)I had to google quite a bit to find recipes without photos. I hope you appreciate the effort. 'Cause the photos? Ewwwww ...
Re: Squick warning!
Date: 2004-12-10 08:04 am (UTC)no subject
Date: 2004-12-09 06:28 am (UTC)no subject
Date: 2004-12-09 06:30 am (UTC)no subject
Date: 2004-12-09 08:57 am (UTC)That being said, I started struggling with depression toward the end of my pregnancy. Most of it was situational, and I knew it, but it was still no fun to live with. Since I had PPD after Baz, and found that a low dose of Zoloft helped me get back to being me, my midwife and I agreed to start me on Zoloft during the pregnancy. That way, I didn't have to wait for the efficacy period to pass, because I was covered before I gave birth. I figure I'll stay on for about three months, and then see how I'm doing.
no subject
Date: 2004-12-09 10:06 am (UTC)As for the nighttime formula feedings your midwife suggests: I was fully committed to breastfeeding when I was pregnant. Then my daughter was born with severe meconium aspiration syndrome and was hospitalized for a month. Then *I* was re-hospitalized for complications from my emergency section (ugh.) All of this TMI is by way of saying I didn't end up nursing, and it was a hard thing to get over at first, but should you decide to formula feed at night or at any other time, it will be okay for you and the baby. Whatever works and keeps you BOTH healthy is the right path for you, and no one gets to judge that. I learned that the hard way!
no subject
Date: 2004-12-09 10:57 am (UTC)I wonder when they started giving Rhogam prenatally. When I was in nursing school (late 1970s), it was strictly a postpartum thing, best I recall.
no subject
Date: 2004-12-09 11:09 am (UTC)It still is, in Europe. There's apparently a 1-2% chance of blood mixing prior to delivery, which is why they now give a prenatal Rhogam shot at 28 weeks. Some women refuse it because (a) they worry about the baby getting exposed to Rhogam, if blood mixing does occur, and (b) they want to wait for the baby's blood to be tested, so that they're not receiving an unnecessary intervention.
I thought about it, and then decided that the risks weren't high enough to make it an issue. I'm refusing some standard interventions (AFP testing, continuous fetal monitoring in labor, antibiotic eyedrops at birth), but I want to pick my battles.
no subject
Date: 2004-12-09 02:43 pm (UTC)My midwife also took my history of depression seriously but I still haven't had PND in spite of everything. I am very pleased that everyone was on the look-out for it though as it meant that when my current symptoms showed up I paid close enough attention to them to know it wasn't PND.
Linnea has number eight tooth coming in now. Rah!
no subject
Date: 2004-12-09 05:28 pm (UTC)Yes, it's the exact same thing you call "Rhesus Anti-D." I like that you call it a "jab." It's somehow so much more vivid than "shot."
I changed GPs because my elderly one swore it was only necessary in second pregnancies. Silly sod. All I know is that it is because I'm Rh-.
But- but- argh. Silly sod, indeed. It's true that Rh incompatibility usually doesn't affect the first baby, but that's because you may develop antibodies to Rh factor when the first baby is born! The Rhogam shot is a preventive measure to protect your second baby. Damn it.
I'm glad you changed GPs.
Linnea has number eight tooth coming in now. Rah!
Linnea is a marvel! Someday I hope to meet her.
Jabs and shots
Date: 2004-12-10 03:01 am (UTC)The nurses wielding tape and cotton wool in pathology are called vampires.
no subject
Date: 2004-12-09 07:53 pm (UTC)The different approaches taken in different countries are fascinating!
(Sorry for hijacking your journal, Rivka -- I'm very glad everything's going well and you have such cool midwives!)
no subject
Date: 2004-12-10 02:59 am (UTC)