Thirty Four Weeks

The hits just keep on coming but I'm experiencing a strong moment so I thought I'd update. I had my 34 week appointment yesterday. I raised the CPC again w/ my OBG for the first time in months. Because it's getting to me so much lately I figured it wouldn't hurt to ask what I could do for reassurance at this point. I half expected her to recommend I start z0!oft immediately. And I don't think I'd say no. She reminded me again that "it happens all the time," and reminded me about my 1:100,000 odds. She said she didn't know anyone who would do a genetic amnio this late (interesting...is there a different procedure for genetic amnios than for lung-development amnios that would make it more difficult to do the former at this point? Or are they the same but high-risk such that no one would bother with a genetic this close to meeting the baby?). She reminded me that if I went to see a peri it would be out of pocket because the insurance company thinks so little of my risk that they wouldn't pay for it (they'd rather take the risk of having to pay later - is how she explained it, i.e. the risk that the baby will have something wrong with it and have a lot of medical expenses. Cold. hard. advice.) Fine, I thought. Commence trying to live with it for another month +.



Fundal height 34 at 34. Exhale. Perfect.



Then she felt around for the head. It's never the thing you're most worried about. I've never been worried about his position, he's been so consistent. Since 19 weeks. Head. Down. Really low, in fact. So she felt down low where she usually finds it and said, "that better be the head. I'm going to get the scanner." My heart sank and I felt frozen, the panic and tears welling up. I knew he was breech in that moment. There is no way she'd get the scanner unless she was pretty darn sure.

She brought out the u/s machine and flipped off the lights while I tried to compose myself. I have not had the best experiences with these scans. Although I am thankful that they are so readily available in that office. There was his head, right under my rib cage. "Little devil!" She said.

His position is one of those things I've been vigilantly watching in order to reassure myself that the baby is choromosomally healthy. There are precious few things I can look to...Fundal height is perfect, he's been head down this whole time, movement - fine. Must be healthy, push that CPC as far back in your mind as you can.

Now he's in breech. At 34.5 weeks. Up go the odds of choromosomal abnormalities again. I asked what could have caused this, trying to get her to comment on a choromosomal link without giving away that I have done my own research. She looked at me like I had just hit her puppy, hard. She took the defensive immediately. I had dared to suggest that she wasn't telling me something. "This just happens, nothing causes it." She said. "Isn't it associated with choromosomal abnormalities?" I asked. "It can be," she admitted, looking like I hit her puppy a second time. Why would I drive that stake in deeper, her face seemed to say. I was just asking. I still don't know why she gets so threatened by an informed patient.

I know breech happens all the time. And I know it can straighten itself out, and does pretty often by 36 weeks. And I know it's not really a 'marker' for any of the trisomies. The rational part of me is reminding myself that this is 'normal' most babies are breech at some point, for all we know he's back head-down again already. He was head down for soooo long, this has to be a temporary blip. He knows where the exit is, his neurons are fine, this has to be the result of me being in a bad position for a while or drinking too much or not enough water or of him just having a burst of energy and getting himself into a pickle.

But the other part of me fixates on statistics like 5-10% of breech babies have something congenitally or choromosomally wrong with them. My thoughts flash back to those few stories of "isolated" CPCs that did end in tragedy. They all start off the same, isolated CPC, nothing else abnormal, doctor said not to worry. No one even bothered to do any follow up. Then, mid third trimester other signs started popping up, still the doctors said not to worry. Excess fluid, size drops off a little, breech position. No worries, it can all be attributed to normal harmless things.

This was a pattern my OBG followed to the T. She thought it was ridiculous for me to be so upset (I was crying at one point). She accused me of not being able to cope if everything didn't go textbook perfectly in my pregnancy. And maybe that's right, maybe I'm overreacting to tiny imperfections and that many, many pregnancies just 'get messy' by the end, but when I get two signs pointing to choromosomal problems (which are easy to miss if you don't do diagnostic testing), I don't think it's so irrational for me to get upset. It's not like I have previa and breech. Or GD and preeclampsia. Unrelated complications that can be managed. Or related complications with an easy fix or at least a not-so-dire outcome. The 'imperfections' I've had come up have both pointed to the possibility of something being wrong with the health of my baby. Above all things I don't want him to suffer. Why is she sweeping my concerns under the rug again? She mentioned the various other things I should be worried about at this stage which are WAAAY more likely, as she put it. PTL, she said, and a few others - none of them particularly scary - she just wanted to give me some perspective, not freak me out more. I don't know why I had to explain to her that none of the things she mentioned, while maybe more common, had an outcome that even came close to having a t18 baby (e.g. PTL at almost 35 weeks, while bad, is not typically as bad as 'incompatible with life'). The equation for risk, if I remember correctly from college, is: likelyhood times magnitude of the outcome (or "impact"). While the likelihood of T18 may be small, the magnitude of the result is such that it still results in a pretty high number. And that's what I internalize. Said that way, it almost scares me how rational I sound.

I've lost my will to google, it seems too real now, too big of a risk. Too close to knowing for sure. I am NOT going to go looking for what kind of breech T18 babies are typically in and for how long. I am not going to look up stats on soft markers + breech. I don't want to know. Before this experience I thought knowledge was power. Now I know it's paranoia.


After the scan my OBG handed me a xerox of an exercise I could do to get the baby to turn. She then started telling me about my options if he doesn't. They are two-fold:

1. External version: The obg hooks you up to all the monitors at L&D and tries to flip the baby manually. Thing is, this procedure is fraught with risks. Placental abruption, cord prolapse, fetal distress, ruptured membranes. That's why you have to be at L&D, in case an emergency c-section is necessary. I read a post on B@byc3nter about a woman who lost a baby doing this. Oh plus, it apparently can hurt like a mother-effer and has a higher rate of success if the woman has an epidural before hand. Probably because she won't be writhing in pain and getting in the way of the dr's manipulation. I am not doing that s--- twice (the epi). AND it only has about a 50/50 shot at working. Some stats I've seen say as low as 30% successful.

2. Scheduled c-section. This I am ok with. I've always been ok with this idea. I know, I know, major surgery, plenty of risks, too posh to push accusations. But I wouldn't mind some certainty in my life these days and neither DH nor I are objecting to the idea of getting this baby into the world as early as is safely possible.

I've tried the exercises and I'm skeptical. If babies are supposed to know which way is down, why do we try to trick them with inversion poses? If we're trying to encourage their 'natural decent' wouldn't turning upside-down confuse them further? And if they really are confused and the whole point is to trick them into thinking down is up, is 10 minutes twice a day really going to fool them? My OBG said the prop-your-butt-10-inches-into-the-air "exercise" works for 50% of women. Doing my own research I found out that there are no studies suggesting that any of these exercises makes any difference. I also learned that between 34 weeks and term about 50% of breech babies turn head down anyway. This makes sense to me. Common sense. The baby is going to turn, or it's not. 10 minutes twice a day or not. And don't get me started about putting an ice pack on my baby's head (not going to happen) or the idea of playing music or shining flashlights to 'attract' the baby downwards. What if those things are bothersome to the baby?

The more helpful suggestions I've heard seem to be guided by common sense and are aimed at creating more room in your abdomen and pelvis for the baby to move - that is the big problem at this stage, room is running out: rocking on all fours, sitting on a birthing ball with your legs a fair distance apart. I've tried sitting up with my legs in the butterfly position while watching TV and putting an extra pillow between my legs at night to open it up down there. Drinking extra water all the while. I think he knows where to go, he was there for a while. And I guess there's still time.

Try as I might, I cannot tell from day to day where he is, if he's head down again. I guess I knew before the appointment that he was moving in different quadrants of my womb than he normally did, but I couldn't tell that he was in breech. I rarely felt him on the left side until the day or so before my appointment. It started to get pretty uncomfortable and I just figured he was getting bigger. Filling out my whole belly now. I dared to hope there was a good reason for it. And now I do as many checks as I can, but still can't tell what's going on. I feel hiccups right at the bottom of my pelvis, just like I always had. I thought that suggested head-down. I went looking for his heartbeat last night and when I got super-low near my pelvic bone is when I heard it the clearest. I thought these signs meant something, and maybe he's flipped again. But I'm having trouble trusting the signs now. Because if they are reliable, then he must have been in breech for an awfully short time. And if they're not, maybe he's been that way for a while.

The silver lining is that now I'm getting weekly appointments and will probably get another u/s or two in to check position. Unfortunately she didn't dwell long enough the first time for me to get a glimpse of an open hand or anything else reassuring. There's still time though.

I did call the peri. My obg gave me the name of someone I should talk to - not because she thought it was necessary, just because she knew I wouldn't be able to stop worrying - so I called to start the process. I called too soon the first time, my obg hadn't faxed the appropriate referral or whatever so I called back today and had to leave a message. I'm not sure what I'd be trying to achieve with a peri appointment. My obg assured me that there was nothing an u/s could do at this point to rule out t18 or reassure me - I don't know if I believe that. I'd love to see that hand or even just hear that the growth is on track, the fluid even. Throw me a bone here. Five+ weeks is a long time to live with this. For me. I think I need a specialist to tell me what the risks are, to give me some perspective, to review my initial anatomy scan or to look at the baby now. Maybe to tell me something like - T18 babies are sometimes breech because they're small or their fluid is too high, neither of which is the case for you. ANYTHING.

Or maybe he'll go back. In which case I may not go through with the appointment. Because the appointment has potential for downside too. I may hear something I don't want to hear. For this reason, even if I do go through with the appointment, I think I will schedule it for after my shower on the 25th. I don't know how I'm going to get through that day even now, if I had additional bad news or fears by that point, I don't think I could do it. And cancelling would mean alienating every friend and family member that I'm close to and some that I'm not. Seriously this event is going to be on the scale of my wedding. It's not what I wanted. But none of this has been how I wanted. Except the being able to get pregnant part, which I do not take for granted. That's life I guess. So I don't really have any choice but to weather through it. A day at a time.