Tag Archives: labor

Full term, and the end is in sight!

Hard to believe, but here I am at 39w1d — officially full term!  I just had what is looking like my last prenatal appointment this morning — one more NST and ultrasound, and then the midwife checked my cervix which is looking like it’s starting to do things (2cm, 60% effaced, medium, soft, and -1, for those who like the stats).

I’ve been talking about the possibility of induction with my providers for the past few weeks — my favorite doctor in the practice is on call next Friday, and L&D had openings, so we went ahead and scheduled an induction for next Friday.  I’m a little nervous about induction, but I’m more nervous about going too late and risking the complications that come with that.  I feel good about being induced at 40w2d — my dating is extremely precise (was tracking ovulation and had several ultrasounds around 6-8w that all agreed with ovulation) so there’s no chance of accidental prematurity, baby was measuring 76th %ile as of last week (bigger than my first son), and since my first son was born at 40w5d (after labor at 40w4d) and my cervix is already ripening I think the chances of my body not being ready for induction are pretty low.  I found some great statistics online, and with a Bishop score of 8 (or more by next week) and a previous vaginal delivery, it looks like my odds of needing a C-section with induction are about 6% or less.  Plus it’ll be good to have a date when I know I can stop taking the Lovenox — I just hope I don’t jump into spontaneous labor an hour after my dose sometime in the next week!  (I actually skipped it this morning, just in case the cervical exam got things moving — last pregnancy a doctor did a membrane sweep at 40w4d without warning me, and I had my first contractions within an hour after that appointment!)

It’s so hard to believe that by next week we’ll almost certainly be meeting our second son.  I mean actually hard to believe — it just doesn’t feel real yet, somehow.  We’re as ready as we can be, and now I’m just hoping for no surprises, no emergencies, and maybe even a similar textbook labor and delivery as we had with S.  It’s so helpful to have the memory of S’s birth to ground me — I feel much less fearful about going back to the labor and delivery ward of our local hospital than I did last time, when my only association with that place was the awful delivery of our daughter.  I now know that things can go well, and I even have an expectation that they might go well, rather than feeling like I’m constantly in emergency mode.  Part of me wonders if my more even-keeled emotional state in this pregnancy will affect the baby.  Maybe this baby will be more laid-back than his big brother?  We can hope!  (S was actually a pretty great newborn — he’s mostly just a bit more clingy and anxious than the average toddler, I think.  But if I got another like him, I’d be thrilled!)  Wish me luck!

 

37 weeks

Well, this is it.  37 weeks.  Officially early term.

I had my second NST + AFI with the local OB today, and everything is looking good.  Baby has finally flipped, so hooray for head-down!

Today I was pleasantly surprised to be seen by my favorite OB in the practice rather than the one I had been scheduled with — I think I’ve only seen her once early on in this pregnancy, but she’s the main doctor I saw during my pregnancy with S and she’s really the reason I came into the practice, so it was nice to reconnect with her.

She did ask me about how I was feeling about induction vs. waiting for spontaneous labor.  I told her I don’t want to go much past my due date, and she said that she understood and agreed and they’d be willing to induce me anytime at 39 weeks or beyond.

That was actually kind of reassuring to hear — I’m not into interventions, and I was really pleased to go into spontaneous labor one day before my scheduled induction date at 40+5 in my pregnancy with S.  But at the same time, I worry a lot about the small but rising risk of stillbirth after 39 weeks — for me, even though the probability is low, my experience with late loss tells me that I would not want to torture myself with wondering if I could have avoided it by inducing earlier if I ever did wind up in that situation.  In addition, the closer I get to my due date, the more stressful it is to have to worry every morning about whether or not I should inject myself with Lovenox (which I’m staying on right up until delivery thanks to the Heparin allergy we discovered in my pregnancy with S).  I was a huge fan of my epidural while delivering S, and I know I can’t get an epidural until 12 hours after my last dose of Lovenox, so if things start on their own and happen quickly I could end up with an unplanned, unmedicated vaginal delivery, which I am just not interested in (though I know and respect that many women are) — obviously I’d deal with it if it happened, but I also worry about what would happen if I ran into complications and had to have a c-section.  Without the option of an epidural or spinal, they’d have to put me under general anesthesia, and I both find general anesthesia pretty creepy and also would be sad to be unconscious for the birth of my son.  Induction offers a nice way to have a little more control over the timing of stopping my medication and not worrying about the small but real risk of developing clots.

So, the way I left it with her is that I’ll wait to see what my cervix is doing in a week or two, and we’ll take it from there.  As a multigravida who had a totally textbook vaginal delivery last time, the risk of c-section is pretty low this time, induction or not (especially given the results of the ARRIVE trial).  My plan at the moment is to aim for induction during the week of my due date, unless my cervix is totally unfavorable, in which case I’d wait until the next week (the end of week 40) to induce.  But I am not interested in the risks of going into week 41 and beyond, so if I haven’t gone into spontaneous labor by then I will stop caring what my cervix is doing.

And there it is.  Unbelievably, our baby could be three weeks away… or even less!  It’s thrilling and terrifying and unbelievable all at once.  I can’t wait to welcome him to the world.

Heparin is Out

Just a quick note to say that everything is fine, but it’s been a slightly more exciting several days than I might have hoped!

Last Thursday when I hit 36 weeks, the plan was to switch from the once-a-day Lovenox injections I’ve been giving myself throughout this pregnancy to twice-a-day Heparin injections.  This is pretty standard — Lovenox is great because it has a long half-life and the side effects are less common and more predictable than with Heparin, but as you get closer to labor the shorter half-life of Heparin becomes more attractive because if you go into labor it leaves your system faster.  This is a good thing for two reasons: (1) you shouldn’t have an epidural when there’s still a bunch of blood thinner in your system, because it can cause rare but severe complications that mess with your spine (scary!), and (2) if you give birth (or need a c-section) when you have too much anticoagulant in your blood you’re at risk for hemorrhage.  To give you an idea of the timing involved, you have to wait 12-24 hours after your last Lovenox dose for an epidural (depending on who you ask), but only 6-8 hours after your last Heparin dose for an epidural.

I’ve had no side effects at all from the Lovenox in this pregnancy, so I wasn’t even a little bit worried about the switch to Heparin.  After all, they’re very similar drugs (Lovenox is actually a type of heparin — what they call a “low molecular weight heparin”).  At first, things seemed fine.  I thought it was kind of cool to learn how to draw up the medication into the syringe and everything — new life skill!  (The Lovenox syringes are pre-filled.)

Then I started to notice red patches around the injection sites.  And they were getting bigger.  By the end of my second day on Heparin, I had a two large red streaks, each about six inches across, that spread across the two injection sites on each side of my belly.  Of course, it was Friday night by the time I got freaked out enough to realize that I should do something about it.  After all, I’ve had little bits of bruising and weirdness at injection sites before — but those always faded with time instead of getting worse. If anything, the area around the first day’s injection was larger and more red than the second day’s.

I didn’t feel like my throat was closing up or anything, so I waited until Saturday morning to call the doctor.  She told me to stop taking the Heparin, switch back to the Lovenox for the weekend, and come in on Monday to talk about what to do.

Today the doctor explained that there were two possibilities they were concerned with: one was that I was having an allergic reaction to something in the Heparin (it may or may not be the medication itself; apparently there are various preservatives and byproducts of exactly how the particular brand of medication is manufactured that can cause reactions).  This was actually the less scary possibility.  The scarier possibility is that I could have caught the earlier stages of something called Heparin-Induced Thrombocytopenia (HIT).  Luckily, there’s an easy test for this, so they drew some blood to check my platelets, which came back normal.  Allergy it is!  The doctor assured me that having an allergic reaction to the medication wouldn’t hurt the baby, so that’s a relief.

So, now they’re recommending that I stay on Lovenox for the remainder of the pregnancy.  I’ll just have to be very vigilant about early labor signs — I’m supposed to call when I feel any sort of regular contractions, so they can help me decide whether or not to stop taking the Lovenox.  In theory, this should all be fine, since most women have very long labors with a first baby — even though I gave birth once before in the second trimester, I only dilated 3-4 cm, so they don’t think this will make my current labor any easier/faster (rats!).  I’m a little bit nervous about it, especially on the off chance that I wind up needing an emergency c-section because of some complication.  I’d really like to not bleed to death, thanks!  And if I need a c-section, I’d rather be awake for it, which I can’t be if I can’t get an epidural (I’d really rather not miss my child’s birth because I’m under general anesthesia if I can avoid it).  I’ve read that there’s a way to reverse the effects of Heparin if necessary, but not Lovenox.  I think I will try to ask more about this when I call tomorrow to ask them to refill my Lovenox prescription (I also have a non-stress test and visit with my regular OB tomorrow, but they might not know the answers).  The doctor also gave me the option to try taking one more Heparin injection tomorrow to see if the red streakiness persists, assuring me that it wouldn’t hurt the baby and was very unlikely to have serious side effects for me.  I may do that, although she didn’t sound very hopeful that the reaction would miraculously have stopped, and she sounded pretty sure that I should just stay on the Lovenox for the rest of the pregnancy.

As pregnancy issues and complications go, I’ve been really lucky in this pregnancy, so I can’t complain that something is finally not going quite right.  After all, you win some lotteries and lose some lotteries, and I’ve been winning all the important ones in this pregnancy, so having this one minor hiccup should not be a big deal.  That said, I think all pregnant women get anxious about how labor and delivery might go, and this is just one more thing that might make it more complicated for me.  I’m not too freaked out about the prospect of not being able to get an epidural when I want one — I’ve been on the fence about epidurals anyway, and even if it’s hard, women have been surviving labor without epidurals for most of human history.  What I’m more freaked out about is the possibility of hemorrhage if things move too quickly or if an emergency c-section becomes necessary and I need general anesthesia.  I think these are all relatively low risks, but I’d like to know more about exactly how likely these various scenarios are.  Mostly, it’s just one more set of unknowns to worry about as labor approaches.  Well, we’ll see how things go, and I’ll ask some more questions at my appointment tomorrow.  Here’s hoping I have a nice, long, not-too-painful, uncomplicated labor and don’t wind up needing to worry about any of this!  (Ha!!!)