The fourth trimester

I feel like I'm remiss in providing some kind of take-home here for the post-pregnancy (that is, Welcome Home Baby!) period of time. There's a lot to say, but I think I can boil it down to a few top points.

1. The first two weeks with the new baby are one of the hardest things/times I've ever been through. You're simultaneously recovering from the physical trauma of labor (and, really, from the last few weeks of pregnancy), while being totally paranoid about this fragile tiny thing you've been entrusted with, and all of that on totally inadequate sleep. It's mind-blowing and perspective-killing. I didn't have any overt post-partum depression, but had plenty of stretches of thinking "People get through this?" in addition to the obvious "they do it more than once??" Days seemed to gape long and difficult, especially once I was on my own during the day. Some tips:
   
   
   
   • Keep visitors at a slow pace. No more than one (or one couple) at a time, no more than an hour per visit, no matter how beloved. That's just how little mental resources you have available. Really, this rule holds for about the first month. (Partner should help run interference, although he's likely to be as brain-fried as you are.)
     
   • Have the house stocked with as many easy-to-prepare meals as possible, and take-out menus handy. You'll be plenty hungry, but have neither brain nor energy to shop or cook.
     
   • Take as many naps as you can. Baby won't always sleep as much as in the first week or so, and you need to make up the deficit whenever you can. Nap on the couch near the basket, on the floor near the crib, or stay in bed with the bassinet nearby. Really, mid-afternoon or whenever. What else do you really have to accomplish?
     
   • Be easy on yourself. I wasn't good for much other than TV (hello, TNT!) and baby advice books for a long time. Just go with it. The idea of reading a book or surfing the Internet will become imaginable again in time. That first trip down the block is a huge victory, but some day you'll go to a nearby restaurant with the kid in the stroller on a whim.
   
   
2. Progress is slow. Yours (see above, heh) and the baby's too -- it's really a sack of potatoes for a long time, just eating and sleeping. Then for a while it's awake in stretches, but just stares blankly, and you feel like you should be entertaining or otherwise stimulating your potatoes, but you don't get much feedback for the waving of toys and jiggling of limbs. Hang in there. The six weeks to that first smile can seem like a long long time. Meantime, you're re-mastering the art of functioning like an adult -- cooking, reading, having conversations of more than a few minutes, leaving the house with the baby. But slowly, like your aches and pains subside.
   
   
3. By the end of three months you'll be in a totally different place. The baby giggles and plays games with you; you're confident about its favorite toys and that it knows who you are; you're probably getting decent stretches of sleep; you are an old hand at diapers, feeding, soothing or singing, etc.; and you have a sense of your baby's temperment and how much of a schedule/rhythm its daily needs have, and you've learned to work within those constraints to do some of the things you used to do. It's important to realize that all these things really will happen, and you'll feel competent again and glad that you undertook this whole project. Of course, just as things start to reach a manageable state, you may be headed back to work, which means finding a whole new balance of life and parenting, but at least you aren't a paranoid zombie, and you've fallen in love with this little spark and its giggle.

That's it in a nutshell -- I really think a "fourth trimester" is a good way to view things, since, while there are many changes and developmental milestones still in the future at that point, there is a unit of "mental arrival" of the kid and recovery of the parent that's quite tangible in this window. I hope that this little summary helps somebody else know what to expect.

Additionally, I recommend finding a mother's group for moral support once you can get out of the house -- lactation support is a good one, or maybe a yoga class for moms and babies -- just for reality checks and social interactions when both seem most lacking. You might get some bonus friends out of it, and it's great to see some older kids so you can look ahead to what's to come at various points. All very helpful as well as fun. Good luck!

Labor report

Ok, here's how it went:

1. Check in (Tuesday evening) around 7:30, sit around for an hour, then get set up for an I.V. (heparin lock), visited by various low-level doctors, given an internal exam, etc. Finally released to go up to Labor and Delivery at, say, 10pm.
   
   
2. In delivery suite, hooked up to an IV (lactated ringers), more visits, finally given Cervidil (to soften cervix) around 11-something. Pretty much set up to spend the night -- changed into a night shirt, took out contacts, etc. Glad I had put in a pillow for labor, as it was much more comfy for sleep than the cheap hospital pillows. Settled in for the night, and managed to sleep a decent amount, despite the incursions of various nurses to check my vitals, replace my IV bag, admire the flow-through in the toilet (which they caught and measured in a little bucket) and test it for keytones, or have me test my blood sugar levels.
   
   
3. Dull morning (Wednesday) as I waited for the Cervidil to reach 12 hours. Spouse came back around 6am and we frittered the morning together, chatting and watching bad TV, etc., while nurses continued with the incursions listed above. [At some point in here I had external fetal monitors (just like those used for the NST's) attached too.]
   
   
4. Eventually they removed the Cervidil, after which we waited around for another hour or two for somebody to certify that everything was ok and we could proceed to the pitocin. Pitocin added to the IV drip, at the lowest level and inched upward. The nurse explained that the goal was to end up with "regular contractions at 2-min. intervals."
   
   
5. We hit regular contractions at 2-minute intervals at the second dose level! Couldn't feel them at all though. (yay?) Sadly, they also didn't cause anything to progress, so we kept the doses inching upward.
   
   
6. Cut ahead several hours, when contractions have been decent sized, just marginally tangible, and going on for some time, but with no progress. (Still around 1 cm dilated.) Haven't even called the doula to come yet, because more bored than stressed -- did a little web surfing during this period. Finally, doctor suggested breaking my water, because we "need to get things going" and because if I'm still not being bothered by any of the contractions, then we're not getting anything done. We agreed with this idea. [Tried to summon the doula at this point, but I think she thought we were consulting her about the water-breaking, so she didn't come until later.]
   
   
7. Aha! feeling the contractions now! eek. Did some walking around, sitting on yoga ball, etc. Best position for weathering contractions appeared to be on ball, leaning back against Spouse, breathing. Whew, hard going. Rode them out for around 2.5 hours, only to find that I'd picked up just over a cm of dilation. I could have weathered that longer, but at that rate, I thought I'd die before I was dilated enough to do anything with.
   
   
8. Asked for an epidural. [Ironically, this is when the doula arrived. She did some nice distracting things like stroking my legs during contractions while we waited for the anesthesiologist, but I fear that we missed the period when her input might have saved me the most.] Application of epidural pretty painless (some odd sensations of cold, etc., along the way), and it started to dull the contractions quite quickly. Once it was all at a steady drip and effectiveness, they turned off the lights so I could get some sleep and recover my strength. [Spouse and doula caught a few z's in chairs in the suite too.]
   
   
9. Something like 1.5 hours later (with pitocin inched up a bit while I was under), I had gone from 3 to 10 cm dilation! They told me it was time to push. The epidural was dialed down a bit so that I could feel enough to push, and off we went! A nurse was urging me on, with cheerleading and describing the sensations I should push toward, and I gripped some handles to pull against while I pushed down. Things got harder as (a) I got more tired and (b) the baby came down far enough that I got no relief from the ache between contractions/pushes. Eventually my legs were being held upward to keep the baby from sliding back too far between pushes (doula held one and Spouse held the other, between grabbing water for me to sip), I was moaning and complaining, but somehow progress was being made. In the end (when a cluster of doctors appeared), it took about 1.5 hours and then the kid was squozen out! They stuck her on my chest, all covered with sticky white goo, but I have to admit that my enjoyment was a bit undermined by the distraction of getting some stitches, having a resident focused on getting the placenta delivered, etc.
   
   
10. From there, some checks for the baby (blood sugar being a primary concern; they gave her formula very early) and then (probably two hours later, but who could say) I was wheeled up to the recovery zone, and two days of timeless introduction to parenthood ensued . . .

Sorry it took me so long to find time and mental energy to summarize all this. Guess that's also it for this space, although I may decide that logging some parental experiences justifies another online venue in the near future. More then.

The future is almost here!

Week 40: Well, this week is when I'm due, and this week is when I'll be induced. (For those who don't know, both my age and my gestational diabetes increase risks of trouble if you go past your due date, largely due to the possibility that the placenta will stop doing its job. So no such option.) In fact, contingent on hospital bed availability, I'll be going in tonight for the first step ("cervical softening" overnight) of induction (which will continue the next day with pitocin to get the real business underway). So if you don't hear from me, that's where I am, with spouse and doula to keep me sane...

You must be kidding

(Still Week 39) Went to a "Babycare basics" class last night, which was useful -- got advice on sponge baths, practice with swaddling and diapers on dolls, and various other tips. However, right in the middle of it I started to have a visual disturbance. It started as a small blurry spot (kind of like the after-effect of a bright light can cause a grey spot briefly) right where I was looking, but gradually spread to encompass a third or so of the left half of my visual field. I initially thought it was an effect of looking at the teacher against a vibrating blue video screen (esp. since it was sort of oscillating), but then it was pretty clear that it was something else. After running some, um, diagnostics (still there with eyes closed; visible in left part of what each eye sees) I got up and got a glass of water, did some deep breathing, made sure I wasn't dizzy, checked my blood sugar, etc. Basically it just hung around for about a half hour (ramping up and then ramping down) and then went away, but everything else was fine.

After the class, since we were already at the hospital, we stopped by the Perinatal Assessment unit and asked whether this was something to worry about (a blood-pressure drop? sign of trouble?). The two results of that were: (1) an additional two hours hanging around the hospital -- a combination of data time (a new non-stress test, bp, urine, a quick neurological work-up, and some other busywork) and down time (waiting for the resident and/or attending to stop by). yawn! (2) Eventually the attending told us that this was not that uncommon (a bunch of the staff had been trading stories about similar incidents during pregnancy) and called it "visual migraine." Because pregnancy hasn't involved screwing up enough systems yet, and I was due for a little malfunction of [blood vessels of] the visual cortex. I mean, really.

So I guess that's water under the bridge, but a bit freaky at the time. I hope that by mentioning it here I can at least reduce the scare factor for any of you guys who might have a similar experience. Let me say, it's just more fuel for my Get This Done, Already jets!

Ready for the next thing!

Week 39: Well, I may have been lucky with aches and pains up until now, but the various discomforts that I described in week 38 have all become quite painful and are starting to switch my mood from amusement with my unweildiness back toward a put-upon morosity. The doctor suggested that my between-belly-and-hip pain might be a hernia, but didn't really advise any intervention other than a support belt (and I get no relief from lifting or clamping my belly, so am unconvinced); I don't really understand hernias, but does that explanation make sense with something that hurts a lot when I walk across the room, but works itself out when I walk a block or two? Anyway, the short-term effect is that I'm no longer commuting (by sidewalk/subway or bus) but am getting rides from Spouse -- I guess if I made it to the last two weeks of pregnancy, that's not so bad. Means the end of just about any exercise that I get, though, except for climbing stairs at the end of the day.

Now we're closing in on my due date (next Friday), which means that we're looking at likely induction in the middle of next week. I did a little prenatal yoga last night to help me relax and encourage Speck to drop (although in the short term it made my hip joints ache, sigh), and will probably spend the next week trying to shift my body and mind from "things to do before Speck gets here -- hold on!" to "ok, now is a good time" and see if that helps move things along a bit. My natural inclinations are non-interventive, but since I'm not really being allowed to wait for labor to start on its own (because of the diabetes et al., however well controlled), I guess I'm leaning toward getting this underway and thus moving on to having a baby! Hope I can follow that through without last-minute unhelpful panic . . .

Flashing the belly

I feel really big, but trying to compare pictures from multi-week intervals, it's hard to see. Anyway, here's the bulge for public admiration...



37.5 weeks when this was taken; 38 weeks today! Doesn't look like this should make it hard for me to walk . . .

Something's up

Weeks 37-38: Generally this period has been more of the same, but in the last 5 days or so (end of wk 37 into wk 38), I've become consistently uncomfortable. Standing up is now a matter of a pained unfolding, walking only partly unkinks that below-belly muscle, and my joints et al. make even a couple of blocks feel like a major undertaking. This may wreak havoc with my commute to work. Also, rolling over in bed at night is not just hard but also somewhat painful, again involving those same belly/hip muscles. I don't know if my belly is just getting larger (although some more t-shirts have been lost from the repetoire) and starting to sag/pull against nearby parts, or if it's something more, but it's a drag, and I'm glad it didn't start before this.

For medical context, I don't think I've had much in the way of contractions, and certainly there's no dilation (and only a little softening) of the cervical realm. [And who designed this rebuild-the-port system??] My doctor says "we're more happy the more uncomfortable you become," which indicates that the aching is probably a sign of some kind of progress, but there's no evidence that the baby has dropped either. So, um, just more for the grump bucket, I guess... Doc is talking about induction either next week (if there is cervical progress) or the week after (if we have to make it all happen from scratch) -- I'm working down the list of old wives' remedies (spicy food, sex, next comes bumpy drives, heh), but it's pretty much up to Speck from here!

Quick out-take

I just thought that, amid all the grumping and recording of symptoms, I should take a moment to recognize that, in fact, I've been pretty lucky on some fronts. In addition to my and Speck's general good health, I've been spared the following common ailments of pregnancy:

1. Morning sickness! This one should count twice, since queasiness really affects your whole life outlook, and I've known people who had to tiptoe around their sensibilities for many months. I wore "sea bands" for a week or two, and I'm eating a lot of ice now, but there was no danger of losing my breakfast at any point. whew!
   
   Edit: this should include the good fortune that I've been able to take prenatal vitamins with no problem (even in the morning!); perhaps it helps that I started months before I was pregnant. Who knows.
   
   
2. Back-ache. I don't know if I was just in pretty good shape going in, or if some combination of the baby's smallness with my build just protected me, but I've made it into the ninth month with no aching back woes. My joints (esp. hips) get stiff, and there are plenty of other discomforts, but again, major back pain is the sort of thing that can color your whole experience to a much more substantial degree, and I appear to have gotten lucky. In fact, have considered a pregnancy girdle, and generally concluded that I don't have any sagging or pulling that needs intervention.
   
   
3. Stretch itch. In fact, only in the last week or so (say, week 35-36) have I had any stretch marks, and then just a couple of them (reddish welts) just in front of my hips (where I have other whiter marks from a weight gain in highschool). Have rubbed my tummy pretty religiously with a pleasant, thick, lanolin/cocoabutter cream from the moment there was a tangible bump, but really haven't had much sense that things were being painfully distorted. (Of course, this might just mean that I was a bit pudgy to begin with, so I did more rearranging than stretching, or it might reflect decent abdominal wall strength holding it all in...)

Hopefully the act of making this list won't tempt the fates. I am having various discomforts now (week 37), especially in finding good sleeping and sitting positions, and am tired and a bit queasy on and off all the time, but pregnancy is a long haul, so anything that's limited to the last <3 weeks is a pretty easy load . . .

Count-down time

Week 36: Well, this is it; anything from here on out is "full term." That means that my busywork doctor appointments now include an internal exam to see whether any dilation or effacement is occuring (no, and a tiny bit), and next week we'll talk about a date for induction, should such be necessary. Meantime, am trying to get one literary project done and out the door, and we're having some folks over this weekend as a last gasp of adults-only gathering time.

Things I'm aware of this week: starting and stopping. That is, when I've been sitting for an hour or so, it's hard to get moving -- in particular, I have a pain in the small geographical expanse below my belly, as though it had been getting bent uncomfortably, and it takes a few minutes of moving around to work it out (and I walk stiffly meantime). Conversely, when I've been walking for a while (as when commuting, but also while doing stuff around the house), I find myself huffing and puffing when I stop; I guess this means it's more effort than it feels like? Anyway, it all makes me feel more afunctional than I already did . . .

The end is near...

Weeks 34-35: Most of my experience now is More of the Same from the last couple posts -- unwieldy belly, very challenging to roll over in bed, lots of kicking at night when I'm trying to get back to sleep after a bathroom trip, chewing ice most of the day. Have had some new belly discomfort -- some feels like a renewal of round ligament stretching, other more achey muscle stuff -- and a couple of definite contractions; not sure whether they were isolated "real contractions" or belated Braxton-Hicks (which I've otherwise never perceived), but I decided to sit with my feet up and wait them out. Also, I have a very faint vertical line on my belly now, from a few inches above to a couple inches below -- almost subliminal, but real. That was described as something that might happen months ago, but I guess not (or my pigmentation is so low generally that it took until now to be perceptible, heh).

The main thing is that delivery is starting to seem like a concrete thing (not a threat, but the next thing to work out). Have packed a bag (actually two -- one with me/baby stuff for hospital stay, and one with comfort/distraction stuff for labor itself), but it's still upstairs for another week or two. We're having some people over this weekend, as a last blast of adult-only socializing, and basically I have to be prepared that things could happen any time after that. (After 36 weeks is full term anyway, and they'll induce by my due date if need be.) Has lit a fire under me in terms of the couple of intellectual projects I want done before Speck arrives!

More low-level tribulations

Week 32: Well, my bellybutton is essentially gone -- it's flat, with a little bruising below (part of stretching, or did I just bang it into something?). This comes close to grossing me out, irrationally. Additionally I've had some periods of mild nausea -- out come the sea bands again -- and the heartburn is a constant friend to the tune of some half-dozen Tums per day (and into the night), although I can get away with no propping in bed. Of course, my belly is starting to make it just a bit harder to get comfortable to sleep, although the pregnancy pillow helps, and Speck is into rumba overtime whenever I'm still, including some impressive somersaults at night and other activity that I've described as "weasel in a bag"...

Made a note to mention two things that developed a while back but never got mentioned here: freckles and skin tags. The latter developed really early (month 3?), perhaps in response to the heat; I have a bunch under one armpit (not the other!), and little bitty ones under my breasts. I understand that they stick around, yay. As for the freckles, I have red hair, so have lots normally (light in winter, darker in warm months), but there have definitely been changes in my chest area. (1) Reasonably early I got a couple of large dark freckles on each breast -- like near-black. (2) I got a number of new/darker small freckles on my upper chest and onto my neck sometime later; the top of this smatter is visible in a crewneck (and odd for this time of year). (3) I am just starting to get a third wave of large light freckles all around and onto my breasts. Now, I haven't been sunbathing (heh), or really even spending an unusual amount of time nude in the (sunny) bedroom. So I just have to guess that skin pigment is another system that in some way responds to hormones...

Week 33: Ugh. Had several nights this week of insomnia. It felt physical; surprisingly, not my unweildy belly, but just sort of restless leg action. I'd get all comfy (and I'm plenty tired) and then fidget, kick around, etc. for ... a couple of hours. One night I think I got all of 4 hours sleep by the end, and that night I even propped myself up. I've tried taking a Tum (in case I'm missing some low-level heartburn), Tylenol (because my hips do get achey), water, potty visits, and the usual distractions one tries in the wee hours, all to little avail. Luckily, I slept like the dead last night, so back to semi-functional to wrap up the week.

On other fronts, I have some odd low-level gut sensations that are just short of nausea but also a bit much to overlook (especially in the car). I find that sucking on/eating ice seems to dull it, so am spending a lot of time either eating ice or fantasizing about it. (It's not just thirst.) Spent a lot of my holiday vacation sitting around with cups of chipped ice nearby...

Also new this week is the start of new medical fun: non-stress tests. They're doing them on me in part because of my age and in part because of the diabetes, but essentially they seem like a sort of physiological test for the baby's well-being. You sit in a recliner with a couple of monitors strapped to your stomach (one for the baby's heartbeat, the other apparently to watch for contractions) for, say, 20 minutes, and then the doctor just looks at the chart (which has been tracing two needle-lines like an EKG). My experience doesn't entirely jibe with descriptions I read online, but I guess they're just looking for a steady heart-rate that occasionally jumps upward (presumably when Speck moves around), rather than showing any drops (that might indicate distress of various types). I'm going to have this test weekly for a while, although they threaten a biweekly frequency as we get toward the end -- eek! (I feel like I'm doing tons of medical busy-work visits already!) One amusing point: folks keep giving me charts to monitor fetal activity via kick-counts -- as though I ever go more than ten minutes while sitting without a full karate exhibition! hah, you can keep the form.