09.19.08 ~ Week Thirty

CBS Appointment
Another good appointment with the midwives is behind us (they are scheduled a bit more frequently now). Yesterday I rushed down from work to get there at 3:30 – this time to meet with Barbara/Barbie. It was the fastest appointment of all time because for the first time I didn’t have a pile of questions to unload. I asked again if the lopsidedness of my belly is normal (not a problem) and whether getting hiccups three or four times a day is normal for a baby in the belly (yes, and it is actually a sign of fetal well being!). This time the scale said I’ve only gained half a pound since the last visit. That really made me question the accuracy of the measurement from the last time since anyone with two eyes can see I’m growing (i.e. the baby’s growing) on a daily basis. My belly (abdominal region) measured 30 cm – which is exactly what it should be at thirty weeks along in the pregnancy. And Barbie/Barbara told me his head is facing down. That could still change since we still have about ten more weeks to go, but I secretly doubt it because I really don’t feel him doing the whole-body summersaults like he used to do. He turns from side to side changing the direction he’s facing (and the areas where he’s kicking and punching me), but doesn’t seem to flip right side up anymore. Well, with one exception actually….which brings me to my next piece of news….

Yoga
A couple of weeks ago I started taking a prenatal yoga class (this endeavor is being financed by my wonderfully generous siblings and parents as my baby shower gift – and for their benefit, I will say right up front that so far it’s worth every penny!!). As with regular (non-prenatal) yoga classes, at the end of class there is a period of relaxation. During the first class I attended, the teacher encouraged anyone who wanted to (except those in the last trimester) to raise both legs against the wall in an “L” shape with a bolster under your rear. I was in the last week of second trimester, so I went for it. It was a very comfortable and relaxing position. But on my way home I noticed an awkward feeling in my belly. When I got home I realized the baby was in a totally different position because suddenly I was feeling kicking and movement in places I had not felt it in a very long time. I was feeling it not on the surface of my abdomen, but rather deep inside along my very low back (really more against organs or intestines) and - what felt like - right on my cervix. And unlike in the past, it was actually a rather uncomfortable feeling (probably because he’s so much bigger and stronger now) and I spent the next few days trying to lie in different positions to get him to turn back to how he had been before. After about two days everything went back to normal (he’s already such an obedient kid!) and the kicking returned to the front and top where I’ve gotten used to it. But at that point it became very clear why that yoga position is a bad idea in your third trimester – unless of course your kid is positioned feet first and you want him to flip!

Other than that little discovery, yoga has been amazing. Even though it’s called the Prenatal Yoga Center, the Upper West Side location I attend is a very small, one room studio, located right down the street from our apartment. The classes seem to vary a bit in size but usually have about 12 to 18 women in them. At the beginning of class everyone has to introduce themselves with their name and how far along they are in the pregnancy. It’s absolutely fascinating to see so many different bellies of different shapes and sizes. Looking around the room I can usually categorize the women into two groups. One group is the Upper West Side group with expensive yoga outfits and huge diamond rings glimmering under the studio lights, while the other group consists of the yoga hippies who wear head scarves to class and request specific poses after introducing themselves.

I’ve been going twice a week and have taken classes with three different teachers so far. Two of the three I’ve met are young and don’t seem to have children of their own. This works to my benefit actually because I think they teach the class just as they would any other yoga class, with only slight modifications. They don’t shy away from harder poses that involve some exertion or balancing, making it much more vigorous than I expected it to be (I’ve come away sore a few times which feels awesome). After sitting at a desk in front of a computer all day long, it’s really nice to go to the yoga studio and get the blood flowing a little. On yoga nights, I tend to feel much less crooked, much less stiff, and sleep much better.

Birthing Center Orientation
I feel like I’ve been seeing a lot of other pregnant women lately because in addition to yoga classes, I also recently attended the Birthing Center orientation class. It was a one day class that took place at the St. Luke’s Roosevelt and was taught by a woman who is both a Lamaze teacher and midwife at the hospital.

The class was very long, but we got to tour the rooms and learn a lot of about the process of giving birth at the Birthing Center. I came away with a much clearer idea of how everything is expected to go, which is surprisingly comforting.

Generally, the process of labor and birth will go something like this: When I start having contractions or my water breaks, we are supposed to call CBS at which point either Barbara/Barbie or Elizabeth (whoever’s on call) will call us back. The first step is a phone triage where they are supposed to try and assess how far along we are. Even if my water has broken, it doesn’t sound like they’ll send me right to the hospital. Unless there is reason to think there might be meconium (baby poop) in it, or already some sort of infection, I think we’ll be told to stay home and try and get labor started. Otherwise, if I’m only having contractions, they’ll try to assess the stage of labor. The idea is not to go to the hospital until I am in active labor. The orientation teacher stressed several times that we will probably do the majority or the laboring at home and should only come to the hospital once we’ve made it through early labor and are in active labor. She also mentioned that the trip to the hospital should not be comfortable… if it is, then we’re coming in too soon.

Once Barbara/Barbie or Elizabeth thinks it’s time to go to the hospital we can go. But we have strict instructions not to go without their permission. The main reason for this is that they are required to meet us there. Unlike on the labor and delivery floor, your doctor or midwife has to be in the hospital at all times while you’re in the Birthing Center. It’s basically a three minute cab ride from our apartment – so I’m betting no matter how we time it, we will beat our midwife there.

When we get there, we’re required to do 20 minutes of fetal monitoring. The orientation teacher did mention to drink or eat something before we leave for the hospital so that the baby is awake and moving. This will make it more likely that the heart rate will have the peaks and valleys it’s supposed to have. If they find anything abnormal about the baby’s heart rate – we can’t stay in the Birthing Center and will have to go to the 12th floor where the Labor and Delivery ward is.

The Birthing Center is made up of three private rooms on the 11th floor if the hospital. Each room has a queen size bed, a rocking chair, and a Jacuzzi tub with shower. They are decorated a little like hotel rooms and have all of the medical equipment stored behind a painting on the wall so that you don’t have to look at it unless it’s necessary. Once you’re there you can do anything you want and can have anyone you want with you. You can eat, drink, walk around, get in the tub, etc. Continuous fetal monitoring is not required, and an IV is not standard procedure. So I will be perfectly free to move around as much as I feel like. There is a common room with a TV, couch, and table and a common kitchen with a fridge, stove, and dishwasher. There is one nurse on duty in the birthing center – but other than her/him, no one else except Barbara/Barbie or Elizabeth will be coming into our room. It’s totally private and separate from the attendings and nurses working in labor and delivery. The whole Birthing Center part of the floor is closed off and is very quiet and peaceful. It has a very different atmosphere from the bustle of the rest of the hospital.

We only qualify for the Birthing Center as long as we’re not delivering earlier than 37 weeks or later than 41 weeks. There is also a pretty extensive list of things that can disqualify you even before the onset of labor (like a breech baby). The idea is that everyone giving birth there is extremely low risk and will not need any medical intervention (including an epidural…gulp). Once we’re there and labor is going on, any kind of fetal distress, failure to progress, abnormal bleeding, other complications, or my wanting an epidural, will result in being sent up to the 12th floor. In that instance Barbie/Elizabeth would still remain our provider and we follow her protocol – not hospital protocol. But I think at that point either midwife would consult with the back up physicians. The only way they step aside totally is if we’re going in for a cesarean-section, which only the physicians can perform.

Once the baby is born (assuming we’re still in the Birthing Center) he never leaves the room at all. They don’t do baths there, just rub him down with a towel and give him right to me. They will also do the weighing, APGAR, vitamins, and eye gel right there in our room. Sometime after he’s born, a pediatrician will come to the room to check him out. If he needs any special attention he’ll go to the nursery on the 12th floor (and someone can always be with him) but otherwise he won’t leave Jason’s and my side. Barbara/Barbie or Elizabeth will probably stay for an hour or two after he’s born – but then they are off duty. At that point if we need anything else, we have to ask the nurse on duty. We’ll stay in the same room where we were during labor and will probably be released about 12-18 hours after the birth. The first day that we’re back home, they send a home-visiting nurse to check up on how things are going, and then on the second day home they recommend you take the baby to the pediatrician. That way a medical professional is still seeing the baby a few times directly after birth - similar to if we were staying in a hospital.

I am very happy to have “lucked” into this kind of a birthing scenario. If my mom and dad weren’t friends with Barbie, there’s a good chance that Jason and I would be getting prenatal care from a physician like most other people do. And without the guidance of the midwives, we may have never known that the Birthing Center is an option. In my opinion it’s the perfect combination of all worlds. The experience at the Birthing Center is designed to be as personal, private, and dignified as it would be if you were delivering in your own home – but yet one floor away exists a medical Mecca where we can turn for help if anything goes awry. And for a girl who doesn’t like to relinquish control, but yet is a bit of hypochondriac (one foot in each world) – it’s the perfect compromise.