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Prenatal Appointment #6 / Pregnancy Ultrasound #11

Today we’re at 28 weeks, 3 days and we had the 28-week prenatal appointment with the OB. Although it doesn’t look like our new OB will be willing to put Molly out of work for any reason other than actual preterm labor (and certainly that’s not what we want to happen), I really do like her a lot. She did a quick ultrasound to see how the babies are positioned – still both feet-down, same as our recent 28-week radiology ultrasound – and to measure their heart rates. Baby A’s heart rate was 147 beat/min, and Baby B’s heart rate was 153 beats/min, both normal for their gestational age.

Molly had previously failed the routine screening 1-hour glucose tolerance test, which a pretty high proportion of pregnant people (especially those with twins) fail. So she had to do the extended 3-hour glucose tolerance test, but we officially found out at the appointment that the results of the 3-hour test were negative. No gestational diabetes! For now at least, and let’s hope it stays that way. What’s funny is that we both have great diets so its not like there would even be much to change if they put her on the special gestational diabetes diet anyway.

We also got the official interpretation results of the 28-week radiology ultrasound, and both babies are measuring normally with normal growth and weight, normal amount of fluid, and cervix length of 3.4 cm long (normal for this stage of pregnancy). The news couldn’t be better!

28 weeks marks the official start of kick counts! Basically, around the same time each day, Molly is supposed to time how long it takes to feel 10 kicks for each baby. If an hour goes by and they haven’t reached 10 each, she’s supposed to drink something cold or sweet, then monitor them for another hour. If after the second hour, 10 per baby still isn’t reached, the OB said to go straight to triage. Right now it takes less than 10 minutes to get 10 kicks each, but the OB said that as they become more crowded in there, it may start to take longer to reach 10 each.

We also turned in our birth plan. The way the hospital works is that the OB provides you with a checklist of “options” for your birth plan, including everything from “I would like the lights in the room to be lowered” to “I would like to be consulted before my baby is given a bottle or pacifier.” Most of them seem rather silly to me, like why wouldn’t you want these things. “I want all procedures that are done and all medication that are given to my baby explained to me” – nah, just go ahead and do whatever you want to my newborn, no need to consult me or tell me what’s being done. “I would like to delay newborn procedures during the first hour so that I have a chance to feed and bond with my baby ” – nah, you can take hir and soothe and cuddle and gawk at my new baby without me during hir first hour of life, I’m not interested. Really? We ended up checking pretty much everything on the “options,” which makes me wonder exactly how much of a “personalized plan” it really is. Ok, whatever.

We added our own option and checked it off on the birth plan – to have the medical staff refrain from announcing “It’s a boy!” and/or “It’s a girl!” We’d really like to meet our kids before their sex is designated and announced by a stranger. Our OB was receptive to the idea, luckily, though she did say it may be difficult to enforce because so many people (two whole pediatric teams) will be present for the birth. She said she would certainly announce it to the staff, and if she is the one who ends up doing a C-section (if that’s even necessary), then she could hold the babies up over the curtain to let us see for ourselves before anyone announces anything. While I wish there was a better way for us to guarantee, or at least be confident, that people may make an effort in this request of ours, I feel good about the fact our OB was receptive to the idea.

The birth plan “options” sheet did, however, have a section for pain management so that got us asking a lot of good questions about epidural vs. no epidural and how the decision could affect the chain of events if an emergency C-section had to happen. And my suspicions were confirmed. We had originally been thinking about trying for a completely natural birth – if you have an epidural, then you lose motor control of your legs and are therefore stuck in bed, unable to get into the positions best for progressing labor. If you think you can handle the pain, then certainly natural is the way to go – labor should be faster and healing is much quicker after the birth, compared to a C-section. But if Molly attempts a completely natural birth (no epidural), and then if they need to convert to a C-section (more common for Baby B as the second twin often doesn’t do as well as the first twin), then they would have to put Molly under general anesthesia and I would be escorted out of the OR. This scenario is one of my biggest fears, because then I wouldn’t be able to with our babies or my wife. Therefore, we learned that it may be the best decision if Molly decides to go ahead and get the epidural catheter placed, and only begin to use it as late as possible in the game. That way, she will still be able to move, walk around, and use the positions to progress labor instead of being stuck in the bed, and they will wait to move her into the OR for delivery until fully dilated and station is +2 (a measurement of how far down the baby’s head has descended). With an epidural in place, if they needed to convert to an emergency C-section, they could give more drugs through the epidural, and likely avoid having to do general anesthesia.

The catch: it’s not like you can get it placed “just in case” and not use it at all. They have to begin using the epidural in some fashion (ie putting drugs through it) at least 30 minutes before its time to push. If the epidural isn’t used at all, then suddenly they put a ton of drugs in it if a C-section is needed, there is a higher risk of giving too high of a dose, which could cause respiratory failure. So, moral of the story is that it’s probably safest to get the epidural placed, don’t use it for as long as possible to allow for walking and ideal laboring positions, then start to use the epidural at least 30 minutes before pushing. We’re still discussing it, but yikes. So much to know and consider!

In the event of a C-section, we were also able to confirm that skin-to-skin with me is possible, possibly as little as 5-10 minutes after birth if all is going well and they appear to be lively and thriving. If not, then they may be shuffled to the NICU or continue to be stimulated and watched before I’m allowed to hold them, and that’s fair, obviously. We all want what’s best for the little orangutans.

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