Today we’re at 33 weeks, 3 days and we had our 32-ish week appointment with our OB. Despite our previous challenges with various OBs, this appointment was surprisingly positive and actually helpful.
She did a very quick ultrasound to confirm their positions (Baby A still breech, Baby B still head-down) and check their heart rates (Baby A was 126 beats/min, Baby B was 141 beats/min). She also confirmed the results of our recent 32-week routine ultrasound and said the babies are growing appropriately and everything looks great, including a nice long cervix at 3.73 cm. If things continue to go so well (and Baby A doesn’t flip to be head-down), she said we’ll be scheduling a C-section for 39 weeks. As much as it would be a bummer for Molly to have to have a C-section, if they could keep cooking until 39 weeks, that would be awesome! The OB said they typically schedule a twin C-section anytime after 38 weeks, but that every day in the womb saves 2-3 days in the NICU – so if they’ll stay in there until at least 39 weeks, then that’s certainly better than taking them at 38 weeks. Still, she said there is 50-60% chance that labor will begin spontaneously before 39 weeks so if that happens (and Baby A is still breech), they’ll just do the C-section when we arrive at the hospital. Unfortunately, it looks like there is a pretty hard rule against any kind of cameras in the operating room so the first photos we’ll get is back in the recovery room. I’m sure there will be plenty of cuteness to be had there.
After switching OBs, we hadn’t talked with the new one about Molly’s bleeding disorder, but our new OB said she had read the notes in the medical chart and knew what needed to be done in preparation of the birth. They are going to order von Willebrand’s testing after 36 weeks, and if her levels are normal then it should be OK to have an epidural or spinal for the C-section. They’ll also do a blood type and cross on her so they’ll know what kind of blood to give her, if necessary. It was still good that we brought it up though, because we found there is a discrepancy between the current hematologist’s recommendations and the recommendations other previous hematologists have made regarding pre-treatment with Stimate. All of Molly’s previous hematologists (over the past 20 years) have recommended she be pre-treated with Stimate before any kind of surgery (no matter how minor), but her current hematologist did not put that in the birth plan recommendations. While Stimate is a treatment for (some types) of von Willebrand Disease, Molly’s bleeding disorder may actually be a combination of von Willebrand’s and Platelet Storage Pool Deficiency, meaning Stimate, which causes release of von Willebrand’s factor, won’t necessarily solve the entire problem, but it certainly would help. So, overall it was still good to bring it up so we can contact the hematologist again and get everyone on the same page.
The OB also agreed to sign a verification statement saying that Molly has a pregnancy-related condition that allows her to work three days per week, instead of five. She actually already went down to three days per week starting last week, and it has been much more manageable for her. Just going out to Sunday brunch is tiring so a reduced work schedule should be much healthier.