Doctoring and Mothering Today

Now that my oldest is almost 4 years old and my youngest is almost 3… it’s a good time to reflect back on my time during pregnancy, post-partum, breastfeeding, maternal/family leave, full-time work, and raising 2 toddlers.

Pregnancy:

Pregnancy really was a wonderful time. Aside from the GERD, waddles, having to pee all the time and drinking a ton of water… it was wonderful feeling the little kicks and getting the attention of people to always help me (open a door, lift things, walk with me, etc.). I worked up until I went into labor… literally.

Hours worked baby #1
Hours Worked Baby #2

The most difficult things to do during MY pregnancy: make appointments, drink enough water, peeing every 2 hours (even during the night), eating (I could only take 4-5 bites before getting full), sleep.

Post-Partum

No one tells you what to expect post-partum. It’s a rude awakening when it’s really difficult to have a BM, wipe, breastfeed, wake up, and think clearly. For me, the SI joint pain from pregnancy lingered on even until today. Bonding with baby is unique and special. It was a wonderful time to watch my babies explore their senses. Sleep and breastfeeding: It’s really tough to get in enough sleep and breastfeed constantly. But after 2 weeks, breastfeeding got better for me. Maybe I was lucky. Sleep got better for me after 2 months After the 2nd kiddo, I think I had a bit of postpartum depression. Coupling the lack of sleep while also trying to be present for a 13-month old really wore me down. I was in a really dark place: the thoughts, the lack of care of harm to myself, the total loss of happiness for things I previously enjoyed. It was all very real, very memorable, and something that I look back on with sadness bc I wasn’t my best for the kids, my hubs, or myself. I’m thankful to have moved beyond that. The Peloton saved me on this one. I told NO ONE.

Breastfeeding:

Rent a hospital-grade breast pump prior to leaving the hospital. Visit with the lactation consultant while at the hospital to really learn how everything works. I was lucky to have a great LC for both deliveries. The first one really encouraged me and taught me good technique. The second was fabulous as she supported me and encouraged my efforts while also allowing me to opt for normalcy and not beat myself up if my milk production wasn’t 100%. Both excellent teachers and perspectives. Breastfeeding is new and it’s hard. Get help early and often! When you come back to work, do what you can. I oftentimes pumped in the OR and immediately put my stash in the freezer during breaks. This became really tough for me as breaks are uncertain and you don’t want to burden people who also need breaks. My milk supply went down fast, but I did what I could and that was my best. Don’t beat yourself up.

Maternal/Family Leave:

I was really lucky to be able to have 3 months off work. My anesthesia group was absolutely wonderful in allowing bonding time. I took the full 3 months. My husband then took his 1 month and we were able to do a solid bond with the kiddos for 4 months and then put them into daycare when they were 5 months old. Would it be great if we had full pay for 1 year of maternal/family leave? Yes. But, in the US, this is the best I could get and I’m grateful for it!

Full-time Work:

This was my own decision to continue working full-time. You can see in the charts above. After my second baby, I came back and still worked full-time. This was a personal choice. Kids are innocently demanding…. so is my job. I don’t really know how to find that right balance just yet. I miss out on my babies, and I miss out on work. In the end, you have to be ok with not being the best at everything. You will make sacrifices and you will feel awful. It was be a gut punch that you readied yourself for, but still feel every ounce of hurt when you miss things. The first tuck-in, the first goodnight kiss, the many goodbyes, the bathtime shenanigans, the sweet baby smells…. you will miss them. It gets easier. But, it still hurts when you miss these things. It’s almost like life moves on without you. That is…. until you get back and see the smiles and feel the hugs and kisses from them.

Raising 2 toddlers 13 months apart:

This is something! We brought home our second baby just after our 1st baby turned a year old. I don’t think the concept of a sibling coming to the house was even a concept that a one year old can grasp. Having two kids so close in age, but at different stages of development was REALLY HARD. They are just now starting to play together and sharing appropriately. It is still hard for us despite both kiddos being potty-trained (nighttime diapers only for my sanity). Everyone says 5 years old is the magical age where things get easier. We’re almost there!

During the delivery of our 2nd kiddos, I had a moment of weakness and thought a third child would be great. The second delivery was significantly easier than the first. Perhaps my body and mind were playing tricks on me. We feel complete. We have two beautiful and healthy kids. We couldn’t ask for more.

Mothers in Medicine: Making Residency Safer in Pregnancy

Maternal wellbeing and pregnancy outcomes in anaesthetic trainees. Anaesthesia and Intensive Care. Volume: 47 issue: 4, page(s): 326-333.

Pregnancy and Motherhood for Trainees in Anesthesiology: A Survey of the American Society of Anesthesiologists. J Educ Perioper Med. 2021 Jan-Mar; 23(1): E656.

A Penned Point: Give yourself a break–Don’t have a baby during residency. March 2012.

Paid Maternity Leave

I had just written a response to a partner’s email regarding outpatient coverage and the focus of work-life balance.  I think it’s a great initiative that she is tackling while brainstorming what could help the group with flexibility as well as some normalcy while raising a family.
This made me think of changes to antiquated practices we currently have in our work environment… primarily, paid maternity leave as well as paid sick leave.  Many of my male colleagues can continue to work and can take as little or much leave as they would like for family bonding or vacation time to spend with their newborns.  This is their option.  Unfortunately, the women physicians in our group are not afforded that same luxury.  There is a 6 week medical leave of absence with a vaginal delivery or an 8 week leave of absence with a C/S as proposed by the OBs.  During this time, we are not paid.  State disability is a joke bc it’s not even enough to cover a mortgage payment.  Look at other large companies, there’s often paid leave or sick leave available to the employees.  Therefore, women who choose to have kids while working as a physician in our group are penalized, especially if they are the breadwinner.
Not only that, even while off on medical leave, we are required to pay into the trust and pay ridiculously high premiums to cover the wide age gap of partners in our practice.  I would be happy to look elsewhere for my medical coverage, but I simply cannot come off our medical insurance plan.
Therefore, I propose there be a fund set aside to create a pool or trust for persons creating families (just as we do for our more distinguished and elderly physician population with our health insurance plans and exorbitant premiums) who will have families and work in our group.
Here are some examples in the news of what is and has been in the pipelines….
Here are examples of companies getting it right:
Please consider updating some or all of the policies for paid maternity leave.  I am open to your thoughts and considerations.

 

Poll on Maternity Leave

What it’s like to be a female anesthesiologist…

Severe Pre-eclampsia and Anesthesia

Chief Complaint: elevated blood pressures, now with elevated liver enzymes

SUMMARY OF RECOMMENDATIONS
1. Nifedipine 60mg ER BID, next dose at 0900.
2. Continue q4hr blood pressure monitoring; increase to q15mins should she have systolic blood pressure >160 or diastolic blood pressure >110. Please call Perinatologist should that occur.
3. NPO for now.
4. Follow-up serum preeclampsia labs at 1200, along with type & cross x2 units.
5. If AST/ALT continue to rise, would recommend primary cesarean section at that time.
6. Continue magnesium sulfate for now, and for 24 hours postpartum.
7. NICU aware.

PROBLEM LIST
1. INTRAUTERINE PREGNANCY AT 25w6d
2. SUPERIMPOSED PREECLAMPSIA WITH SEVERE FEATURES
3. TRANSAMINITIS, NOT YET 2x THE UPPER LIMITS OF NORMAL

HPI/HOSPITAL COURSE: 37 y.o. G1P0 at 25w6d, hospitalized for exacerbation of chronic hypertension, found to have preeclampsia with proteinuria. Patient received betamethasone and magnesium sulfate course. Since <deleted date> with change of her regimen from labetalol to nifedipine 30mg XR BID, patient had had normal to mild range blood pressures.

Patient had acute exacerbations in her blood pressures to the severe range. Please see my note from <date> in regards to her antihypertensive course. After her 10mg IV hydralazine yesterday evening, starting magnesium sulfate, and increasing her nifedipine to 60mg XR BID, she has now had normal to mild range blood pressures overnight. However, her 0000 and 0600 AM labs show an acute rise in her LFTs above her baseline, with AST now 74 and ALT 81. Platelets remain normal range, as is serum creatinine (0.5). Magnesium level this morning at 6.4, infusion rate decreased to 1gm/hr.

Review of systems: denies headache, visual changes, RUQ or epigastric pain. No contractions, leakage of fluid, or vaginal bleeding. She is feeling fetal movement this morning.

Allergies:
• Amoxicillin Rash
CONV. REACTION:Rash
• Penicillins

Exam:
Vitals:
BP: (!) 140/97
Pulse: 89
Resp: 18
Temp: 36.7 °C (98 °F) 36.7 °C (98 °F)
TempSrc: Oral Oral
SpO2: 98% 98% 98%
Weight:
Height:
General: no acute distress
Cardiovascular: regular rate, normal rhythm. Intact S1/S2
Pulmonary: clear to auscultation bilaterally
Abdomen: gravid, non-tender to palpation
Extremities: non-tender; trace lower extremity edema, symmetric. 2+ brisk patellar reflexes

Ultrasound (12/5): Cephalic presentation. estimated fetal weight 28th percentile, 776g. Normal umbilical artery dopplers.

Labs:
Lab Results
Component Value Date
WBC 14.4 (H)
RBC 4.51
HGB 13.7
HCT 41.3
MCV 91
MCH 30
MCHC 33
RDW 11.8
PLT 313
PRENEUTROABS 9.56 (H)
DIFFTYPE Auto
NEUTOPHILPCT 66.4
LYMPHOPCT 24.0 (L)
MONOPCT 7.9
EOSPCT 0.7
BASOPCT 0.9
NEUTROABS 9.56 (H)
LYMPHSABS 3.46
MONOSABS 1.14 (H)
EOSABS 0.11

Lab Results
Component Value Date
NA 133 (L)
K 4.0
CL 102
CO2 22
GLUCOSE 84
BUN 11
CREATININE 0.5
OSMOLALITY 275 (L)
ALBUMIN 4.0
LABPROT 7.4
CALCIUM 7.0 (CL)
ALKPHOS 91
AST 74 (H)
BILITOT 0.2
ANIONGAP 9
ALT 81 (H)
GFRCNAFA >60
GFRCAFA >60

NST: appropriate for gestational age and magnesium sulfate administration. Baseline 135, mild to moderate variability, occasional 10×10 accelerations. Rare variable decelerations.
Toco: irritability

Assessment/Plan:
37 y.o. G1P0 at 25w6d, admitted for superimposed preeclampsia with severe features.

With preeclampsia with severe features, we do try to wait until 34 weeks for delivery; however, delivery is recommended once in the steroid window for the following: persistent symptoms of preeclampsia (i.e., headache, vision changes, upper abdominal pain), worsening or uncontrolled blood pressure despite medication therapy, development of pulmonary edema, placental abruption, eclampsia, HELLP syndrome (i.e., platelets < 100,000 or LFTs > 2x normal), evidence of acute kidney injury (i.e., creatinine >/= 1.1 mg/dl), eclampsia or non-reassuring fetal testing.

I discussed my concern that her liver enzymes, which had mildly been elevated on admission, are now acutely rising, which would be an indication for delivery at this time. However, at 25+6 weeks, I recommend rechecking her preeclampsia labs again at 1200. If there is a further acute rise, I do recommend delivery via cesarean section at that point.

We discussed the risks/benefits/alternatives of primary cesarean section, as well as the possibility for a classical hysterotomy, in which she would not be allowed to labor in the future. Risks of cesarean section discussed included:

Risks of cesarean section:
1. Bleeding, with the possibility or requiring a transfusion. Risk of transfusion include allergic reaction (1/50,000), transmission of HIV/Hepatitis B or C 1/1.5-1.7 million. The patient is accepting of blood transfusion if needed, and a type and cross x2 units will be ordered at noon.
2. Infection, requiring intravenous antibiotics and potentially prolonged hospital stay
3. Damage to surrounding organs, not limited to baby (<1%), bowel, bladder, nerves, vessels, ureters.
4. Possible need for hysterectomy in the event of irreversible catastrophic bleeding
5. Wound complications not limited to separation and/or infection
6. Medical complications not limited to deep venous thrombosis, pulmonary embolism, cardiovascular accident, myocardial infarction, death.

I would not advise induction of labor at 26 weeks, as the chance of a successful vaginal delivery prior to 28-30 weeks in a primip is low.

Patient will remain NPO and on magnesium sulfate (for maternal seizure prophylaxis and fetal neuroprotection) at this time, as we await her 1200 labs. Will continue q4hr blood pressure monitoring, and she will be given her 60mg XR nifedipine at 0900.

Scientists-discover-critical-molecular-biomarkers-of-preeclampsia
From Debuglies.com

Spinal Anesthesia in Severe Preeclampsia. Anesthesia & Analgesia: September 2013 – Volume 117 – Issue 3 – p 686–693.

PDF version of article above

Subarachnoid block for caesarean section in severe preeclampsia. J Anaesthesiol Clin Pharmacol. 2011 Apr-Jun; 27(2): 169–173.

Comparing the Hemodynamic Effects of Spinal Anesthesia in Preeclamptic and Healthy Parturients During Cesarean Section. Anesth Pain Med. 2016 Jun; 6(3): e11519.

Recent advances in pre-eclampsia management: an anesthesiologist’s perspective! Anaesthesia, Pain & Intensive Care ISSN 1607-8322, ISSN (Online) 2220-5799.

Hemodynamic Changes Associated with Spinal Anesthesia for Cesarean Delivery in Severe Preeclampsia. Anesthesiology 5 2008, Vol.108, 802-811.

Traveling with an Infant

We took our first trip as a family of 3 to Maui (or should I say 4 since I’m 14 weeks pregnant).  Granted, it’s a roughly 6 hour/5 hour plane ride to/back.  I had read up on multiple blogs regarding what to bring, how to travel, what to expect, etc.  I’ve created a bullet list of must-have things to travel with or pack for your little one (ours was 7 months old at the time of travel) Continue reading “Traveling with an Infant”

Pregnancy #2

July 22, 2018

Well, this is quite the title.  We knew we wanted to expand our family.  Arden has been such a good kid, and we felt like we could handle another kiddo.  But little did we know it would/could happen so soon.

The first day of my last period was May 31.  I’ve never had a regular period, so I didn’t think my period would be any different post-pregnancy.  Arden had a mixed formula/breast milk feed since she was about a week old.  Despite breastfeeding/pumping 12x/day, I could never get my milk supply to meet her feeding needs.  Even knowing this, I still tried to pump for about a month at work before my supply went completely down to nothing.  So, my pumping ended around June 20, 2018.

As it was nearing Arden’s 5 month birthday, my husband and I thought I should take a pregnancy test just for kicks as I hadn’t had my period yet… but that wasn’t out of the ordinary for me to go 30-40 days between periods.  But something gave me an inkling that the pregnancy test may be positive.  About two weeks before the pregnancy test, I had what felt like a period cramp right in the middle of my abdomen.  It lasted for about a day, and I thought I was going to get my period soon.  Then, I also had breast tenderness… but that wasn’t uncommon as that’s a common symptom for me prior to my period.  But two weeks passed after these symptoms and still no period.  So, I took the pregnancy test a day after Arden’s 5 month old birthday.  Lo and behold it was positive!  I couldn’t believe it!  I had to show my husband.  He was shocked and happy all at the same time!  We get our first ultrasound in two weeks and this time I promised my hubs that we could know the gender before the delivery.

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Week 7 – Aug 6, 2018

Today I’m 7 weeks, 6 days.  I had my first ultrasound a week ago and by ultrasound the Nugget measured 6 weeks 6 days.  The fatigue has been unrelenting.  I need naps daily or I hit the sack early like 9p.  Last night, Arden kept rolling over onto her tummy and I was getting up every two hours to turn her over.  It makes me a little nervous for her to be on her tummy still as she still hasn’t mastered rolling over to her back.  The Nugget’s due date is March 19, 2019.  That means the two kiddos will be 13 months apart.  Whoa!  For right now, I still have my Mondays off… but that is going away mid-October.  I’m a little worried when it does go away.  I haven’t been able to workout for the last 3 weeks bc of fatigue.  I just have no energy.  But I know I need to do something so I’m trying to still get evening walks in before Arden goes to bed.  I ordered a 1 year subscription to SugarySixPack because she has workouts for pregnancy and they’re safe as she’s a certified trainer and she did them herself throughout her pregnancy.  Obviously, listen to your body and see how it feels… everyone is different.  Another workout plan that I thought was helpful (but I only did during my third trimester) was Expecting and Empowered.  Cravings have included pineapple, baked potatoes, sandwiches, ice cream, VG plain donut, Nilla Wafers, potato chips… let’s just say it’s not the healthiest cravings.  The morning sickness is getting more intense and certain foods are turning me off (fried foods, onions, sauces, tomatoes).

Week 8 – Aug 14, 2018

This week was a rough long week at work.  I worked for 13 days with one day off (Sunday – post OB).  Also, this week, Arden got hand, foot, and mouth disease at day care.  My post of her illness is here.  The worst of it was probably the first 3 days she had the illness.  My morning sickness is getting better.  I find that I have a little more energy to go for walks around the block and not just be a dud on the couch.  Feeling better this week despite the work hours.  Thanks to my mom and husband for being here this week to help out with Arden.  And the craving of Le Croix is back!

Week 11 – Aug 28 – Sept 3, 2018

Cravings this week:  mashed potatoes, pizza, Le Croix, cookies…. everything but healthy.  On weekends, I find that my energy level is zapped!  My best productive times are from 7a-11a and then 5p-8p.  From the hours of 12p-4p… I’m pretty much a zombie or need to nap during that time.  It’s a bummer bc I feel like such a bore.  My poor husband!  Earlier this week, I took the NIPT to test for common genetic issues in our baby.  It came back negative for any of the common chromosomal abnormalities.  And, we found out we are having a little boy!   I am so excited to hear this news!  For some reason my husband was thinking we would have another girl… and I was thinking ‘oh man, we’re gonna have to try again for a boy if it’s a girl and I don’t know if I can handle being pregnant a third time.’  Well, luckily, we hit the jackpot and we couldn’t be more thrilled!!  So far everything is looking good for our lil Nugget!

Week 12 – Sept 4 – 10, 2018

This week, we’re going to surprise the moms with the announcement of our pregnancy.  I found a cute lil shirt on Etsy for Arden that says “Look Whoooo’s going to be a big sister!”.  I also ordered gluten-free cupcakes with blue buttercream filling on the inside as a gender reveal for the moms.  Lastly, I was able to get a colleague to help cover my #2 day from 5p-8p so I can witness my mom’s happiness when she is here.  I’m so glad we’re telling them this week as I’ve been starting to show probably since week 9.  That’s way sooner than I showed with Arden.

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Week 13 – Sept 11 – 17, 2018

This week was a blur!  Trying to get ready for the trip and making sure everything is packed.  meeting with the contractor, interior decorator, and architect for our lil building project.

Work hours = 40.5 (in 3 days)

Week 14 – Sept 18 – 24, 2018

We were in Maui this week for our first family trip with Arden.  (Click here for advice on traveling with an infant).

Work hours = 0

Week 15 – Sept 25 – Oct 1, 2018

Although I didn’t anticipate this to be a busy week… it was.  Bear had multiple deadlines and was really worked this week.  I missed seeing Arden 2 days this week.  That’s so heartbreaking for me.  The days that I don’t see her really makes me stop and think about priorities and changing my work schedule.

M O M  G U I L T.

Yes, it’s a real thing.  Before Ardenbug, I focused on my education and career.  I didn’t have a problem putting in the time, staying up late, covering extra shifts, taking extra call, working on weekends and holidays.  Then it all changed when she was born.  My priorities changed.  I’ve learned to give up my weekend calls and happily take the early day home if need be.  It was an adjustment.  But I want to be as present and available to my lil girl.  There are still days/nights where I won’t see her.  This past week, I didn’t see her two of those days because I left before she woke up and got home after she went to sleep.  Those days are especially hard for me.  Not because of the work hours, but because I didn’t get to see my Ardenbug’s smiling face.  I ever thought it would hit me so hard.  I was never the baby type.  But, this whole process proved me wrong.  And that’s ok.  I’m human.  And I want to be present as much as I can.  So, if I don’t say YES to weekend activities or things…please don’t take it personally.  I just want to see my kiddo and spend time with her because time stops for no one.

Work hours = 33 (in 3 days)

 

Week 16 – Oct 2 – 8, 2018

Nothing new this week.  Arden started really crawling and getting about the house this week.

Work hours = 44.75 (in 4 days)

 

Week 17 – Oct 9 – 15, 2018

Arden has been having a productive cough and sometimes the mucus will cause her to gag and vomit.  Poor thing has vomited 3x this week.  And to top it off, Bear and I both got some food poisoning over the weekend.  After multiple episodes of vomiting and diarrhea, I called my OB bc I wanted to check on baby G.  One of the midwives said I probably ate something that didn’t agree with me and it wasn’t food poisoning.  Nope.  My hubs and I were both having diarrhea and vomiting.  So, I called Bears’ mom for backup and as soon as she got to our place, Bear and I headed to the ER and got 2L LR, Reglan, Zofran, and some labs.  Lil G looked good on ultrasound (I HAD to come and check him out,….couldn’t help it).  After a couple of hours, we headed home and laid low and slept for most of the afternoon/evening.  Thank goodness for the moms being relatively close by (my mom would’ve helped but she got a stomach bug too).  We’re now on the mend!!

Work hours = 36.5 (in 3 days)

 

Week 18: Oct 16 – 22, 2018

I had this week off, but was able to pick up some work at some surgery centers.  It was nice to be able to pick Arden up from school.  She’s such a happy kiddo!  This week, we’re moving everything out of the downstairs bathroom, bedroom, den, and laundry room in anticipation for our renovation.  I really hate moving bc I hate the packing and unpacking.  Luckily, my Bear is super supportive and is the muscles behind the move.  This week, I’ve been feeling Lil G’s kicks and I have missed that feeling of those lil flutters in my belly.  I’ve also been feeling pretty tired this week.  Not sure if it’s bc I’m still recovering from our sickness last week, or if I’m just overall more tired.  Seems like nap time wants to hit me around 2pm.

Work hours =  23.25h (in 5 days)

Week 19: Oct 23 – 29, 2018

This has been a busy week!  We have moved all the stuff from the downstairs bathroom, bedroom/closet, den, and laundry room.  We moved the upstairs couch downstairs, and the downstairs couch upstairs.  We re-arranged the newly placed downstairs couch.  We’re exhausted.  Not only that, Chase Travel rewards happened to screw up our flights that we need ASAP.  So that was a stressful debacle just now.  Just found a super great website for traveling with baby to decrease lugging stuff across the country:  Baby’s Away.  

Work hours = 22.75 hrs (in 3 days)

Week 20: Oct 30 – Nov 5, 2018

Had an excellent vacay up in Nor Cal!!  We stayed in a cabin in the woods and went hiking in the forests/redwoods.  Big Basin Redwood State Park and Henry Cowell State Park were my fave.  Is it bad that I have an inkling to move up there?  Not gonna lie that I browsed Redfin for housing.

Work hours = 10.25 hrs (1 day)

Week 21: Nov 6 – Nov 12, 2018

First full week back to work.  Was a bit brutal of a call night and pre-call day.  Had this one patient on OB and the husband was trying to make all the decisions for his wife.  She was a primip and he insisted on a C/S for his wife when she was just slowly progressing.  I placed her epidural and she was comfortable and went from 1.5-3cm dilated in about an hour.  However, apparently it wasn’t fast enough for his liking.  So, he insisted on his wife having a C/S.  Baby looked fine on the monitor, and had been looking great since admission.  It’s unfortunate that bc he felt he was a doctor (a plastic surgeon) that he could make these decisions for his wife.  The OB and I proceeded to talk to him that it was normal to take some time to progress for the first pregnancy, but he wasn’t having it.  Once she finally gave consent (but you could tell unwillingly), I spoke to her about the risks/benefits of anesthesia for C/S.  The doctor husband said he’s very familiar with anesthesia.  So, I asked if he was an anesthesiologist and he said he was a plastic surgeon.  Unless you did an anesthesia residency and are well-versed in the basic knowledge of anesthesiology, please do not confuse your plastic surgery/medical degree with my expertise.  He set a great example of how I will never be with another physician or healthcare worker who is providing care to me. (end rant)  🙂

Lil G is moving around and kicking nicely.  🙂

Work hours = 40.75 (in 4 days)

Week 22: Nov 13 – 19, 2018

Arden turned 9 months old this week.  Otherwise, feeling good and about 10 weeks ahead in size vs my first pregnancy.  The peeing on myself when I sneeze has commenced again.

Work hours = 34 hours (in 3 days)

Week 23: Nov 20 – 26, 2018

This week was busy and rough.  Work the day before and after Thanksgiving.  Got the Christmas tree up yesterday!  Lil G is kicking around.  Got my glucola test today (11/26) for my 24 week test.  This time I stayed NPO.  My diet has NOT been good this pregnancy.  Everything sweet has been so appealing to me.  Sweets and carbs have been my jam.  But, I have no real cravings like I did with the first pregnancy.

So I got the results back from the 1 hour glucola test and my BS is 155, and it should be less than 130.  Ugh!  I read this girl’s blog entry and totally related.

Now, I work on diet, portion control, snacks, and exercise.

Work hours = 43 hours (in 4 days)

Week 24: Nov 27 – Dec 3, 2018

This was a hectic week.  Got a bunch of things squared away with the renovation.  It’s coming along.  We’ve passed two inspections so far.  Got my eating in gear with no sugar and meal planning in place.  Really cut back on the sweets.  I actually feel better.  I’ve even managed to get in two workouts over the weekend!  Lil G is an active kicker!  There’s not set time when he gets active… I just feel him kicking around randomly.  That is so different from Arden bc she would typically be quiet throughout the day and then kick around 8pm when I sat down on the couch.

Work hours = 53.5 hours (in 5 days)

Week 25: Dec 4 – 10, 2018

I have been clean eating for the last two weeks since I failed my 1st glucola testing.  Today, I did an experiment of doing random blood sugars.

7:00a — fasting since 8pm the night before.
BS = 84
8:58a — done one hour after my last bite of breakfast (1/2 cup greek yogurt, strawberries, paleo granola)
BS = 97
9:22am — last bite of homemade beef and bean paleo chili (1 cup). 1 tbsp unsweetened, unsalted organic crunchy peanut butter.
12:33p — last bite of work soup (1/2 chicken and sausage jambalaya, 1/2 lentil and chickpea, salt load thru the roof).
13:43p — BS 93
16:45p — last bite of grilled chicken, brown rice, veggie bowl from FlameBroiler.  1/2 an orange.
17:36p — BS 120
19:15 — granny smith apple; 1 tbsp natural, organic crunchy peanut butter.  1 piece of dark chocolate.

More info I found on glucola testing and GDM:

Work hours = 56 hours (in 6 days)

Week 26: Dec 11 – Dec 17, 2018

This was a really rough week for me.  In fact, this past month has been really tough with the increased work hours, remodel, baby at home.   This is the most I’ve been depressed in a long time.  I know it will pass.  But, there’s no ME time for just the self and there’s no together time with husband.  It’s taking it’s toll on me, but I know it’s temporary and that it will all pass.  I was really lucky to not have any postpartum depression… but this is how I imagine it would feel.  Somedays I’m lucky to see my lil girl for an hour before she goes to bed, but lately it’s been 30 minutes.  I’m exhausted.  I’m sad.  And I’m ready for December and the holidays to be over.

The Dangers of Hidden Depression

Depression Hotline

10-characteristics-of-PHD
From https://drmargaretrutherford.com/the-ten-characteristics-of-perfectly-hidden-depression/

Work hours = 54 hours (in 5 days)

Week 27: Dec 18 – Dec 24, 2018

Hubs and I had our first date night out without baby in at least 10.5 months.  It was wonderful.  Went close by to Amaya… but we were both exhausted.  We need to make some changes to when the moms come to help.  I think if I’m working late… that would be a good time to help hubs.  Or I proposed a weekly date night and I think that will help get back to that closeness we had before baby.

Work hours = 41.75 hours (in 4 days)

Week 28: Dec 25 – Dec 31, 2018

We had Christmas at both families’ homes.  With two kids and my work schedule coming up, I’m not sure how long that will be sustainable.  I’m more than happy to have everyone come to our home.  Simplicity and less stress.  We had a terrific Christmas at home.  Arden absolutely loved hearing the gift wrapping tear and the sights and sounds of Christmas.  She always acknowledged the Christmas tree everytime she woke up in the morning as well as when she woke up from naps.  She got so many wonderful gifts and I had so much fun watching her interact with her new toys.  we put the fireplace on for the first time and she got to see fire, which intrigued her greatly!  On the 26th, we drove up to Big Bear to show our lil one some snow.   She totally looked like the bundled up kid from A Christmas Story!  She wasn’t too fond of getting all the layers on, but once she got out into the cold, she was ok.  She got to see snow falling down as well as snow on the ground for the first time.  We also took her sledding, which she seemed to be open to the idea when we would drag her on the sled.  But when we got on the sled with her on a little slope, she would cry at the end of the run.  It was so completely cute!  I’m glad she could have this experience.  One of my main goals in being her mom is to give her many different experiences.  I don’t want her to be spoiled with stuff…. but I do want her to be spoiled with healthy food, cultural experiences, and travel.

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Work hours = 7 hours (in 1 day)

Week 29: Jan 1 – Jan 7, 2019

Back at work… lil G has been kicking up a storm.  I’ve started kick counts and he has no problem meeting the 10/hour during the day (whereas Arden would get her kick counts around 8pm when I sat on the couch).  The reno was on hold for the holidays.  I’m definitely looking forward to it being done by the end of January!  Talked to hubs about potential middle names for our #2, and I’m really loving Lukas.  🙂

Work hours =  40 hours (in 4 days)

 

Week 30: Jan 8 – 14, 2019

I am off this week. What that really means… I have no work responsibilities. But, I’m getting up in the middle of the night to nurture/feed Arden and getting her ready for school in the mornings and taking her to school. She’s such a good kid, but there is definitely more effort involved in getting all these things ready. The last two days, I’ve taken Arden to school in my sweat pants and no makeup. And honestly, I’m ok with that. I really do appreciate my husband bc he normally takes Arden to school on his way to work. We don’t have the moms coming this week as they really were a huge help this past weekend to allow Ross and I a baby-free weekend. The Reno project has restarted from the holidays. Tiling will be started this week! Garrett has been kicking like crazy and meeting his kick counts. The meal prep has been going well.

Felt a bit lightheaded one night this week.  Not sure what happened… I hadn’t been working.  I’ve been doing very well with my diet, healthy stuff, no sweets.  Everytime I would standup (esp after being bent over), I would feel lightheaded.  It wouldn’t help with sitting either… I had to go full on horizontal and lay down to feel better.

Took my 3 hour glucola test and passed the first two blood draws (fasting, and 1 hr after 100g drink)… then got the call that my glucose was slightly elevated on the last two draws (2 hours after the drink and 3 hours after the drink).  I’m disappointed that now I have to go and meet with a diabetic educator.  Pretty much since I found out that I had a positive 1 hour glucola test, I have been on a lower carb, no-sweets diet.  That’s been about a month and a half.  Ugh.  So, I’ll have a separate entry on Gestational Diabetes Mellitus (GDM).

Work hours = OFF!

Week 31: Jan 15 – Jan 21, 2019

I’ve been battling a nasty cold that I got from our Bug, which she got at daycare.  It’s an upper respiratory infection, most likely viral in nature.  A lot of coughing, sinus pressure, headaches… but I’m going the minimalist route for now — good wholesome foods, fluids, rest, and Tylenol.  Lil G has been kicking around as usual.  He’s so active compared to Bug.  I feel him all throughout the day and night.  Makes me worried that he won’t be a good sleeper.

Work hours = 37 hours (in 4 days)

Week 32: Jan 22 – Jan 28, 2019

I’m still battling my cold.  It’s been almost 2 weeks.  I have an OB appt today, so I’ll kill two birds with one stone and just get a second opinion.  The reno is coming along: baseboards are in, W/D is in, tiling has occurred in the laundry and downstairs bathrooms.  Plumbing and toilet are in.  Waiting on paint, vanity, bath accessories, cabinetry, and countertops to arrive… the end is in sight!  The project was supposed to be done by the end of January, but realistically looks more like mid-Febrary.  LLC established and getting business accounts setup.  It’s been busy, despite my random days off.  I’m getting up to pee every 2 hours…so I just feel tired all the time.

Work hours = 50.25 hours

Week 33: January 29 – Feb 4, 2019

This week has been a blur!  Everyone at home has been sick.  I worked on Super Bowl Sunday.  Happy Chinese New Year — it’s the year of the pig!

Garrett will be a lil Chinese Astrology pig!

Feeling bigger…. having to pee more…. eating smaller meals….

An interesting article from NYT on pregnancy and alcohol.

Work hours = 48.5 hours

Week 34: Feb 5 – Feb 11, 2019

I’ve started splitting my night calls as I just don’t have the stamina (nor can I get comfortable sleeping in the call room) to do a full night call anymore.  I’m definitely feeling more tired this go around.  Lifting and chasing Arden, preparing meals, working full-time, it’s tougher.  But, I’m still planning on working until I go into labor or have my set maternity leave (whichever comes first!).  Not only am I tired, I’m insatiably thirsty…despite drinking 3x 32oz waters throughout the day and 2x 32oz waters at night…. waking every 2 hours to pee…. eating such small meals bc I have early satiety…. constipated despite my best efforts to get in green juice and poop tea. 😉  I think the month leading up to delivery is the hardest.  Lil G is active as usual and definitely more active than Arden was in utero.  Hopefully he’ll be a good sleeper like his older sister.

Work hours = 33.5 in 3 days

Week 35: Feb 12 – Feb 18, 2019

I am off this week.  The reno should be near complete this week!!!  It’s been going on since the beginning of November 2018!  I’m ready to have the garage back as well as a porta-potty out of the driveway and access to our movie room and downstairs bathroom and hallway again!  There was a lot going on with this and coordinating things.  Plus, I watched the Bug on Friday and it is A LOT to take on…. especially while pregnant.  I have a huge respect for stay at home moms who tackle this daily!  I was exhausted after the day.  But, we went out to the Aquarium Friday afternoon and she had a wonderful time looking at the fish and seeing the movement of the water.  It was great to get her out of the house and I know she enjoyed the external stimulation.  Sunday, she ended up developing a fever of 102-104F and that scared the crap out of me.  I gave her Tylenol immediately.  She was lethargic after her second nap (she typically has two naps for 30 minutes at a time, but this time she had 2 two hour naps!).  Plus, instead of wanting to play after her nap, she just wanted to be held… she’s typically not this cuddly.  After calling urgent care to let them know we were on our way, the answering service transferred me to the nurse and they both kept telling me that they close in 5 minutes…despite us living 5 minutes away and with our daughter having such a high temp.  I was furious.  I hung up and opted to go straight to our Children’s hospital ER.  They were fabulous.  After Bug went through a series of vitals checks and physical exam (which she was not stoked on), she got some motrin and we were in and out of the ER in an hour!  That’s a huge feat by any medical facility!!  By the time we got home, her fever had subsided to 99F and she was wanting to eat, drink, and be merry.   We watched her like a hawk all night and the rest of the holiday weekend.

Tylenol 15mg/kg

Motrin 10mg/kg

Hours worked = 0

36 weeks: Feb 19 – Feb 25, 2019

Bug went back to school today.  Her highest temp after the ER visit was 99.  We still gave her some tylenol this morning before school just to help her through the day.  She also has molars coming in…. so that can help with the pain.  Lil G has been meeting all his kick counts.  I’m still peeing every 2-3 hours at night…and drinking about 100oz daily.  I have this insatiable thirst esp during the 3rd trimester…and that has been with both babies.  He’s looking large in the belly.  We had our 36 week growth scan and everything looked good.  He’s looking like he’ll be 7.5 lb at birth.  NST/AFI was great.  No issues.  Had my last OB shift on Friday and it was busy!  But luckily, got to go home around 9:30p and didn’t get called back.  Saturday, my mom and aunt came and watched Arden while hubs and I organized the media room, Arden’s new room, and Garrett’s room.  Lil G’s bassinet is setup in our room and ready to go.  We cleaned, dusted, mopped, vacuumed and were exhausted.  I’m super thankful that my aunt cooked up some great meals that got us through the day!!  Sunday, Ross’ mom came to help watch Arden while Ross did some heavy cleaning of the garage (where I could park the car again!! woohoo!).  The construction has come to a close… they moved the port a potty on Friday, Feb 22.  The construction guys have been using the house toilet, despite me paying for a port a potty, so I was pissed.  Now, we just have a final walkthrough and some flooring to tackle and painting.  It’s so great to have this done.  Arden has been having some little colds/runny nose, but has been playing and her happy self.  She’s started becoming more vocal about what she wants and what she doesn’t want.  She had a lil temp (100F) and we gave her some Tylenol.

Hours worked = 48.5

37 weeks: Feb 26 – Mar 4, 2019

This week was brutal.  We are on the home stretch with our renovation.  The grandmas now come on the weekends to help with Arden while we organize, clean, and recover from the reno.  It’s crazy to live in the space during the reno…I’m not sure I’d do that again.  There were 3 days this week that I didn’t get to see Arden bc I was at work late those days.  That absolutely killed me.  As much as I love my job, I love my kiddo more and I feel like I’m missing out on her activities, milestones, etc.  This week, I also caught Arden’s cough — it’s productive, but I’ve felt ok (no sinus pressure, headache or fever).  My sleep has gotten noticeably worse this week — I’m insatiably more thirsty; drinking about 60 oz at night.  I pee every 1-2 hours and can’t catch up with my thirst.  My blood sugar checks for GDM have been stellar.  Fasting blood sugars have been less than 90.  Lil G is kicking away and moving.  All is good on the home front… just looking forward to meeting this lil dude!  Had a realization with Ross… how the heck are we going to do this without losing our sanity?  2 kids under 14 months?  Arden will be 13 months old in a week.  We just re-enrolled her for the next school year, and our future son is on the waitlist and they couldn’t tell us when we could start.  That’s super stressful for us bc we both work full time jobs.  Our moms are out of town.  I’m just annoyed and stressed that he may not be able to go to school at 4-5 months.  But, we just have to wait and see.  4-5 months down the road….Arden will be 17-18 months and eligible to move up to the toddler class.  So hopefully this will all work out and I won’t have to be worried about that.  There’s been a ton on my mind and my memory is not keeping pace.  Perhaps it’s the sleep deprivation for the last 2 months (getting up to pee)… or just trying to remember everything going on in life.  Does it get easier?

Hours worked = 48.5

Week 38: March 5-11, 2018

Final walk through with inspection completed this week.  Final painting, flooring, and touch ups.  It finally feels like this project is coming to an end and I am grateful!!  Last night, Arden was super tired and fussy to go down to sleep.  We were working on transitioning her from her bottle to a cup, but there’s something soothing for her about the nipple that the cup simply won’t comfort.  I’m getting up every hour to pee.  My U/S looked great.  AFI was 14.  NST was terrific.  Cervix is still high and just waiting for lil G to come on down.  He’s still super active and kicking.  It’s nice to be able to be home and laze and eat and pee when I want/need to.  I weighed 161 lb,…the exact same since Nov 2018.  The only thing I did was change to a modified Whole30/paleo diet cutting out processed sugars bc of the GDM.  Don’t worry, lil G is growing… him pushing on my stomach and decreasing my food intake and more intake of healthier meals is probably causing my weight to just plateau.  We have weekly U/S and NSTs moving forward.  Dr. W and I discussed possible induction on March 18 bc I really don’t want to go beyond 40 weeks with this pregnancy.  I’m just not comfortable in this state.

 

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Hours Worked with Arden

 

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Hours Worked with Garrett

Neuraxial anesthesia and External Cephalic Version

ACOG: If Your Baby is Breech

What is an external cephalic version?

External-Cephalic-Version
From Pregmed.org

Wikipedia: external cephalic version


Randomized trial of anaesthetic interventions in external cephalic version for breech presentation. British Journal of Anaesthesia 114 (6): 944–50 (2015)

  • Conclusions: Spinal Anesthesia (SA: hyperbaric bupivacaine 9mg + fentanyl 15mcg) increased the success rate and reduced pain for both primary and re-attempts of External Cephalic Version (ECV), whereas IV Anesthesia (IVA) using remifentanil infusion (0.1mcg/kg/min) only reduced the pain. There was no significant increase in the incidence of fetal bradycardia or emergency CS, with ECV performed under anaesthetic interventions. Relaxation of the abdominal muscles from SA appears to underlie the improved outcomes for ECV.
  • Editor’s key points: There is no consensus on best anaesthetic technique for external cephalic version (ECV).  In this study, success at ECV was higher using spinal anaesthesia compared with remifentanil infusion or no intervention.  Pain was also reduced in the remifentanil group but success at ECV was no different to the no intervention group.  The effect of spinal anaesthesia in ECV may relate to relaxation of the abdominal musculature.

Neuraxial blockade for external cephalic version: Cost analysis. J Obstet Gynaecol Res. 2015 Jul; 41(7): 1023–1031.

  • Neuraxial blockade is associated with minimal hospital and insurer cost changes in the setting of external cephalic version, while reducing the cesarean delivery rate.

External cephalic version with or without spinal anesthesia: a cost-effectiveness analysis.  American Journal of Obstetrics and Gynecology, January 2016Volume 214, Issue 1, Supplement, Pages S206–S207.  

  • It is both effective and cost-effective to utilize spinal anesthesia to perform ECV in term, nulliparous women with breech fetuses. Translation of this potentially impactful approach into broad obstetric practice should be undertaken.

Effect of Regional Anesthesia on the Success Rate of External Cephalic Version: A Systematic Review and Meta-Analysis. Obstet Gynecol. 2011 Nov; 118(5): 1137–1144.

  • Six RCTs met criteria for study inclusion. Regional anesthesia was associated with a higher external cephalic version success rate compared to intravenous or no analgesia (59.7% vs. 37.6%; pooled RR 1.58, 95% confidence interval [CI] 1.29-1.93). This significant association persisted when the data was stratified by type of regional anesthesia (spinal vs. epidural). The number needed to treat with regional anesthesia to achieve one additional successful ECV was 5. There was no evidence of statistical heterogeneity (p=0.32, I2=14.9%) or publication bias (Harbord test p=0.78). There was no statistically significant difference in the risk of cesarean delivery comparing regional anesthesia to intravenous or no analgesia (48.4% vs. 59.3%; pooled RR 0.80, 95% CI 0.55-1.17). Adverse events were rare and not significantly different between the two groups.

Does Regional Anesthesia for External Cephalic Version Increase the Risk of Emergent Cesarean Delivery? Obstetrics & Gynecology: May 2016

  • Neuraxial Anesthesia (NA) for External Cephalic Version (ECV) increased the risk of emergent cesarean delivery (CD) without impacting ECV success. These findings differ from previous randomized controlled trials (RCTs). The increased risk and decreased success of our ECVs compared to ECVs performed in the context of RCTs could be explained by patient selection, variation in operator experience or technique, or variation in anesthetic management.  Future studies should further evaluate the risk of NA for ECV in true practice scenarios outside of RCTs.

Clinical outcomes after external cephalic version with spinal anesthesia after failure of a first attempt without anesthesia.  International Journal of Obstetrics & Gynecology. Volume139, Issue3. December 2017: 324-328.

  • Repeat ECV with spinal anesthesia after a failed first attempt without spinal anesthesia increased vertex presentation at birth and decreased the rate of cesarean delivery.

Effect of Intrathecal Bupivacaine Dose on the Success of External Cephalic Version for Breech Presentation: A Prospective, Randomized, Blinded Clinical Trial. Anesthesiology 10 2017, Vol.127, 625-632.

  • Results: A total of 240 subjects were enrolled, and 239 received the intervention. External cephalic version was successful in 123 (51.5%) of 239 patients. Compared with bupivacaine 2.5 mg, the odds (99% CI) for a successful version were 1.0 (0.4 to 2.6), 1.0 (0.4 to 2.7), and 0.9 (0.4 to 2.4) for bupivacaine 5.0, 7.5, and 10.0 mg, respectively (P = 0.99). There were no differences in the cesarean delivery rate (P = 0.76) or indication for cesarean delivery (P = 0.82). Time to discharge was increased 60 min (16 to 116 min) with bupivacaine 7.5 mg or higher as compared with 2.5 mg (P = 0.004).
  • Conclusions: A dose of intrathecal bupivacaine greater than 2.5 mg does not lead to an additional increase in external cephalic procedural success or a reduction in cesarean delivery.

 

 

 

 

3 months postpartum and time to start a new workout regimen

Three months have flown by since Arden was born.  I started doing Classpass about a month ago to get back into pilates.  During my experimentation with Classpass, I found barre classes to be quite tough and intriguing.  From the various barre studios around me, I found Studio Barre to be fun, encouraging, girlie, and upbeat.  For a good cardio burn, both Cycle Bar and 9 Round were great at keeping my heart rate up!

From https://anomalily.net/classpass/

In about a week and a half, I have to go back to work.  Right now, I have mixed feelings about this as I’ve enjoyed my time with Arden.  I think the first week will be tough.  It’ll be the first time I’ve been away from her for any length of time.  Our hospital did a roll out of Epic, which is an electronic medical record — I’m nervous as this will be my first time using it when I go back.  I haven’t given an anesthetic in 3 months… this means I need to dust off the cobwebs and put my thinking cap back on.  I can only imagine I will be drained with the early mornings and late nights and plenty of mental stimulation.  It will be a different kind of tired vs. child-induced tired.

I want to put myself in the best place to handle these stresses.  Despite my current passes at my various studios, I will need a home workout to do when I can’t get out of work in time.  This led me down a rabbit hole last night of searching for various home workouts and reviews.

I’ve done plenty of home workouts as evidenced here and I appreciate everything it provides.  However, how do you keep the workouts fresh and non-repetitive?  The P90X series is awesome for a tough cardio and sculpting workout in 30 minutes with great results.  But there’s only so many times I can do the same exercises over and over again.  Then, I went to Sweat/BBG by Kayla Itsines.  This app/workout program got me wedding dress ready in 3 months!  This was a fabulous workout that had plenty of cardio, jumps, squats, upper/low/full body, weights, etc.  But I had the same problem of repeating workouts.  I was getting great results, but I couldn’t stay motivated to do the same workouts over and over again.

Searching for a constantly changing workout regimen led me to Alexia Clark.  There was just a little bit on her website describing her workouts, but I wanted more info.

After reviewing all this information, I decided Alexia Clark’s program is the way to go.  My classpass/barre pass ends at the end of May.  I’m pulling the trigger to start Alexia Clark on June 1.  My husband watched a bit of the review video with me and says he would start with me.  Now how’s that for motivation?

 

And this nifty little macro calculator was just what I needed to help me get my diet on track.

 

Do you have any recommendations or workout programs I should check out?

 

Pregnancy, epidurals, and birth plans

A little background info… I’m an anesthesiologist for a fairly busy practice. That means we get called when you need an epidural or c-section. I am currently in my first pregnancy (so I haven’t experienced my own birth process), however I’ve seen and managed thousands of epidurals for delivery.

One of the most important things moms can do for their pregnancies… Eat right (clean, get plenty of veggies and fruits) and exercise. This is the best prep work you can do! Secondly, have an open mind when selecting your birth plan. You are not in control of what will happen. What happens with your baby is what will dictate what you will need and what will be best for your baby. Many mothers have opted for a “natural” delivery and have been successful. Some mothers have been in a fully equipped medical center and have had bad outcomes unrelated to interventions for their baby.

Your goal as a mom is to guide and give direction to your delivery team of your wishes — but this is a process that changes throughout your labor so flexibility is key.

Epidurals are NOT harmful for your baby. There are multiple studies that’re well backed with huge sample sizes that prove this. Epidurals can slow certain stages of labor, but it’s NOT harmful to you or your baby. There are a lot of misconceptions about epidurals. Whether it’s patient experience, epidural effectiveness (and this can be patient controlled), or fear of the unknown… epidurals have been given a bad reputation and sometimes these traumatic experiences are passed down without rhyme or reason (similar to the anti-vaccine movement which is dangerous!).

So, pick a birth plan… be flexible with it. Do what you can to optimize your health (and birthing experience) via diet and exercise. Lastly, no one loses when they’re comfortable. Comfort leads to a good experience and overall a happy mom, baby, and family.

Here’s my plan (which isn’t for everyone):

1) more plant-based diet w some fish

2) exercise via walks, hikes, and pilates/yoga/barre

3) birth plan: vaginal delivery with minimal pain (epidural immediately: I don’t want to feel a thing)… but anything to get the baby out safely.

4) breastfeed like crazy if possible

5) go back to work after 3 months

6) breast milk for at least 6 months (but will try for a year)

My plan isn’t for everyone… it’s for me. Good luck!!

Walking labor epidurals

What is an epidural?

What is a “walking” epidural?

Anesthesiology 2 2000, Vol.92, 387. Walking with Labor Epidural Analgesia: The Impact of Bupivacaine Concentration and a Lidocaine–Epinephrine Test Dose.

MJAFI, Vol. 63, No. 1, 2007. Walking Epidural : An Effective Method of Labour Pain Relief. 

Int J Women’s Health, 2009, 1: 139-154. Advances in labor analgesia.

R. Can J Anesth/J Can Anesth (2010) 57: 103. Walking epidurals for labour analgesia: do they benefit anyone?

MOBILIZATION IN LABOUR AFTER REGIONAL ANALGESIA. Euroanesthesia May 2005. Royal Free Hospital. London, UK.

Impact of first-stage ambulation on mode of delivery among women with epidural analgesia. Australian and New Zealand Journal of Obstetrics and Gynaecology 2004; 44: 489–494

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From WebMD

Walking Epidural with Low Dose Bupivacaine Plus Tramadol on Normal Labour in Primipara. Journal of the College of Physicians and Surgeons Pakistan 2010, Vol. 20 (5): 295-298.

Clinical Guidelines: Labour Analgesia. Jan 2017. King Edward Memorial Hospital, Australia.

BJOG, Feb 2015. Neuraxial analgesia effects on labor progression: facts, fallacies, uncertainties and the future.

Position in the second stage of labour for women with epidural anaesthesia. Cochrane Database of Systematic Reviews. Feb 2017.

Ambulatory Epidural Analgesia in Obstetrics: Clinical Effectiveness, Safety, and Guidelines. Canadian Agency for Drugs and Technologies in Health. Rapid Response Reports. Nov 2010.

Contin Educ Anaesth Crit Care Pain (2004) 4 (4): 114-117. Epidural analgesia in labor.

CSE for Labour Analgesia. 

cseanatomy

From the ASA 2017 (October in Boston):

  • CSE: 1 cc 0.25% bupi + 15mcg fentanyl (good for primip)
  • 25g Dural Puncture without dosing sometimes (primips)

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Pregnancy

The first day of my last period was April 25, 2017.  According to my Glow app, my average period length is 6 days and it looks like there’s roughly 37 days between periods.  That’s about 10 days longer than the average Jane.  That last period occurred on our honey moon! We came back home on May 9.  Then, I had a weeks worth of diarrhea from May 20-27 and ended up taking ciprofloxacin at that time.  As June approached, I was just fatigued for a bit and so was Bear.  We thought we had caught a bug or had some kind of weird travel lag from the trip.  I was still surfing regularly with Ross — maybe a couple times a week.  Around the summer solstice June 20, I had some light cramping. Breasts had been tender for a while, but that wasn’t anything out of the ordinary as my period approaches.  In early June, we went to  the Toast the Coast Wine Festival at the Del Mar Fair (June 10) and then the evening of June 20, we had burgers and beers at Encinitas Alehouse.  I had a funny feeling to pee on a pregnancy stick that evening, so I did.  Lo and behold it was POSITIVE!  I quickly called out to Bear to make sure he got an eye on the reading to make sure I was reading it correctly.  The next day, we went to the drug store and got one of those digital ones so there couldn’t be any reading errors.  It said PREGNANT.

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Once we found the info out, I immediately called to setup an appointment with my chosen OB/GYN.  I feel lucky to have a job in anesthesia because I get to directly see the work of our surgeons and care providers so it gives me an idea of who to seek for my own care if needed.  I setup an appointment with Kim Washkowiak for July 5 (1st ultrasound) and then an initial consultation on July 11.  I also started researching best books to read during this time and finally chose the Mayo Clinic Guide to a Healthy Pregnancy.

According to the Mayo Clinic Guide to a Healthy Pregnancy: From Doctors Who Are Parents, Too! that we’re reading, the chart states the following….

  • Week 1 If the first day of your last menstrual period was: Apr 25
  • Week 3 Conception likely occurred around: May 9
  • Weeks 5-10 Period of greatest risk of birth defects
    • Beginning of organ formation: May 30
    • Major organs have formed: Jul 4
  • Week 12 Risk of miscarriage decreases: Jul 18
  • Week 23 Some preemies can now survive: Oct 4
  • Week 40 (full term) Estimated due date: Jan 30

Mayo Clinic Guide to a Healthy Pregnancy: From Doctors Who Are Parents, Too! (Bestsellers) (Kindle Locations 2230-2237). RosettaBooks. Kindle Edition.

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10 weeks, 1 day

But according to our OB and U/S reports, we’re due February 20, 2018.

July 5, 2017

I’ve had about 2 weeks of low grade nausea.  I keep wanting to eat small meals to stave off the “morning sickness” that rears its ugly head throughout the day.  I’ve got some ginger candies to help.  I’m also eating more plant-based meals (Veestro and Splendid Spoon) and craving grapefruit and fruits!  I haven’t worked out much bc of the nausea.  I’m trying to get 3x 16oz waters down in a day.  Initially, I was having to pee a lot…. not just during the day but it would also wake me up in the night.

Week 18 – Sept 19-25, 2017

Recap:  The nausea was the worst for me from weeks 7-13.  It slowly got better.  Things I did to calm the nausea: ginger chews, ginger hot water/tea, bananas, toast, crackers, pasta, hydration, rest.  I found it worst during the day.  During that time, I also shunned Veestro and Splendid Spoon.  In fact, I could hardly tolerate any of my paleo foods that I typically eat.  Crackers and carbs were my savior.

Fast forward to week 18… life is good!  We just got back from a 2 week vacation to the Azores. I’m back at work and now I have Mondays off.  We’ve been doing research on state disability, maternity and paternity leave, vacation days for 2018, infant day cares, pediatricians, etc.  I still don’t see much of a baby bump yet, but my usual clothes are starting to feel tighter. Got my flu shot!  Pregnant ladies, it’s IMPERATIVE you get your flu vaccine (not the nasal one though) — read the CDC guidelines here.

So far, we’ve found the following books helpful:

Week 21: Oct 10 – 16, 2017

I’m still feeling pretty energetic and able to maintain my pilates workouts.  Typically, I aim for 3-4 one hour sessions/week.  The ladies at Club Pilates in Del Mar are fantastic and are always offering me alternatives for new moves as I advance in my pregnancy.  I’m hoping to keep this up until delivery and beyond!  We’e completed two prenatal classes so far.  Scripps offers a lot of classes and resources and we’re taking advantage of the learning opportunities!  So far, we’ve done Getting Ready for Baby part 1 and 2.  It was a great overview for absolute essentials we may need for our newborn as well as how to change a diaper, swaddle, when/how to bathe, etc.  It also included an excellent session given by a pediatrician on normal/abnormal poops, diaper changes, breastfeeding, circumcision, vaccines/shots, etc.

I’ve been in a rabbit hole of baby registry items/reviews and we’re slowly building our list.  I’m pretty meticulous about researching anything prior to pulling a trigger on anything big (house, car, insurance, stocks, appliances, electronics, etc.).  I consider a newborn to be a really BIG thing!

OB Anesthesia entries from my blog:

Week 22: Oct 17 – 23

This week, it was recommended that I only stick to the pilates 1.0 or 1.5 classes.  😦  Pilates has been great, but they’re totally right.  My cardiovascular capacity needs to really stay in check.  The mini is the size of a papaya this week.

Week 23: Oct 24 – 30

We just got back from our last flight to Boston.  Overall, I felt like I traveled fine… but I could see it being tougher as the pregnancy progresses.  Lately, I’ve been booking infant care tours for our little one when they turn 3 months.  I have two girlfriends with 2 kids who are terrific moms…each offer the advice of getting a nanny (instead of daycare).  I think a nanny or our moms would be great, but my biggest push for the daycare is to engage early development and socialization.  I think the nanny and our moms are great to help on certain days, but Bear and I work and that would be a 5 day a week commitment.  That’s a lot to ask for from our moms who live out of town.  Plus, I do not want a complete stranger (i.e. the nanny) around our baby just yet.  Consider it the mamma bear in me.  But, I want accreditation, vetting, background checks, early childhood education, experience…. and from what I am finding in my searches… it’s really hit or miss with the nanny.  I really am taking to the Montessori method for independent learning and self-soothing and the way it encourages infants/toddlers to participate in their environments.  Plus, one of the Montessori schools we’re looking at does language immersion.  Many educators have said that the most absorbent stage of learning is from 0-6 years.  Great link that compares infant care and nanny care.

YouTube video of LePort Montessori Infant School

Plus, I don’t really believe in decorating a nursery and such — we’re in the midst of creating/designing/constructing a companion unit and will then at a later date do a large remodel of the house.  So, simplicity and minimalism are my jam.  I read this article on the Montessori way of setting up your home for infant and I love it and would like to replicate it!

Comparing Montessori and Reggio learning styles (2 infant care philosophies we are looking at):

I’m ecstatic to learn about MontiKids ($30 off with referral code: REFW6UGPGEGO5) – a toy delivery service that bases it’s philosophies on Montessori.  Every 3 months, the company will send you age/development appropriate toys to you.  I am so thankful for minimizing screen time and maximizing play/learn time with my future kiddo.

My YouTube Kid Playlist

We had our first breastfeeding class last night. It was actually really really informative.  We’re always the smallest “bump” in the class as I think most of the moms in there are due November…. and we’re not due until February.  But, I love having the info ahead of time so I can plan….and I only know my schedule one month in advance 2 weeks prior to the new month.  We’re definitely on board for 6 months of exclusive breast feeding and then starting organic, non-GMO, hormone-free foods around that time with supplemental breastfeeding.  I’d love to breastfeed for at least 1 year if it’s possible.  We’ll see!  I know it’s not an easy task.

All things Montessori:

We had our 24 week growth scan ultrasound on Oct 30. Everything looked great!

Week 24: Oct 31 – Nov 7

This week, the mini is the size of a large zucchini.  At this stage, we have a viable fetus.  Things are still going well.  I’m feeling little kicks.  Mini’s insertion of the umbilical cord is just slightly off center on the placenta.  The last growth scan showed no vasa previa and the baby was already positioned head down.  Funny thing, at every ultrasound… the Mini is super chill.  The ultrasound tech will push the probe into my belly to shake/wiggle the baby to move and change positions…. but to no avail.  Hopefully, they’ll be this chill when they’re born!

I’m looking at various cord blood companies to see whether it’s worthwhile to bank stem cells from the umbilical cord when the baby is born.  Basically, it’s kind of like having a backup source of undifferentiated cells that could turn into anything (bone marrow, red cells, white cells, tissue, etc.) if we ever need to use them down the line.  My biggest question is: what’s the viability/longevity of these cells to be effective if we need them?  It’s a pretty large upfront cost.  And nothing is guaranteed.  So… I asked my OB what she did with her kids and she said the first one it was free, and then she paid for the 2nd and the 3rd.  I’m going to continue my polling today to figure out if it’s worth it or not.  What I’d really like to know is if anyone has had to use these stem cells….. was it worth it?  Did it change the course of disease or alter treatments?

table-1

Cord Blood Info:

So after reading through every one of these links…. I’m leaning more towards NOT banking.  If something isn’t going to be useful 10-20 years down the road…. why bother?  Plus, in 10-20 years, research and medicine will have advanced that there may be better treatment options available – i.e. creating stem cells that are a match to a recipient.  There are public stem cell and tissue registries.  I suppose the key thing is would we have a match for our multi-racial family from a public bank/registry?   We both have ZERO genetic history of diseases or cancers.  It’s a big upfront cost — and I’m not sure the technology is quite there for advanced treatments.  But, if I were to choose a private cord bank company right now, I’d probably choose CBR.

Update Jan 15, 2018, 34 weeks, 6 days: We ultimately re-discussed the cord blood/tissue banking and decided on CBR.  After chatting with several moms who did it…. a lot of them have regrets for not doing it…. and the ones who did it have peace of mind.  Bear and I further researched the topic and decided we would do it and chose CBR.

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24 weeks, 3 days

Had my 24-26wk Glucola testing on Nov 6.  This was after an unseemingly busy call day and night.  In fact, I got called back to the hospital at 2am and was starving — so had half a bagel at 2am (and therefore breaking the 12 hour fast rules).  I went in for the Glucola test at 7:30am.  The Glucola drink is 50g of sugar that tastes like a really flat Sunkist soda.  I thought for sure my test would be positive given my cortisol surge with the busy and stressful call day…… and fueled by my half bagel at 2am.  But, low and behold, my result was 126 (range less than 139) and negative for gestational diabetes.  Woohoo!!  Here’s some interesting reading material on gestational diabetes and diagnosing it: part 1, part 2.

Week 25: Nov 7-13

Definitely seeing and feeling changes during this week.  There’s no mistaking that I’m pregnant.  Before I just felt “fat” and heavy in the belly — so funny that some of my colleagues asked if I put on weight.  That stuff doesn’t bother me, but it cracks me up how guys can be so frank.  I’m still trying to do at least 3 classes a week of pilates.  I’m really enjoying Club Pilates that’s a studio all around the country.  Currently I’ve dropped down to just the 1.0 and the 1.5 classes — but they’re still kicking my booty!  I was consistently doing the 1.5 and 2.0 classes up until 23 weeks.  My fam has an ongoing bet whether the Mini is a boy or a girl.  I love it!  I even want to get in on it — but I can’t be the biased house.  So far…..here’s the tally…
Stud Hubs = girl
Mimi = girl
Aunt Chawn = boy
Uncle Larry = girl
Mom’s friends (Raymond and Nashat) = girl
My thoughts = I have no idea! How do people predict this stuff? Girl names keep popping in my head though.
At work (Lisa, Rick, Suzette, Thuy, Katy) = boy
At work (Juliette, Christina, Annetta) = girl
Baby shower majority = boy
Massagers at ThaiSport = girl
I can’t wait to see the bets roll in!
Week 26: Nov 14 – 20
Even at 26 weeks, I’m up daily at 6:22am… perks of the job.  There’s usually one or two pee awakenings in the middle of the night usually anywhere from 1-4am.  I think this sleep deprivation thing will be just like a call night.  I’ve been doing those for years (yes, at least a decade).  Night call on OB is roughly an every 2 hour wakeup call for an epidural or a bolus or a C/S… or it’s a trauma rolling in through the OR.  I think I’ll handle the transition well — but maybe that’s wishful thinking.  I want to do it all — have an amazing career, raise the Mini and be an awesome mom, and be everything my husband has ever dreamed.  Is it possible?  Will I be tired? Time will tell.  In the meantime, I’ve had a fabulous time jammin’ out on my uke.  In fact, I got an early Christmas present for myself — a new uke!
I’ve been doing more research and reading and listening to Audible books every spare chance I get.  This is of course at the same time when November and December are the busiest times at work (a lot of people try to fit their doctor visits in before their deductibles run out at the end of the year)…. and we’re starting a small (phase 1) remodel.  But, there’s never a good time to get stuff done despite being busy, so we just go for it!
Here are the books that I’m currently listening to or reading or are on my future reading list:
Week 27: Nov 21-27
 Happy Thanksgiving week!!!
  • Nov 23: Took the Amtrak train up to Camarillo to hang with Ross’ fam for Thanksgiving.  The train is the way to go!  Lots of space, bathrooms (important when a prego gal is going to the bathroom every 2 hours!), wifi, charging outlets, cafe cart, etc.  Ever since living in Boston, I have been a huge fan of public transportation!  It’s the way to go!  Thanksgiving was great.  Lots of great food, company, conversation, and mingling!
  • Nov 24: I’m on call today and just got called into work — that’s the life of a doc — we signed up for this so don’t feel sorry for us.  We know being on call and away is part of the gig.  No sympathy needed.  Saturday, we’ll go to my mom’s house and have another yummy feast!  For some reason, this year…I’m really loving and craving leftovers!  I know my mom will hook it up as I told her to prep a lot so I could eat it for at least a week.  Been playing the uke a lot lately (especially since getting my new tenor uke!).  Starting to form calluses on the fingers (used to have these when playing the violin)… such a good thing!  This lil kiddo is def gonna love music and the uke!  Now, to play more classical music and read to them!
  • Nov 25: Thanksgiving at my mom’s was great.  Lots of great food and leftovers and of course football — that’s our Thanksgiving tradition!
  • Nov 27: Everything looked great at my 28 week appointment. Got my dTaP vaccine.  Baby’s HR in 140s and baby is growing nicely.  My BP was good 119/64.  155lb on the scale (whoa!).  That’s about 20lb over my norm!  It’s definitely an adjustment to seeing the changes in my body…what it can and can’t do.  I’m getting more short of breath these days and that’s with hardly ANY activity.  Taking a flight of stairs – yeah… short of breath.
  • Things I miss most: hiking, wine, rock climbing, feeling in shape, being at peace (vs thinking about a million things constantly), date nights (usually too tired by the end of the week)
  • Things I won’t miss: being thirsty and drinking water all the time, peeing a couple of times in the middle of the night, not being able to sleep through the night while also being tired in the day (currently thinking about a lot of things right now), the low pressure/cramping, being short of breath, reflux, asking myself whether something is too hard or too heavy to lift or push, the hormonal push to growl at everyone
Some great link finds:
 Week 28: Nov 28 – Dec 4
 Today, the Mini is the size of a large eggplant.  Kick counts have started.  I have to get 10 kicks in an hour from now until the due date.  So far, the Mini has been meeting the 60 minutes on the 10 kicks.  Today was a long day at work — 11.5 hours all while being czar as well.  I feel like the month of December has been full of 10-12 hour days.  So, I decided to keep a log of my hours from now until my due date.  This Mini is gonna be resilient and adaptable.
I started having sacroiliac pain will doing bridge in pilates last Wednesdays.  It was a new feeling for me.  It felt kinda like something pulling my hip bones apart.  The pain was sharp and constant (but nothing I couldn’t handle) and stayed right in that sacroiliac joint.  It has resolved since then after a couple of other pilates classes.

1200px-sacroiliac_joint
From Wikipedia

The Mini is doing well and making all their kick counts (10 in an hour).  Yesterday, we saw Todd and Lauren’s baby Skyler and she was absolutely adorable!  Almost 2 months old and such a gem to hold.  Todd and Lauren will be great parents!  One of the other girls there, Jenny who has had 4 kids, was such a wonderful wealth of information!  I felt like we talked most of the night!  Great food and company and baby welcoming!
My stress meter has been high this week.  The lack of sleep, the million things I’m reading and thinking about for a work-related issue/project, and the planning/decision-making for our phase 1 renovation of our home.  The great thing is that Bear is a great shoulder to lean on and I think he can tell that I’m feeling stressed (rarely do I show it).  I think it’s adorable how he looks after me and makes sure I’m ok.  D-Day was Dec 4.
Week 28 work hours: 51.5 hours
Week 29: Dec 5 – 11
Our mini is the size of a cauliflower this week!  There’s no mistaking that I’m preggo now — the belly can’t be sucked in.  It’s been interesting going through the changes with my body.  It’s such a surreal experience: the bump, the reflux, the constant peeing, the oops pee, the constipation/gas/bloating, the smaller stomach size (I get full on half my meals!), the sleeping positions to get comfy,… and it’s only going to get more interesting as the weeks go on.
 Week 29 work hours: 44.5 hours

Week 30: Dec 12 – 18
 The OB shift was a gnarly one on Tuesday.  Worked solid from 7a to midnight.  There were a lot of colds on the OB floor.  It’s only a matter of time before I come down with something.  As luck would have it, I got assigned two TAVRs on Wednesday and worked from 8a-3:30p…. and that’s post-OB at #21.  Well, I did come down with a cold.  Mainly sore throat and slight sinus congestion.  Bear was sweet and brought some tom yum soup home for me as well as picked up a whole pharmacy of goodness.  I hit the Chloraseptic, lozenges, and Emergen-C.  Called the OB to find out if these meds were safe to take.  Theraflu is NOT safe for pregnant gals to take.  Tylenol and Robitussin are safe (neither of which I’ve needed).  Fortuitously had Thursday off bc I was unassigned that day (oftentimes we get work at a surgery center or something).  Spent the day on the couch in my jammies.  Bear brought home some pho for lunch and just took really good care of me.  He’s a solid support system!  Back at work today (Friday) for a full day and working both days this weekend.  The Mini is making their kick counts and growing!
We had another OB appointment today and growth ultrasound.  Everything is looking great!!  My BP is 110/60.  Fetal heart rate was in the 140s.  I weighed in at a whopping 156 lb.  For our ultrasound, the Mini measured at 3lb 15oz and is 60% on the growth curve!  They’re in the middle range for amniotic fluid, which is just right.  So far, everything is just going great for our lil Mini — who isn’t so mini anymore!  I’m feeling more of the symptoms of heartburn, stomach fullness, bloating/constipation/gas/etc…. and the bladder is taking a beating!  Nowadays I’m getting up 3-4 times a night (roughly every 2 hours).  The gals at work eagerly remind me that this is just prepping me for motherhood — funny but too realistic of a joke!
Week 30 work hours: 48.25

Week 31: December 19 – 25
 This week was a rather joyful week as we were in the Christmas spirit!  The work week was a busy one as people try to fit in their surgeries before their insurance deductibles reset at the beginning of the 2018 year.  This year, my fam came down from Temecula and I whipped up a cabernet beef short rib, mascarpone polenta, and banana bread pudding.  My mom and aunt brought fermented cabbage, salad, and brownies.  We picked up some sides like beet salad and broccoli salad.  Overall, this was the first time I was making the recipes, but I was ecstatic that it came out as yummy as it did!  I did make some tweaks to the original recipes as I added some things more to my taste.
On Christmas Eve, Ross and I headed up to LA to spend time with Ross’ fam.  His brother made reservations at Fogo de Chao, a brazilian meat restaurant.  The meat cuts were tasty and the buffet bar was loaded with veggies and yummy fruit (I went back for thirds on the winter citrus fruit!).  For dessert, we had a delicious fruit ice cream.  After a big lunch (I didn’t even eat dinner that night bc I was still so full!), we headed back to Ross’ fam’s place and played Bingo, LCR, and pictionary.  Everyone was having a great time!
Christmas day, Ross and I had a nice peaceful morning opening presents and listening to Christmas music with the fireplace going.  It’s bittersweet to think that this will be our last Christmas alone together before the Mini comes!  It’s exciting to think how the Mini will change our lives in incredible ways!  Today, we pulled the trigger on MontiKids bc it’s such an amazing company that creates toys that are age appropriate with a focus on development and the Montessori way.  Here’s one gal’s review on MontiKids.
Hours worked: 35 hours
Week 32: Dec 26 – Jan 1
 My last full night call was Dec 26.  It ended up being a really nice, decent call night…. but I couldn’t get comfy sleeping in the call room.  I find that I absolutely NEED my Snoogle pillow.  So, not much sleep Tues night.  Came home and crashed Wed from 8a-11a.  Did a pilates class and felt good.
  • Thurs, Dec 28th: I don’t think I drank much water that day and ended up feeling pretty dehydrated.  Went to pilates and as I was doing bridge pose started feeling light headed like I was going to pass out.  I stopped and rolled onto my left side and put my legs up on the reformer foot bar (venous return is key!).  I stayed in this position until I felt back to myself (roughly 10 minutes) and then I finished off the class.  BUT,… when I went home that evening, the Mini did NOT make their kick counts.  They would maybe do 1 kick in an hour (instead of the 10 they’re supposed to get).  I fell asleep before I remembered to call the OB office.
  • So, Friday, I went to work and did a double heart day and then walked up to Labor and Delivery to get on the monitor to check out fetal heart tones.  Everything seemed to be ok — and that was a huge relief for me!
  • Saturday, Dec 30: Ross got a new car!  We needed to seriously upgrade his ride to something more child friendly and safe for our lil Mini!  The new year will be welcomed in 2018 with a lot of new changes!
Pilates this week has been a real kick in the pants.  I felt faint twice and realized that the wedge padding I use is not high enough for me bc I still feel light headed and get reduced venous return with any increase in heart rate.  Bridge pose is out for me as are most exercises on my back.  I’m super bummed about that.  For January, I dropped from the unlimited pilates plan (go as much as I want) to just the 4 class pass.
NYE was a busy day!  I worked from 7a-5:30p and then went out to a nice 7p dinner with my Bear at our first date spot Cucina Enoteca.  We got home around 9ish and tried to stay up, but we passed out on the couch from then until midnight!  Thank goodness for DVR bc we could rewind the NY ball drop and watch it and celebrate!  We opted for a new year tradition: planting one tree/plant (indoor or outdoor) each year!  This year we planted three indoor palms (chamaedorea costaricana, howea forsteriana, chambeyronia macro) and one outdoor palm (from our wedding: the blue green palm — butia capitata blue).
 Hours worked: 37.5 hours
Week 33; Jan 2 – Jan 8, 2018
 Our Mini is the size of a pineapple!  Nowadays, sleep is escaping me (from the multiple wakeups to pee to just not being able to sleep despite being exhausted) — my most comfortable position is propped up with pillows and oftentimes I find my best sleep upright on the couch.  Bear is starting to nest — it’s so cute to see.  I easily go through a liter of La Croix in a day, but I found out that the BPA in the aluminum cans clearly aren’t good.  So Bear went to Jimbo’s and bought three different soda water beverages in glass containers.  He is soooooooo thoughtful!  At work, I’m heading to the bathroom every 2 hours.

Hours worked: 26 hours

Week 34: January 9 – 15, 2018

Even though this week was a bit lighter for me (I had originally taken this week off as a staycation, but opted to just take Friday off), I couldn’t get comfy sleeping.  I took an OB call on Wednesday and was essentially done around midnight (I have a midnight rule at work: if I’m still at work at midnight, I just sleep in the call room).  While sleeping in the call room, I was only sleeping 1.5 hours at a time.  The insatiable thirst and constant and consistent potty breaks are starting to become unbearable.  I’m tired all the time and it’s from getting up every 1.5 hours all through the night.  It’s not even something I feel like I could fix unless I had a urinary foley catheter in place.  The belly feels like it’s getting bigger: getting up and out of bed is becoming more difficult (I have to roll to one side and then get up vs just getting straight up from a bend at the waist); the SI joint pain has returned with more frequency but it’s not unbearable; the Braxton-Hicks contractions are more common and coming higher up on my belly — before I would have maybe 1 every couple of days — this week I’m having several a day.  The Mini is still making their kick counts.  The gals on OB think I’m having a boy — they base this on: my “glow”, lack of acne on my face, the way I’m carrying the baby, my lack of all over weight gain…. although I’m not sure any of these old wives tales are accurate in any way.  I’d be ecstatic with a healthy baby, regardless of sex.

I’ve finished several books:

  • Brain Rules for Baby (Updated and Expanded): How to Raise a Smart and Happy Child from Zero to Five – listened to this on Audible (during 2nd trimester) and it’s outstanding.  Highly recommend for first-time parents and just setting a solid groundwork/foundation to build when baby comes.  This book was such a gem as it related a bit of science to baby development.
  • Unconditional Parenting: Moving from Rewards and Punishments to Love and Reason – started this on Audible (3rd trimester).  This book was a nice eye opener that not all praise and punishment is the right kind.  I learned a lot about fostering positivity with effort and not just for anything that is done.  I agree that punishment is not a good system for motivation, but this book really uncovers that reward is NOT the best system for motivation either.  I plan to implement these techniques for our Mini.  This was my 3rd favorite book in the bunch I’ve been reading.
  • Montessori from the Start: The Child at Home, from Birth to Age Three – listened to this on Audible (3rd trimester).  Also gifted to both moms. This was a close second to Brain Rules for Baby (for me).  It tackles the principles of Montessori and the whys and hows to implement this method of development.  It promotes independence of the child, but also places importance on how to promote brain development with the simple things (simple toys: no bright lights or sounds, no screens, the power of imaginative play, etc.).  I highly recommend this book as a 2nd read after Brain rules for Baby.

Starting these:

Our baby shower went off without a hitch!  It was great catching up with people and seeing the outpouring of love for our lil one on the way!  We could’ve easily fed 50 people — it’s always hard to know how much food to factor in.  We had Cardiff crack (tri-tip), burgers, pulled chicken sliders, coleslaw, veggies, dips and chips, cakes, cookies, potato salad.  It was an incredible feast!!  I only wish I could eat more!  I was only able to get a bite of beef tri-tip, one burger slider, and one chicken slider down before I was super stuffed!  Dessert came later around 7p for me.

The Braxton-Hicks contractions are more frequent now — having at least one daily — but anywhere up to 5 in a day.  Still waking up every 1.5-2hours nightly for a pee.  Drinking adequate amounts of water (I probably go through 4x 32oz of water daily and also 1x 32 oz water nightly.

We ultimately re-discussed the cord blood/tissue banking and decided on CBR.  After chatting with several moms who did it…. a lot of them have regrets for not doing it…. and the ones who did it have peace of mind.  Bear and I further researched the topic and decided we would do it and chose CBR.

Hours worked: 19.5

Week 35: January 16 – 22, 2018

This week has been insanely busy.  Not sure if that’s how the schedule just worked out this week or people are back to signing up for surgeries.  Additionally, this week Bear and I felt that the Mini was significantly bigger.  I feel more fatigued, larger, more difficulty moving around, more thirst and urinating, etc.  Lately, my craving has been winter citrus — oranges and mandarins.  Really, I’m craving anything with liquid… I can’t get enough.  Another great treat we’ve enjoyed is root beer — what is going on with these cravings?  Bear has been nesting hard!  He’s organized the house, setup the bassinet, installed the car seat, packed his hospital bag and the baby’s bag.  It’s so cute to see him so excited and nesting!  He’s been such a great husband, supporter, massager, and I know he’s gonna be an amazing father!  I can’t believe how fast the days are moving now!  We got our Cord Blood Registry kit and filled out everything for it so it will be ready to go with our hospital bags.

Things I’ve been looking at today:

Hours worked: 54.5

Week 36: Jan 23 – 29, 2018

We had our 36 week AFI and NST. I’ll be doing these twice a week now as I’m deemed “high risk” because I’m AMA (advanced maternal age: > 35 years old). My BP was great at 108/76. Fundal height was right on track at 36. AFI was normal at 9 (but the range I was told was 5-25). I want that number to be higher. Dr. W asked if I could drink more water. I’d happily do that — currently I’m drinking 6 x 32oz of water in a 24 hour period. My urine was free of protein and glucose. All good things. I’m 160lb. Whoa! Mini is head down right now. So far, everything is good!  Had the 2nd AFI and NST after a 14 hour workday.  AFI was 9.5 and NST was perfect – nice and reactive.  Dr. W said I could stop working at anytime, but I really want to save up all that time for when the baby comes.  Good to know that I can pull that card when I just can’t take it!  I was really dragging after working 37.5 hours in 3 days.  My legs are swelling, despite my best efforts of wearing calf compression socks and trying to put my legs up.  There’s a dull ache by the end of the work day.  Luckily, my Bear is always down to give my legs and feet a good rub down at the end of the day.

And I had to look at the odds of going into labor…

Hours worked: 45.5

Week 37: Jan 30 – Feb 5, 2018

Our 1 year wedding anniversary on Feb 4!!  I can’t believe how quickly the year flew by and everything that has come our way!  It’s been an incredible year! Nevermind that it’s SuperBowl Sunday (go Eagles!)…  we spent a wonderful relaxing spa day at Rancho Valencia.  The Duet 90 minute massage was incredible (we had Sara and Noelle — both were fantastic!).  A chill day lounging by the pool — I couldn’t have asked for a better way to celebrate our 1st year wedding anniversary!  In fact, Bear and I decided we will have a full spa day every wedding anniversary.

My cravings lately have been all things citrus and A&W root beer!  I’m trying to cut back on the sodas – I’ve never had such a craving for them (not even before pregnancy!).  This led me to look into the issues of artificial sweeteners.  Basically, I’m gonna stick to organic oranges, mandarins, OJ and La Croix Naturally Essenced Sparkling Water Variety Pack, 12 ounce Can (Pack of 24) bubbly waters.

Feb 5 was our weekly appointment for NST/AFI/Dr. W for week 38 (which is tomorrow!).  I’ve lost a couple of pounds and was 158.8lb for today’s visit.  Who knows what that is from as I haven’t changed anything in my diet or activity level (although this past week was pretty taxing). 117/73, hr 70.  FHR 140s.  Good NST read with adequate accelerations and contractions.  I’m contracting several times throughout the day, but not regularly.  AFI was 10.5 today!  On the cervical exam, Dr. W said I was at best finger tip (which is more than what it was last week – softened closed cervix).  There’s some spotting after the exam this go around.

Things on my mind lately:

I’m already thinking of getting out and about with the newborn.  We have a retirement party coming up for some of our colleagues and I want to go…but I also want to bring the Mini.  I think my strategy is a carrier and keeping it a short visit.

Getting a newborn out in a restaurant:

Hours worked: 47.5 hours (in 4 days)

Week 38: Feb 6 – 12, 2018

Had a bit of light spotting on Wednesday (38 weeks, 2 days).  Still contracting away. The tiredness is evident – the lack of sleep for the last month has been tough.  Maybe next week I’ll get the doctor’s note. NST was reassuring and the AFI was 10.1 on Thursday.  Everything is still going great!

February 10, 2018 — There’s been a change in my contractions.  Instead of just being abdominal contractions, they’ve turned into more back and abdominal contractions.  Right now, they’re about 8-10 minutes apart, lasting 40sec – 1 min.  Looks like we’re getting close.  With the contractions is the urge to poo.  I’ve started spotting again.  I’ve been up since 4:30 bc of the new back contractions — they’re pretty uncomfortable.  The abdominal contractions just feel like a strong menstrual cramp.  I’m on call this weekend (I traded down to #3 today bc I was #1 in the main OR).   Let’s see how this day plays out!

For the Chinese zodiac…

  • If baby is born before the Chinese New Year (before Friday, Feb 16, 2018), they are the year of the ROOSTER
  • If baby is born after the Chinese New Year (on or after Friday, Feb 16, 2018), they are the year of the DOG

Saturday, Feb 10, 2018

I woke up this morning around 4:30a feeling a lot of low back pressure and new buttock/tailbone pressure.  It woke me up from sleep.  It lasted for about an hour and then subsided.  Luckily, the day before, I traded with Milbern down to #3 for my #1 weekend call.  The new back pressure was off and on throughout the day — timing the contractions were about 11-13 minutes apart.  They definitely felt different from my other contractions which were mainly front and abdominal.  By the time the evening rolled around, my contractions were 5 minutes apart and still painful!  We went in to Labor & Delivery to get checked out since they said come to the hospital if you’re 5-1-1 (5 minutes apart on the contractions, 1 minute in length, and for 1 hour total).   Once we got to the hospital around 6pm, I got checked out and was only 1 cm dilated.  We found that the baby’s position was OP/OT.  One of the midwives suggested some positions to try at home to see if we could turn the baby — trust me, I was all ears to help get this baby into a more deliverable position!  We left the hospital to try these techniques.  There was a website she recommended called SpinningBabies.com that was super helpful for a bunch of these techniques.  We tried me being on all 4s with a bit of inversion.  We tried a hot bath with ice packs on my back.  I tried a couple of the techniques from the Spinning Babies website.   We tried these different techniques all the way until Sunday, Feb 11 at 2am.

Sunday, Feb 11, 2018

2am we came back into the hospital bc our contractions were now about 3.5 minutes apart.  The pain was still pretty intense despite our best efforts to get the baby to turn.  When we came back in, they opted to either give me some Tylenol and Ambien or Nubain and Phenergan.  I opted for the Nubain/phenergan combo as the pain was intense and the midwife stated I needed to relax to allow my cervix to dilate.  I was able to sleep for 3 hours and then after waking up, they decided to admit me as I was 3 cm dilated and 80% effaced AND could get an epidural.  That’s exactly what I did next.  Shiyin did an awesome job with the placement.  After that, I was able to get comfortable and get some rest.  I was started on Pitocin a couple of hours after the epidural.  By around 3pm, I had progressed to 6-7cm dilated.  Then I had SROM’d and enjoyed a celebratory pickle.  By around 7pm, I was 7.5-8cm dilated, but baby was still OP.  There was a forebag of amniotic fluid that was ruptured by the midwife.  We again tried a bunch of the different positions to help move the baby out of OP, but to no avail.  Around 8:30p, I was 10cm dilated and started pushing.  I was doing 10 seconds of pushing x3 per every contraction.  My OB (Kim Washkowiak) who wasn’t even on call came to deliver her.  This went on for an hour until our little girl was born at 22:09pm.  She looked perfect!  We were able to get skin-to-skin immediately and our cord blood and tissue was sent.  She got checked out by the baby nurse and everything looked great!  She was 7lb 3oz, 21 inches long.  She came out with a cute conehead!  An hour after delivery, she was latching and had a strong suck and we were able to breastfeed immediately.  This has been such an adventure and we’re so excited to see what each day brings!

Hours worked: so far… 42 hours (in 4 days)

Screen Shot 2018-02-10 at 6.20.40 AM


BRAINSTORMING

http://www.babybargains.com

https://www.babygearlab.com
https://www.momtricks.com/

Setting up a baby registry
Help and favors registry
https://www.babylist.com/hello-baby/pregnant-chickens-kick-ass-registry

Strollers

Baby Carriers/Backpacks:

https://www.consumerreports.org/cro/backpack-carriers/buying-guide.htm

Car Seats:

Breast Pumps:

Beds:

High chairs:
Graco Blossom 4 in 1 system

Great Day Cares:
https://www.babylist.com/hello-baby/8-important-signs-of-a-great-daycare

Local Day Cares to check out: