First prenatal appointment

We had our first prenatal appointment this morning. We met with one of our midwives, Polli. Before getting pregnant and once we found out we were pregnant we did a lot of research on what we (but mostly I) wanted out of pregnancy and delivery. I read a lot of personal accounts but also research about the effectiveness of midwives vs. obstetricians. Basically, it comes down to the use of interventions during prenatal care and childbirth. Midwives have lower rates of all forms of interventions (cesarean sections, episiotomies, forceps deliveries, etc.). Here's an abstract from a randomized control trial in Canada where low-risk mothers were randomly assigned to be treated by a midwife or an OB/GYN or family doctor. A retrospective study in the US also shows that women under the care of a midwife receive fewer c/s. Women who see midwives are also more satisfied with the care the receive and with their delivery experience as shown in this article. Midwife-assisted births were also studied here in Southern CA with positive results in a longitudinal study of LA County and USC's midwifery program. Although, I've anecdotally heard that UCLA's midwives are much better than USC's. After taking all of this into account we decided a midwife was a better fit for us.

So we're using the UCLA midwife group. I think it's a bit unusual how it's set up but the midwife group sees patients as apart of a midwife-OB/GYN practice. There are 5 midwives and 5 OBs. I'll see all of the midwives over the course of my prenatal care and then whichever midwife is on call when I go into labor will deliver our baby. The midwife we met with today (Polli) told us that they all have different personalities but they really follow the midwifery vision which is that this is a partnership between us and the midwife and we make the decisions together. They are minimally invasive but use technology and interventions when necessary.

So here's the run-down of what happened at the visit:
-Filled out my medical history.
-Met with a nurse to get blood pressure taken, pee in a cup and given a pregnancy book and packet of information.
-Met with Polli for about 20 minutes to go over medical history, determine the due date, explain procedures & prenatal screening/testing and have our questions answered.
-Physical exam (breast exam, overall wellbeing, internal check & swab).
-TB test
-Blood work and another urine test.

Polli gave me a due date of 4/30. So I'm going to say my due date is between 4/25-4/30.

Prenatal testing

We are low-risk since we're both young and healthy and don't have any history of birth defects in our families. Polli recommended that we have two prenatal tests. We'll do an ultrasound at 12 weeks along with blood tests and then we'll do a 2nd ultrasound at 18-22 weeks with some more blood tests. She felt, and we agreed, that these are the only tests that are necessary for low-risk pregnancies. If any of the tests show potential problems then we'll move on to more invasive tests (amniocentesis) if necessary. I'll go back on Oct 16 for the ultrasound and my next visit. After that I'll be seen once a month until close to the end of pregnancy. Polli explained to us the fears some people have about ultrasounds and why this particular one is safer.

Other notables

I will give birth in UCLA Medical Center just like any other delivery with an OB/Gyn. UCLA was recently ranked the #3 hospital in the country by US News and World Report and the #1 hospital in the West. We're confident that we are getting the best care possible especially in the case of an emergency. Their c/s rate is 12%. 50% of their patients do not have epidurals. Intermittent fetal monitoring is ok and I don't have to have an IV so I will be able to move freely during labor. I'm free to eat and drink during labor. The baby will be given to me immediately after birth so it can have immediate skin-to-skin contact (this is probably the most important thing to me for our birth) and can nurse right away. The baby will only be taken away after it's done nursing. Babies room-in with moms, they don't even have a standard separate nursery for babies. I can have an early check-out if I want.

Recommendations
-Start taking an omega-3 supplement. An over-the-counter medication called "Expectalipil" was recommended which is derived from seaweed instead of fish.
-Exercise. Recommended walking, swimming and prenatal yoga.
-Weight gain should be between 25-35 lbs. She reminded me that the less I gain the less I'll have to lose later.
-Call right away with any bleeding, since my blood type is O- and Scott is A+ our baby could have a different Rh factor than I do. I'll need shots at a couple points during pregnancy/delivery but if there's any bleeding during the pregnancy I might need a mini-shot.

That's about it. We will return on October 16th (my mom's birthday) to see the baby for the first time and to meet with the midwife again.

9 weeks!

How your baby's growing: Your new resident is nearly an inch long — barely the size of a grape — and weighs just a fraction of an ounce, but he's poised for rapid weight gain now that his basic physical structure is in place. He's also starting to look more and more human. His embryonic "tail" is now completely gone and his body parts — including organs, muscles, and nerves — are kicking into gear.

His eyelids are fused shut and won't open until 27 weeks. He has earlobes, and by week's end, the inner workings of his ears will be complete. His upper lip is fully formed, too, and his mouth, nose, and nostrils are more distinct. The tips of his fingers are slightly enlarged where his touch pads are developing. All major joints — his shoulders, elbows, wrists, knees, and ankles — are working, enabling your baby to move his limbs. As for his heart, it has divided into four chambers now, and the valves have started to develop. External sex organs are there, but won't be distinguishable as male or female for another few weeks.

How your life's changing: You still may not look pregnant (although your belly will probably pop earlier if you've been pregnant before), but emotionally you may feel like you're on a roller coaster ride. Mood swings are common now; it's perfectly normal to feel alternately elated and terrified about becoming a parent. This feeling can persist throughout your pregnancy and well after your baby's born. Try to cut yourself some slack. Almost all expectant parents worry about how a new baby will change their lives, but the vast majority later say that becoming a parent was one of the best things they've ever done.

You may be feeling extra gassy or bloated now, too. That's primarily because the major doses of progesterone your body produces early in pregnancy relax smooth muscle tissue throughout your body, and that includes your gastrointestinal tract. This relaxation slows your digestive processes, which can cause more gas, bloating, burping, flatulence, and generally miserable sensations in your gut, especially after a big meal. Find out how to get relief.

If you're over 35 or have a family history of a genetic illness, such as cystic fibrosis, you may want to consider genetic counseling or a prenatal test called chorionic villus sampling (CVS), which is given between ten and 12 weeks and screens for certain birth defects and abnormalities.

How I'm doing: I'm doing well. Most of the nausea is gone. I still struggle to eat some meals and some foods turn me off but the queasiness has mostly left. I do find it hard to cook meals since handling raw meat is still a little rough. It's getting better every day though. My biggest problem right now is staying awake. For the past week I've been sleeping 10 hours on average each night. Even with all that sleep I still feel tired all day. So if you see me yawning, you're not boring me, I could just really use a nap. Even simple daily activities like taking a shower tire me out. Most mornings I lay down for a few minutes after I get out of the shower to recuperate. It makes getting ready in the morning a slow process. So I take things slow. Thankfully a large part of my day is spent working at my computer and so far I haven't had problems falling asleep sitting up. I'm anxious to get out of the first trimester (3 more weeks to go) since my energy should return fairly soon after that.

My clothes are getting tighter and tighter as the days pass. I only have a few pairs of pants that I can't button anymore but more of my clothes are feeling uncomfortable. Debi and I went shopping for some maternity clothes last weekend and I picked up a few more pieces (Thanks Debi!). Including a couple of pairs of pants with adjustable waistbands that will work through the in-between stages. I also picked up a belly band so that I can wear my regular pants a while longer unbuttoned and no one will be the wiser (or they wouldn't have been until I mentioned it now). It's hard to say for sure, but I think I've only gained about 3-4 lbs so far. Nothing really noticeable. But my uterus has doubled in size and is now as big as a tennis ball. There's lots going on, no wonder I'm so tired.

My first prenatal appointment is Tuesday. I'm excited to meet our provider. Hopefully we'll get off to a great start with this little one. We're excited to get some advice and make sure everything is going well so far.

8 weeks

How your baby's growing: New this week: Webbed fingers and toes are poking out from your baby's hands and feet, his eyelids practically cover his eyes, breathing tubes extend from his throat to the branches of his developing lungs, and his "tail" is just about gone. In his brain, nerve cells are branching out to connect with one another, forming primitive neural pathways. You may be daydreaming about your baby as one sex or the other, but the external genitals still haven't developed enough to reveal whether you're having a boy or a girl. Either way, your baby — about the size of a kidney bean — is constantly moving and shifting, though you still can't feel it.

How your life's changing: You may notice that your bra is getting more snug. Soon you'll likely need a larger size with better support. Rising levels of hormones cause breast growth and other tissue changes, all in preparation for lactation. Your breasts may continue to grow throughout pregnancy. Don't be surprised if you go up a cup size or two, especially if it's your first baby. Keep this in mind, and allow for room to grow when investing in a new bra.

Feeling fatigued? Hormonal changes — in particular, a dramatic rise in progesterone — may be contributing to your sluggishness. Nausea and vomiting can certainly cost you energy, too. And you may be having trouble getting a good night's sleep at this point, especially if you're uncomfortable or find you need to get up to pee.

How I'm doing: This week has been up and down. For most of the week I was feeling nauseated and extremely tired. I feel asleep on the couch before 9 PM one night and then slept for over 10 hours. I feel tired most days all day long. The past two days have been much better. My appetite has returned for most meals and the nausea has reduced significantly. I hope it stays away. Last night and today was the first time I've had a headache and really wanted to take Excedrin but couldn't (no aspirin during pregnancy). I took one Tylenol which sort of dulled the headache slightly but nothing works like Excedrin unfortunately. My mom sent me my first maternity clothing items. Thankfully I don't need them yet but it's probably not too far off. I've been anxious to go shopping but Scott has held me back since I don't need anything yet. There are a few items in my wardrobe that are nearing retirement. Nothing is too small yet, but waistbands that are snug are becoming more uncomfortable.

7 weeks

Since I'm running behind, here's what's happening now in week 7.

How your baby's growing: Your baby still appears to have a small tail (actually, it's an extension of his tailbone), which will disappear in the next few weeks. But that's the only thing getting smaller. Now almost half an inch long — roughly the size of a raspberry — he has elbow joints and distinct, slightly webbed fingers and toes. In his oversized head, both hemispheres of his brain are developing. His teeth and the inside of his mouth are forming, and his ears continue to develop. Eyelid folds partially cover his tiny peepers, which already have some color, and the tip of that nose you'll be tweaking someday is emerging. His skin is paper-thin and his veins are clearly visible.

Your little one also has an appendix and a pancreas, which will eventually produce the hormone insulin to aid in digestion. His liver is busy producing red blood cells, and a loop of your baby's growing intestines is bulging into his umbilical cord, which now has distinct blood vessels to carry oxygen and nutrients to and from his tiny body. You can't feel his gyrations yet, but your baby is like a little jumping bean, moving in fits and starts around his watery home.

How your life's changing: You're in the throes of the first trimester, when many women suffer from common pregnancy woes. Keeping food down may be next to impossible, thanks to morning (noon, and night) sickness, caused in part by the pregnancy hormones coursing through your body. Stash a box of crackers next to your bed, and eat a few to curb the nausea before getting up. (Not all pregnant women have morning sickness, so don't worry if you've been spared — you're one of the lucky few!) You may also need to use the bathroom a lot more often than usual — your blood volume increases dramatically when you get pregnant, which leads to a lot of extra fluid getting processed through your kidneys and ending up in your bladder. The nausea should fade as your pregnancy continues, though you may continue to make frequent trips to the bathroom.

If you haven't already, now's the time to choose an ob-gyn or midwife. Most practitioners won't want to see you right away unless you have a serious medical condition or you're having problems like vaginal bleeding, abdominal pain, or severe nausea and vomiting. They'll probably schedule you to come in once you're between eight and 12 weeks pregnant. At your first visit, your doctor or midwife will go over your family health history, do some routine blood tests, and answer any questions you might have.

How I'm doing: Morning sickness continues. Sometimes it's in the morning, sometimes it's at night, sometimes it's off and on all day long. Mostly, it's no fun at all. I've also found it really hard to find something I feel like eating. I certainly never thought I'd have that problem. Even things I normally enjoy, like hamburgers, make my stomach churn. Even ice cream doesn't sound especially appealing.

I'm also feeling incredibly tired. My body is reminding me how much work it's doing. I could take a nap every day. I try to rest whenever possible.

6 weeks

How your baby's growing: The cells that will make up all of your baby's body parts and systems are dividing furiously as her body begins to take shape. Right now she's about the size of a small lentil bean (4 to 5 millimeters across). If you could see through your uterine wall, you'd find an overlarge head and dark spots where her eyes and nostrils are beginning to take shape. Shallow pits on the sides of her head mark her developing ears, and her arms and legs appear as protruding buds. Her hands and feet look like paddles, with thick webbing between the developing digits, but her fingers and toes will soon become more distinct. Below the opening that will later be your baby's mouth, there are small folds where her neck and lower jaw will eventually develop. (Inside, her tongue and vocal cords are just beginning to form.)

Your baby's heart (which is starting to divide into the right and left chambers) is beating about 100 to 130 beats per minute — almost twice as fast as yours — and blood is beginning to circulate through her body. Her intestines are developing and tiny breathing passages are beginning to appear where her lungs will be. She's also starting to build muscle fibers and, halfway through this week, she'll likely start moving her tiny limbs. Unfortunately, you'll probably have to wait until you're several weeks into your second trimester before you get to enjoy feeling your baby's calisthenics.

How your life's changing: If you haven't already, you may soon find yourself riding pregnancy's emotional roller coaster, feeling moody one day and joyful the next. Disturbing as this may be — especially if you pride yourself on being in control — what you're going through is completely normal and will probably continue throughout your pregnancy. Up-and-down emotions are partly caused by fluctuating and (in many cases) very high levels of hormones. But hormones aside, your entire life is about to change — and who wouldn't feel emotional about that?

Spotting (finding spots of blood on your underpants or toilet tissue after urinating) or bleeding is common in early pregnancy, but sometimes it can be the first sign of miscarriage. If you have any spotting or bleeding, call your doctor or midwife right away so she can determine whether your spotting indicates a potential problem.


How I'm doing:I spent the entire 6th week in on vacation in Chicago and Madison, WI. It was a nice break from work but unfortunately morning sickness set in midway through the week and right on schedule. Queasiness was off and on the starting the 2nd half of the week. So far it's hard to pinpoint a rhyme or reason to it.

Our first prenatal appointment has been rescheduled to September 25th. We also have decided against getting an ultrasound at this appointment since it is unnecessary for low risk pregnancies (and not routinely performed by our provider) and might be associated with changes in brain development (male babies who received ultrasounds early in development are more likely to be left-handed).

We got a little practice while we were in Chicago with our new cousin Willow Rivka; only 6 weeks old.