36 weeks + 1 day

Almost to the finish line and I have so many mixed feelings about this:

  1. Incredulity – I can’t believe this pregnancy is almost over – where did the time go!?
  2. Panic – How are we ever going to complete our to-do list before the due date? I have so many things I want to accomplish before the baby gets here. Some minor home improvement projects, wrapping up everything at work (I am so behind – it seems insurmountable!)
  3. Anxiety – Labor is not the most pleasant experience so I can’t say I’m necessarily looking forward to that part! We also almost didn’t make it to the hospital when my second was born, so I’ve been thinking about scheduling an induction this time around. I do prefer to go into labor without intervention, but didn’t love how chaotic things felt with my last delivery.
  4. Exhaustion – I’ve been staying up late to get things done and work has been super hectic because patients keep calling to make an appointment before I go. I feel guilty leaving them for so many months (although have amazing colleagues who will see them while I’m out) and keep saying yes, even though the days are long. Also, my belly is getting heavy and being on my feet during the day is exhausting!
  5. Worry – Will baby be healthy? Will my older kids be alright with the new addition? How will we handle the sleep deprivation? What if this baby also has colic (like my first)?
  6. Sadness .- This may very well be my last pregnancy (definitely will be, according to my husband!). I know I’ve been incredibly blessed to be pregnant 3 times (especially after my fertility struggles the first time around), but it does make it sad to think about closing the door on my childbearing years.
  7. Excitement – Another newborn! I can’t wait to see and hold him. I wonder what he will look like. I had a growth ultrasound yesterday (still being monitored because of the false negative toxoplasmosis result) and they estimated that he was 6 lbs 9 oz. I couldn’t believe it! That’s like a real baby! He was so cramped in there – space is certainly getting tight.

In other news, our (current) littlest guy started preschool 2 weeks ago. It was ROUGH in the beginning. He had a tough time adjusting. As it happened, he wasn’t able to attend the first 3 days we had enrolled him because he woke up sick on the first day of school! We couldn’t believe it. This kid has been the healthiest since birth (despite a germ-y older brother), but of course he had to wake up with a fever on his first day. Fortunately, our nanny was available to help us out. However, she had other plans the last two days of the week, and my husband and I had to work, so we threw him right into the deep end – he stayed for the whole day those first two days! He was always so tired when we picked him up. And he cried…a LOT.

So the following week, we decided to stick with the half-day schedule. I wasn’t sure how this would fly with my oldest (they are at the same school but different classes, so I didn’t know if he would be confused/upset if his brother was picked up earlier), but he did great. We told him his little brother couldn’t stay the whole day yet because he was too small, even though he really wanted to. Drop-offs were still tough that first half of the week (he even angrily hit a teacher one morning after I left!), but he soon began to adjust to the schedule, and started to cry less and less at drop off.

This Monday, the sweetest thing happened. He clung to me like he always does when we arrived at school. But when I told him that it was time for me to go and that he should stay with his brother (they have a joint playtime in the morning while all the kids arrive), he took a few steps towards his big brother with tears welling up in his eyes, held his hand, and tried his best to look brave. He turned around to look at me when I left, but he didn’t bawl for the first time! And since then, it has only continued to improve. Today, he walked away from ME when I dropped him off, and happily took a spot next to his brother on his yoga mat.

Overall, he’s adjusting REALLY well and I am so happy this happened before the new baby comes to town. They’ll have their summer break soon, and then we’ll need to decide whether it’s time to enroll him in the full day schedule!

Here are a few books I found useful to prepare your little ones to start preschool. Both kids really loved these books during their transition periods, and I think they very plainly lay out the emotions kids may experience when leaving their parents for the first time.

Worried and kicking

It’s been 5 days since I learned about my possible toxoplasmosis infection and I’ve just been a rollercoaster of emotion:

  • doom and gloom: worst case scenario congenital toxoplasmosis situation. How will we adjust to having a severely disabled child? Is this fair to my other children? How will our lives change?
  • denial: this MUST be a false positive. I don’t spend time around cats, I don’t eat meat, I have barely eaten raw fruits and vegetables this pregnancy and never without washing them. Then I think about the one time our cat lady neighbor picked up two packages for us while we were away. This was back when I was very early pregnant, 1-2 mo. What if one of her cats pooped on the packages and then I grabbed them? Is this enough contact to transmit toxoplasmosis? Would my IgG be positive if this were the case?
  • anger: why did my ob check this lab? There seems to be no clear guideline to doing so (for asymptomatic patients without exposure risk). I switched to this ob primarily to have the same person I saw for regular visits deliver my baby instead of a resident (to clarify: not because I didn’t think they’d do a great job, but because I would prefer for residents I work with not to see me in labor. Although, two residents did deliver my second and I can barely remember who they were) but now I’m having second thoughts. Should I have stuck with my original group, who didn’t check for toxo because it’s not standard of care? Now I’m on this wheel of test after test after test (what I’ve been trying to avoid since my first induction for suspected pre-eclampsia) and I’m mad at myself because it’s of my own doing. I also wish she had a clear algorithm in mind. If she sends off a test, then she should have a clear plan as to what to do if it’s positive or negative. Yet, I know that this is not always true in medicine, and this is how we learn.

My husband is a level-headed, pragmatic individual. He is not worried at all. He says that worrying won’t change the situation. There is literally nothing I can add to the situation by worrying, and I need to relax and wait to see what the doctors say next week. I have an ultrasound scheduled and will follow up with high-risk ob the day after (by phone at least). I wish I could be reasonable like him and not worry, but I have a tough time doing so. I worry about the need for invasive testing or treatment which could be dangerous to the baby. I worry about being in a perpetual state of worry (is this the ultimate sign of anxiety or what?) during this pregnancy. I worry that the baby will need unnecessary testing when he’s born. And I think about what it would be like to have a baby with congenital toxoplasmosis – how different from my prior newborns. How will I handle that on top of having a newborn and 2 toddlers?

In the past few days, the baby has started to kick more. He was moving early on this time around, but his movements have been much more intense and exaggerated. I like to think that he’s telling me not to worry, to calm down, that he’s alright. I hope this is true. Only 3 more days until I have my ultrasound. I pray that everything is normal.

Bad news

This month has been hectic. It started with a lovely get-away (without kids!) for my husband and I. It was lovely. We were away for a week and were able to sleep 10-12 hours per day, finish both our conversations and our meals, lounge leisurely by the pool (under an umbrella, of course), walk along the beach, read, and simply be.

As always, I returned home with a desire to incorporate some of that into my daily life: taking a few minutes per day to just be together, reading more for fun, enjoying leisurely meals, exercising. Except we came home to a 1 year old and a 3 year old and two full-time jobs so none of the above happened.

It’s also a busy time. I’ve been taking advantage of my second-trimester energy to complete a few projects, including submitting plans for a minor home renovation. I’ve also had a pesky cough since our time away and though it would go away but it didn’t, and the coughing would often rob me of my energy and cause me to feel even more tired than usual. To top things off, my oldest came down with hand foot mouth disease (HFMD) and was home the entire week prior to a flight I was taking solo with both kids. He was in pain and cranky the entire week (apologies to all of the moms I counseled on HFMD by saying it was merely viral and would blow over) and, the worst part of all was that he wouldn’t sleep through the night! So the first few nights my husband and I stayed up with him. And then my youngest got a fever (but fortunately did not erupt into HFMD) and then HE wouldn’t sleep through the night.

So I set off with both kids in recovery ALONE on a 6 hour flight and it was by far the worst flight we’ve ever had. My kids have traveled a lot because even though we don’t live close to family, I think it’s so important for them to spend time with them. They are usually shockingly well-behaved. I come prepared, keep them entertained, and they generally keep their crying and tantrums to a minimum. But last week was a different story. Both kids were on the mend, I felt like crap from a combination of not sleeping as well as fighting off this cough (oh and being pregnant), and they wouldn’t nap! So we kept things pretty together until the last 30-45 minutes. And then when the plane landed, all hell broke loose. Both kids wanted to be carried but I only had two hands and had to carry the carry-on bags (we only had travel backpacks with us but it was a lot to juggle!). Then my oldest started throwing a tantrum about everything – he didn’t want to let me into the aisle to organize our bags, he didn’t want his brother to sit by the window, and on and on and on. Meanwhile, I’m frantically trying to organize everything while his little monkey of a brother is climbing over the seats. My oldest won’t move from his spot so I tell him “I’m going to pick you up and sit you down here so that I can grab everything” and do just that. He loses his **** and starts yelling “Mommy you HURT ME!”. Meanwhile, I’m dying.¬† As calmly as possible, I tell him it’s time to get off of the plane. A very nice lady helps with one of our bags, I carry my youngest off the plane, and my oldest begrudgingly drags his bag and follows behind, complaining all the way.

At the gate, I have to find and unfold our stroller, which was a waste of effort because neither kid will sit in it (but at least I can pile some bags on it). The oldest is crying and blocking people as they walk off of the plane while the youngest just wants to be held. I hightail it out of there with the oldest hitting me on my backpack and throwing the world’s greatest tantrum. We are the last people off the plane and the pilots are begrudgingly walking behind us because (I learned on another trip) they can’t leave anyone behind when they leave the plane. Awesome. And then, to top it all off, I have to walk approximately 20 minutes with one kid in my arms and one kid whining the whole way because we have landed at a huge airport, at possibly the furthest airline!

It was a total disaster. I saw my parents at the exit, handed the kids off to them, and then walked off to baggage claim to burst into tears. I could tell the security guard knew I was going to lose it because he let my parents follow me to the baggage claim to help out with the bags.

Until yesterday, I thought that was the worst thing that had happened. Then, my ob called me. Before I left, I had a few third trimester labs drawn. Apparently, one of those labs was toxoplasmosis. I had already had this checked in January (at 7 weeks) and both IgM and IgG were negative. For some reason, my ob rechecked it. She admitted that this was controversial – that many people don’t recommend rechecking due to low likelihood of infection in our area and false positives. But then she told me that I had a new positive (IgM, with IgG still negative). She wasn’t sure what to make of it. She had spoken to the high-risk obstetrics group at my hospital and they would follow up with me and likely have me return for an ultrasound, as well as labs, maybe an antibiotic, etc. She told me not to freak out so I promptly did just that – freaked out.

Toxoplasmosis!? That’s one of the terrible infections we learn about in medical school that can cause a slew of problems in newborns. WTF!? But I don’t own any cats…and I’m a vegetarian! I couldn’t believe it. I did what I always tell my patients not to do – turned to Dr. Google, and PubMed, and every person I know who is an obstetrician or infectious disease expert. I received a slew of responses: it’s probably nothing/a false positive, you definitely should not ignore this, you need serial ultrasound monitoring, they need to test the baby, there’s nothing you can do anyway because you’re 24 weeks along.

I’m also a bit annoyed at my ob. Why did she check it if it’s controversial? Her exact words were “I’ll probably change my practice after this”. And I am not entirely sure she knows exactly what to do at this time. She referred me to the high-risk ob, and that person called me, but I’m traveling and can’t be seen tomorrow, and she’s going to be out of town next week. The ID expert I spoke with told me to get labs ASAP, but the ob told me it wasn’t time-sensitive. Her exactly words were “I’m going to be blunt with you because you’re a doctor: if this is a true infection, there’s not much you can do at 24 weeks”. But shouldn’t it matter if it’s a true infection?

So I’m just waiting here, anticipating the worst. And it’s made me realize that I’m done having kids. I always thought I wanted a fourth, but pregnancy is too tenuous and stressful. I think about the experiences I’ve had with my kids – my pre-eclampsia scare with my first and him being in the NICU after birth (the briefest NICU stay ever, but seemed like the longest to me), my positive first-trimester screen with my second and having to see genetics for additional screening to rule out a chromosomal abnormality, and now this with my third. I pray that he will be healthy. That this is either a huge misunderstanding (false positive) or that he does not catch this infection. I’ll have an ultrasound in one week and hopefully will have some additional information at that time – and hopefully it’s all good news.

Charley horses and baby kicks

A few days ago I woke up with a terrible muscle cramp in my right leg. It woke me up from my sleep, which was aggravating because I really love my sleep. But it was also incredibly painful! I had completely forgotten about Charley horses during pregnancy, but yes, it is a thing that happens.

(Speaking of things that happen: here’s another one no one told me about. After my second delivery, I experienced terrible uterine contractions – almost as bad as pregnancy – whenever my newborn nursed. This is apparently a thing. When you nurse, oxytocin is released, leading to uterine contractions. Because the uterus has less muscle tone after your first delivery, this contraction is often quite mild – it definitely was for me. However, with each subsequent pregnancy, they become more intense (as uterine muscle tone increases). I was literally doubling over in pain after my second was born, so I am NOT excited to experience this again!)

I have also started to feel this baby kick. At first (around week 17) it felt like very light flutters. It still feels light, but I am certain now that it’s the baby. This makes everything feel more real. We bought baby’s first outfit yesterday. I can’t go too crazy (I already have 2 kids’ worth of boy clothes) but I definitely wanted him to have a new hospital outfit.

I also have his anatomy scan this week. I am always so worried about this test, but trying to stay calm before the ultrasound.

 

My nanny is drinking pregnancy tea

This hurts my heart because she’s preparing for her second round of IVF and I feel like a terrible person for having two children already and now being pregnant with a third (and I haven’t told her about this yet, although I’m pretty sure she’s figured it out). It hurts my heart because I remember those days very vividly – wondering why everyone seemed to get pregnant so easily and why it was taking me forever. What was wrong with me? Would I ever be a mother? I wore fertility bracelets, temped, took supplements, checked CM, joined a yoga for fertility group, set up a meditation corner in my bedroom to relieve stress, started acupuncture, and on and on and on. And I think: how much harder would it have been if my job was to take care of small children? And how conflicting it must be when that job is paying for your opportunity to have your own child.

In addition to my nanny, I haven’t told a lot of people I’m pregnant yet, but there are two people in particular who I should have told but I have not. They are very dear friends to me. One recently miscarried in her first trimester after deciding to have a second child, and the second is undergoing her second round of IVF, having failed a first in an attempt to have a second chid. I should have told them, but didn’t know how to break the news directly after they announced what they had been through. And, to be honest, distance and our busy lives make it easy to evade. But I am 15 weeks tomorrow, so it’s time. And eventually I’ll need to tell my nanny, who likely already knows. I only hope that in a few weeks to months she shares the news that she’s expecting as well.

What people are saying

I am finding that the reaction you receive when you tell someone you are expecting your third baby is quite different than the reaction you receive when you tell someone you are expecting your first baby.

When people found out I was pregnant with baby #1, they were ecstatic. There were congratulations all around, experienced moms waxing nostalgic about those early days, huge baby showers to be had, and overall excitement. Everyone was thrilled.

When we were pregnant with #2, people were also excited, but perhaps a bit worried. They seemed pleased that our son would have a brother, but did sometimes comment that the less than two year difference in age was a bit aggressive. Overall, however, there was excitement.

With this baby, baby #3, we have definitely received a number of congratulatory comments. But we have also heard quite a bit of:

  • “Was it an accident?
  • “Was it planned?”
  • “What?”
  • “OMG, why!?”
  • “Let me guess – you’re pregnant” (in response to: “I have something to tell you”)

So, it’s been a bit different. But we ourselves are very excited for this third baby, for whom we did plan!

 

 

 

12 or 13 weeks

So I just wrapped up the first trimester. I can’t believe it’s already almost March! I went in for my nuchal translucency ultrasound (part of the first-trimester screen) last week and it is always so amazing to me how much babies change between the 7 week scan and the 12/13 week scan. At 7 weeks, you see a small fluttering heart, but otherwise nothing that looks like a baby. By 12-13 weeks, the baby is skeletal but all there – head, arms, fingers, legs, toes, etc. It’s amazing! I always feel a bit out of the woods once baby is still there at 12-13 weeks, but there is still a long way to go.

Another thing that happened during the scan: they’re pretty sure it’s a boy (for reference: I have 2 boys)! It is still so early in the game, but I know that if all goes well with this pregnancy, the 3 boys will have a blast. It will be chaotic, messy, and definitely a strain on our grocery budget – but they will have a great time together. Since I will be 35 when this baby is born, I also opted for noninvasive prenatal testing, so the boy/girl question should be confirmed later this week.

Since finding out the gender, I have had a few friends ask me if I’m disappointed I’m not having a girl. I honestly have to say that I am not. My main wish for this baby is that it be healthy. And after that, a very selfish wish (two actually) is that it be easy-going and a great sleeper. As a mom of two boys, I know boy. I have everything ready to do the boy thing over again. They can room together for longer than I imagine siblings of mixed gender would be able to, and my job will be much easier when they’re older and can do activities with their dad. Also, I was really nasty to my mom (who is a saint and whom I love dearly) when I was an adolescent, so I am not excited about the possibility of being on the receiving end of that treatment (as much as I do deserve it). I imagine teenage boys are not a walk in the park, but they must be easier than teenage girls! So my greatest concern in this department is: what are we going to name him!? So tough to think of a third boy name.

As for me, I’m feeling a bit better. I’m still pretty tired, and sometimes still feel nauseous. My belly definitely popped this weekend so I look more pregnant and I officially pulled out some of my maternity gear. Now comes the awkward (for me) process of letting people know about my pregnancy. I actually told a few people at work very early on (7 weeks!) because of some changes to the maternity leave policy and updated schedule requests for fall of 2018. This is very unlike what I have done in the past – previously waiting until 14 and 20 weeks respectively. I told a few close girlfriends from high school/college very early on and just this weekend told a few close local girlfriends. And slowly other people will learn about it and then my patients will start asking me about it (some have stuck it out with me through 2 pregnancies already!) and all of the necessary planning will unfold.

I have to be honest with you, after going through infertility with my first, every moment of every pregnancy feels like a dream and a great blessing. Sometimes I feel like pinching myself. There was a time when I seriously doubted that we would ever have one child, and here we are, parents to two healthy children with a third on the way.

Updates from the 1st trimester

I’ve been thinking of all of the things I want to remember from this first trimester. With my first pregnancy, I journaled all the time. With my second, I journaled less. This time around I forgot the password to access my (very sophisticated) Word doc journal and haven’t written anything since before becoming pregnant.

So first I’ll start with early pregnancy symptoms. I hate early pregnancy symptoms because they can literally be anything, so when you’re trying to get pregnant every little twinge becomes a reason to obsess over whether you could be pregnant.

I honestly didn’t feel any different than I have during my last few cycles. A bit of back pain a few days prior, but I’m pretty sure that’s more related to my 40 lb 3 year old and 25+ lb 1.5 year old. We flew for the holidays and I felt incredibly nauseous on the descent, but didn’t think much of it as I had experienced nausea with some prior cycles. What really tipped me off was this: no hormonal acne. Around the time of my menstrual cycle, I develop a few cystic acne lesions. I had zero by day 30 and this definitely piqued my interest. When I went to bed that night, I thought I felt something developing on my chin, but it was gone by the next morning. And that was it-I took a pregnancy test the next time.

During these first few weeks, I’ve felt:

-general stomach uneasiness

-nausea, usually worse in the early evening

-cravings for: carbs, juice (orange and mango), pineapple

-no desire to drink coffee (usually a staple of my diet) and no real desire to eat chocolate (another staple of my diet)

-intense moodiness

-incredible fatigue

I’ve also felt great worry, which is a staple of my pregnancies. I honestly wish women didn’t start showing until ~week 20, after the anatomy scan. With this pregnancy, I am showing EARLY. A handful of people know for a number of pragmatic reasons, and this makes me even more nervous! With my first, we didn’t even tell my family until I was almost 12 weeks pregnant. I didn’t notify my new employer until I was 14 weeks pregnant, and my colleagues at the time didn’t know until almost 16-18 weeks! With my second, I didn’t say anything until honestly around 20 weeks+ (although our families knew right away). I was negotiating a new contract at the time and didn’t want my pregnancy throwing a wrench into the plans.

I had one bit of good news at 7 weeks: baby had a heartbeat. But this is only minimally reassuring. The miscarriage rate on a population level is still 5%, and I’m sure we all know people who returned for their second check-up to find that the baby’s heartbeat was gone. So I am trying to stay sane until my 11 week appointment. And the week after I have my nuchal translucency/first trimester screen and my appointment with a genetic counselor (I’ll be 35 when this baby is born so I’m adding Harmony/Panorama/non-invasive prenatal screening test onto my routine prenatal testing). I think if I can get past the next 2 weeks (which are also riddled with work deadlines), I’ll be able to breathe a little more easily. Although then I’ll have the anatomy scan hanging over my head.

Well, I feel fortunate to be pregnant for now, and will try to keep my anxiety in check while I count down the days! The crazy thing is that in just 2 weeks I’ll be done with my first trimester, and then there are only two to go!