32 Week Appointment

Yesterday was our 32 week appointment - the schedule included non-stress test, level II ultrasound and short visit with MFM doc, midwife follow-up.  (And just for reference, today is the one day anniversary of Gracie's last day alive in my belly...)  The appointment was not bad, but it wasn't as good as some of our previous appointments.  I left the office feeling frustrated.


Important information from the day

• Trace protein levels detected in my urine - not going to worry unless the same thing turns up on Tuesday.  Blood pressure was a little higher than it was last time, but nothing to be concerned with.  I have now gained 25 pounds since our 9 week appointment.
• NST was ultimately considered reactive, but it took an hour for it to be deemed as such.  Bean was moving a lot and I had to constantly chase her around with the heart rate sensor, but there were times that she was moving that the monitor was just not detecting a heart beat at all, simple because she was moving so much.  Because of that, nothing (such as the heart rate elevations that the NST specifically looks for) was recorded during those heavy periods of baby movement.  I am hoping that the rest of the NSTs go better than this, but given our overall record with NSTs, I am not holding my breath. 
• Results of the ultrasound...  A formal biophysical profile was not performed, but the US tech specifically mentioned that Bean was doing everything that she would have needed to do the BPP...I assume that this means she would have scored 8/8, since she pointed everything out to us and it was good.  Jellybean was an active girl yesterday.  I think she was still unhappy about the hour of NST monitoring.  She came in at the 51st percentile for overall growth with an estimated weight of 4 lbs, 3 oz...this is exactly how much Gracie weighed when she was born.  Kind of weird, especially considering that this appointment was so close to Gracie's anniversary.  Given this placement on the growth curve, it puts the collection of growth estimates all over the place.  The girl that did yesterday's ultrasound is the one that estimated her to be in the 39th percentile 8 weeks ago; a different technician did the measurements 4 weeks ago that gave the estimate of 61st percentile.  I am inclined to think that the 51st percentile is a little closer to accurate at this point. (It's that whole intra/inter-rater reliability thing for those of you who have been forced to take research classes at some point...)
• We will continue with NST 2x/week and the ultrasound to complete the biophysical profile1x/week.  We will have a formal midwife appointment 1x/week, but will also usually have one pop in when we are there just for the NST.  
• We will see MFM again in 4 weeks, and unless anything changes, that will likely be the last MFM appointment for Bean.
• And of course, a picture or two.  The first picture made me laugh as soon as I saw it.  It immediately assured me that Bean is, in fact, our daughter.  (After looking closely, I am pretty sure that it's her index finger, but you get the point...)

Now on to my frustrations from the day

• The NST ran into my MFM appointment time.  I was assured that someone was going to go to the other side of the office (literally 40-50' down the hallway to the other end of the SAME office) and let MFM know that I was going to be a few minutes late in coming over to see them.  My appointment was for 3:30, which is their last appointment slot of the day.  When that appointment is done, they pack up and drive an hour back to their main office.  When we walked up to their 'reception' area at 3:44, we got all kinds of attitude from the girl sitting there because we were late.  While we were waiting right outside of the ultrasound room, she went in to tell the US tech that we were there.  The tech said something along the lines of 'Yeah, I heard, but I already started tearing everything apart, so they're going to have to wait a few minutes while I put it back together.'  In the meantime, the doc walked into the same room and said "what do you know...3:44 and about 50 seconds."  To me, that means that at 3:45, they decline to see you because you are too late for your appointment.  I was kind of pissed that they were talking the way they were when we were right outside of the room and could hear them very clearly, so I spoke up and said "Excuse me, did anyone from OB/GYN Assoc tell you that we were going to be a few minutes late?  I've been in the office since 2:30 and hooked up to a NST since 2:45.  They told me about half an hour ago that they were going to come over and tell you that I would be late."  "No.  Nobody said a word to us...did you hear that girls?  She's been in the office since 2:30..."  Not that big a deal, but the whole thing just kind of pissed me off, especially since they could have just unhooked me from the (at that point) non-reactive NST and had MFM throw in a biophysical profile when they did the US. The attitude that we got for being late kind of pissed me off, too, primarily because we all run late at some point...whether it is as a provider or patient, we have all run late at one time or another. 
• We met the new midwife yesterday. Instead of just seeing me in the scheduled slot after the MFM appointment, she kind of squeezed me in while I was hooked up to the NST.  It was a bit chaotic, so it was hard to form an impression of her yesterday.  We see her again on Tuesday, so perhaps it will be a little less chaotic and we can actually chat with her for a few minutes.  The one thing that I was not crazy about was how she did my fundal height measurement.  I felt that it was really sloppy considering our history of IUGR caused death.  She measured me while I was in the recliner, hooked up to the NST; she measured OVER the stuff strapped to my belly and never felt for my pubic bone, which is the starting point.  Minor detail, but something that could turn out to be important in the long run.  The midwife that we usually see has spoken quite highly of her, so I am hoping to leave Tuesday's appointment with a better impression. 
• I am frustrated, that after being pregnant for 15 of the last 20 months and having a stillborn child thrown into that mix, that I still leave the OB office feeling like very few people actually listen to the words that come out of my mouth.  Specifically, I am talking about care providers.  Not all of them, but many of them.  I know they hear me speaking, because they nod their heads and smile and then give me some stupid cookie cutter answer.  But here's the deal...I am not an idiot.  I am an educated health professional.  I have read and read and read about pregnancy and childbirth, even before I was pregnant.  I don't call the OB's office in a panic every other day because the baby kicked 18 times yesterday but only 14 times today.  I only call when my baby is dead.  Literally.  So I get frustrated when my providers ask me a question and then don't want to hear my answer because it is different than the cookie cutter answer they were waiting for.  I get frustrated when they say "Do you have any questions or concerns at this point?" and then become annoyed when I do have a question or concern...and then they follow up the obvious annoyance with a standard cookie cutter answer.  It's happened several times in the last 12 weeks with various providers, and it's really starting to piss me off.  It's part of the reason that I pushed for less 'big medicine' and a smaller circle of providers that I know will listen to what I am saying, give me a reasonable answer, and tell me when I am legitimately being an idiot...instead of always acting like I am an idiot for actually having something to ask when they open up the floor for questions or concerns. 

So that's it for this week...a little update, a couple pics and a little ranting and venting.  Will probably post a brief update again next week...