February 27, 2009

I went to the hospital today for pre-surgery blood tests and was strongly reminded of \u201cLa maison qui rend fou\u201d from Les Douze Travaux d\u2019Astérix (English version)


I was initially directed to head to the obstetrics ward to report for my surgery \u2013 which was a bit disconcerting since I thought I was just in for bloodwork! Turns out the receptionist had simply misread the date. I was then directed from one wicket to the next. The nurse drawing blood did a fantastic job \u2013 I have notoriously difficult veins and often end up with multiple pokes and quite a lot of bruising. This time I have no bruising at all, which I don\u2019t think has ever happened before.


I have now been officially admitted to the Montfort \u2013 complete with bracelet; but luckily they did let me go home\u2026 After returning to the first wicket with all my paperwork duly stamped I finally did get my special number to call but it can only be used between the hours of two and four pm. It\u2019s a bit disconcerting to know that I am having surgery tomorrow, but not to have any idea when to show up nor where to go.


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February 25, 2009

We attended the Montfort\u2019s \u201cVirtual Tour\u201d this evening \u2013 essentially an orientation session with one of the nurses who went over the various procedures for coming to the hospital, showed us pictures of the maternity ward areas, went over some of the things we could expect and answered questions. The nurse was extremely nice.


We filled out some additional paperwork \u2013 one of which was obviously an assessment for post-partum depression risk. I was amused by the question that asked whether we had experienced or were about to experience major life changes recently since virtually every aspect of our life is undergoing major change at the moment. Presumably they were not counting becoming parents...


We particularly appreciated hearing about the reasoning behind some of the rules in place on the ward (visiting hours are only 4pm to 8pm daily). She explained that they had found that longer hours were hard on new mothers, resulting often in overtired parents melting down emotionally towards the end of the evening. The regulations have obviously been well thought out. The nurse explained that they do sometimes allow exceptions at the discretion of the nurses \u2013 the idea is not to follow the rules for the sake of the rules, but to look out for the best welfare of mom and baby. Unfortunately Erika won\u2019t be able to come and visit as she is under the age of 14 and not a sibling. We might have been able to get an exception with some begging, except that Erika has also had a bad cold.


The entire maternity wing is new as of this summer and it looks very nice. Since we are scheduled for a c-section, we\u2019ll probably be put in a \u201ctraditional\u201d room \u2013 defined as a room with a shower, instead of Jacuzzi tub. (Getting into a tub after a c-section is apparently not something that is very easy at first.) We\u2019ve signed up for a ward room since it\u2019s free and we don\u2019t have any additional coverage. We were also relieved to hear that the Montfort doesn\u2019t \u201cdo\u201d sugar water supplementation \u2013 something that other area hospitals have been known to do without consulting the parents...


I was quite embarrassed to find myself in tears after hearing about what to expect during and after a caesarean \u2013 as I told the nurse this is so dramatically different from the natural home birth plans we had hoped for. I do feel a bit better about going to the hospital after the tour.


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Our sixth ultrasound today confirmed that Elizabeth is still a girl :) She is also still firmly transverse, so it looks like the caesarean is going to go ahead as scheduled this Saturday.

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February 23, 2009
The Montfort called today to set up an appointment for blood work on Friday. I\u2019ve been told I need to start fasting as of 11pm on Friday evening, regardless of the time of surgery on Saturday. They didn\u2019t give us any additional information \u2013 details like when and where to show up are apparently on a need-to-know basis and we don\u2019t need to know yet. I\u2019ll apparently get a special number to call after Friday\u2019s appointment which will give us all the information.

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February 20, 2009
A caesarean has been scheduled for Saturday Feb 28th, so that is the absolutely latest appearance! The doctor thinks it's pretty unlikely that baby will turn in the meantime, but I'm scheduled for two ultrasounds in the meantime to check\u2026 My parents will be in Toronto that weekend. Baby is measuring small, which "probably means formula supplementation" and a longer hospital stay. Humbug. I did like the surgeon though. Part of me is grateful that we live in a time of good medical care, and part of me wants to know why this has to be soo complicated!

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February 19, 2009

We had our appointment with Dr. Gravelle this morning (the obstetrician).


We arrived a few minutes early and were disconcerted to open the door to a dark and silent office. Obviously they were not open yet. We couldn't find a light switch, so we waited in the hall, which gradually filled up with other pregnant ladies. By the time of our appointment, the office staff had arrived and turned on the lights.


It was interesting to compare the routine of the obstetrician appointment against that of the midwives. Both require you to pee in a bottle, but the midwives have a much more elaborate procedure and get you to test it yourself, while the obstetrician has a nurse to handle this for you. The nurse also does a quick history and checks blood pressure.


Dr. Gravelle was extremely nice and went through our options with us. They are pretty limited. In the case of a breech, we could try a trial of labour, but it is impossible for a transverse baby to be born shoulder first. She also said that even if the baby wasn't transverse, there would have been a good chance of ending up with a caesarean section because a uterus shaped like mine may well not be able to contract properly. Coupled with a smaller baby that might not tolerate a long labour as well, she said that a planned caesarean was not necessarily a bad idea under the circumstances. She also explained that she would strongly recommend against trying an external version to turn the baby. Even in a normally shaped uterus the success rate is less than 25%, and there are risks to both baby and mom. In my case, it's extremely likely that there is a reason that Elizabeth has settled where she is. The likelihood of a successful version is very low, and the risks quite high. She said she would definitely not risk it if it was her child. She went on to say that she is a surgeon though and very comfortable with caesareans\u2026


Although we had heard a great deal about how busy obstetricians are, and although we were expecting a short and rushed appointment as a result, Dr. Gravelle took her time explaining the whole caesarean section process and answered all of our questions. It's possible that "normal" appointments are different, but we really appreciated her thoroughness and really great bedside manner, especially since this wasn't at all the hoped for birth plan! One of the books we had ("The Birth Partner") mentioned that some obstetricians like to physically inspect the uterus by pulling it outside the abdomen, and that since the benefit was "questionable" and some women find it "uncomfortable and nauseating" that we might want to request that the surgeon not do this. It turns out that Dr. Gravelle does this, mostly because she finds it easier to suture up the uterus when she can see what she is doing. It's not strictly necessary so she did offer to suture by feel, but after her explanation it seemed to me that I'd let her do what she thinks is best.


We have two more ultrasounds scheduled just in case - Dr. Gravelle said it's always very embarrassing to pull a "breech" or "transverse" baby out by the head! Since there is a risk of a cord prolapse if I go into labour, both the midwives and Dr. Gravelle want to ensure that the caesarean happens before that. It's a delicate balance between letting the baby mature in the womb (and get a little bit bigger!) and getting her out prior to labour. Getting operating room time at such short notice is also tricky, so we're going to be taken in between emergency cases. The caesarean itself is scheduled for Saturday February the 28th, which is when I start week 39.


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