Tomorrow: Time to Deliver Near You

This was the subject line from an email I got from my good friend, Barack.  He emails me ALL the time and is ALWAYS in my bidnezz so I wasn’t too surprised that he knew that we were headed to the new perinatologist clinic to talk to new doctors about transferring care to a new hospital.  But it turns out he was really just talking about healthcare reform.  Not a word about where we would deliver.

But even without the President’s prodding, we had decided that it was time to deliver near us, or at least that it was time to find a hospital near us . . . and hopefully deliver much, much later. 

We had booked an appointment with a high risk pregnancy clinic in the East Bay, because if I was going to spend a month in the hospital and the peas were going to spend a month (or more?) in the NICU, we didn’t want to have to drive across a bridge to get to that hospital.  We wanted something closer to home.

It didn’t start well.  The woman behind the desk informed me that they had CANCELLED my appointment because they thought something was amiss with my insurance and they couldn’t get a hold of me to verify it . . . um. . . because I forgot to call them back.

Sometimes you hear stories about moms who suddenly have these super human powers when they feel that the safety of their children are threatened.  Well, I think that gets doubled or maybe even squared when you are carrying twins, because all of sudden I had the energy (and the urge) to leap over the counter, squeeze through that tiny window, pick up that woman by her skull and pound her body into the wall. 

But instead I burst into tears and she said, “Let me check with the doctor.  I’ll see what we can do.”  And of course they fit us in.  Me and my peas are high risk lottery tickets of nature.  We deserve VIP treatment.   (Matt is quick to point out, of course they fit us in; that’s what they do.

First the blood pressure – a little higher than normal: 122 over 69 (or is it 69 over 122?)  Weight gain, up 3 pounds from last week.  Gulp!  Then waiting to see the doctor, looking at posters of fetuses of different gestational ages and looking at the tiny 28 weekers and the huge term cartoon babies (really huge, since they weren’t actual size).  Eventually the doctor walked in.  Looks nice, affable, a lot like Mr. Whipple of the squeezed Charmin fame.

Now granted, given our experience, the bar for being a good high risk preganancy doctor is kinda low.  Just don’t say the words, “dead baby” and you’ll get a gold star.  But low expectations notwithstanding, this doctor was great.  He managed to describe all of the risks in a non-alarmist manner; he didn’t sugar-coat any of his answers, certainly, but his responses were optimistic-leaning, almost cheerful.

One thing I haven’t been able to get my head around is the mandatory 32 week due date.  I understand that if there’s a problem or if I go into early labor all bets are off, but what if everything’s going fine?  I mean, if I have to be in the hospital for 24/7 monitoring from weeks 28 – 32, what’s the difference: on week 31 day 6 they will only operate if they absolutely have to but on week 32 day 1 they open me up no matter what?  If I’m being monitored anyway, can’t we just wait a little longer?  

Yes, I know that they can do great things with babies at 32 weeks, but so can I; any way you look at it, my belly is better than their plastic box.  If everything’s going fine, can’t we just let nature do its thing?

My Internet research told me that no, 32 weeks was the norm.  Granted, web reconnaissance is just a notch above getting advice off of bathroom stalls, and only because Google makes it possible to search more bathrooms, faster.  But I also found the email address of a woman who delivered mono/mono twins last spring.  Boys.  Born at 4.5 and 4.3 pounds, in the NICU for 3 weeks.  Six months later, they are still doing great.  We emailed back and forth and having been there, she also thought that, no, our doctor probably wouldn’t allow us to go past 32 weeks.

This is what I wanted to ask Dr. Whipple.  But he beat me to the punch.  After I said that we knew we were trying to get to at least 28 weeks, he said, “Well, we hope to get you much further.  34 or 36, even.  We probably wouldn’t let you go much past 36 weeks.” 

36 weeks!  That’s practically term!  I was so excited I didn’t want to ask him to repeat it, in case he’d change his mind or something.  But Matt asked anyway.  He told the doctor of the protocol that we would have been subject to at our San Francisco hospital.

Here’s what Dr. Whipple said: “We feel that this type of pregnancy is so rare that there really aren’t the numbers available to justify a hard and fast protocol.  We’re going to base it on how you and the twins are doing.  Of course, if there’s a problem or a sign of cord crimping, we won’t hesitate to take them.  We won’t risk the babies’ health.  But we won’t operate if the babies are doing fine.”

Woo-hoo!!!!  That’s exactly the attitude we were hoping for.  He said other things we wanted to hear, too, like “Get all your traveling in now.”  (I’m planning a trip to St. Paul with Chiara and my mom in early November, along with a trip to El Paso and a side trip to visit my sister at college in San Antonio—without Chiara for the San Antone trip).  “You won’t be driving to San Antonio,” the doctor frowned.  No, flying.  “Then you should be fine.  Come in for an ultrasound before you go.”

As for mandatory hospitalization, we’ll play that one by ear, too.  Around week 25 or so, I’ll come in every week for stress tests and such and 3 times a week by 28 weeks.  And then we’ll see.

Other things that made me weep with joy:  all the doctors at this high risk clinic share the same philosophy and most of them have worked together for the better part of 20 years.  The most junior on staff has been there 8 years.  Dr. Whipple (not his real name) is one of six doctors at this clinic, so there’s a good chance we will see other doctors on the rest of our visits, which is fine with us.  It’s good to meet everybody because you never know who will be on call when the day comes.  At the hospital where we will deliver there are two obstetricians and two anesthesiologists (just for the pregnant folk) on the floor 24/7.  Plus a third OB on call.

“Of course, I can’t give you guarantees,” the doc said as he shook our hands good-bye.  “But we have lots of good outcomes.  I delivered my first mono/mono twins twenty years ago yesterday.  On my birthday.  And they’re still doing great.”  He smiled proudly.

I think this was the most reassuring prenatal appointment we’ve had in all of 2009.

And now for something cute about Chiara: I’ve read studies where they look at “gendered” toys and give the trucks to girls and the baby dolls to the boys.  The girls wind up rocking the trucks and putting them to sleep while the boys dismember the dolls and use the appendages as nunchunks.  Well, Chiara has done a similar gendered thing with her tool set.  It has become her picnic basket, or as she calls it, her “pick-a-nick” basket.  The screws are ice cream cones, the wooden wedge is a cheese knife, which she uses to spread cheese (or pea-ah-nut butter) on the little square washers, which are crackers.  If she had a little truck to play with, I’m sure he’d be invited to the pick-a-nick and offered some ice cream.

© 2010 Janine Kovac