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Posts tagged ‘perinatologist’

Journey with K: pregnancy and birth #3

I checked in the hospital directly from the clinic as at the 41st week check up, I brought my suitcase.  It was a so-called LDR room.  All furniture was light birch color and it was big.  It had a big TV and there is a sofa that can be converted to bed.  There even was a rocking chair.  I was impressed.

Then the perinatologist at the shift whom I’ve seen a few times during prenatal visit, rubbed on something in my cervix.  It was a tablet, apparently and I started to bleed.  That is supposed to loosen my cervix and induce labor.  It didn’t.  So a few hours later, he started me on Pitocin.  The labor began.  From the beginning, it was 10 minutes interval.  Then soon became 5 minutes.  Still there was no sign of my cervix opening up.  Pitocin dose kept increasing.  Time has passed and his shift ended.  Apparently, there was no perinatologist in the night shift. Because of that, they stopped Pitocin dose increase.  They’d rather have a delivery after 7 am next day when a perinatologist is available.  That meant that I, in labor, have to wait overnight.  I’ve been waiting and waiting and waiting and an obstetrician resident occasionally checked my cervix but still no sign. Around 3 or 4 am, I no longer could tolerate the pain and requested for epidural.  I was asked at the check in, but I declined.  I somehow thought it was against nature.  But in that pain, nothing really mattered.  But the nurse told me, “you can have the epidural at 7 a.m., when an anesthesiologist is available”.  Oh, sh-t!  It’s all about hospital’s convenience.  In hindsight, it was a reasonable.  They’d rather have an anesthesiologist in the night shift available for emergency.  Mine was by no means, life-threatening emergency.

Anyway, in the morning, I finally got an epidural.  I was really scared that a resident did the epidural under supervision of attending anesthesiologist.  That’s the nature of teaching hospital.  Anyway, she did very well and succeeded at the first attempt. Immediate relief kicked in.

After that, they pumped up Pitocin even further.  Nope. My cervix was so resistant even if my contraction is less than 3 min interval.  Then around 10 a.m., perinatologist in the shift (who turned out to be the one I consulted) came in and broke my membrane.  Water gushed out.  In two hours, my cervix is fully open.

Now the time to push.  I’ve read a horror story about a doctor laughing at laboring mother accidentally pooping.  I really wanted to avoid that, especially in front of my husband.  So I probably didn’t push hard enough. Still, somehow, my baby decided to be born and came out.  It was 24 hours after the doctor rubbed in a tablet on my cervix.

I think so many have described that moment of joy.  I was exhausted but elated.  My husband was really scared, though.  Yet, he cut the cord and he held K. K was now with us!

The recovery was pretty good. At first K was jittery because his thyroid hormone level was a bit high. As a new mom, I struggled to nurse at first.  It took about 5 days for me and K to collaborate to nurse.

In the LDR room, after all the nurse left, my husband said, “I never thought my own baby is so lovely.”  This word was etched in my brain.  We were really happy.



Journey with K: pregnancy and birth #2

This time, the referral lady at the student health was not as kind as before. Her first response was that my condition doesn’t qualify for seeing a perinatologist. That’s the first time I had a question about US healthcare system that almost everyone has asked: who decides I need to see which doctor? Apparently it’s the lady at the student health or the insurance company behind it. Until then I didn’t pay attention to all the buzz about HMO and other healthcare stuff. All I knew was Hillary Clinton tried something and was flatly rejected.

So I rashed out. I thought my baby’s life was at stake. I explained that it is the endocrinologist who recommended to see a specific perinatologist because she is an expert of genetic issues and high risk pregnancy. In fact, the local hospital refused me to have birth there because they didn’t have a perinatologist.  Why can YOU, a referral lady, can tell me I’m too healthy to see a perinatologist???? I insisted and insisted to call the endocrinologist.  The lady at first refused but finally gave in.  The endocrinologist was crystal clear: I need to see a perinatologist.  So reluctantly, she processed my referral.

At the perinatologist’s office, however, I was told that there is no particular genetic implication with my Grave’s disease (by this time, blood test showed that I have antibody that stimulates my thyroid to cause hyperthyroidism).  So, in one sense, the referral lady was correct. Only complication she might see was that because my thyroid stimulating antibody (called TSI) was so high that baby’s thyroid might be stimulated and enlarged.  If the baby’s neck was enlarged, he might have trouble going through birth canal.  She told me that there are three ranks of obstetricians – regular obstetricians who handles healthy pregnancy, high-risk obstetricians, and perinatologists, who handles the highest risk for both mother and baby.  She thought I was more appropriate for high-risk obstetricians, but she’s willing to take me as patient.  So without hesitation, my husband and I decided to have our baby delivered by one of the perinatologists at UC Davis medical center in Sacramento.

It was quite different from the birth I first envisioned, but the baby’s health is the first and foremost priority.  I was happy with it.

The rest of the pregnancy was rather stable.  My thyroid hormone was brought to normal in about three months and the doctor was monitoring things really well. We were so excited when we were told that the baby was a boy.  I knew that our parents in Japan would ask for a boy, as the tradition goes.

I kept working in the lab.  As my belly expanded sometimes I cannot reach stuff but my lab mates including my husband were very kind and helpful.  In one occasion, K kicked my bladder and without realizing, I wetted my chair!  I thought the water was broken.  Well, false alarm. And due date was near.

And passed.  My husband started to get so irritated.  So was I.  My mother was happy about the delay, because she wanted the baby be born on my father’s death date, believing he is reincarnation of my father (eventually he was born three days after my father’s death date).  But I wasn’t.  I couldn’t wait to see my baby.  So I did the only think I could in such a mental state: knitting.  I started and finished a full size knitted afghan in three days!  My husband did something more surprising – he sewed a computer bag from old pair of jeans!  He had never sewn anything.  And ever since.  So he must be so out of character back then.

A week later, the doctor checked my fluid and noticed getting lower.  So she sent me to the hospital to induce labor.

To be continued.


Journey with K: pregnancy and birth #1

I cannot forget the excitement when I saw the positive line on the pregnancy test! I think many mamas can relate to that.

I was a graduate student in University of California, Davis back then.  So to confirm and start prenatal care, first I went to the student health center on campus.  My health insurance required that.   After I gave my urine cup in the lab, I was waiting in the exam room when a nurse practitioner entered. Nurse practitioner was somewhat nervous: not surprising, probably she had given many pregnancy diagnosis to many women who did not wish.  She first placed a piece of paper on the desk.  Nothing was written.  Then in a nervous face, she asked, “do you intend to get pregnant?” and I said “YES!!” then she flipped the paper that had a big “+” mark, “Congratulations, you are pregnant!”

This was actually only the second time I went to the student health since I came to the US.  I didn’t see a doctor for five years!  I had no idea about the complication of health insurance system in the US then.  Now that side of journey had started, too.

The referral person asked me where do you want to give birth.  Without much thought, I chose the nearest and only hospital in town.  The she arranged the first prenatal appointment and there my husband and I went.

I saw a nurse midwife.  She explained that in the hospital’s birthing center, they offer water birth with midwife.  That sounded very cool!  Both my hubby and I were very excited of that and I started to imagine.  Then she started physical exam.  Touching my neck, she said, “Hmmm…it’s a bit large.  Do you have thyroid disease?” I said “No”. And she started to tell several symptoms like loose stool, fatigue, etc….I had them.  I blamed my loose bowel to alcohol, and fatigue for lack of exercise.  To overcome, I walked about an hour in the morning and by the time I arrive at the lab, I was exhausted and ended up resting in the backroom of women’s restroom. Only solution I thought was, “I need to do more exercise.”

But suddenly what midwife told fit into pieces.  She ordered thyroid panel blood test and we left making the appointment for the next prenatal visit.  Then the next day, the hospital called me that I have hyperthyroid and they can’t deliver my baby because it was such a high risk, and that another hospital in the same group about 40 minutes drive from where I live, can.  She also said that I need to see an endocrinologist.  The hospital group didn’t have an endocrinologist locally, so they suggested to go see different medical group, run by UC Davis.

Now I came back to the referral room in the student health. This time my heart was heavy.  There was only one endocrinologist in town so they arranged appointment to see her.  At the first appointment, she told me what I already knew: I have hyperthyroidism and my pregnancy is high risk.  She made a referral to a perinatologist, who is very famous for her genetic diagnosis work.  Well, I knew a thing or two about genetics: I was a Ph.D. student in molecular genetics then.  But what happened at the molecular level and what was happening in my body were somehow disconnected.  The endocrinologist immediately started on Propylthiouracil – or PTU for short – second commonly used medication for hyperthyroidism.  Most commonly used one is methimazole, but because it was teratogenic, I couldn’t take it.  Suddenly, I started studying FDA’s pregnancy category – both PTU and methimazole was category C – that is, unless absolutely necessary, the medication shouldn’t be used during pregnancy.  I was devastated.  Did I have to give up this pregnancy?  Will I have miscarriage?  I was overwhelmed with these ideas.  Anyway, she ordered additional blood test and I left.

The next thing was to see a perinatologist.  I had to go back to the student health again to get referral.

To be continued.


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