18.8.11

The Final Countdown

The doctor confirmed yesterday that Pea is locked and loaded - baby's head is all the way down and as he said, 'He's waiting but not quite ready'. Tomorrow is 4 weeks until the September 16th due date, which seems to be the one day all the doctors agree the baby never comes on. It seems that one way or another in the next 4 and 1/2 weeks I will have this little baby because the doctor is not willing to let me go more than a few days past the due date because of the gestational diabetes. So, anyone care to make a guess on Pea's birthdate?

I thought I would take a few minutes to comment on my pregnancy and post-pregnancy team for those who are interested in who is involved and how in the months leading up to birth, who will attend the birth and what support you get in Germany after birth. I could think of no better term than team although they are all working independently from each other to a large extent but given the number of pokings and proddings and happy encouragement I am getting from all of them it definitely feels like a large support team.

First and foremost, is the Saffa. While no expert on pregnancy or childbirth, he does have the experience from his two older children and has been calm and supportive through the year, attending every doctor visit possible, keeping me busy and active, encouraging me and picking up some of the effort around the house, shopping, cooking and whatever else I couldn't manage at one point or another, and smoothing over rough patches. He's kept me smiling through the ups and downs and I can't imagine doing this without him.

The next member of the team is my gynecologist. She has been my doctor the last couple of years. I saw her for the first time during pregnancy about 2 weeks after my home pregnancy test and found her much friendlier and open than the normal German doctor, who is very clinical, has limited bedside manner and sends you packing with orders but no explanations or interest in your opinions on your health and or treatments. Standard protocol for each visit was an ultrasound to check the size and development of the baby, urine and blood tests, a question and answer session and explanation of any variations from that routine when needed. Visits were about once a month in the beginning and have become more frequent towards the end. In these final weeks, I go once a week. One thing that I think did not occur to her and where I assumed I would get more advice was on when and how to engage the other members of my team. I think it was a given to her that I knew what else to do and it was a given to me that she would alert me as to when to choose a midwife, a hospital, attend birthing classes, etc - as a result I was late on almost everything else as I stumbled across these things more by accident than anything. More on that later. I didn't always know even what questions I should be asking.

By far the two most expensive doctor's appointments I had were with a doctor specializing in pre-natal ultrasound. The first appointment I had with her was around the 13 week mark to perform a nuchal translucency screening (an examination that looks for soft markers for Down's syndrome). Combined with blood test screenings, the doctor gives you a result presented as odds you will have a baby with Down's Syndrome. There can be false positives and false negatives, so depending on the results you may elect to go on to an amnio for confirmation. I debated whether or not to have the test at all and barely got in before the 14 week cutoff due to this debate. I couldn't imagine I would really do anything different as a result but in the end decided that this non-invasive test would at least give me an idea of the odds and if high it would be worth to know in order to have time to understand and prepare for what was ahead. The second visit was for the detailed 20 week scan where she checked for everything possible from brain development, heart function, deformities, size and so on and impatient me could find out the sex of our baby. During both of these visits I felt conflicting emotions as I hoped everything was ok but at the same time was completely entranced with the images of our little baby on the big, high resolution screen. Truly beautiful and a moment of wonder and on the second visit both the Saffa and I were a bit teary eyed seeing Pea in so much detail. We were elated for days afterwards.

Next came the diabetes specialist. At the 26 week or so, the routinely given GTT (Glucose Tolerance Test) came back showing that I had gestational diabetes. I was sent off to a specialist to repeat the test with more accurate machinery and when this again came back positive, they quickly accommodated me with the dietician. The doctor and the dietician only spoke German but we managed fine and I was shown how to test my own blood, walked through a suitable diet and then left to record my sugar levels four times a day for a week with the modified diet. A follow up with the doctor showed that the diet was keeping the sugar levels under control and I was turned on my own to experiment a bit to extend the diet and monitor my levels, only needing to return if I saw my sugar levels creeping or spiking up. It's been a mixed blessing - I miss having sweets and carbs but haven't put on as much weight as I would have and generally have felt very good on the low carb, low sugar diet.

Around the 30th week I came to know that I was supposed to have a midwife. I suppose I was somewhat aware of this earlier but never really looked into what this was all about, when I needed to get one and how. After extensive reading and research, the first consideration when deciding on which midwife you would like to have on your team is whether or not you want the midwife present at your birth or not. Midwives in Germany perform a range of services from regular checkups similar to the doctor prior to birth, birthing and baby care classes, attendance of the birth and home visits to care for mother and baby after birth. If giving birth in a hospital, you will typically be attended by the hospital midwife staff so many women opt to have their midwife only for the pre- and post-birth services and work with the team at the hospital during the actual birth. If going for a home birth, birthing center or hospital birth you can also pay additional to have the same midwife present at the birth. My key advice and one of my lessons learned is that it is never too early to select a midwife. By the time I started calling through a long list of recommendations and listings for midwives who speak English around my 30th week, they universally agreed that I was way too late for selecting a mid-wife and the situation was made worse by it being holiday season in Bavaria so many were not even available in August. At this point, I decided I had no choice but to work with the midwife staff at the hospital as I was going to be lucky to get anyone at all. Finally two weeks ago after more calls than I can remember, a midwife center took pity on me and I now have a midwife for pre- and post-birth care. On top of that, other than having to interact in Denglish from time to time, I also happen to really like her. We meet once a week and she checks on my and the baby's health, answers any questions I have and performs acupuncture on me. The Germans, especially in the Munich area, are big believers in the use of acupuncture to help prepare the body for labor and also to shorten the overall labor and delivery time. For me the jury is out but I decided to give it a try and find the sessions very calming and meditative if nothing else. Once we are home from the hospital, she will come to my house 1-2 times a day up to 10 days after the birth to help with recovery, breast feeding and baby care. From 10 days after birth on, she will come less frequently over the following weeks to continue to help with any of those points and to make sure Pea is progressing normally.

Last, but not least, is my deliver doctor and the team at the hospital. A major difference from the US is that doctors are split into specialties by prenatal care and then those that focus on labor and delivery. So rather than have a doctor who will be with you the whole pregnancy and delivery (or at least another doctor from the practice), you have to select a doctor for the birth separately. My gynecologist recommended him and the hospital and the Saffa and I took a stroll by the hospital one evening - it is walking distance from our apartment and next door to a very nice beer garden. I knew right away that this was the place I wanted to go - the building is in a calm neighborhood, surrounded by big shade trees and dappled sun and it felt very peaceful there. We went back a few weeks later for the hospital information session and although it was all in German I could follow most of the presentation. I liked the doctor very much. He had an obvious passion for his work and there was a very friendly synergy between him and the other staff at the presentation. Yesterday the Saffa and I went to initiate the full registration, met the doctor 1:1 and had an examination with him to see how things are progressing. I liked his responses and philosophy on all the questions I asked and feel we made the right decision on hospital and doctor. The staff were also friendly but who we will have for the delivery will depend on who is on duty on the time so will have to reserve comments on that for a later post. I have a weekly mommy and mommy-to-be lunch and a few of the new mothers have given birth at the same hospital recently all agreed that they were very happy with the care they received there so I feel further reassured.

The last person I should mention is my birth preparation teacher. I found one who is American-German who offers classes in English and completed the class last weekend. She covered topics such as newborn baby care, as well as labor and delivery - from multiple angles such as preparation, breathing techniques, positions, what the body is doing during the whole process, what is normal and when you need to take urgent medical action and so on. I thought the class was very good and also found the instructor very encouraging. I have supplemented the class with a couple of books that helped reinforce my understanding of the process and options. I don't think you can be fully prepared from classes and some books but I am prepared as I think I can be and after some earlier fears am calmly and optimistically looking forward to the big day(s).

Posted from Munich

3 comments:

J said...

ok, I'll say 5 Sept, only because it's Labor Day in the USA and I like the irony of it.

Expat Traveler said...

It's your first. I don't know if you are showing any braxton hicks yet and that also helps to determine a date. But I'm going with Sept 18th. That's a great day!

Wow oh Wow! So much information. Although you had so many docs, my midwife did all of what you spoke about in one. Yes delivery too. Although I did have to go to a special doctor for high blood pressure at the hospital. As well, since our LO ended up with merconium (sp?) at birth, an additional doc had to come in to be sure she was okay. There might have been more people in the room, but I wouldn't have known since that wasn't my focus.

Some advice too is just be sure to eat as much as you can before your big labor starts coming. you need the energy! And you might expect to be pushing for a while since it's your first.

Expat Traveler said...

p.s. I think I have that song in my head now... lol