Chickens Laying Eggs

Congrats Fish!

 

I've been quiet and busy but I need some feedback and I trust this forum more than a BBC birth board or talking to co-workers (who mainly are just freaking me out at this point even though they're trying to help). I haven't meant to stay away but I'm tired, things are really hard, and Mr. Bandit's company pretty much closed down his whole division when COVID lockdown happened so I'm the only earner in my household right now.

I'm going to be 25 weeks tomorrow. I don't know if people here really remember, but I have a history of endocrine issues; in my early 20s I had a pituitary macroadenoma emergently removed because when they found it, it had formed a blood clot and I was in danger of serious complications every moment it was in and it had cut off my peripheral vision. I was on steroid therapy to supplement my cortisol levels for a year, and synthroid for even longer. My cortisol levels never truly recovered, but they are consistently on the lower end of normal or the upper end of 'not great but not in danger yet', and the side effects from the steroids were becoming so severe psychologically that it was safer to phase me off them and take the chance I'd go into adrenal crisis. Around two years ago, when we were going to start trying to conceive originally, I had a routine blood test that revealed some elevated prolactin levels so they did another MRI and I'd had prolactinoma regrowth on my pituitary gland. Fortunately they had caught it in time that it was small enough to not require surgery immediately, and they put me on medication that did shrink it. Even after they gave me the go-ahead to safely start TTC because it had shrunk significantly I wasn't ovulating, we were in the process of scheduling a medicated IUI when we also made a small adjustment to the dosage of the medication that reduces my prolactin levels, and I almost immediately got pregnant "spontaneously." As someone who was working two years to get pregnant I really hate this term but that's tangential.

They want prolactin to rise during pregnancy and breastfeeding, which means ceasing that medication, so that combined with your pituitary gland already going a little pregnancy-crazy can increase the size of prolactinomas. I've been monitored pretty carefully by both my primary care doctor, endocrinologist, and an ophthalmologist but my city is so small and the doctors so overloaded that my first OB/GYN visit wasn't scheduled until a few weeks ago (for tomorrow, ironically). I lost fifteen pounds my first trimester from being so sick and generally food adverse, and I still haven't gained a net amount compared to my pre-pregnancy weight. I've also been increasingly dizzy, so during my last phone appointment my endocrinologist said she wanted me to go in for a blood draw to check my levels again, particularly my cortisol, as I'm displaying pretty much all the symptoms of low cortisol/adrenal insufficiency in pregnancy. Annoying, but I could deal with steroids for a few months. On Friday, however, I realized at work and noticed to my horror that my distance vision had seemingly degraded overnight, which is one of the big red "your tumor might be growing dangerously" signs. I called my endocrinologist once I established it was a consistent thing, and not just a spontaneous adjustment/strain problem, and she's referring me for an urgent MRI (in Edmonton, which should get me in in 1-2 weeks instead of locally, where it will probably take 6+ weeks).

So I have all that going on. And then I fell in the shower this morning. Really, really hard. I use "fell" here because I'm not sure if I slipped or blacked out. I don't remember the sensation of slipping, but I do remember the sensation of hitting the lip of the tub, and I was pretty coherent when Mr. Bandit came in because he heard the crash. I took the shower curtain down with me so logically it seems like I slipped and grabbed it, but I just have no idea. I called the HealthLine and they told me to go to my local hospital, they even faxed over the incident report from me calling so they were ready for me. I'm bruised and shaken but fine, baby is entirely unaffected, placenta still looks good. But during my recounting of the above, the labor and delivery nurse asked me who my high risk OB/GYN is, and I told her I hadn't been referred to one. She put her pen down and, I don't remember the exact wording, but she very strongly implied that if I delivered in my current city's hospital, they were not equipped to deal with my other potential complications.

This has been on my mind for awhile, but hearing it from someone in the ward I would be delivering in has left me pretty shaken. I've always thought I'd be more comfortable delivering in Edmonton (where my specialists are and where there are, wow, a few MRIs lying around, there isn't one in my city's hospital at all they share some kind of MRI truck with other rural hospitals?), but having to drive over two hours while in labour or every week/other week for an OB/GYN appointment put me off so it wasn't something I advocated for. I've gotten the vibe that if my cortisol levels are still sub-optimal that my endocrinologist is going to want me to see a sub-specialist of some kind regardless (it would also probably mean induction the moment lungs are fully developed, from what I've been reading), but if that doesn't happen I... guess I want some feedback and reassurance, particularly from people that have given birth. Trying to deliver in my current city, at this point, is going to cause me so much anxiety I'm worried my labour is just going to stall and refuse to progress because I won't feel safe.

Is it fair, with this information, to advocate harder for an OB/GYN in Edmonton and deliver there? If I go into labour spontaneously is a 2.5 hour drive way too much? How do I even go about this conversation? Does anyone with experience in the Canadian health system even know if this IS something I can request without a doctor also pushing really hard for it?

My ideal birth plan is "I go into the woods with a barefoot midwife who burns herbs and chants," but that was nixed pretty fast so I don't know how to regain some sense of having a say in this. Maybe I'm just being a control freak? No one seems to think I am, but there's an annoying voice in my head telling me I'm being an over-dramatic, demanding primadonna if I start making requests like this.

I'm sorry. That was a lot. I'm really worked up. I'm also accepting hugs.

 

Jesus that’s a lot. I don’t know about Canada but I changed providers when I got pregnant with my second. I wanted to deliver at the hospital with the better NICU (where our oldest got transferred to). No one second guessed me and all my providers were on board with me switching systems.

 

Jesus @Cashmere Bandit that is a lot to deal with. I’m glad you’re ok, but the fall and complications sound scary to go through, and you’ll be in my thoughts. I will say too that you are not being a control freak - you have a health issue that needs to be taken seriously plus pregnancy is a huge deal. These are things that require advocating for yourself.

My inclination here would be to plan for a delivery in a location that’s best equipped to handle any potential complications. You have enough things going on here that I think a specialist is worth seeing, and good for your nurse for recommending that. I had to see one for this pregnancy as a precaution; even if you don’t need much intervention, the extra monitoring is good for peace of mind, or at least taking some uncertainty out of the equation.

 

I have no advice but I can definitely give hugs!

 

I have no advice regarding the healthcare system in Canada @Cashmere Bandit, but I can sympathize in regards to pregnancy complications. I can only offer hugs and this piece of advice: Never stop advocating for yourself and your child. If at any time you feel you need a different doctor, second opinion or anything else, seek it. Nothing wrong with that!

 

Thanks, ladies. I think this will give me the... idk, buoyancy I need to really go after this issue more aggressively than I have previously. I'm not sure if I'm suffering from a touch of pre-partum issues but I've been having a lot of trouble feeling any "connection" or warmness about pregnancy, so as a result maybe I've let things that made me uneasy slide because I hadn't registered this as important. I think I can override that mean little voice now.

I'm sure if I went back enough pages I could track this information down for myself, but was switching more of a precaution or were you pretty sure going into it your second would need a NICU as well?

Just to clarify on the vastly different level of care to better explain how very different the two experiences we're talking about are - my local hospital's maternity ward has six-ten actual beds, no NICU, no nursery (although I'm under the impression this is becoming standard), no MRI, and only a handful of operating rooms total. The OB/GYNs have a terrible reputation for being catty with each other (every single one of them) to the point that they will tell patients to leave negative reviews of other OB/GYNs in various places. My co-workers had been expressing vague concern from day one about me delivering locally, but I sort of shrugged it off until the actual nurse seemed to agree with them. Mr. Bandit's older brother lives in Edmonton and has a spare room that's already been offered to us, so there is definitely a low-cost way for us to just stay in Edmonton near my due date (with people we like, even!) as long as COVID restrictions for private gatherings have eased a little by then. His parents/family in general are super supportive so finding a way to stay in or get to Edmonton is sort of the least concern here - which is maybe also worth bringing up when I talk about this to my endocrinologist.

Thank you. Sometimes, hug help more than anything else.

 

The birth of my first was a horribly traumatic experience and I could not repeat it. The worst was my two day old child being moved to a different hospital and being stuck where I was. Needing NICU was a guess at first but a reality when he was born at 27wks. He was never going to go past 37wks, and likely 34 by the time they found the IUGR and pre-e at 26 wks (which happened at 30wks with my first), which changed everything, obviously. I had tons of extra monitoring which likely saved us both. When he was delivered he has been failing NSTs for a week and barely passing BPPs for days.

I highly recommend talking to your pcp and/or a therapist about how you’re feeling. Prenatal mood disorders are the strongest predictor of post natal depression, and just having a support system in place will help so much if you need it. Even if it’s just knowing what to look out for and making sure your partner can help you get help.

I had ppd with my first and never treated it until a year before I had my second. PPD again but now I have a support system in place and am able to deal with it (and the reality of having a baby in a pandemic) much better.

 

What you just shared about the local place makes it really sound like going elsewhere is better, especially when you have a place to stay. No nursery is pretty common now, but the lack of other things are flags especially if you have a high risk pregnancy. Hell, I wouldn’t even want to deliver at a place where the people who have lives in their hands are that fucking petty.

 

My endocrinologist called on Friday. She said she was waiting to call till she had an emergency MRI date scheduled for me (and was already pissed about that not happening yet), but that my numbers look closer to normal so we're holding off on steroids for now.

I shared both what had happened with the fall and what the labour and delivery nurse said at the local hospital, and was probably way more emotional and freaked out than she's seen me before - she told me just sharing that I'd potentially blacked out and that I'm constantly dizzy was enough for her to send me for a high-risk referral in Edmonton with a strong recommendation and preference from her that I deliver there, but she agrees that the nurse commenting on it really reinforces the need. It will ultimately be up to the OB/GYN I consult with, but at least things are moving in that direction now.

Even if now I'm waiting for another phone call to schedule something this week.

Thanks again for the feedback and letting me have my mini-breakdown-word vomit here. I think it helped me verbalize things and definitely helped reinforce that I wasn't being unreasonable.

 

So glad to hear you’re on the way to feeling better about the plan for everything.

 

I have seen some things in my unit in my short time there. Even if you were having a low risk pregnancy and just wanted the peace of mind of a "better" (whatever that means to you) option - go for it and don't settle until you're satisfied with your OB. It's so necessary to have someone you trust. Don't let anyone else, including your doubting voice, tell you different. Good luck