Two Week Warning

Today marks the beginning of my 38th week of pregnancy – only two more weeks to go until d-day, give or take.

For those of you who were wondering, the 36-week appointment went really well. Baby was head-down, face-back, and all his measurements were perfect. He weighed approximately 6 pounds, 8 ounces at that appointment, meaning he’s on track to be an 8 pounder when he’s born.

We did have a bit of bad news at the next appointment. My group B strep (GBS) test was positive, which means there is an increased risk of the baby having serious problems like meningitis or pneumonia. Yikes!!

I hadn’t even considered the possibility that the GBS test would be positive. It was negative with both Jackson and Gracie, and I didn’t really think anything of it this time. It turns out that many women experience positive tests for one pregnancy but not others – sometimes, it’s the first time around that it’s positive, while other times they will have negative GBS tests for the first pregnancies and then test positive in the 3rd or 4th pregnancy – but then be negative again for subsequent pregnancies. Because GBS is benign for most women, it can come and go without anyone knowing about it.

There is a very easy way to greatly reduce any risks to the baby from GBS – I can just get IV antibiotics during labor in order to reduce the population of the strep bacteria during delivery. But that means that I will definitely have to do two things during birth that I was hoping to avoid – have an IV (I know, I’m a wimp) and be at the hospital fairly early so that they can start delivering the antibiotics at least four hours before birth. It’s no guarantee that nothing will happen to the little guy, but it reduces the risk of GBS transmission from 1 in 200 to 1 in 4000.

I don’t like those odds.

Because we have extensive experience with reducing bacteria colonies, I had a number of questions for the midwife who delivered the crappy news. First and foremost, why would they wait until labor to treat the infection? The midwife’s answer was that “it wouldn’t work,” but that’s not entirely correct, according to the internet. The actual answer is that you can do oral antibiotics and eliminate the infection, but because the bacteria live in the intestinal tract, they can re-colonize at any time – so there is no guarantee that the infection would be gone at the time of delivery. She also told me that the only antibiotics they can use to treat this particular infection are penicillin, amoxicillin, or Ancef. Again, I know this isn’t true – even though GBS is slightly different than the group A strep that causes some of Gracie’s infections, it responds to most of the same antibiotics. So, yes, the “cillins” will work, as will Ancef, but there are other options that also target strep – Keflex, for example, which is a cephalosporin like Ancef, and Bactrim, and Cipro, and even the “big guns” – vancomycin and daptomycin and linelozid.

The new midwife didn’t know who she was talking to.

It’s not her fault that she usually delivers this message to people who have no medical knowledge and hadn’t adjusted the delivery for someone who can speak the language, but I do wish she had exhibited a bit more respect once she found out that I could communicate intelligently. It’s the same old thing as with many other doctors – they make the mistake of underestimating special needs parents. It’s a familiar battle but no less obnoxious.

The next question was a practical one, but related to the first. What happens if we don’t have four hours from the time we get to the hospital until delivery? She did not answer this question to my satisfaction, either. She said that we would have to stay inpatient for a full 48 hours after birth if we did not have four hours to deliver the antibiotics. While that may be true, again, the internet delivered a more comprehensive answer. Essentially, they want to deliver two IV doses four hours apart, so if there is not a four-hour window between arrival and delivery, they will only be able to do one dose, which is better than nothing but not ideal.

I did mention that if there were ever a family the pediatrician would discharge early, it’s us, since they know us so well and know we’d be on the watch for any unusual symptoms. The midwife chuckled but she didn’t seem to agree or understand what I was really saying. She has no idea about the extent of the medical experiences we’ve had with Grace. Again, it’s familiar but obnoxious.

Ultimately, this new wrinkle is upsetting and unfortunate, but as with everything else in life, we will get through it. I really wanted to have my ideal birth experience with this kid, since he will be our last, but that’s not going to happen. And that’s okay – after all, it’s MUCH more important that Elliot is safe than that I have my ideal birth experience.

I am still worried about his chances of contracting a serious infection, although it sounds like the chances will be greatly reduced if I can get to the hospital early. Chad commented last night that it’s “Grace trauma” rearing its ugly head, and that’s probably true. We went through so much with her (we still are going through so much with her) that the thought of doing it all again with another kid is exhausting.

I do have a plan that I’d like to propose to our regular midwife when we see her next Friday. If we can do a 14-day course of oral antibiotics, that should reduce or eliminate the GBS colony enough that it’s no risk to the baby at birth. Fourteen days would be more than enough, since they don’t want me to go past 40 weeks and I know I’ll be induced at 41 weeks at the latest. It doesn’t make sense to me to wait – because the only risk to the baby is if my vagina is colonized with this bacteria (which it still may not be; the colony may be solely in my intestines), why not eliminate the threat ahead of time and create a greater chance of him being healthy at birth?

I know our regular midwife will at least have an intelligent conversation with me. She understands that I’m not the average pregnant woman, and she definitely understands that Grace is not the average child – she was also traumatized by Grace’s birth, apparently, because she has mentioned many times particulars of the birth that continue to stand out to her nearly eight years later.

None of us is ever guaranteed a healthy child or a perfect birth. I am trying to remember that. But in the meantime, I’m saying lots of prayers that Elliot is as healthy as possible, knowing that the outcome is beyond my control. Hang in there, little guy! We’re going to do the best for you that we can.

 

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