QuestionI am 24 years old and this is my first pregnancy that I have carried to term. The date of my last menstral period is 1/09/2004. I am writing you because I am becoming quite concerned about the knowledge that my healthcare provider has concerning pregnancy and delivering. I am going to a clinic where you don't see a doctor, you see a nurse practioner and you don't see the doctor until you deliver. That in itself concerns me, however this is the only clinic my insurance will pay for, but what is really bothering me is the fact that I can't seem to get anyone to listen to my concerns. I am 39 weeks pregnant and I am only 5 feet tall and my husband is 6ft 4in. I know that seems irrelevant, but trust me, it is pertinent information. My cervix is not dialating past a one and from what the nurse practioner says, it is up high and over to the left. It isn't even lined up for a vaginal birth. There has not been any women in my family that have ever done natural childbirth due to the cervix not dialating and I am afraid I will fall into this category as well. They said if I dialate one more centimeter then they will induce even if my cervix isn't lined up properly and see how it goes from there, but if it doesn't then they are going to make me wait until 2 weeks past my due date before trying anything else. What concerns me about that is that the baby has already been estimated to be slightly over 8lbs and he is taking up every bit of space in there already. So much that he isn't moving nearly as much as he usually does. I have already been to the hospital about that and they said that his heart rate is still within normal limits and not to worry. My other concern is that I also have a history of fibroids, endometriosis, dysplasia, and polycystic ovarian syndrome and I have been experiencing some severe pain in my lower abdomen that is NOT contractions, they feel exactly like the pain I felt when I had fiborids and cysts rupturing, but they refuse to check me out or do another ultrasound because my insurance only pays for 2 ultrasounds during pregnancy and I have already had them so they don't think it is neccessary to check it out. And as if that weren't bad enough, I am having severe swelling to the point my shoes don't fit and I am seeing what to me can only be described as fireflies in my eyes on a regular basis. However, my blood pressure is still normal. I don't know what to do. I feel like they should either go ahead and try to induce and then possibly do a c-section or go ahead and schedule a c-section now. I am concerned for my health and the health of my baby if there are fibroids growing right now. I am really nervous about the whole thing. The last ultrasound I had was at 4 months pregnant and that was to see the sex. So they think because there were no fibroids present at the time of that ultrasound that it is unlikely that they are there now, but the last time I had them, I had just had an ultrasound 2 months before and there was nothing there, we discovered them when they ruptured. Please advise. How should I handle the situation? Am I worrying over nothing or should I be concerned? Please help. Thank you so much in advance. Have a great day.
AnswerEverything you mentioned is fine and you need not worry. Your height and your husband's height has nothing to do with your delivery. It will, of course, contribute to the height that your child will reach when it becomes an adult. The fibroids will not come into play during the delivery and you do not need another sonogram to evaluate the fibroids at this time, since there is nothing you can do until the baby is born. We usually do not do anything until a patient reaches her due date (not even induce you after you reach 2cm). As you approach your due date, you will start to have contractions. They may be every day, then every hour, then every 20 minutes, etc. They may be in your back or low down near your vagina. Eventually, the contractions will become more regular and will localize to your belly button. When you start having contractions every 3 minutes (from the beginning of the contraction to the beginning of the next contraction) at the level of your belly button, strong (feels like your forehead during a contraction), and each contraction lasts for at least 45 seconds (it will start out only lasting 30 seconds), and all of this lasts for a full hour, it is time to call your doctor and have your cervix checked. If the cervix has dilated further than 3-4cm, it is time to enter the hospital. Then you will gradually reach 5cm. After 5cm, you usually will dilate your cervix around 1cm/hour until you reach Full Dilatation (10cm). Then you will have to push the baby out. You will be allowed to push for 2-3 hours. If you cannot get the baby down and out within 2-3 hours, or if there is a reason to deliver you earlier, a cesarean section will be offerred. If you do not go into labor by 40 weeks, we usually start non-stress tests (NST) and biophysical profiles (which is a sonogram that assesses position, amniotic fluid, estimated fetal weight, etc). If there is any indication for induction, it will be donel If you do not show any signs of any problems to the baby, you can safely wait (and is recommended) until two weeks after your due date. Usually, to induce you, we insert a Cervidil suppolitory the night before and allow ripening of the cervix. Then, after 12 hours, pitocin is started to give you congtractions. This is continued until you deliver or have to have a cesarean. A baby is not considered too large unless it is close to 10lbs, however you will be given the option for a cesarean section if the baby is more than 9.5lbs. It is normal to be 1-2cm dilated for weeks prioir to labor starting. At 39 weeks, there is not as much room in the uterus for the baby to move around, but that is normal and so is the slowing of the fetus. (Of course, if you do not feel ANY movement in 24 hours, you should call your doctor and get a NST). Your prior history of PCS, endometriosis, fibroids, or dysplasia will not cause any problems, and even if you are starting to get pain in your abdomen, there is not much that can be done except analgesic therapy (Tylenol, etc). As long as you have normal blood pressure and no protein in your urine, foot swelling is a common problem. You must remember that there are rules that must be followed in the hospital and a cesarean section (or even an induction) cannot be scheduled unless there is an indication to do so. If something goes wrong because an inappropriate induction or cesarean was done, it results in terrible results. I would suggest that you merely follow the instructions of your midwife and, if you want more information, demand to speak to the covering doctor, but I believe everything is being done correctly, from what you describe. Good Luck.
