36 week OB appt

My appointment went really well today!!!  I am only a little bit more effaced and possibly a little more dilated (the doctor didn't want to push things to their limits when measuring because he wants me to make it another week), and I am officially off of bed rest!!!!  Well, kind of.  I'm supposed to "take it easy" for one more week, but my doctor said that I can get up and do a few more activities (nothing strenuous).  For example, he specifically said I am not allowed to work out.  But he did say that I am allowed to take the dog for a short walk.  I think that I have been abusing some of my newfound freedom, however.  Immediately after leaving the OB's office I went shopping.  First, I went to Half Price Books with Keith to sell some books (Yeah!  $2!).  Then I went to Target to pick up a couple of Christmas gifts.  I have had these gifts in my mind for a few weeks, but have not had permission to shop.

When I got home I took a long bath.  My discharge instructions from the hospital said that I was not allowed to take baths.  I was extremely disappointed because just a few hours before receiving my discharge instructions I had told Keith about how excited I was to go home and take a nice, relaxing bath. But today I made a point to ask the doctor if baths were allowed, and they are!

Next, I set to reorganizing the nursery.  I have been haphazardly sticking items into drawers as they have been arriving.  But there was no real system of organization.  Thankfully, I now have a stocked diaper bag, nursery items are organized by category, and I was able to get rid of some unnecessary items.

While in the nursery, I discovered some iron-on transfers that I bought several months ago.  I had also bought some plain, white onesies.  I figured that now was as good a time as any to do my next craft project!!!  Unfortunately, I have never been very good at iron-on transfers, and today was no exception.  The package instructions said that I needed to iron on top of a hard surface.  It said that if your ironing board had a soft pad on it that you should place something hard on top of it like a chopping board.  Apparently they meant a wooden chopping board, because my plastic cutting board melted to the first onesie.  I had it almost completely removed by peeling slowly, but it tore as I was trying to pull the last dime-sized section from the board.  The iron-on for onesie number 2 did not transfer completely, so there were holes in the middle of the pattern.  The iron-on for onesie number 3 had two layers: layer 1 was dark blue and layer 2 was metallic to make the letters shiny.  Unfortunately, the second layer transfered on half of the pattern, but not the other half.  The iron-on for onesie number 4 began traveling across the fabric and so I have a smeared pattern.  Baby might wear onesies 2-4 when running short on laundry because they aren't horrible, they are just bad.  Thankfully, my favorite design is the one that transferred the best (it says "Future Tree Hugger" and has a koala bear holding onto a tree), but my second favorite design is the one that smeared ("My Stroller is a Hybrid").

I figured that updating my blog would be a good rest, but now it's time to prepare dinner!  (Preparing dinner isn't as strenuous as it sounds - we still have quite a few leftovers from last week's festivities.)

Baby = Pain in the back

No, I don't mean she is a pain in the back figuratively.  I mean it in the literal sense.  I have been in nearly constant pain since I woke up Saturday.  I thought things were getting better yesterday, but then I overexerted myself (read: I folded some clothes while reclined on the couch with my feet up), the pain got worse and has not gotten better since then.  Every time I move now I either get cramps or low back pain.  I have a doctor's appointment this afternoon, so I will find out the verdict then.  Thankfully, tomorrow I will be 36 weeks, and while that is still a little bit pre-term, one of the doctors at the hospital said that at that point I can start doing cartwheels if I so desire.  I might not do cartwheels, but I will probably try to organize the nursery better, clean out the refrigerator, and cook some food that we can freeze and then reheat over the next several weeks.

The only other change has been on the scale.  I was down 18 pounds when I came home from the hospital.  I am now down less than 9 (in less than 2 weeks).  And no, I did not overindulge on Tofurkey Day - Gwen's position and size prohibit eating too much.  However, my wedding ring no longer fits (I can manage to shove it on my finger, but if I keep it on for longer than 2 minutes it is almost impossible to remove), my shoes are tight, and my lean body mass percent has risen 1% since I got home from the hospital.  That last point may seem puzzling if you don't know how body fat/lean body mass percent works on home scales.  The scale creates a circuit from one foot to another.  In order to create the circuit, however, it has to travel through all your fat, muscle, bones and blood.  Muscle contains lots of fluid, while fat contains little.  Therefore, fat has a higher resistance than muscle (electrical signals travel well through fluids because of all of your little ions that are floating around).  If you are dehydrated and you step on the scale, your body fat percent will read too high, and your lean body mass will read too low.  If, however, you are retaining water in your legs, the muscle percent will read too high.  This is how I have "gained" 1% muscle mass in the past 1.5 weeks despite being on bed rest.  And because I'm not out of my teaching mode quite yet I will offer one more snippet of information about body fat percent measurements.  If you use the scale, it only measures body fat in the lower part of your body (the circuit goes from one foot, through your leg, through your hips, down the other leg, into your other foot).  If you use a handheld body fat meter the circuit goes from one hand, through your arm, chest, other arm and into your second hand.  Therefore, if your fat is not evenly distributed in the top and bottom halves of your body, you are likely to get a high or low reading.  Also, I would question the accuracy of any percentage a home scale offers - I use mine not to monitor actual percentage, but to follow trends.  I can tell if my body fat percent is climbing or falling, but I don't believe it is providing my true body fat percentage (it is precise, not accurate).  If you want a better test of body fat percent that does the top AND bottom halves of your body, you do something called bioelectrical impedance in which you have one electrode on your left ankle and the other on your right arm.  But you still run into problems with dehydration.

Our movie picking ritual

Keith and I had a bit of a movie marathon yesterday.  With me being on bed rest (and making 2 Christmas gifts as well as working on a cross stitch for Gwen's room), him putting up all of our Christmas decorations (which took about 8 hours; we have a lot of decorations), and the poodle being glued to my lap since he was brought home from a 2 1/2 week trip to grandma and grandpa's, a movie marathon just made sense.  We watched Elf, Sweeney Todd, Far and Away, The Peacemaker, and Terminator Salvation.

Keith and I have somewhat different tastes in movies that I think mimics our differences in musical taste.  In music, he loves Journey, Kelly Clarkson, and Beyonce.  I like Iron & Wine, Regina Spektor, and Florence + The Machine.  Notice, he likes mainstream rock and pop and I like the more independent, or as Keith calls it, "weird" music.  The same goes for movies.  I do like a good popular movie, but I am also far more likely to sit down and watch a documentary or independent (read in Keith-speak as "weird") movie.  He, on the other hand, has a list of popular series of movies that he always gravitates back to whenever we are discussing what movie we should watch.  Here is how the movie choosing discussion typically goes in our household:

Keith: What do you want to watch?
Me: I don't care.  Let's watch whatever you want to watch.
Keith: Whatever I want to watch?
Me: (Knowing the danger of answering yes to this question) Well, within reason.
Keith: The Lethal Weapon movies?
Me: No
Keith: Back to the Future?
Me: No
Keith: Any of the Terminator movies?
Me: No
Keith: Something with John Wayne in it?
Me: No
Keith: Dirty Harry?
Me: No

So as you can clearly see, I didn't really mean it when I said that we could watch whatever Keith wanted to watch.  What I really meant was that I didn't feel like using my brain power to think of a movie to watch and I wanted Keith to suggest something up my alley.

The next step in the movie picking process involves Keith mentioning a movie and me agreeing to it.

Keith: Do you want to watch Bride Wars?
Me: Yeah!  That sounds good!
Keith: Really?
Me: Do you not want to watch it?
Keith: Not really.
Me: Well, then why did you suggest it?
Keith: I don't know.

After about 15-20 minutes of looking through our DVDs and Netflix instant watch list, we finally decide on a movie.  Usually, the movie is a bit more of a "Sara pick" than a "Keith pick" since Keith is nicer than me and more willing to give in.  So I told him last week that when he is on paternity leave we can watch all of the movies that he wants to see (I'll probably be so sleep deprived that I won't even care, and will likely fall asleep anyway).  But yesterday I started feeling generous a bit early (he had spent over 8 hours turning our living room into a winter wonderland) and told him that we could watch one of the movies that I usually veto.  That is how we came to watch Terminator Salvation.

I am fully willing to watch Terminator 1 or 2 from time to time - they are classics.  But time to time means no more than once ever 1-2 years.  Terminator 3 and 4 should not have been made.  Terminator 4 (the one we watched yesterday) reflects a Michael Bay film.  There is a lot of fancy cinematography, and you can't always figure out quite what is going on since the camera cuts quickly from one shot to the next.  Also, there is not much of a story line; it's all about the action sequences.  If you can't tell by my description of Michael Bay movies, I don't really care for them.  Thankfully, Keith doesn't like them either, so we spent much of the movie making fun of it or pointing out the unrealistic parts (which have to be pretty unrealistic for us to comment on them when we are watching a movie about machines taking over the world).

SPOILER ALERT: So when we got to the end of the movie we were both ready to pounce on anything.  At the end of the movie, John Connor's heart is failing and he is going to die.  The half-robot-half-human character volunteers to let Connor's wife take his heart to perform a heart transplant.  And the following reaction is one of the reasons that I love us together:

Keith (the doctor): Yeah, because I'm sure that they have all of the supplies that they need to perform a heart transplant just sitting around.
Me (the former transplant immunology PhD student): And I'm sure that the robot-man is a perfect immunological match for Connor.
Keith: And they probably have enough immunosuppressive drugs sitting around in their tent that he will be able to take them uninterrupted for the rest of his life.
Me: And I'm sure that her training as a veterinarian makes her completely qualified and competent to perform a transplant on a human.

That is a pretty typical conversation in our household, and I love it. :-)

I think I spoke too soon

So maybe my medicine was not as marvelous as I thought.  Within about 30 minutes of writing my last post my symptoms came back with a vengeance, and have now been present for almost 6 hours.  My in-laws are coming into town tonight and I was joking with my father-in-law on the phone earlier that the last time my mother-in-law came into town I was sent to the hospital as she was entering the city.  Hoping that doesn't happen again! 

Marvels of Medicine

I have felt much better since yesterday.  Things have calmed down quite a bit, and I no longer feel that Gwen's birth is imminent.  The doctor increased my dose of my tocolytic on Monday (he had previously decreased it because it caused heart palpitations) and since the increased medication kicked in I have had decreased symptoms, and thankfully no palpitations.  This year for Thanksgiving, I am thankful that I am still pregnant, and despite progressing some, Gwen still seems to be waiting a bit longer to be born.

Another thing that I am thankful for is that Simba is coming home today!!!  He has been at grandma and grandpa's being spoiled for the past 2 1/2 weeks, and I am so excited that I get to see him tonight.  We may have to break a couple of habits that he learned on his vacation.  He will not get daily peanut butter from me like he does from grandma Lou and I will not hand feed him his dog food like grandpa Big Guy.  But he will be spoiled in other ways.  I have missed him so much that I will probably make him sit on my lap during the whole holiday weekend to get forced belly rubs. :-)

35 weeks...almost

I had a doctors appointment today.  I was a little bit worried because since yesterday I have had preterm labor symptoms with increasing severity and frequency.  The doctor told me that I have progressed some - I'm now 4 cm dilated - but that at midnight tonight I will reach the final milestone that he wants me to meet before giving birth: reaching 35 weeks.  We'll see if these symptoms continue to get worse, or if yesterday and today were somewhat of a hiccup in my pregnancy.

Before my symptoms started getting worse yesterday I felt "off."  I don't know how to describe it, but I started to seriously think that baby might be born in the next few days.  I shrugged it off because I have feelings that things are going to happen all the time, and it is usually just me worrying.  But if you worry about things enough, one time you are going to be right.  While it wouldn't be the end of the world, I hope I'm not right this time.  This baby could use a couple of more weeks on the inside.

Pros and Cons of Home

I have now been at home for about 3 days, and I have noticed that there are some good things and some bad things about being at home:

Pro: The food is better

Con: I have to make my own food instead of it being delivered to me in bed

Pro: I have more freedom to move around and get out of bed

Con: I abuse that freedom and bend the rules of bed rest a little bit.  I have been pretty good, but it is really tempting to sometimes get up and unload the dishwasher or organize a few things.  I haven't been up for more than 15 minutes straight more than a couple of times a day, however, which I think is permissible because I have shower privileges and a shower takes about 15 or 20 minutes.

Pro: I have all of my stuff

Con: I have all of my stuff and it distracts me from what I should be doing

Pro: No more monitoring, shots, or interruptions.  I have been able to sleep much better in my own bed

Con: No more monitoring, so I don't know if certain things are normal or not.  I guess if what I have been feeling is not normal I will find out if I have progressed at my OB appointment on Monday afternoon.

Pro: I have very few responsibilities

Con: One of my normal responsibilities is Simba, and he is not a responsibility right now because he is visiting his grandma and grandpa.  I miss him. :-(  Thankfully, he is coming home the evening before Thanksgiving. :-)

Pro: I have much more privacy at home

Con: Part of that privacy is from Keith because he can't swing by and see me during the day.  I don't need privacy from Keith - I would prefer seeing more of Keith.

Pro: I don't have to sit on that light blue "soaker" that they put on hospital beds in case of accidental fluid losses (like if you pee your bed)

Con: If my water breaks I'm not sitting on one of those soakers (Keith said that he is tempted to smuggle one out of the hospital for home use...just in case; it can always be returned after the baby is born).  Question: How do you prevent ruining furniture if your water breaks when at home?  Do you just hope that you aren't sitting on the couch or laying in bed?  But what if you are?  This is really concerning me and I would like to know what other people have experienced if you are willing to share.

Normal Pregnancy or Preterm Labor?

One of the problems with the symptoms of preterm labor is that they are very similar to the symptoms of normal pregnancy.  Two of these symptoms that I have been struggling to decipher are nausea and back pain.

Back pain is something that pretty much all pregnant women experience.  Preterm labor back pain is slightly different in quality and location from most back pain.  It is a low, dull back pain.  However, what if you just happen to have a sore lower back?  I have gotten a sore lower back when not pregnant by slouching in a couch or chair, so might my slouching now be causing me low back pain?  As for the quality of the pain, it is really hard to determine what is causing it.  It can either be musculoskeletal, gastrointestinal or preterm labor if you have dull pain in your lower back.  This one has been a bit tricky, but I think I have been able to determine the difference between a more superficial pain (musculoskeletal) and a deeper pain (preterm labor or GI pain - however, if no GI symptoms show up in the hour after pain I assume it is preterm labor pain).

The other tricky symptom is nausea.  I had morning sickness until I was 26 weeks pregnant.  This caused me to lose about 18 or 20 pounds (depending on how well hydrated I was).  I didn't gain any weight until I was 29 weeks pregnant, at which point I gained 3 pounds before my 32 week appointment (the one where my OB sent me to the hospital).  I was still nauseated about 1-2 days each week, but the other 5-6 days I felt pretty good.  While in the hospital I lost weight (this is a pretty normal occurrence, but I am now back down 18 pounds), and I also developed a new symptom of steady nausea.  I have had nausea every day since last Friday.  If I don't eat it usually isn't that bad.  But once I eat the nausea gets worse.  I thought part of the problem is that at the hospital I was forced to eat on a specific timetable, mostly at times when I was not hungry.  But now that I am at home I am still becoming nauseated whenever I eat, however much less so now that I am able to choose when and what I eat.  So my question is this: is this just par for my pregnancy course, or is this a symptom of preterm labor?  If my morning sickness would have gone away at the end of my first trimester, as it does for many pregnant women, I would attribute this to preterm labor.  However, there has been nothing normal about my pregnancy nausea, so this might just be my normal.

I guess it doesn't really matter if these are normal pregnancy symptoms or if they are pre-term labor symptoms.  I am on bed rest.  I am taking a tocolytic (a medication that calms down your uterus).  And if I were to go into labor today despite these interventions they wouldn't do anything to stop it - they would just let things run their course.  I guess I will mention these symptoms to my doctor at my next appointment, but I'm not going to sweat over them because worrying won't change a thing.

coolest thing ever - I'm not exaggerating

While I understand how this works from a medical and scientific standpoint, I was still somewhat taken aback when the doctor told me.  I was being examined by the doctor for dilation and he said, "I can feel the baby's head."  What?  My baby is supposed to be closed up safely inside my body.  You aren't supposed to be able to poke it in the head!  It makes sense that when you are over 3 cm dilated that you can feel the baby, but as a soon to be mommy it was probably the coolest thing I have ever heard.

Going home

I am being sent home on modified bed rest this afternoon.  This essentially means that for the next week I will be doing pretty much the same thing at home as I am doing in the hospital.  The doctor said I can walk around a bit more than I do here because I am at 34 weeks and they also understand that I have to fend for myself at home much more than I do here.  In 1 week I can add a little bit more activity (I will still be on bed rest, but if I have to get up to do things I am allowed slightly more time out of bed).  At 36 weeks he said I can start doing cartwheels as far as he is concerned, which is fine by me.  I am tired of being in bed.  I am sad that I lost 4 pounds of muscle over the past two weeks.  I have never wanted to work out more in my life than I do right now...the eliptical is calling my name.  36 weeks - the first week of December does seem to be a pretty good time to have a baby. :-)

Privacy

I woke up a bit grumpy this morning.  Sure, part of this has to do with the fact that I woke up at 3:30 and couldn't convince my body that it needed more sleep.  So at 3:45, I rolled out of bed thinking that a warm shower might send my body the message that it was still bed time.  When I came out of my room, I saw that the screen saver was no longer up on the nurse's computer - this meant that she had been in my room charting on me while I was in the shower.  I knew that it wasn't time for her to chart on me yet because she is supposed to check on me and chart on me once an hour, and she had been to my room at 3:40 (I had pretended to be asleep because 1.) I wasn't in the mood to talk to her, and 2.) I figured that if I talked to her it might wake me up more and that there would be no way of going back to sleep).  I had specifically gotten up at 3:45 for my shower in order to avoid her.  Apparently she remembered something she had to do in my room, or she had heard the water running in my bathroom.  Either way, she was in my room and she was writing about me.

This charting has made me more and more irritable over the past few days (if you have seen my last two blog posts you would know some of the background).  This morning, as I was laying in bed after my shower, slightly bitter at my nurse for charting that I was in the shower in the middle of the night, I realized the reason for my grumpiness.  I have no privacy.

I understand that I am in the hospital, and not having privacy pretty much comes with the territory.  However, it wears on you after a while.  I am getting tired of being around people.  Not the people who come to visit me - I love to have visitors.  It is fun to see friends and family and it sure makes the time pass by much faster.  Not Keith - I think I would be going crazy here if it weren't for the fact that aside from 6 hours where he has gone home to take care of a few things, he has been in my room constantly, aside from going to work, since last Monday morning.  But I am getting tired of people checking on me each and every hour.  I am trying to not be annoyed, because I realize that it is their job and this is the reason that I am in the hospital.  However, I wish they would just come in to give me my medicine and to put me on and take me off of the monitor (this would only require them to enter my room 8 times each day).

Part of the reason that I get a little bit annoyed is because I am low maintenance.  I don't need people doing things for me once an hour.  If something is really all that urgent I will push my call button to get in touch with my nurse.  If I do not need medicine or monitoring I will let you know if I actually need you.  I think I am the exception and not the rule, as many of my nurses tell me that I am a really easy patient (granted, I'm just kind of along for the ride right now; many people in high risk maternity are much higher risk than me).

What bothers me more than the hourly checks from nurses (and it does happen every hour - I have a TV in my room that I have tried to watch all of 4 times because I have not yet made it through an entire TV episode without being interrupted...and I refuse to leave the TV on while someone is in my room providing me health care because that was a big pet peeve of mine during my internship.  Well, that and cell phones) is the interruptions from people bringing fresh linens and newspapers.  Please stop coming to my room and asking me if I want to buy a newspaper!  I really feel like it is in poor taste.  My medical care is probably costing about $20,000 to $25,000 for this two week stint.  You really can't throw in a free newspaper?  As for the people who bring fresh linens, they are usually male.  This wouldn't bother me if they would knock and wait for an answer before coming into my room, but most knock as they are opening the door.  One opened my door this morning without even knocking.  I thought it was Keith coming into my room because he doesn't knock, and then I saw a man arm that I didn't recognize.  It wasn't a big deal because they only open the door part way (the towel cabinet is just inside the door of my room), but I would be really angry if one of my healthcare providers were doing a womanly medical procedure on me (which has happened a few times since I have been here) or if I were changing clothes in my room (which I learned not to do pretty quickly - now all clothes changing takes place in the bathroom...but what do people on complete bed rest who don't have bathroom privileges do?).

This is a long term floor, and the nurses tell the patients to treat the rooms like their own apartments (bring in pictures, plants, blankets, decorations, but no dogs - they used to allow dogs but one bit a nurse and she was out of work for 8 weeks), but how am I supposed to do that when strange men are coming into my room multiple times a day?  I don't care if male doctors or nurses see me in less than flattering situations because they are my healthcare providers.  But I really don't need the guys delivering towels to barge into my room whenever they want.

So this is what has been bothering me.  I am tired of the lack of privacy.  I am kind of nervous about going home tomorrow (possibly, if everything goes well today), but at the same time, I am ready for a break from being cheery and presentable at all hours of the day and night.

More charting paranoia

I found out last night before bed that the nurses chart my activities.  One of my nurses was complaining because the options provided for them to choose from didn't cover my activities.  "They don't have crafting or working on the computer on here!"  Apparently she can choose between options including talking on the phone, visiting with family, sleeping or watching TV.  The computer charting system thinks that I can't be productive while in the hospital.

Charting paranoia

I don't think that I ever realized just how many things nurses keep track of in regards to their patients.  I have charted before for nutrition evaluations, but all I have to talk about is someone's diet.  If it doesn't have to do with their eating or bowel habits, it likely won't be in my note (unless there is some psychosocial issue affecting eating or nutrition).

Nurses, on the other hand, are responsible for keeping track of the person as a whole.  After I had been in the hospital for about 5 days, one of my nurses said, "Let me know when you are ready to take your shower so I can change your sheets."  I figured that this was just because my sheets hadn't been changed in about 3 days (I hadn't requested to have them changed because I don't change them every 3 days at home so I figured that I wouldn't request others to change them that often), and it would be a convenient time for her to change the sheets while I was out of bed.  But when I got out of the shower, not only were my sheets changed, but my nurse came back into the room and charted that I had taken my shower.  I had been taking daily showers since my second full day in the hospital, but I hadn't even thought about telling them when I was taking my showers.  Often my hair would be dry before my nurses would see me again, so I have a feeling that it looks, according to my medical record, like I didn't take a shower for 5 days.  Since then, I have still been taking daily showers and my nurses have seen me with wet hair 2 times and asked if I had showered.  My nurse asked me again today to inform her when I take my shower so she could change my sheets.  So in the last 11 days it looks like I have only taken 4 showers, according to my chart.

I didn't realize that they were monitoring my food intake until today.  I know that for some patients we (the dietitians and me) would ask that the nurses estimate how much of the meal that the patient ate to make sure that they were eating enough.  However, it never occurred that they might be keeping track of my intakes.  It makes sense that they would track it because I am a pregnant woman and they want to make sure that I am eating enough.  But if they have been tracking my intakes since I entered the hospital, I can tell you that their records are completely wrong.  For one thing, I often don't feel hungry when they bring me my tray.  As a third trimester pregnant women, it is recommended that I eat 6 small meals a day instead of 3 large meals.  This hospital's meal service is not amenable to that.  They send 3 meals: Breakfast at 8:00, Lunch at noon, and Dinner at 5:00.  I am usually not hungry at these times.  They wake me up at 6:00 am every day to do fetal monitoring, so I am usually hungry by 7:00 am.  I have a snack drawer right next to my bed, so I either give in and eat a snack at 7:00 making me not very hungry by 8:00, or I hold off until 8:00 and eat my entire tray of food.  An entire tray of food is really too much food, so when noon rolls around I am usually not very hungry.  However, I tend to like the food served at lunch more than the food served at dinner, so I try to eat the food because I know that I might be getting a bad meal later.  I usually save a couple of items off of my lunch tray to give to Keith when he comes to visit me at 1:00.  But then dinner is a 5:00 - way too early.  I am accustomed to eating dinner at about 7 or 8 at night, and I am not hungry at 5:00 because I ate at noon when I wasn't hungry in case dinner was bad.  So I usually give my entire dinner tray to Keith.

Even when Keith and I don't eat my entire tray, I take certain items off of my tray to store in my mini fridge.  I figure that Keith or I might be hungry later, and there is no sense in throwing away food we might eat.  The kitchen here is probably wondering why some dish or piece of silverware goes missing from my tray every meal.  And at other meals they end up with 2 extra plates on my tray because Keith or I eat something from my refrigerator.  Long story short, usually 100% of my tray is cleared of food.  Some of it ends up in my belly, some if it in Keith's, some of it in my night stand, and some of it in my refrigerator.  Furthermore, I have acquired food from the outside through guests, my baby shower, and Keith (he brings me small items from the cafeteria periodically - the food in the cafeteria is much better than the food on the trays - and he also brings me free food left over from resident lunches).  I often eat this food instead of the food from the trays.  There is no way that the intake estimates are accurate in any way.

I didn't realize until today that they are tracking my eating habits.  And frankly, the more and more that I find out that they chart about me, the more and more paranoid that I get.  At home I might miss taking a shower one day.  But here, there is no way because I know that big brother is watching.  At home, I have a rule that I will eat what I want when I want it (within reason - I won't go and eat a dozen chocolate chip cookies) because I have struggled with losing and failing to regain weight this entire pregnancy.  I figure that I will change this strategy if I start to gain weight too quickly, but given that I still have entire days of nausea, I doubt this is the case (today was one of those days, causing me to not eat anything from my lunch or dinner trays and to send Keith down to the cafeteria for ice cream at around 3:00).  Here I feel like they are judging my every meal: "Is she eating enough?  Is she eating too much?"

Finally, I found out that each and every hour, they are charting on my position in bed: am I sitting up, laying on my left side, my right side or my back?  How high is the head of my bed?  This is important because the best blood flow occurs when on your left side and the worst is on your back.  I refuse to lay flat on my back, but I will lay on my back if I have the head of my bed elevated.  However, I don't want my medical record to read that I am cutting off the oxygen to my baby by laying on my back.

I sure hope that they don't let me know anything else that they are keeping track of.  I am already modifying my showering, eating and sleeping habits because I want my chart to show that I am a good soon-to-be mommy.  I realize that no one is combing through my chart to check my showering or sleeping trends, but knowing that they are writing it down makes me paranoid that they are tracking and making judgments regarding if I am a fit future mom.

Pregnancy nostalgia

I started feeling pretty nostalgic this morning.  It might just be the pregnancy hormones, but I saw a commercial for a pregnancy test and started to feel all warm and fuzzy inside, thinking back to 7 months ago.

I found out that I was pregnant super early.  Keith and I had been trying for a few months, and I had been reading quite a bit about the early signs and symptoms of pregnancy.  I had my first sign about 10 or so days after my period (this is super early, but at the risk of providing too much information, which I have already done several times in this blog, I have a really short cycle, which adjusts the time tables for everything associated with early pregnancy).  There is something called implantation bleeding where the fertilized egg implanting in the uterine wall causes a teensy bit of bleeding.  I noticed this and got really excited.  In fact, one of my friends facebooked me around that time (after bleeding, before pregnancy test) and I told her that I thought I might be pregnant, but it was too early to take a pregnancy test so I wouldn't know for about another week.  It turns out I was right!

I became a little bit OCD with pregnancy tests.  I calculated the amount of time it would take for pregnancy hormones to reach detectable levels (hormone levels double daily), added that to the day that I started bleeding, and decided that would be a good first day to take a pregnancy test.  However, I was too impatient for that, so the day before the day that I had come up with from my calculations I took a pregnancy test.  It was negative.  But that didn't discourage me.  I went out and bought another box of tests and decided I would retest the next day (the day that I had calculated).  The next day (two Tuesdays before Mother's Day) I took another pregnancy test.  It was around noon, and after 2 minutes the test was negative.  But after 10 minutes the test was maybe positive.  The problem with this is that you are supposed to read the test in a certain window because if you wait too long to read it you can get a false positive.  So I decided that I would test again the next day.  I didn't quite make it to the next day.  I made it until about 6 pm before I became impatient enough to test again.  That time, the test looked maybe positive after about 5 minutes (the line was faint).  Once again, I was out of pregnancy tests, and didn't have a definitive answer.  I decided that I was having too much trouble reading the tests with the little lines, so I would get some digital tests.  But then I was worried that the digital tests wouldn't work right, so I also bought some more of the tests with the little lines.  I retested the next day on one of the digital tests and it said "Pregnant!"  Then I wanted to confirm the test, so I took another test with the little lines.  Both lines showed up! (Yes, you counted correctly.  At this point I had taken 5 tests.)

I decided it was time to go shopping!!!  Mother's Day was only 2.5 weeks away and I had some soon-to-be grandmas to shop for!!!  I made my way to Halmark to see if they had any good grandma items.  I found countdown calendars that said "XX Weeks Till I'm A Grandma."  I figured that would be a good way to announce my pregnancy!

Then I went home because I had to prepare to tell Keith.  I had already bought a couple of baby items that I was going to wrap up.  I was going to have Keith open the present and gather from the items in the box that he was going to be a daddy.  I had purchased some baby fire boots (Keith is a volunteer firefighter whenever we go home to visit his parents, and has been for years) and put them on the feet of a little baby Eeyore stuffed animal.  I made a trifold diaper for Eeyore and put him in the box.

Keith came home that night, opened the gift, and didn't understand right away.  He looked a little confused regarding why I bought him a stuffed animal and fire boots.  I think he may have been in disbelief, and just hadn't let it sink it what a stuffed animal and miniature shoes might mean.  I told him that he was going to be a dad. :-)

A couple of days later, Keith's parents came into town.  We decided to tell them on Saturday night by giving Keith's mom her mother's day gift.  But before we told them I decided that I wanted to take another pregnancy test, just to be sure.  Early in pregnancy, you never know what might happen, and I didn't want to tell Keith's mom that she was going to be a grandma and then her not become one.  But test number 6 was still positive!  We gave her the gift, she opened it, and said to Big Guy (Keith's dad), "I told you so!"  Apparently by taking a 3 hour nap Friday afternoon, and then shopping with Lou (Keith's mom) and mentioning that I had been craving pickles (a normal craving for me when not pregnant...sometimes you need a little low calorie salty snack) she had decided that I was pregnant.  I told my mom in a similar way on mother's day, and I told my dad and his wife by sending them a book about going to grandma and grandpa's.

I wasn't done with the pregnancy tests, however.  I scheduled a doctors appointment for when I was 4.5 weeks pregnant in order to get a blood test done to confirm that I was pregnant.  But before going to the doctor I wanted to make sure that I was still pregnant.  So then came pregnancy tests 7 and 8.  Yes, during the month that I found out that I was pregnant, I took 8 pregnancy tests.  But I figured that I might as well use them up since pregnancy tests have an expiration date, and I was pretty confident that we wouldn't try to have another baby before they expired.

So that's the story of how Keith, his parents, my parents, our siblings and I found out about Baby Gwen. 

Why I'm Really Okay with Staying In the Hospital

I was told by the doctor this morning that he likes to play things conservatively and would feel most comfortable if I stay in the hospital for one more week, until I'm 34 weeks pregnant.  He seemed apprehensive to share this information with me, most likely because most people in this situation would be  chomping at the bit to get home.  However, I had already resigned myself to the fact that I am in the hospital, it is the best place for me to be, and I will likely be here for a while.  Here are my reasons why I am really okay with staying in the hospital for one or more weeks:

1. I have people cooking for me.  True, the food may not be great, but I am learning with each and every meal which items I should order and which I should avoid.  If I get a truly horrible meal, Keith can always run down to the cafeteria and use some of his meal stipend to get me a replacement item.

2. I have people cleaning for me.  I can get clean bed linens as often as I desire.  I also have people who come in daily to take out the trash, mop the floor, and clean my bathroom.  At home, the house would slowly deteriorate into a state of mess since I would be unable to clean up after myself (however, I do realize it would get less messy than usual since it is pretty hard to make a mess when you are restricted to bed).

3. I don't have to remember when to take medicine.  I have nice nurses who keep track of that for me and tell me it is time to take a pill.

4. I am less likely to get blood clots.  I currently am being given heparin, wearing TED hose (anti-clotting socks), and have "space booties" that inflate every few seconds to simulate walking.  At home I would likely only have a blood thinner and my own initiative to keep blood clot free.

5. I enjoy both eating and going to the bathroom every day.  At home I can either lay down in bed on the top floor of our house, where the bathroom is located, or I can lay on the couch on the main floor of our house, where the kitchen is located.  There is no kitchen on the top floor and no bathroom on the main floor.  This means that I would have to take stairs several times a day in order to accomplish both eating and bathroom while I am home alone.

6. I have seen Keith more in the past week than I had in the previous several months.  It is nice that he is a doctor in the same hospital in which I am a patient.  He swings by between cases and before he has to go to conferences.  He is also working just 2 floors away in the same wing of the hospital, so if I need him for anything he can be here in about 3 minutes flat.  At home, I could go all day without hearing from him.  In the hospital, I am becoming spoiled by seeing him every few hours.  Also, he is doing his Anesthesia rotation so he wears scrubs every day.  That means that his wardrobe is provided on carts distributed throughout the hospital.  He also has a meal stipend, so he can get food from the cafeteria around the clock.  If he stays at the hospital with me, he gets an extra hour each day to visit with me or sleep, since he doesn't have to drive back and forth from home.

7. At the hospital I am seconds away from health care.  At home, I would either have to drive myself to the hospital (I doubt they will give me driving privileges though, since right now I only have bathroom privileges), call an ambulance, call a friend who lives a good distance away from us and may or may not be at home, or rely on the nice woman who lives next door to me but has dementia to drive me to the hospital (they took her car keys away from her a couple of years ago, so I don't think that she would be the best choice of a driver).  Being close to health care is very much a benefit at this point.

8. Peace of mind.  While it would be nice to sleep in my own bed, I would likely instead lay awake and worry in my own bed.  If I have any concerns that something isn't "right," I can push my nurse call button and ask them to examine me.  At home I would just have to wonder, or find a way to my OB's office or hospital.  Furthermore, if baby were born today, it would be much better to be down the hall from the NICU than to accidentally give birth at home and be 20-25 minutes away.

So, while it's a bummer, I prefer staying in the hospital to going home right now.

Wimpy Little White Boy Syndrome...why I'm glad we're having a girl

We have all heard that girls mature faster than boys.  However, this happens much earlier in life than most people realize.

In the world of the NICU, nurses and doctors from all over the nation know about the wimpy little white boy.  For some reason, caucasian male premature infants do not do as well as little girls.  Furthermore, babies of other races tend to do better than white babies (although, girls still tend to outperform boys).  From what I've been told, here is the hierarchy of babies from the largest two racial groups in the US (I don't know how other races fit into this scheme):

Black girls
White girls
Black boys
White boys

So there you have it!  Little girls tend to be more advanced and heartier than little boys (perhaps the sugar and spice helps in some way).  Advanced, in a teeny tiny baby may seem like a foreign concept.  I mean, they aren't doing calculus or running marathons.  What does it mean to be more advanced, or to mature faster, as a preemie?  At this point in gestation (33 weeks tomorrow), it means that our little diva will likely figure out how to coordinate her suck, swallow, breathe reflex faster than if she had a Y chromosome.  This could either get her from feeding tube to eating from a bottle, or from the breast, faster, or could prevent the feeding tube entirely.  Avoiding the feeding tube is a big reason why we are holding out for 34-35 weeks (as long as Gwen will allow it since she is the boss at this point).

So this is why we are glad that we are having a girl.  Plus, the shoes are much cuter. :-)

Hospital/Baby Update

I can't believe I am going to say this, but the reason you didn't hear from me via blog yesterday is because I was so busy I had absolutely no time!!!  This is a major blessing in the hospital.  I thought I was going to go crazy on Thursday morning because at that point few people knew I was in the hospital and I felt pretty lonely and uncertain about what was going on.  Since then, the outpouring of love and support has been almost overwhelming.  It is so nice to know that there are so many people out there thinking about and praying for us and who are willing to take time out of their busy schedules to check in and help out.  So, first of all, thank you all.

Now onto the update!  Unfortunately, the main gist of things is that I am going to be confined to this hospital room/bed for quite some time.  The only standing privileges that I have are to go to the bathroom and to shower (however, it has been specified to me that the showers are to be short).  Thankfully, I have retained these privileges and have not had the misfortune of being seen by another doctor who notoriously kept one pregnant woman here for 179 days with 100% bed rest (sponge baths and bed pans).

The reason for my bed rest and extended hospital stay are that I have dilated more since I entered the hospital.  I am currently 3-4 cm dilated and 80% effaced.  The doctors wanted to do a test on me yesterday called fetal fibronectin.  Fetal fibronectin is the protein glue that holds your amniotic sac to your uterine wall.  When this protein glue starts to break down, the amniotic sac is less supported and you are more likely to have your water break and go into labor.  If the test is negative (no FFN is detected breaking down and leaking out) there is a less than 2% chance of going into labor in the next two weeks.  If the test is positive it doesn't really mean anything - the glue is breaking down, but you could go into labor tomorrow if it is breaking down quickly, or you could go into labor in 5 weeks if it is breaking down slowly.  I was really hoping, of course, for a negative test result yesterday.  When I woke up yesterday morning they did the swab and then checked my cervix.  Unfortunately since I had dilated beyond 3 cm they didn't send the sample to the lab because after you are greater than 3 cm dilated it is almost certain that the test results will come back positive.

I spoke with the high risk maternity attending yesterday after finding out that I had progressed and that we were unable to do the FFN test.  He said that his plan is to keep me here until early next week and to see if things calm down a bit and if the progression has stopped.  I asked him about taking other tocolytics (meds that stop/slow down contractions/labor), but he said that they probably wouldn't change my meds.  The problem with tocolytics is that we really don't know enough about pre-term labor.  We know that there are several causes, but we don't know what all of the causes are.  We have a lot of tocolytics, but we don't know which tocolytic will work on which pregnant woman since each one targets a different cause of pre-term labor.  Furthermore, we don't have any real good ways of testing what is causing the pre-term labor, so the general approach is to throw a bunch of tocolytics against the wall and see what sticks.  As my attending described it, "There are several hammers and several nails, and we would have to find the right hammer to hit the right nail on the head or it won't slow things down."

If I were much earlier in my pregnancy, let's say 25 weeks, they would try a plethora of tocolytics on me to stop things since the outcomes on 25 week old fetuses are much worse than for 32 week fetuses.  However, tocolytics are not risk free.  At this point, my baby would be born healthy enough that the risks of many of the tocolytics outweigh the benefits.  If baby were born today there would be three reasons to be in the NICU: 1.) they don't develop the suck, swallow, breathe reflex until around 34 weeks, so they have to be tube fed; 2.) they sometimes get tired breathing because, even with the steroid injections, their lungs haven't quite developed all of the way; and 3.) they are teensy and sometimes have temperature control issues.  None of these are devastating long-term problems, they are just discouraging inconveniences that  would last for 2-3 weeks until baby is able to grow enough to not need the extra help.  The doctors have me on one tocolytic, procardia (a calcium channel blocker that calms down the uterus), that has very minor side effects.  Essentially, it can make my blood pressure go a bit too low.  However, I am in the hospital and am stressed out somewhat - I don't think there is a risk of my blood pressure dropping too low.  Additionally, they check my blood pressure before each and every dose of procardia to make sure that it is safe to give it to me.

I spoke with my primary OB after speaking with the high risk team.  He agreed with their assessment, however is a bit more conservative in his approach.  He has adopted the "wait-and-see" attitude for me and said "I would like you to stay in here at least until Tuesday since you will be 33 weeks at that time. On Tuesday we can reevaluate things and develop a new plan."  From interacting with my doctor over the past 32 weeks, I know that this really means, "We are going to keep you here until Tuesday.  On Tuesday you will be 33 weeks.  After you are 33 weeks we will reevaluate things and keep you here one more week until you are 34 weeks.  At 34 weeks we will reevaluate things and keep you here one more week until you are 35 weeks."  I know that the best outcomes occur after passing the 34-35 week mark, so we are keeping our fingers crossed and keeping our prayers going that baby will be willing to stay in for at least 2 more weeks.  I have a feeling that I will not make it to term and that they will keep me here until baby is born.  But it is better to be in the hospital with baby in my belly than to be in the hospital with baby in an incubator being fed through a tube.

It looks like this anticipated Christmas baby may now turn into a Thanksgiving baby.

Stickin' it to the man...hey, I'm trying to come up with a silver lining

So it looks like I may be admitted to high risk maternity for the next week (or longer).  I spoke with my OB this morning, who made a special visit to the hospital to check on me, and he said that he would really prefer if I stay in the hospital for the next week because he, like me, would prefer that I not have the baby before 33 weeks.

I saw the high risk maternity team (minus the attending who was in the ultrasound lab) and they told me that I might be able to go home this weekend at the earliest.  They are going to do a test on me tomorrow morning called fetal fibronectin.  Essentially, fetal fibronectin is the glue that holds the amniotic sac to the uterus.  If they swab for fetal fibronectin and it comes back negative, that means that there is about a 2% chance of having the baby in the next 1-2 weeks.  If, however, the test comes back positive, it doesn't really mean a whole bunch of anything.  All that a positive test indicates is that the "glue" is starting to not hold as well.  This could mean that the baby could be born in the next 1-2 weeks, or it could mean that the baby will be born at term.  If the test comes back negative, they might send me this home this weekend as it would be unlikely that I would have the baby before 34 weeks.  If it comes back positive my OB will want to keep me here for at least a week to make sure that I can get as close to 34 or (even better) 35 weeks as possible.  Unfortunately, one week may turn into two weeks may turn into three weeks.

The silver lining to this cloud is that I get to stick it to the man.  I currently have two health insurance policies.  My primary insurance is Aetna.  I don't remember the exact coverage scheme, but I pay a certain percentage until I reach such-and-such amount of claims.  Then I reach something called a donut hole (unfortunately this donut hole is not nearly as wonderful and delicious as Tim-Bits from Tim Hortons).  While in the donut hole I am responsible for paying 100%.  Once I reach the other side of the donut hole my insurance will pay 100% for the rest of the coverage year.  I have totaled things up and it looked like (prior to this hospital admission) that we were going to reach the far end of the donut hole, but not quite get to the 100% coverage from Aetna.  Therefore, we decided to keep my OSU insurance.  The way that secondary health insurance works is that anything that the primary insurance doesn't pay gets kicked to secondary insurance before it gets kicked to the consumer.  The hope is that secondary insurance will cover part of the cost that normally goes to the consumer until we reach 100% coverage from Aetna.

Any of you who have heard me talk about OSU student health insurance know that I don't like it.  I purchased it because I had to have it during grad school (in fact, my former grad program paid 90% of my insurance payment each quarter, so back then I only had to pay $50 per quarter for health insurance...not a bad deal).  But now I pay full price, I have had them deny claims that they should have paid, and I had them cancel me as a client for a week during this pregnancy (before I was covered by Aetna, so I was insuranceless).

One small thing that brings me a twinge of joy throughout all of this is that OSU student health insurance is going to get a HUGE bill for this hospital visit.  Furthermore, we are going to reach the far end of the donut hole for Aetna, so we will have FREE healthcare coverage for the rest of the year!!!  I see in my future many check-ups and preventative care visits. :-)

My trip to the hospital

I am currently sitting in a hospital bed, hooked up to a contraction monitor and receiving IV fluids.  This is not really what I expected when I left to go to my OB appointment 14 hours ago.  I knew I had been experiencing some symptoms of pre-term labor, but I only had one time when I thought I might have been having braxton hicks contractions, and even then I wasn't sure.

My main symptoms have been menstrual-like cramps, low back pain (definitely not musculoskeletal - more like the pain you get when you have to poop, but you don't actually have to poop), and, for the past few days, a recurrence of nausea.  These symptoms seemed fairly benign, so I figured that I had been overreacting during the past couple of weeks when I had been telling people that I thought I might be having pre-term labor.  Sometimes people who are pregnant just cramp for no real good reason.  I mean, I am carrying a 4 pound baby (weight estimated from my ultrasound last night) in there after all.  It makes sense that things might get a bit crampy.  And low back pain?  All pregnant women get back pain.  Add in the fact that bowel habits aren't necessarily normal during pregnancy and you get a pretty good explanation for low back pain.  As for the nausea, this is not a new symptom for me.  I got a reprieve from nearly constant nausea and "sour" stomach starting at 26 weeks, but usually once or twice a week nausea would come back for a visit.  Three days in a row of nausea seemed a bit worse than it has been, but since when can you compare things to the "usual" in pregnancy?  Nothing is usual.

I told my doctor about my symptoms and he said that he wanted to do a cervical exam just to make sure that I wasn't dilating.  I had talked myself out of thinking I was having pre-term labor at that time, so I thought this was no big deal and I was going to get a normal report of no dilation or effacement.  However, when he checked me I found out that I was 1 cm dilated.  1 cm...that's only 10% of the way there.  I'm sure that's not a problem.  It's probably pretty normal to dilate just a little bit during early to mid third trimester.  He was a little bit concerned and told me my options.  He said that he wanted to send me to the hospital for 1-2 hours of monitoring just to see if I was having contractions (I told him I wasn't sure if I had been having them and he said that it is likely that I wouldn't be able to tell if I was).  He also said that he might put me on a calcium channel blocker just to calm things down in my uterus a little bit.  And if they found that I was contracting I might be put on bed rest.  Either way, I should take it easy for the rest of my pregnancy.

Keith and I went to the hospital.  Since I wasn't too concerned (I just thought we were heading to labor and delivery for a 3 hour detour of our normal day, and that we would be going to Bible study just a little bit late) we made a pit stop at Java City.  I wanted some milk because they told me that I would have to pee for another urinalysis, and I had to prime the tank.  I also hadn't eaten for a few hours, so we grabbed a couple of snack to sneak up to triage in case I felt the need for nourishment.

We went up to triage, we found out that when my doctor phoned over to labor and delivery that I would be coming he said I was 1-2 cm dilated.  Was he just telling us 1 cm so we wouldn't panic?  Or did things get exaggerated going through the grapevine?  We hung out for a little while as paperwork was being processed.  I gave my urine sample, I got hooked up to the fetal heart rate monitor and the contraction monitor (toco), and then waited for the next 1.5 hours as they collected data.  Thankfully, baby's heart rate is strong, baby is moving around a lot, and I maybe had one mini-contraction during the entire 1.5 hour stretch (the nurse told me it was a contraction...when I looked at the read-out it looked pretty unremarkable to me, but I suppose I should trust the judgment of a labor and delivery nurse over that of a myself, a medical dietetics graduate student).

Unfortunately, when the nurse checked me she said I was 3 cm dilated.  Here's the thing about checking dilation: it's all by feel.  It is not the most scientific measurement.  One persons 2 cm may be another persons 3 cm.  They train their fingers by reaching into circles of different sizes and learning by feel how far apart their fingers spread for each cm.  So the question at this point was if I was always 2 or 3 cm dilated, or was I progressing?  Had I started at 1 cm in the OB's office and now that I was at the hospital I was at 3?  Or was I always 3, the OB didn't want to alarm me so he told me 1 instead of 1 to 2, and then he measures differently than the nurse?  It was time to call in a third person to check my cervix.  Person number three is a resident in OB (he and Keith actually got to bond a bit talking about rotations that you have to do as a first year resident).  He checked my cervix and said he was pretty confident that I am 3 cm.

Because of the uncertainty of always being 3 cm or progressing from 1 to 3 cm at just 32 weeks pregnant they decided to admit me overnight.  There were several reasons for doing so.  First, they wanted to make sure that I wasn't contracting, so I have been hooked up to the toco for about 10 hours now.  Second, they want to make sure that I am 3 cm dilated today, and no more.  Third, they want to pump me full of several medications.  Since I have been here I received IV fluids (this is my first IV ever!), IV antibiotics (they don't test for Group B Strep until you are 35-36 weeks preggo, so they gave me abx as a precaution.  Also, if I have an asymptomatic UTI (the reason for the urinalysis), it could cause the cramping and dilation.  The antibiotic essentially could kill two birds with one stone, or if I don't have a UTI or GBS it could be yet another case of antibiotic overuse.  But I guess it is better to be safe than sorry when it is my baby's health that could be affected), calcium channel blockers (to calm down my uterus...however it hasn't felt calm over the past couple of hours), and a steroid shot (to help the baby's lungs finish developing so they are surfactant filled if baby happens to be born early).

I've got to say that I'm glad I have a husband who is a doctor at this hospital.  I have made sure to casually work into conversation with each and every one of my caregivers that he is a doctor here.  I want them to know that we are medically educated people and to talk to us like we understand, and I also want a little bit of the VIP treatment.  I have no shame in saying that, and from interning at this hospital I know that staff and family members of staff (especially family members of doctors) get a little extra TLC.  Also, he ran home to get some essential supplies and then came back and slept in my hospital room last night (even though it meant that he only got 4 hours of sleep).  It was nice because he was able to roll out of recliner (he slept in the chair in my room because he didn't want to bother with a cot), shave and brush his teeth, and then go straight to work just a couple of floors away from here.  When the doctors come to talk to me today or if any decisions need to be made, he told me to page him and he will come to see me to help me to sort through everything.  He also said when he gets a chance he is going to come to my room to do his charting.  He is a good one. :-)  I'm very glad to have such an amazing husband!

Hopefully things will go as planned, baby Vogt will stay in cookin' for another 5 weeks or so (or at least 2 or 3 more weeks when major milestones have been met by the fetus, like the ability to eat without a feeding tube and the ability to breathe without assistance), and I won't find out the gender of baby Vogt before I cut my cake open on Sunday.  Somehow I think that the cake cutting might be anti-climactic if we already have a baby born of a known gender...