Monday, April 11, 2005

How overdue babies are monitored

Week 41 + 3 days

So, we're not officially overdue until week 42 according to the doctor today.

In Finland, once you are 10 days past your due date, you are sent to your maternity hospital for observation rather than your usual health center (neuvola). We are registered at the Kätilöopisito (Midwife University Hospital) or "Kättäri" in Helsinki.,32,660,546,960

When I called to make my appointment last Friday, I was told it was very busy today and was asked if we'd be willing to have an intern participate in the interview and ultrasound. I agreed since I know its an important part of their education and was assured that the students would be supervised in the interview by the head doctor.

We first met with a midwife who used an external heartbeat monitor for about 20 mins to see if the baby was under stress. She also handled the usual clinic-visit tests: blood pressure, urine analysis and belly palpatations to check on the baby's position.

We were then passed down the hallway to wait for the intern -- or what turned out to be interns. First, a group of three males who were then joined by another two female students! It was quite an audience, but they were all very pleasant. One was acting as the examining doctor and ran through a routine list of questions about my current and past condition. The doctor himself came in towards the end of the interview and listened as the intern reviewed what he had learned.

I then moved onto the examing table - fully clothed since this was just an external exam and ultrasound. I found it interesting to listen to the doctor as he explained to the students what he was doing and why. He also did the routine palpatations to check the baby's position and head position (degree of engagement) and measured the size of the uterus.

He introduced a 'potato sack' move for guesstimating the weight. With his hands cupped on either side of the belly, he gave it a moderate shake to see how much moved and how much resistance it gave him. One of the students, later tried the 'milk carton' method where by eyeing how many liter sized milk cartons would fit across the belly, he came up with his own estimate.

Following the doctor, the interns lined up to have a turn nudging and measuring my belly. I had to draw the line at three of them as I began to feel a bit dizzy from laying down on back so long. They were all most concerned about having cold hands -- and one of them must have really been rubbing his hands together to warm them up before touching me :-)

Next up was the ultrasound examination. This was performed entirely by the doctor with him occassionally posing questions to the students. He first checked for the amount of amniotic fluid by scanning the four quadrants of the uterus for pockets of it. Next was a review of the health of the placenta which evidently begins to calcify and become porous as it ages. He then checked for 'breathing motions' - either by actually watching the diaphragm or stomach move. Following that was a review of the heartbeat and bloodflow through the heart. Last up was a birth weight estimate based on the circumfrance of the head, length of the femur and most importantly - the size of the stomach! This was a surprise to me, but evidently, its one of the most reliable measurements for babies and adults, alike. The ultrasound's automatic calculations were throwing up very odd estimated due dates and the doctor explained that the earliest ultrasounds are actually the most accurate and the later it gets, the less accurate this estimate becomes.

We picked up all sorts of extra details and information from the lecturing the doctor did during the examination, but it was a bit strange sitting there feeling more like a case study sub ject than the actual patient. I've decided against having any students attend the actual delivery and birth because of this - no need for an audience or anything that will take the concentration from us. After sharing this part of our pregnancy with a group of interns, I can with a clear concious refuse :-)

At the close of the visit, we as group discussed how ineffective estimated due dates actual can be. Only a very, very small percentage (around 6%) of babies are actually born on their EDD, yet the anxious parents-to-be (not to mention the equally excited relatives and friends) often watch the date come and go. Though we tried to prep ourselves that its plus/minus two weeks from the due date, being on the minus side was definitely easier. And, even if 'overdue' doesn't officially kick in until 42 weeks, we find ourselves constantly talking about Peanut being late and answering curious inquiries from family & friends who wonder if we've just forgotten to inform them about her birth. The doctor was proposing a 'birth month' as guidance for expectant parents rather than a date to be circled on the calendar. I think it would have relieved me of some anxities and the feeling of somehow being off schedule.

At this point, the doctor said no internal exam was neccessary because whether the cervix was ripe or not was almost immaterial since there have been no contractions and everything looked normal. He went on to explain to the horror of the students that the US, they most likely would not let a pregnancy carry on so long and would force the cervix to ripen manually with a balloon sort of instrument.

In the end, the prognosis was that Peanut was doing just fine still and there was no reason to help her out yet. We have another appointment in three days for a similar examination.

Total cost = 22 euros

No comments: