23-week midwife appointment

I went to the midwife today for my 23-week appointment. (I know that's
a weird number, but they start visits at 8 weeks and then want you to
come in every 5 weeks.)

Everything looks just great. The baby's heartbeat is strong and
regular. My blood pressure is 108/62, I don't have any swelling in my
hands and feet, and I don't seem to be spilling any sugar or protein.
She tested for anemia because I complained about dizzy spells and
shortness of breath, and my hemoglobin came back 13.6 - which is
excellent, especially for a pregnant woman.

She thinks the shortness of breath is normal pregnancy stuff, and the
dizziness is probably related to low blood sugar. She recommended that
I have three snacks a day, avoid too much sugar at once, and eat
protein at every meal and snack - so now I have to think of lots of
easy high-protein snacks. There's only so much cheese you can eat.

I am still two pounds under my pre-pregnancy weight, which has me a
little worried. The midwife isn't concerned, though. She says I'll get
hungry soon.

We spent a lot of time talking about post-partum depression. I'm
probably at higher risk, because I've had two mild depressive episodes
and because my sister had real trouble with it. I wanted to know if
there's anything I can do to reduce my chances of developing PPD after
the baby is born. She said that the most important thing is to make
sure I have a strong support system in place - including help with the
baby, having someone else to do the cooking and housework, making sure
I have opportunities to leave the house without the baby, and possibly
joining a new mother's group. She also said that I might want to
consider using formula for one night feeding, even though otherwise
I'll be exclusively breastfeeding, because PPD is linked to sleep
deprivation. Finally, she gave me the name of a psychiatrist who
regularly works with their practice and suggested that I might want to
meet him before the baby is born, so that if problems arise I will
already know who to go to for help. She tried to impress upon me the
importance of being willing to take antidepressants if necessary, even
if I'm nursing - I told her that, as a psychologist, I know enough
about the potential developmental impact of having a depressed mother
that I will be perfectly willing to take whatever medications I need.

Some of this seems like it might be more than is necessary, but I feel
better knowing that all the bases will be covered.

I got the slip for my 28-week labwork. They do the 1-hour GTT
routinely. I asked her some questions about it, and she said that if I
refused it we could talk about other options - but I think I'll go
ahead and do it. I'm planning to get Rhogam at 28 weeks. They're also
going to test for thyroid problems because there's a family history -
but she said that's just a precaution.

I continue to be very, very impressed with my midwife practice. This
visit was 45 minutes long, and I had all the time in the world to ask
questions and get them answered. We've now met all three of the
midwives, and although I still have a favorite, I will be perfectly
happy to have any of them attend our birth.

And of course, I am also very impressed with the Li'l Critter and her
stellar health and behavior. What a fine baby we're going to have!

Rivka
Li'l Critter due 4/3/05
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Visit my weblog at http://respectfulofotters.blogspot.com