Wednesday, October 15, 2014

34 Weeks: DIY Prenatal Care (AKA Unassisted Pregnancy)

First, the update. Flynn and I are both healthy. He's super squirmy and really strong. I'm having a totally typically 3rd trimester. That means I'm very fatigued, get crazy edema if I don't keep my feet up, and will actually break down in tears if I don't have taco bell multiple times per week. Of course taco bell gives me indigestion so bad I end up in tears anyway.... But as far as pregnancy symptoms go, that's all pretty mild.

So the topic of this entry is unassisted pregnancy. That means monitoring your own health, instead of paying a doctor to do it for you. It doesn't mean refusing to ask for help when you need it. It just means not asking for help when you don't need it. I have a history of first trimester miscarriages. Whether I need it or not, I feel more comfortable with a lot of monitoring and testing in the first trimester. This is very hard to accomplish on my own. So, I saw my family doctor. Then, we moved. My husband changed jobs and I was no longer insured. Obamacare actually makes it more expensive to see a doctor if I'm insured, than if I pay out of pocket. And since my husband has decent full time work, we don't qualify for medicaid. We had just planned to pay out of pocket for my checkups. The last half of my pregnancies tend to be pretty boring. Weight, fundal height, urine test...."everything looks good. See you in a few weeks." Rinse. Repeat. Out of pocket costs don't even equal our portion of an insurance premium unless I have 4-5 visits in a month.

Unfortunately, there's no such thing as a pay as you go option for prenatal care. Even the low cost community clinic refused to see me for a single check up, unless I signed a contract and paid thousands of dollars up front. In this area, it's $2000-$7000 up front. That just covers the check ups. If I need any kind of treatment or testing, or choose to go into the hospital to birth, that's all extra. $400+ per check up (because the cheaper place will induce at 38 weeks, which you agree to in the contract)?????? That's just ridiculous. I don't need to pay an expert to tell me how much I weigh, or read a test strip for me. I'll just do it myself and save my money for things I can't actually do myself.

There are lots of ways to go about an unassisted pregnancy. They range from just trusting that if everything seems good, it anal retentive monitoring and record keeping. Being a medical profession and prone to doting, Jason is always wanting to check my blood pressure or something anyway (even when I was having regular care) so I figured it would be better to just do the charting. The amount of different sources I had to reference to find out what to chart, and what is normal in each of those areas...that's why I wrote this entry. There's no reason for this stuff to be some kind of big secret.

Our family is having weekly prenatal checks. This is mainly because Jason and the kids really enjoy being involved in the pregnancy in this way. Everything monitored at a standard prenatal visit is literally so easy a child can do it. So, this has not only been a great bonding experience, but empowering for everyone involved. That's not to say doctors are useless, though. They are invaluable when it comes to deciding what to do when things go wrong. If I start seeing signs of gestational diabetes or something is just testing way off, I'll be making a b-line for urgent care or the ER!

Back to the cost thing, we bought everything we need to monitor everything an OB would, and more, for $80 on amazon. If I didn't spend so much time finding just the right deal, I still could have found everything for $150.

As you can see in my pic, we are just using a plain old notebook for charting. At the top of each page, I wrote my name, birth date, and due date. This is to make things easier for the medical staff, if I end up needing to be seen for something.

Then, I added sections for each of the following;

Date -

Weeks Gestation -

Weight - We bought a new scale for this. I was having doubts about the accuracy of the old one.

Fundal Height - We bought a new tape measure for this. I couldn't figure out where we put any of the flexible ones. Fundal height is easy. The bottom can be felt just above the pubic bone. The top, below the belly button at 20 weeks. It rises an average of 1cm each week until birth. Average isn't specific though. Don't get all hung up on that number, like OBs seem to nowadays. Normal and healthy is a range of up to 3cm more or less than gestational age. So, at 30 weeks a normal fundal height is anywhere from 27-33 cm. That's what doctors are talking about when they tell you how many weeks you're measuring.

Presentation - This is what position the baby is in. If you know the clinical terms, great. If not, layman's terms are fine too. I haven't entered mine yet because Jason wants to use the clinical terms so he can learn them, but hasn't looked them up yet. :) Head down, facing rear, is good enough though. Head up, feet down, facing left. Head right, feet left, facing up. These are all examples of what I might have written.

Fetal Heart Rate - We bought a stethoscope for this. I dare to say that someone less practiced with a stethoscope than Jason might have to use something more powerful, like a home doplar. This can be a hard vital for us to get. Even when we find the heartbeat easily, Flynn likes to change position while we're counting beats. The range for a healthy heart rate changes throughout the pregnancy. It starts faster, and slows a bit as the baby develops. By the third trimester, about 110 - 160 beats per minute is considered a healthy range. Of course, drastic changes in habits are often more telling than pure data. Flynn's heart rate is around 150-160. If it suddenly dropped to 110, I'd start monitoring. If it stayed there for several hours, or there were other abnormalities, I'd probably go into urgent care to make sure everything was OK.

Fetal Movement - This is a place to generally describe what the baby's movements have been like. Mostly this just helps you recognize his personal patterns and know what's normal for him. When Flynn was reacting to the pain from my abscessed tooth a couple months ago, his movement became "frantic" because he was in mild distress. His heart rate was also high, and I spent the night in the hospital getting him calmed down.

Edema - This is the swelling, bloating, or water retention that is so common in pregnancy. I find that I'm so used to it that I actually underestimate the severity. So, it's helpful to have someone else poke at my wrists, ankles, and knees, and give their opinion of how bad it is. I'd still be writing "mild" but my family assures me I am firmly into the "moderate" category, at my best.

Blood Pressure - We bought a basic blood pressure cuff for this. We use the stethoscope to hear my heart beat. Alternatives are to buy a digital cuff that does it all for you, or just use the free machine at your local pharmacy. Normal range is still just as high as ever, but up to 20 lower than when you're not pregnant. Below 90/60 in either area is considered hypotension (aka low enough to cause problems). Above 140/90 in either area is considered hypertension (aka high enough to cause problems).  Blood pressure can do crazy things during pregnancy though, so I try not to get caught up in the numbers unless they're WAY off, or stay outside normal ranges for more than a couple weeks.

Preterm Labor Signs - This is a descriptive area. A place to note anything that could be a sign of preterm labor, even if I'm sure it's not. It helps identify patterns that can either reassure me that everything is fine, or realize something is amiss.

We could have picked up the same tests the OBs use. Glucose, protein, and maybe ketone. Those are about as complicated to read as a pregnancy test. We opted for something slightly more complicated. We spent the extra $0.02 per strip and picked up the ten test strips. Ten tests on each strip, and each has to be read a specific number of seconds after dipping. We often use a second or third strip to confirm our results, and the kids don't get to be as involved. 100 strips for $12 means we can be pretty wasteful and probably still have strips left after the birth.
I did look up healthy ranges for everything on the urine test strips. That is just too much info for one entry, though. So, the short version is that glucose, or high levels of protein or ketone is bad. If I see those for more than a couple weeks, I'll be going into urgent care for further testing. The other stuff is mainly just extra info, unless I start getting really crazy results.

Then, at the bottom of the page, I list anything else of note. Allergies are acting up, or short of breath lately, or maybe breasts are starting to lactate.

And that's that. Prenatal chart info, all in one place. If I notice something missing or in need of updating, I'll make edits. ;)