What to Expect When You're Expecting: Pain, Mostly

Time for a check-in!

We've made it to the third trimester, the point in a pregnancy when you're visibly, upsettingly pregnant.  When you vaguely resemble a cow and gain an unattractive, flat-footed waddle.  When people start standing up for you on the train, and you, in turn, start begrudgingly accepting the offered seat.

Pregnancy has often been described as "miraculous" and a "blessing" by those who have never experienced it.  In reality it is a living nightmare of discomfort and peeing a little whenever you sneeze.

The first trimester did have some benefits.  For one, the fatigue was so severe that I slept for about 16 hours a day, leaving little time for me to dwell on the severe nipple pain.  I will say that I experienced no nausea, which I did unironically consider a "miracle" and a "blessing."  Armed with the overly cautious paranoia of first-time parents, Andrew and I attended every single one of the first trimester appointments to keep track of what was happening.  And what was happening was pretty much what you'd expect.  Each appointment lasted three or four hours and came to the same conclusion: everything looks good.  Everything looks normal.  Everything is perfect.  The dire warnings we had read online of issues like neutral tubes not closing or hernias developing were all for naught, because in every test, the embryo (and later, fetus) was perfectly healthy.  In fact, it was almost unusual how goddamn perfect the thing was growing.

 Kid is overachieving like a North Korean general.

At the very beginning of this whole pregnancy mess, Cedars-Sinai gave us a big informational packet that included a list of all the appointments we should expect to attend.  Most included what the purpose of the visit was: the anatomical scan at week 20, for example, or the RhoGAM injection at week 30 (if needed).  There were a series of visits during the second trimester that were simply labeled "pregnancy check-up."  These seemed, to me, to be general appointments to address any issues one might be having at that time.

The second trimester is generally considered the easiest of the three.  When we reached ours, I looked up a list of what to expect.  It included 9 symptoms, 7 of which included the word "pain."  (One of the ones that didn't include the word pain was "lightning crotch."  Yes, I'm serious.)  Pains include round ligament pain (a sharp, shooting pain in your abdomen), back back, rib pain, and leg cramps.  The discomfort was... well, uncomfortable, but expected and manageable.  The creepily named "quickening" (when you feel the baby move) happened early, around week 16, and became a regular staple of the baby's uterine residence.  All was well.  Well enough that I felt comfortable skipping the vague "pregnancy check-ups."

So today we had the first of our third trimester check-ups, the purpose of which was to get the DTAP and flu vaccines.  By now, the bellybutton has inverted, and fun new symptoms have reared their ugly heads.  Restless leg syndrome and costochronditis and, once again, fatigue.  Still, all expected, and manageable.

Andy and I went in to our 10 a.m. appointment.  We were greeted by the doctor around 12:30 p.m.  "Hi, I'm Dr. Hoffman," she said.  "Where have you been?"

I blinked, taken aback by this greeting.  The short answer was that I had been working full time, interning part time, and attending school full time, leaving little time left for two-hour waiting times at the doctor's office.  I had missed three second trimester appointments, all of which were utterly non-specific and one of which I was overseas for and couldn't have possibly attended even if I'd wanted to.

"My concern is that you missed all of your second trimester appointments--" started Dr. Hoffman, and there began a thirty-minute lecture.

"Did I miss anything specific?  I mean, is there anything I needed to actually come in for...?" I ventured, not entirely sure I understood her upset.

We were clearly misunderstanding each other.

The answer was no, I'd missed nothing of critical importance.  I had missed weigh-ins ("But I have a scale at home.") and blood pressure readings ("But I can take those at home, too.") and the measuring of the stomach.  (For this, Dr. Hoffman pulled out a very medical-looking tape measure and took a very casual measurement of the abdomen.  No clue what the purpose of this was; it seemed like a kid playing doctor if I'm honest.)

Dr. Hoffman expressed concern that Andrew and I were "not taking this pregnancy seriously."  She pointed out that I had missed my glucose test and my DTAP vaccine.  ("But that's literally why I'm here.  I just had my vaccine, and the packet said to get it between week 30 and 33, and I'm at week 31," I protested.  This was ignored.)  Dr. Hoffman said I need to come in to ask questions and have my biometrics monitored, and refused to believe I had been monitoring them myself.  She asked if I'd had any bleeding (no) and how often the baby moved (goddamn constantly).  She seemed almost eager to have a "gotcha" moment, but there was simply no reason for me to have come in, and I had no questions for her.

Actually, that's not true, about me not having questions.  I did have questions.  I wanted to know how to manage the excruciating rib pain.  But we never got to that, because Dr. Hoffman really, really wanted me to take a glucose test for gestational diabetes, one I couldn't take because I hadn't fasted that morning and no one had told me I needed it.  The test looked unpleasant; it involves drinking a massive bottle of Kool-Aid-like substance.  This test seems sort of optional and I would rather not drink a massive bottle of sugary crap, so I asked if I could opt out.  Dr. Hoffman took this as a personal affront and further evidence that Andrew and I are crusty anti-establishment hippies who distrust Western medicine.

"You have to; gestational diabetes can lead to very serious complications," she said.

"But I don't think I have that.  I mean, what's the prevalence?  What are my risk factors?  Are there any symptoms indicating I have it?" I asked.  (Her answers: she doesn't know the prevalence but insists it's common.  I looked it up later; it is relatively common, affecting 1/10 people.  She ignored my question about risk factors, which I looked up later; as I expected, I am in a very low risk category.  She said there are often no symptoms at all, which is patently untrue; there are definitely warning signs, none of which I exhibit.  And if you have gestational diabetes, the prescribed response is typically diet and exercise, two things I'm already doing correctly.  But Dr. Hoffman didn't want to talk about ways to prevent or respond to it; she just wanted me to drink the damn Kool-Aid.)  (Side note: I was not firmly opposed.  In fact, after doing my own research, I decided to do the test after all, but in the moment I wasn't going to be bullied into it, especially since I had not fasted and could literally not take it at that appointment anyway.)

Dr. Hoffman went on to say that she was concerned that we would skip more of our appointments in the third trimester and that the next time she would see us was when we were in labor.

"I intend to come to all of my third trimester appointments," I reassured her.  "Especially since the packet tells me the purpose of all those visits."

 The packet makes a lot of assumptions about the patient having insurance.  'Murica.

She ignored this response and continued in her lecture.  "If you come in when you're in labor, and we've only seen you two or three times, how can we treat you?  You'll come in and say, 'where's my doctor?'  And I can't claim to be your doctor if I never see you."

"...are you threatening to deny us care if we miss any more appointments?" asked Andrew in shock.

Dr. Hoffman backpedaled wildly.  "No, but I would have to talk to my chair about it," she said sternly.

Andrew and I exchanged a look.  Talk to her chair?  What the hell did that mean?  I'm pretty sure if you show up to a hospital in labor, regardless of how many appointments you've missed, the doctors have to deliver the fucking baby.  It sounded like she was threatening to "tell" on us.

"I would like to speak to my partner, please.  In private," said Andrew stiffly.

Dr. Hoffman hoffed out of the room, closing the door a little harder than necessary.

"We're getting a new doctor," said Andrew immediately.  I concurred.  Dr. Hoffman's thirty-minute lecture seemed rooted in a belief she had developed that we were lackadaisical and adversarial.  Nothing could be further from the truth.  We have STEM backgrounds, are extremely pro-Western medicine, and have been keeping very close track of the pregnancy.  Skipping a general check-in with no defined purpose during the safest point of the endeavor had seemed kosher to us.  And we had no intention to skip any in the third trimester, certainly not as we inched closer and closer to actual delivery.

Dr. Hoffman never came back.  We waited ten or fifteen minutes, then left, setting up a follow-up appointment with a different doctor on the way out.  The whole experience left a bad taste in my mouth.  In fairness to Dr. Hoffman, she's at a Beverly Hills hospital and probably has to deal with a lot of anti-vaxxers, herbalists, and aggressive doolahs, but her unwillingness to listen to us or answer our (reasonable) questions about gestational diabetes really, really turned us off on her.  If she wanted patients who didn't question methodologies and submitted themselves to all optional tests without complaint, then she should have become a veterinarian.  Pregnancy has already made me feel enough like a cow without being treated like one by my doctor.  And, as Andrew said as we were leaving, "No one disrespects my cow!"

"Get your yogurt drops and let's go, honey!"

This was my first bad experience with the pregnancy (externally-speaking, anyway; physically I feel like crap).  Our first doctor was actually a nurse practitioner.  Her name was Eleanor and she was an older woman who wore embroidered black leather boots under her white lab coat.  She was amazing, but apparently, we need to see a doctor, not a nurse practitioner, in the third trimester.  We had seen a doctor, a chipper young man, for the 20th week anatomical scan, who we'd liked as well, but apparently, he's no longer practicing at that office so we can't see him.

As we inch closer to the end, I find myself getting anxious.  And not just because I can't take my anti-anxiety meds, or because of the occasional realization that I have an extra brain in my body, along a bunch of fingernails growing inside of my abdomen. 

 Pregnancy nails are amazing, by the way.

I worry about the delivery and of course, the doctor is a big part of that.  Dr. Hoffman is very clearly the wrong doctor for me.  What if the next doctor isn't any better, though?  My experiences with others at Cedars-Sinai has been so great and I worry now that it lulled me into a false sense of security.

Worse, I never got to ask my question about the relief of the chest pain.  The discomfort in my ribs borders on unbearable at times and I would have liked to have been able to have a frank conversation with the doctor about it.

Some other strange and unexpected symptoms as we waddle into the third trimester include ridiculous fucking nail growth and a hemorrhoid, which, it turns out, is super painful.  (I literally though I'd prolapsed my goddamn anus.)

Instead of a picture of that, though, here's my cat.  

You're welcome.

It's exciting to think that this exercise of creating a human being out of blood (one of the most black magic-y things I can honestly imagine) crescendos into a torrent of unimaginable pain and viscera (again, super fucking metal).  In Spartan culture, only two classes of people could have their names inscribed on their tombstones: women who died in childbirth and men who fell in combat.  Yeah, that's right.  Labor was considered on par with going to war.  I suppose that, post-labor, all of the current discomforts will seem small by comparison.  My mom went through twelve-and-a-half hours of natural labor with me.  I can't say I'm looking forward to that long of a labor; I don't want Dr. Hoffman to have the time to go "talk to her chair."  Joking aside, though, I think at this time we have no reason to worry.  The discomfort is temporary.  The glory is eternal!

 All of my drinking motivational posters ironically also apply to pregnancy.