Tuesday, March 11, 2008

adults say the darnedest things

I'm a little shy of an official 6-month update and despite promising last post to upload an updated belly pic before that milestone, I haven't actually gotten around to it. I can tell you, however, that my fundal height is right on track, measuring 26 centimeters at last Friday's appointment, at 26 weeks 1 day. And my blood pressure's good. And I'm assuming no news is good news as far as my glucose test administered that morning. It would seem like I'm doing everything just about as right as I can, if only I hadn't gained 7 whopping pounds in the four weeks since my previous appointment, putting me at a total gain of about 17 pounds according to their scale, but more realistically (since that first weigh-in was at 9 weeks) at about 20-22 pounds according to my pre-pregnancy weight and my scale at home.

I should back up and say that despite spending time all summer getting ready to conceive (making sure my health insurance coverage was adequate, kicking my caffeine habit, popping folic acid supplements, etc.), I was apprehensive about my BMI still officially lingering in the "overweight" range and remember asking at our very first appointment what my doctor thought was an ideal weight gain range for me and how to go about that, all things considered. I was referred to the nutritionist, who was incredibly supportive and constructive in her advice, but essentially based her recommendation of gaining only 15-25 pounds solely on said BMI. Since I'd already gained 6 to 8 pounds at that point (I blame that first-trimester weight gain on a combination of raging hormones and psychologically giving in to the whole "eating for two" myth), deep down I felt like that was pretty unrealistic. Maybe I could stay within 25 pounds but I'd be personally happy if I stayed within the typically suggested range of 25-35 pounds. I suppose I should have followed up on all this with my doctor, who clearly got the range recommendation memo, focusing on my weight at all but one appointment so far, but never actually had a conversation with me about that recommendation.

Between mid-November and mid-December I gained 4 pounds, which received a mild scolding at our second appointment. She recommended I start walking (when I was not only walking, as much as I could in the crappy December weather, but still doing The Firm a few times a week), and limit my intake of juices and snacks. Between December and January, magically their scale recorded no weight gain, likely a combination of December's weigh-in being off for one reason or another, and my fear of another scolding leading to desperate measures to trick the scale, outlined in this post. Our doctor was, not surprisingly, pleased by this. Between January and February, I gained 4 pounds, which got no mention during the as usual slightly rushed appointment. So 4 pounds is what I hoped for on Friday, but I guess those crab rangoon and extra slices of pie caught up with me.

For some reason I wasn't all that concerned when I stepped on the scale, which is probably why I felt completely cornered and downright shocked when our doctor, accompanied this appointment by a bright-eyed and bushy-tailed resident, wanted to address "this weight issue" after barely saying hello. I swear her exact words were, "what's that about?" but my much more emotionally stable partner recalls her asking "what happened?" Either way, I was left mostly speechless but what I managed to say probably came out a little defensive as she again encouraged me to begin walking and avoid the hidden calories in juice and fruit. Laying back to let her measure the height of my uterus (and again not sure how to respond to her exclamation "polka dots!" when she obviously caught a peek of my underpants), and listening to the baby's heartbeat were already a bit of a blur as I walked out of the office and caught another blow as the gal at the front desk guessed that I'm expecting a boy based on how my face has changed. I hesitated before asking for clarification, knowing I probably didn't want to know the answer. But I asked her anyway, "what do you mean by my face changing?" She sort of danced around it but essentially pointed to my chin, which has been prone to the occasional breakout lately. Why would you say something like that if you're not prepared to point out a pregnant lady's pimples?

Anyway, my doctor's obsession with my weight has only added to some gut instincts I've had about her since the first appointment. I left the appointment feeling downright depressed, not only about my own body image but as if I wasn't in fact trying to do everything as best as I could for my baby. Instead of addressing her concerns about my weight gain in the context of everything else, which has, knock on wood, been going swimmingly well, she focuses on the one thing I'm not doing perhaps as well as I could. Furthermore, she focuses her attention on the weight I've already gained, which I can't really do much about, without giving me any constructive feedback about how to proceed. All in all, I feel like I'm in an incredibly unsupportive relationship with the person who has a 50% chance of delivering my baby.

Needless to say, it was enough to trigger an emotional well that had been filling up for weeks. I'm feeling better now that, after calling around for two days, I have an appointment with another doctor in another practice that's actually taking new patients (not to mention one who's nearly into her third trimester) but one that's still affiliated with the hospital that, overall, we're happy with and have heard really positive things about in terms of labor, delivery, and post-natal recovery. And don't get me wrong, I'm not just looking for a doctor who simply smiles lovingly as I pack on the pounds. I'd just like a doctor who treats me as one of two patients, not just the slightly imperfect vessel for the smaller patient hanging out inside.

It does make me wonder about the whole pregnancy weight gain issue, though. Basing a recommended weight gain on BMI alone is like measuring the baby's growth on the outmoded practice of measuring the fundal height, which is now, of course, done in combination with the much more accurate ultrasound measurements. Just for fun, I plugged in my weight immediately after high school, when I wasn't exactly skinny but generally slender and probably in the best shape of my life, and the BMI it spit out was barely within the "normal" range.

Needless to say, I'm ready for a much-needed spring break family visit this weekend, which will give us plenty of photo opps to snap the 6-month belly. I'll be back next week with a full update...

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