Pregnancy after 35…

I had the luxury of getting a lovely little stamp (well typed and printed) on all of my pregnancy records: Advanced Maternal Age. If turning 35 isn’t enough about starting to feel that uphill climb, you are now considered “at risk” just because you hit that 35 mark.

Old PregnantNow, I had other risk factors that were much more serious than just my age. I was considered obese and also have hypertension (high blood pressure). Those items, I would think, should be much more at the forefront of someone’s records than “Advanced Maternal Age”. Perfectly healthy women, with no previous issues, still get this stamp of “disapproval” from our lovely medical community.

Please do not misunderstand my words. I loved my OB/GYN. She supported me through miscarriages, first birth (with HBP) and my second birth (with the AMA). She was amazingly supportive throughout the whole thing and only once mentioned the age thing early during the pregnancy.

First, why do we get this tag anyway? This is not a science article, so do not expect a lot of references to specific studies; however, here’s what I’ve learned when trying to find out how my age could affect my pregnancy.

We get this tag because there are certain risk factors that increase as we age. This is generally true, but when pregnant, more so. Ladies, if you’ve been pregnant, you know. If you haven’t been pregnant, you understand. Pregnancy is HARD. It’s truly the most physically challenging thing I’ve ever endured in my life. (No, I haven’t climbed Mt. Everest.) Then add to that our naturally aging bodies. It’s a lot for our system to handle. Sometimes, it’s too much.

Some of the most common complications with AMA pregnancies are (you may have guessed from the above):

  • High Blood Pressure. This can be a result of preeclamsia – a form of high blood pressure only found during pregnancy.
  • Gestational Diabetes. I had this with my second (after I turned 35).
  • Genetic abnormalities. This can include Trisomy 21 (Down Syndrome).

There are other factors, but when my OB talked to me about it, these were the three big ones she brought up – maybe because they were the ones to most likely affect me, but ultimately they did in one pregnancy or another. Due to my other conditions (HBP and Gestational Diabetes), I also saw a perinatal doctor. These are the docs who deal with the realities of high risk pregnancies on a daily basis. Either the baby has high risk factors or the mother, as in my case. When I worked with my perinatal doc, he explained more to me about the AMA risk factors. However, his big three were the above mentioned.

Because of my early miscarriage, we did the early genetic screening on all my pregnancies (including the miscarriage – before knowing). My first screening came back that the baby had Down Syndrome. We found this out the day we also found out she passed. (A whole other blog on that…) It was most likely the heart not developing properly, which is common with babies who have Down Syndrome. However, with that we knew every time after that we would be getting the genetic testing.

This is something that is recommended for women over the age of 35. I highly recommend it for everyone woman! There are many reasons, but for me the research in early genetic testing is critical. It can help doctors determine possible reasons for miscarriages (much like my first) that they may otherwise not know. This testing is not free, but it is affordable. The testing is also very general. It is not like a micro array test where they look through each gene. This is just a general overview making sure there’s no missing or too many genes. They can also let you know the sex of the baby (if you wish to know early).  Best part, they only take blood from the mother! No invasive needle poking in to the womb.

Having HBP and Gestational Diabetes with my second pregnancy forced me to eat very specific foods and be aware what I was eating and when. I learned that pregnant women release a hormone that is part of the cause for the Gestational Diabetes (it inhibits insulin production, increasing glucose levels in the body). This hormone is released in a way that your body has had the hardest time to lower your insulin levels while you’re sleeping. This is part of the reason they give you those icky sugar drinks in the morning. Bleh!

While the process of pricking myself four times a day and taking my blood pressure twice a day was not what I would call fun, I did enjoy the science of it. I enjoyed seeing my numbers come through and thinking about what it was that I ate to cause that number. I enjoyed recording the data and then discussing it in my meetings with the docs. I really learned a lot when I asked questions related to my specific eating habits and how they affected my pregnant body.

I have had HBP since my mid 20’s.

Swollen Pregnancy Feet

A side effect of HBP & Pregnancy – Swollen Feet. Only flip-flops fit them.

So I knew going in with all my pregnancies I would be “at risk” from the start. This, for me, meant more, like a lot more, doctor’s visits. In the end, I went to the doctor’s office twice a week for the last 6 weeks of my pregnancies. And I visited the perinatal doc every two weeks. This is tough to do when you’re working on top of that! You also get more ultrasounds – this is a nice thought. Where Gestational Diabetes can cause the baby to get extremely large in the womb, the opposite happens with HBP. The babies are undersized and underweight. This is why I got more ultrasounds. They wanted to track baby’s progress to make sure she (and then he) were developing within the norm.

My first baby, no problem. She was developing perfectly. I also did a lot during pregnancy on my own to eat right and exercise when I could. I didn’t gain weight until the very end and only gained 15 lbs total. I brag, because that didn’t happen with my second!

20180527_185249

36 Weeks Pregnant with #2

With my second, he was a monster baby. I gained almost 30 lbs total and that was still with me eating well. The scans always said his stomach size was over the 99% percentile… how can one be OVER the 99% percentile? His head size was also quite large. Don’t worry though, it ended up that he was just super crammed in my little belly. He came out 8 lbs 7 oz and 21.5″ long. So sometimes those ultrasounds are not as accurate as we’d like to think. Just know they’re a gauge, not a deciding piece of data.

So, why do I discuss all these things? Mainly to say that pregnancy, no matter what age, is a risk. It is putting a woman’s body through extreme circumstances. As we naturally age, our body doesn’t rebound and recover the way it once did. This means we naturally take on more risks. So add to that a pregnancy, one of the most extreme things a human body can do – MAKE ANOTHER HUMAN – and it’s understandable why this stamp goes on all of those medical forms. I was the walking, breathing, living embodiment of 3 of those risk factors. Some were not the direct cause of my age, but they certainly never got better either.

So, although the thought of seeing that on a form can sting, know that it’s for the best. It means your doctors want to take special care of you and your little human(s). They want you to get the absolute best care you can receive and want to make sure that the life growing inside you is healthy and safe.

It also means you need to be ready. You need to be aware that you may inherit these risk factors, for a time, so you can bring a life into this world. Do what you can ahead of time: get regular check-ups, manage your diet and exercise when possible. And do what you can early on: don’t eat for two, do continue to work-out lightly and see your doctor regularly. This can help make those risks minor. And if you do happen to get the AMA-related diagnosis, you can always make the best of it by learning how you can be the healthiest person for your baby.

AzEIP – Advocating for your child! (for families who live in Arizona & my personal story)

If you live in Arizona and have a little one with special needs, you need to know about AzEIP and Raising Special Kids. If you have a good pediatrician, they should have already directed you to these programs. If you have not been directed, you may want to at least inform your pediatrician of these programs.  These are critical components to helping your child become the best person they can be from an early age.

secrets-to-raising-a-happy-babyAzEIP:

So, what is AzEIP? AzEIP stands for Arizona Early Intervention Program. From their website: AzEIP is a “statewide interagency system of services and supports for families of infants and toddlers, birth to three years of age, with disabilities or delays.” There are so many great things about this program, but the most prominent is that it’s FREE to families if your child qualifies.

So, what is considered a disability or delay? Well, areas of Fine Motor, Gross Motor, Speech, Feeding and Cognitive Development are just a few main ones. If you suspect or your child’s pediatrician suspects your little one has a delay in any of these areas, you can file for an evaluation.  You do NOT need your pediatrician to do this. This is important. You, as the parent or guardian, can request the evaluation, even if your pediatrician does not. You can advocate for your child! I love this.

The referral:

A pediatrician only sees your little one for a very short snip of time. You see and know that baby much more intimately. You’ve spent sleepless nights, been through exploding diapers, and spit-ups galore with your little one. You fill out an “Ages and Stages” form at the doctor’s starting around 9 months. This doesn’t encapsulate the whole picture. Depending on your working status and general care, you may not even be able to fill out the form as completely as you’d like. This is OKAY. This is just to give your pediatrician a snapshot in to your child’s development. But, if you feel that this is not catching the things you’re seeing, you need to do a couple things.  First, talk to the pediatrician. DO NOT wait for them to notice these things – more likely they will not. Let them know what you observe on a daily basis with your babe. It helps him or her get a better picture when you’re communicating (and advocating) for your child. Second, fill out the AzEIP referral form. Though your pediatrician may not be terribly concerned, if you still are, fill out this referral. The pediatrician should not be offended that you did this and should support your decision as a parent or guardian.

My kids have a great pediatrician. She has the mindset of “better safe than sorry”. She recommended I refer my daughter at 9 months and my son around when he was about the same age. She explained the process to me and the likely outcomes for both. She helped me find the website and start the application process (we did my daughter’s referral right in the exam room).

hi-doctor-baby-852-cp-is-8colThe outcomes:

  • My daughter did not qualify for AzEIP care. Though she wasn’t crawling well, she was moving. Because AzEIP has a threshold requirement, she did not meet that threshold. And, with a little more time and patience, she learned to walk (16 months old). She’s almost three and no one would even know that she was a little behind the curve in this area.
  • My son did qualify, in multiple areas. When he was evaluated, he was not sitting up on his own, he was doing this “inch worm” type crawl to move and they noticed – as his pediatrician did – the hypotonia. He qualified in his gross motor skills (PT/OT), fine motor skills (OT) and feeding (Feeding therapy).

What to expect at the evaluation:

Well, the best thing is that they come to you! They will come to your house to do the evaluation. They like to observe your little one in their own environment, but also try to make it as convenient as possible for the parent or guardian. Typically, there’s 2 rounds. The first round, the service coordinator will come and do a general evaluation of your child. They will also just talk to you about your observations and get your insurance information. The program is free to families, but they still do charge your insurance for their part. This means that AzEIP will absorb anything insurance does not pay so you pay nothing. If the service coordinator determines that a more in-depth evaluation should be performed, they will schedule a second visit with you.  This visit will usually include a therapist (or two) to evaluate your child more closely. Depending on what you tell the service coordinator, she’ll do her best to match you with the proper therapist so the evaluation is as efficient as possible. Due to their busy schedules, plan on a waiting period of about 2-3 weeks between evaluations. This is mainly due to linking all the correct people on the same day to meet with you and your child. At the second evaluation, the therapists will work with your child directly while you talk to them about your child’s overall development. This usually lasts anywhere from 30 mins to an hour, depending on what they need to check.  The have a chart they use to identify the markers of delayed development. There are 2 ways to qualify: below a certain threshold in one specific category (threshold depends on the category), or a combined score of 70 pts or less.

(Between the time that it took from the first eval to the second eval, my daughter began to crawl. This was the main reason she did not qualify at the second eval. So sometimes it just takes patience for your child to develop at their own pace.)

What to expect after the evaluation:

If your child was declined services, it may still be prudent to follow up with therapies elsewhere. The only difference now is that you will have to pay your co-pay/deductible out of pocket.

If your child was offered services, the therapists and service coordinator will go over the services for your child. They will also set-up a plan of action for the next 3 to 6 months depending on need. At the end of the allotted time, they will most likely set-up a time to do a re-evaluation to determine new goals and services.

(A good example of this is with my son. He initially qualified for physical therapy only. After his first re-eval 6 months later, he qualified for physical therapy, occupational therapy and speech therapy.)

babiesonthemove-57Being present:

These in-home sessions require a parent or guardian to be there for the initial meeting. Depending on the actual service provider, they may allow you to sign off on another family member or sitter/nanny. Mine did not – they required me there each time. These sessions can work around your schedule, as needed. Because I worked part-time in the mornings, I could schedule my meetings in the afternoons. Once I became a SAHM, I had the freedom to schedule when therapy best suited my son.

It’s important you’re paying attention to what the therapist is doing, saying and coaching. They only see your child once a week, or possibly less.  You are the one that will need to do these therapies each day. It’s tedious and sometimes difficult, especially if you have a second (or third) child in the midst. It’s critical to their development to listen to these therapists. They have special training and coaching techniques to help you best help your child.

Your child will likely resist the therapy. He or she is used to doing things a certain way, and let’s face it: Therapy is hard! It’s building muscles and developing connections that weren’t there already. Your little one is used to the way they currently do things – it’s easy. Now he or she is being introduced to something that isn’t easy, possibly hurts a little and definitely is not comfortable. If your little one is not vocal or does not use speech, your baby will likely show you distress through: Crying, screaming, resisting, trying to get away, seeking comfort – either from you or a favorite binky. You need to know that this is normal and okay.

The best way to prepare your child is to make sure he or she is well rested.  The worst thing you can do is schedule an appointment right when you know it’s nap time! If you are not doing feeding therapy, then make sure your babe has eaten enough to not be hungry. Also, you should make sure he or she has a fresh, clean diaper before the therapist begins working. Eliminate your child’s excuses to cry – this way if little one does cry, it’s specifically due to the training. sad-baby-si-770x513Though he or she cries a little due to discomfort, it’s okay! It takes a lot to retrain poor habits: just imagine if that cannot be communicated well. Imagine the confusion, distress and down right frustration. Now imagine you couldn’t communicate back! Your only way to say you didn’t like what was happening was to cry. It does get better! After regular therapies, your child will begin to be used to what’s going on around him or her and not be so distressed.

Know our goals:

You will set goals with your service coordinator and therapists about what improvements you would “reasonably” like to see in the next few months. These items may not be huge milestones. I remember one for my son was just to, while standing, side-step along the couch. That was it! It seems so easy and little, but depending on your child’s need, it could be life-changing.

Baby crawling indoors smilingAlso, you need to set and know your own personal goals. Not with your child’s development, but your expectations as your child’s caregiver. You will not be perfect about following up on therapy every day. You will not be perfect about providing the perfect environment for your child to develop new skills. It’s not feasible to think you can do it all. And best part – NO ONE is expecting you to! You need to be the BEST caregiver you can be for your little one. You do not need to be the PERFECT caregiver – they don’t exist! Note the difference – do your best, not what’s considered perfect.

At the end of all of this, there is no gold star, participation ribbon or trophy to be won. There’s no crowd of people applauding at the accomplishments (well, maybe grandma and grandpa). There is just you, your child, and your family. Remember that this is why you started this whole process. You wanted to be the best advocate for your child! Don’t lose heart, don’t let set-backs be disappointments, and just do the best you can each day. You are rockin’ this parenting thing!

 

“Of Course” – Hearing this phrase from a 2 1/2 year old makes me laugh

20190330_081327 (2)Do your kids have cute phrases they use? REAL phrases that they use correctly, you would just never imagine this little human using it? I do! She’s a talker and has been since about 6 months old.

She picks up on words very quickly and understands their meaning just as quickly. She uses full sentences and can even verbalize “why” she was doing something. Granted, the “why” is, many times, a two-and-a-half year old reason, but it’s great to hear her use words this way.

She speaks in full sentences, but my husband and I are the only two people on the planet who can fully understand her.  She has some words that make no sense.  We have no clue where she even got the name she came up with other than she made it up! Our favorite by far is “crannits”. You heard me “crannits”. For about a week, we couldn’t figure out what she was talking about.  She would get so upset with us when she would ask for her crannits and we didn’t follow through.

Back story: The week prior to this, my husband and I had our guest bathroom fixed.  The floor had some water damage and we had some boards replaced. My husband then bought the click-lock flooring to use and installed the flooring himself. He used the tile spacers to help him from getting too close to the wall. He had to buy the hammer and other tools to get the job done. After the job was done, we cleaned up the tools and took them to the garage.  This is when the crannits requests began.

CrannitsSo, after about a week of hunting all over the house for these crannits, we figured out her request. She was asking for the tile spacers! She called them crannits. What a fantastic name! We now all call them crannits. We hope it catches on.

This is our little girl. If she doesn’t know the name of something, she’ll make one up. Many times, when she makes a request of me… OK, let’s admit it… a demand… I reply with, “Sure, baby” or “Of Course” or “Yes sweety”. She has related these phrases with an act of affirming love from me.

So when I ask her “Will you do blah blah blah?”, more often than not she responds with “Of course”. It’s a perky little reply with determination to help mommy with her request. Many times it’s things like, can you get the wipes for me (because your brother has a dirty diaper and I didn’t smell it)? Or could you put your plate in the sink? Nothing major, just little things.

Then there’s the half breath “Of course” after she’s crying and I ask her if she wants to do something. This could be from “Do you want to go to bed?” or “Do you want mommy to give you a hug?” or (my favorite) “Do you want mommy to hold you?”

20190304_122946 (2)Every time she says this, it makes my heart giggle – yes, even in the sad moments. I giggle at the fact that she uses it so well. I giggle at the fact that there may be better phrases or words for that particular situation, but she still goes to her old stand-by “Of course”. She says it so matter-of-fact. Many times she’s saying it before I finish my question.

I hope she never gives up on this phrase. I love how she uses it. I love all the words she knows and is continuing to learn. I’m amazed by her vocabulary and ability to put these words in to full sentences.