A Quick Update

It's late and I should be in bed so I am just quickly posting an update.

For the most part, all is well, Baby Q appears to be healthy, my blood pressures and glucose levels are all doing great.  On Tuesday I went in for my first NST for the week and everything was perfectly normal.  Dr. L gave me the all clear to leave and then the nurse asked him if he was going to check me.  He assumed she was referring to checking my amniotic fluid levels but he had already done that last Friday so she clarified that she was referring to checking me for dilation as well as taking a sample to perform the Group B Strep test.  When he realized what she meant he made the statement, "oh yeah, but I don't know why because she never dilates!"  Well upon checking me to his surprise and mine he found that I was actually 2cm, he then proceeded to attempt to calm me down and reassure me that it does not mean I will be going into labor anytime soon.  If you know me well then you know that his reassurances did little to calm my panic at the time.  I just kept thinking of all the things I need to finish before she arrives.  I remained in a panic much of yesterday but after sleeping on it I awoke feeling more accepting of it, what will be will be after all.

Today, Wednesday, I went in for a 36 week ultrasound and it's estimated that Baby Q is in the 92nd percentile and weighing approximately 7lbs 6oz - in other words, she's another big baby!  At this point in pregnancy they estimate that a baby gains about ½ a pound a week and so with another 4 weeks to go until my due date we're looking at adding on another possible 2 pounds.  It's important to remember that these estimates are +/- a pound but I found from my experience with Y that it was pretty accurate.  At 38 weeks she was estimated to be about 8lbs 10oz and she was born just over a week later weighing 8lbs 14oz.

As for what this means for my decision about VBAC or C-Section, I do believe I have come to a conclusion but I am still gonna wait to talk to Dr L on Friday when I go in for my other NST.  I feel comfortable with the decision but I still want to ponder and pray about it before announcing it to the world, so stay tuned!  If all goes well I will be posting again in the next few days to let you all in on my little plan!

The Debate Continues...

I've been meaning to write this post for over 24 hours but I was pretty down-in-the-dumps after my appointment yesterday so I really just avoided writing it. I've finally pulled myself up by my boot straps and pushing ahead, so here I am, writing this post.

After my ultrasound on Monday I was so very hopeful about getting the VBAC that I so badly want and then at my appointment yesterday when I finally got to meet with Dr. L and discuss the ultrasound with him all of my hopes kinda came crumbling down.  I figured it was time for another candid discussion regarding my desire to have a VBAC and so I raised a few questions regarding the risks involved.  Well he kind of dropped a bomb on me.  You see, I've done a little reading up on VBACs because I want to know what I'm getting myself into and based on these readings I had pretty much made up my mind that I was going to attempt a VBAC.  The bomb that was dropped on me though, is that I am a high risk patient so the risks I was reading about in these other stories and books aren't really applicable to me.  Well, I guess it's more like those risks are applicable to me...but having Gestational Diabetes and Chronic Hypertension open up an entire new world of risks that I had no clue about.  Just talking about those risks intimidate me.  In the end I just want to make the decision that is healthiest for me and Baby Q and hearing about the possibilities really makes me question what the best decision is for us.

I guess before I was focused on VBAC vs. C-Section.  I knew the risks of a VBAC as well as the risks of a C-Section and in weighing them VBAC always came out on top.  What I never fully accounted for in my previous analysis was what happens if I choose VBAC and I'm unsuccessful in that attempt.  That was the discussion I had with Dr. L yesterday and ultimately that is the discussion that really has me wondering what path is the right one for us.  He also gave me a copy of the consent form that I'll have to sign regardless of which choice I make.  When he handed it to me to read over he forewarned me that it was going to be a shock to the system, and he was right.  It put me even more in a funk even though it was written to be unbiased and gave risks of both. I'll type it up below so you can all read how delightful it is for yourselves!

In reading and talking to other people on message boards and such I always get such a negative vibe when they refer to Obstetricians and everyone seems to scream that I should just switch to a midwife.  Well, being a high risk patient makes that decision for me, I pretty much have to see an OB and to be quite honest, I don't think I'd change even if I could.  I like my doctor and I can always rely on him to give it to me straight.  And so, with all the OB bashing that I hear and read about I have to hand it to Dr. L he hasn't tried to coerce me into making a decision either way and I know that regardless of what decision I make he'll go with it and do his best to make sure that both I and Baby Q come out of it healthy.

Here's the lovely consent form I mentioned above:

Statement of Informed Consent

For Patients with a Prior Cesarean Birth

1. I understand that I have had one or more prior cesarean(s).
2. I understand that I have the option of undergoing an elective repeat cesarean or attempting a vaginal birth after a cesarean (VBAC)
3. I understand that approximately 70% of women who undergo a VBAC will successfully deliver vaginally and that the remaining 30% must have a cesarean.
4. I understand that VBAC carries a higher risk of harm to my baby than a cesarean and these risks have been thoroughly explained to me.
5. I understand that the risk of a uterine rupture during a VBAC in someone such as myself, who has had a prior incision in the noncontracting part of my uterus is around 1%.  I understand that if my uterus ruptures during my VBAC, there may not be sufficient time to operate and to prevent the death of, or permanent brain injury to my baby.
6. I understand that if i deliver vaginally, it is likely that I will have fewer problems after delivery and a shorter hospital stay than if I have a cesarean section
7. I understand that VBAC carries a lower risk to me than does a cesarean delivery and the risks of each procedure have been thoroughly explained to me.
8. I understand that during my VBAC, the use of oxytocin (Pitocin) hormone to make my uterus contract may be necessary to assist me in my vaginal delivery and the potential effects of this drug have been thoroughly explained to me.
9. I understand that if I choose a VBAC and end up having a cesarean during labor, I have a greater risk of problems than if I had had an elective repeat cesarean and these risks and potential problems have been thoroughly explained to me.
10. I understand that in having a vaginal delivery I am exposing myself to the future risk of symptoms of pelvic relaxation including urinary and fecal incontinence and these symptoms have been fully explained to me.
11. I understand that the decision to have a VBAC is entirely my own, and the option of an elective repeat cesarean has been discussed with me
12. I have read or had had read to me the above information and I understand it.
13. I have had an opportunity to ask any questions I would like to ask regarding all of the matters described in 1 through 12 above.

I have received all the information I want.  After discussing the matter with my doctor:

It then has 2 spaces for signature, one above "I want to attempt a VBAC" and another above "I want a repeat cesarean."

On behalf of myself and my baby, i agree to accept the risks associated with the procedure I have chosen and release my physician, nurse, hospital and other health care providers from any and all damages related to any injury, illness and/or death resulting from the risks associated with the procedure I have selected.

There is another space for signature and date as well as a space to print my name.

Doesn't all that sound depressing to you too???

Holding On to Hope

At my 20 week ultrasound when I was told that Baby Q was in the 96th percentile, I pretty much had little hope of having a successful VBAC.  But today I have a new reason to hold on to hope!  I had an ultrasound today and she is only in the 54th percentile, at 28 weeks 6 days Baby Q is 1372 grams (about 3 pounds).  At about this same time of gestation Y was 68th percentile so I am celebrating that 14% difference today.

I was positive that I was going to be told that she was around the 70th percentile today but I was very surprised to learn that she isn't even close to it.  We did find out that she is currently in a head up position which only has me a little concerned.  Generally by this point babies are in a head down position but I keep reminding myself that Y was transverse (sideways) until almost the very end of my pregnancy and just when I had given up hope, she turned herself into that downward position.  I don't think it'll be anything to be seriously concerned about until at least 34-36 weeks, though I'll be sure to ask my doctor about it at my appointment on Wednesday.

I mentioned in a previous post that my ultrasound was rescheduled for Wednesday, May 25th.  Well this morning I awoke to a message from the doctor's office asking me to call them as soon as possible.  This threw me into panic mode because I figured that had received the results to the 24 hour urinalysis which I completed last week.  I quickly drew the conclusion that they had found a high level of protein in my urine, the doctor wanted to meet with me immediately, I would likely be diagnosed with pre-eclampsia which would undoubtedly lead to me spending the rest of my pregnancy on bed rest which would then lead to me having to find something to do with Y because I can't possibly take care of an active toddler while on bed rest.  I allowed myself to run through all these possible scenarios for 15 minutes until I finally got up the nerve to return their phone call.  Needless to say all that panic was for naught, they only wanted me to call back so quickly so that they could reschedule my ultrasound for TODAY instead of Wednesday.  It still took a while for my blood pressure to return to normal though, I allow myself to get worked up way too easily!

My Current Inner Struggle: VBAC or C-Section

Ever since finding out we were pregnant I have had one subject nagging me constantly at the back of my brain:  Vaginal-Birth-After-Cesarean (VBAC) or C-Section.  I thought I had my mind made up, and I guess in many ways I still do, but the opposition is always knocking at my brain with all the possible what-if scenarios.  It can be extremely nerve-wrecking especially when I realize that I have another 7 months to deal with what is quickly becoming an inner-turmoil. 

When pregnant with Y I had a lot of preconceived notions about what my birth experience would be.  I decided (or thought I had decided) fairly early on that I would NOT be induced and I would NOT have a C-section.  I knew the statistics and I knew the risks and I wanted no part of it, and that was that.  Well up until I was 37½ weeks pregnant, sick of being pregnant, and had an Ultrasound Tech tell me that I was carrying a 9lb. (+/- 1lb.) baby inside me.  That is when the tune changed and when the doctor said that unless my body started to labor on its own then he would induce me in 1½ weeks I was all over it.  Well, sort of.  I still really didn't want to be medically induced so I set out to do what I could to induce labor on my own (obviously none of it worked) but I was excited that there was a definite end in sight.

As most of you know, my body didn't cooperate with me and we drove to the hospital around 6:30am on a Wednesday morning and after checking all my vitals and setting everything up I had a pitocin drip by 7am.  As I look back I realize how naive I was.  I just knew that I would be holding my dear sweet little girl in only a few hours, I actually figured it'd be no later than 8pm - 13 hours was plenty of time, right?  I mean I was already 3cm when I got there, how long could 7 more centimeters take?  HA!  I didn't even reach 4cm until 12:45pm.  Anyway, I won't bore you with the entire, drawn out story but I will say that when I finally got the go ahead to begin pushing at 12:00am I was still only 9¾cm.  After pushing for 2½ hours she was still only at a -2 station.  At 2:30am the option of C-Section was presented and even though the likelihood of a 3rd or even 4th degree tear was presented, it was still an extremely hard decision for me.  By 2:45am I had caved and once again changed my tune, I was being prepped for surgery.  Between the time that I was pushed into the OR and hearing the time called out at 3:49am I don't remember much aside from being colder than I had ever been in my entire life - that is no exaggeration!  B said I snored through the entire operation, but really, can you blame me?

I have no regrets regarding the outcome of my labor story, I got a healthy and happy little girl.  But I have realized that I regret not taking more of a stand or asking more questions.  I've told B that this time around I REFUSE to be induced - easy to say when you're 8 weeks and not 38 weeks, but this time I feel as if I have a new resolve.  I don't believe that my body was ready for labor when I was induced and I think the end result of a C-Section was a direct result of that.  Now I am not, by any means, anti-C-Section.  I healed extremely well and extremely quickly, though I've nothing else to compare it to.  But I often find myself running through all the what-ifs that can occur anytime you make an important decision, you sometimes find yourself wondering what would have happened had you made the opposite choice.

And so I replay all this over and over again in my head as I research all the Pros and Cons of VBACs and C-Sections and I realize that the hardest part of it is the unknown.  No two labors are alike so I really have no clue what to expect.  I may end up with a much smaller baby, I may go into labor on my own at 38 weeks or so, the possibilities are endless and the reality is that those possibilities could either be positive or negative. 

I consider myself one of the lucky ones: I have a hospital that allows VBACs, I have a doctor who is willing to perform a VBAC and I have health insurance that covers a VBAC and with those three things half the battle is already won.  I have made a few decisions regarding this pregnancy though.  I will not, under any circumstances, plan now to have a C-Section, there will be no scheduled dates or even the discussion of one.  It's not even on my radar until at least 36 weeks.  I will be much more firm in my decisions this time around, it's my body and ultimately the decision is mine.  I will not refuse to have a C-Section if I absolutely feel it is necessary but at the same time I totally plan on doing a TOL (Trial of Labor).  I will continue to do research and know all of the pros and cons of VBACs and C-Section and I will not allow the opinions of others to corrupt my own opinions on the matter.  I will definitely be seeking out information and advice from those who have had successful VBACs.  I will be having several frank conversations with my doctor between now and then on increasing my chances of having a successful VBAC.

Just thinking about this subject can really bring tears to my eyes.  It is really becoming an emotional topic for me, I guess I'll blame it on the hormones.  I know that there is a lot riding on the outcome:  I know that with each C-Section the uterine wall becomes more and more fragile and that with each subsequent pregnancy the risk becomes greater.  I guess that is why I am putting so much pressure on myself.  We know that we either want 3 or 4 children but if they have to be delivered via C-Section (and having 2 C-Sections and 0 Vaginal births almost guarantees that) I can honestly say I wouldn't feel comfortable having any more than three.  And as I said, 3 may end up being all we really want to have but I don't want this debate to dictate that.  I'm a worrier by nature and so all the risks involved do intimidate me to some degree.  I guess I need to learn to rely more upon the comfort that Heavenly Father can provide over my own means of comfort.  "Let go and let God" as my mom and grandma used to say.