Tuesday, August 10, 2010

There is no gray, only black and white

So, I had another growth ultrasound this morning. You see, at 32 weeks, this kiddo was measuring greater than the 97th percentile, so they're getting increasingly nervous about vaginal delivery. I went back today and--shock!--he's still measuring greater than the 97th percentile. (Why exactly was I the only one in the room not surprised by this news? Did they expect him to fall off the growth chart? And, if he did, wouldn't that be a BAD sign??)

Anyhow, it sounds like the general obstetrical recommendation is that babies measuring greater than 4,500-5,000 grams (somewhere around 9.5-10lbs) are at greater risk for all kinds of delivery complications, so OBs usually recommend c-sections at that point, regardless of cesarean history.

So, clearly that's where I'm headed. I have an appointment with my doctor tomorrow, but I can almost guarantee that he's going to recommend moving my c-section up to between 39-40 weeks.


I'm not going to go against this recommendation, because god forbid something happened, I would never forgive myself. But I genuinely can't help but feel that these recommendations are based on a general CYA strategy, since there are only extremely limited correlations between size and things like shoulder distocia (which is what they're currently afraid of).

And I'm just pissed. The feminist in me believes, deep down, that these recommendations are those of a male-dominated world where we try to shut down and control women's bodies as much as possible to control for "risk." I'm not saying this is part of a deliberate anti-woman conspiracy, but I do think that the world would look a lot different if people make less of an attempt to control and more of an attempt to genuinely understand. For instance, I asked the doctor last week whether genetics played any role. (I was, for example, 10lbs, and delivered vaginally with no problems. And the smallest baby in our entire family--both sides--was my brother who was greater than 8lbs, and we were all delivered vaginally. I suppose that could be coincidence, but it seems much more likely that it's related to the fact that we make and deliver big babies.) He said no. I also asked if they had a sliding scale that accounted for a woman's height--I'm 5'10" and just have to believe that it's easier for me to push out a 10lb baby than someone who is 5'1"--he again said no.

Perhaps he's right, though the midwives in his own practice actually disagree with him, for what that's worth.

I think it's because doctors don't like gray areas. When a gray area appears, they try their hardest to make it black or white. And I feel like that's what they're trying to do here: paint my situation as an absolute when it seems so clearly to me that it isn't.

In the end, I just need to get used to this. Like I said, I'm not going to allow a feminist hunch to push me to ignore a medical opinion. If it were just me and not my baby, I'd be more inclined, but it's not, so there we are.

But it definitely is starting to get me all lathered up. Like I need man-made intervention for EVERY part of the baby making and having process. And I just don't believe in my heart that's true.


Also, if they ask me one more time if I'm diabetic, I'm going to slap someone. Check my fucking chart. I passed my 1-hour glucose screening. If you want me to take it again, fine. But the baby is big, and it appears to have nothing to do with my blood sugar or his. So, look somewhere else for an explanation of his size. (I recommend genetics, for what it's worth.)

Oh, and to add to the number of things that are making me feel crappy about myself, a new study came out this week that basically said that women who gain more than 44lbs (which I have) have a greater risk of big babies, and that big babies have a greater chance of long-term problems like diabetes and obesity. (Again, I don't know how much they controlled for OTHER factors, like whether the people gaining 44lbs were overweight to begin with--I wasn't--or what the family history for the diseases were for the bigger babies--we have none--but whatever.)

So, just for those of you keeping track at home: gain 35lbs, you're a wonderful mother with healthy children. Gain 44lbs, you're dooming your offspring to a life of medical problems. 9lbs apparently makes all the difference.

You see? Black and white.

So, to sum up: I'm cranky and uncomfortable. This "little" guy is huge. And I'm a horrible mother who is dooming her child all because she ate too much ice cream for 8 months.


anna said...

aaahhh, yes, the 3rd trimester snarkiness- love it! I totally agree with you about the black and white thinking on this (though even as a M.D., I try desperately to think in the gray as much as possible, but maybe that's just because I'm a psychiatrist?!). I'm sorry that you've been pigeon-holed into a c-section. I feel your pain, my dear. If it's any consolation, the second c-section recovery was much easier than the first time around. And in my view of things, congrats, Momma, on growing such an amazingly healthy baby boy...you done good so keep eating the ice cream!!!

Somewhat Ordinary said...

I really don't see how docs use the measurements. I have known so many babies that were way off from what the doctor's expected. My son was bigger than they expected and I've known people who were freaked out over the prospect of a 10 pounder and they had a baby in the 8-9 pound range.

I gained exactly 40 pounds, had a 9 pound baby who at 2 1/2 has hovered between the 35th and 50th percentile.

Caro said...

For what it's worth my doctor said bog babies are easier to birth vaginally - more to push against. Not sure I believed her but anyway.

Oh and all the babies in our family are over 8 lbs and my cousin who is 6 foot had a couple of 10lbers. It's definitely genetic in my opinion.

Nearlydawn said...

Ummm - I'd so totally go with the midwives UNTIL I'd proven that I couldn't deliver naturally (with drugs of course). If you KNOW this about your family AND you are tall/were a big baby, then I'm not sure the Dr isn't just CYA a bit too much.

Frankly, what pisses me off is that Drs tend to answer questions to support their current position. If you'd asked him in the beginning of this PG, or if you'd not been PG, then I bet he would have answered differently.


No, my personal example won't be yours, but my baby was supposed to be 10lbs, so we did a C-section. He was 8.5. Now, granted, his HEAD WAS HUGE, so I was very, very glad to have done a C. But, he wasn't huge overall... They were off by 1.5 lbs, which is a LOT of off.

I really might just look for a 2nd opinion. C-sections aren't too easy to get over, IMHO.

kim said...

Most people I know IRL who've been told that their babies were big and weighed such and such pounds ended up having average size babies. My first son weighed 9.2. I am five feet tall barely. I did deliver him vaginally, although I was stuck at 8.5 centimeters for several hours unil he turned his head and came out in minutes. I was scared when pregnant with my second son who ended up weighing 7.2. So you never can tell. I prob wouldn't want to chance a vbac on a big baby though.

As far as what Caro said above, that was true for me, I literally had to hold my first son back so the Dr. could ge to my room.(The nurses told me to go ahead but I was scared of tearing) I had too push for a while w my smaller son. I hope everything goes smoothly for you whichever route you end up going with.

Ms. Planner said...

Can they MAKE you have a c-section?

Just asking because I think the arguments and assumptions you outline in support of your VBAC are spot on. And I continue to support you on your quest to have one.

I totally agree with you on the rationale that medical situations should take in to account factors such as height, weight, genetic history, etc. As someone who is petite in height and weight, I often can't stomach the dosage of medication typically given to adults.

And as for the 44+ lbs...please don't worry! I am 5'1'' and gained 40 lbs in my first pregnancy (with a 6lb baby). Missy has always been in the 15% for weight. She is tiny. I think what you feed them when they come out matters more.