Tuesday, August 31, 2010

Friday

I can't remember if I mentioned this, but I scheduled one last appointment with my OB for yesterday. You see, I had been cycling through different doctors in the practice, but there is one doctor whom I LOVE and whose opinion I really value, so I scheduled an appt with him yesterday. I'm so glad I did. This guy is GREAT. He speaks to you like a grown up--lays everything on the line and lets you make an informed decision. He doesn't try to sway, just very dispassionately lays out the stats.

Imagine! Treating you like you're an intelligent person capable of making an informed decision?

Anyhow, he was actually comfortable letting us schedule for next week. (In other words, he felt comfortable that we understood the risks and trade offs and was happy to let us make the call.) He also fully explained that, chances are, everything would be just fine. He was basically like: "look, in a majority of cases you could literally just show up for the delivery and have things turn out fine. In a small percentage of cases, things go wrong, and obstetrics is about managing for those cases."

How true! (I mean, don't get me wrong, I'm not about to not show up for appointments, but it was a refreshingly honest take that basically says: this is a normal, natural process. Sure it's not without risk, and we can help you manage that risk, but know that that's what it's about.)

He also very frankly explained: "hey, look, WE (doctors) would prefer to do a c-section. We know the risks and generally how to avoid them. There's more uncertainty with vaginal delivery particularly with a big baby. We can't predict shoulder dystocia and that's troubling. But, there's more to the decision. And, chances are, everything will be fine. People birth big babies all the time"

He also explained that the chances of shoulder dystocia are less than 1%, and of those cases, the chances of permanent damage are less than 2%.

So, it was a helpful conversation. It did what I wanted it to do--put the risks in perspective. He isn't hyberbolic, which the other OB in the practice was. (He was making all kinds of faces and was pretty dismissive of my questions. That, frankly, is what was putting me in a bad place.)

That said, hubby isn't entirely comfortable waiting until next week. For a number of reasons, I think he just feels like the longer we wait, the higher the risk of...well, of a number of things. So, we said we'd schedule it as late as we could this week.

So, Friday it is.

I feel SO. MUCH. BETTER. Just having talked to this doctor helped put me in a totally different space. Sure, I'm still not happy with the c-section, but whatever. I don't feel pressured into it; I feel like it's our call. And I feel like we're making an educated decision. And, yes, I do still hope I go into labor between now and Friday. But if I don't, we'll figure it out.

So, send labor vibes. And wish us luck either way.

Friday, August 27, 2010

That old familiar feeling

So, here I am, 39 weeks tomorrow with a baby who, by ultrasound, is measuring 9.5lbs.

The cutoff (according to my ob) for a c-section--regardless of VBAC--is 4,500g. A week ago, he was measuring 4,300g. I currently have a c-section scheduled for September 1. On the upside, I was expecting last week's growth ultrasound to show him at greater than 4,500g. It didn't, so I bought myself another week to possibly go into labor on my own. I felt really good about that for almost a whole 24 hours.

But then, of course, the reality of the fact that I have ZERO signs of impending labor started to set it. I've had virtually no contractions, no dilation, no losing of the mucous plug, nothing. (I mean, seriously, people? I had no labor symptoms with almost 14lbs of baby in me with twins and ditto for this. It's shocking that we couldn't actually MAKE a baby on our own because apparently babies find my uterus to be a place from which they have zero desire to emerge!)

So, to be honest after the initial 24-hour "I still have a window to VBAC!" high, I'm just feeling discouraged. I've gotten my mind set on a VBAC and now that hope is slipping away from me. And there are so many emotions wrapped up in that. (Including this incredulous "are you KIDDING me?!" feeling. I mean, what are the f'ing chances?! This c-section is absolutely not VBAC related. Seriously, people??)

Anyhow. For the past two weeks I've now been obsessively googling "signs of labor," and "ways to naturally induce labor."

Ummm....does that sound familiar? Obsessively checking Dr. Google for signs and symptoms that maybe, just MAYBE this will end the way you envision?

Yeah, so frankly, this is all starting to feel WAY TOO MUCH like all of those months I spent googling "early pregnancy symptoms." And, the desperation I'm starting to feel is eerily similar to that last cycle before my first IVF. At that time, I remember the raw feelings. The: "this is IT. My LAST CHANCE to avoid such a dramatic medical intervention."

I wanted that cycle to work so badly. Just like today, I want to successfully VBAC (and avoid surgery)...so badly.

But the thing is, as of today, I just don't want to feel like this anymore. I don't want to revisit those IF feelings, that desperation. Yes, I know this is different for SO MANY reasons, but for whatever reasons, it FEELS the same. And I hate it.

So, part of me just wants to say fuck it. Much as I DO NOT want to have a c-section, I don't want to feel this way anymore.

And so...for today anyhow...I give. I'm just going to mentally prep for a c-section and be done with it. I need to start focusing on how to make that experience as much as it can be and I need to stop thinking "are-you-fucking-kidding-me-that-yet-ANOTHER-random-and-highly-unlikely-fertility-related-thing-has-happened??" Because, that thinking is negative. And, really, look how lucky I am? I have two beautiful children and I'm lucky enough to have a third on the way. I need to STOP thinking that this is supposed to look a certain way and just say that we take different paths and it's fine.

So...that's what I'm trying now...

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.

Bla.

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.

Whatever.

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.