Tuesday, October 14, 2008

High Risk Appointment.

So I was quietly crapping myself about this appointment, last time I didn't find the OB particularly friendly and I was scheduled to see her again yesterday.

I posted this on a forum about my mindset leading up to the birth of this baby...

"I've spoken to the OB at my High Risk Clinic about my fear/apprehension regarding the birth of this baby but she essentially brushed me aside, saying "all mother's have fear associated with the birth of their child".

The OB wants me to try for a VBAC and I am the first to admit that I would dearly love to experience a vaginal birth, but I am literally terrified of the whole thought of something going wrong . Specifically, I'm terrified of the baby being born with the cord wrapped around it's neck, or going into distress and not breathing when it's born. It keeps me awake at night.

Isla was born 5wks early via c-section because I lost too much blood during my pregnancy which caused PVL (Periventricular Leukomalacia) which means she has brain damage caused from the lack of oxygen to her brain while I was bleeding.

The idea of having a c-section doesn't phase me, although I'd rather not have a) major abdominal surgery and b) the longer recovery associated with it, particularly having Isla to look after - the whole no lifting etc would be practically impossible. And, I should add, that I know that having a c-section doesn't guarantee a healthy baby etc.

I've tried talking it over with my mother, who seems to think that I only want to have a c-section because I'm afraid of the pain or labour and birth which is completely untrue.

Is it wrong to even contemplate having a c-section just to ease my fears?"

So for the past 10ish weeks since my last High Risk appointment, I've found myself swaying between desperately wanting a VBAC and COMPLETELY freaking out about something going wrong and wanting a c-section. So here's a run down of what happened at my appointment yesterday.

BP = 120/70 perfect - hooray!
Baby is engaged - OB says head is locked in there and the only way she'll move now is out! OMG
Excess fluid not an issue - ultrasound yesterday showed that baby was touching the placenta and walls of the uterus, so not completely suspended in fluid. Fundal height only 2cms ahead, so measuring 36wks.
Since being weighed at 7wks pregnant, I've only gained 3.5kgs - although I did lose 5kgs between weeks 7-12 so about 7ish kg gain. Very happy! Should have roughly gained 12kgs by this stage.
Then OB asked if I've thought about the birth and asked whether I'd made a decision as to what I want to do. I was ready for the whole VBAC push but she sat and listened to everything I had to say and was very supportive of what I want and need from her and the hospital.

My questions to her:

ME: "I keep swaying between wanting a VBAC and wanting a c-section, purely because I am scared of something happening to the baby during the birth, what would you suggest for someone like me who already has a child with special needs?"

OB: "Ultimately it's up to you, if you feel more comfortable with having an elective C-Section then I am happy for you to have that. You will find that if you want to attempt a VBAC you will have a lot of support from the Midwives. We will do everything we can for you, whatever you decide. 2/3 of women who attempt a VBAC are successful, but 1/3 require another c-section for a number of reasons. Of that 1/3, 1/300 will have something go wrong, like uterine rupture".

ME: "If I decide to try for a VBAC, will there be limitations to it?"

OB: "Yes, most importantly you must be making progress with your labour, ideally, 1cm per hour. If your labour slows, I would consider using syntocin, but I would prefer not to. You may end up needing a c-section if labour does not progress. If there is meconium in the waters when they're broken, then we'll do a c-section. If there is any sign of foetal distress, we'll do a c-section"

ME: "Will I be strapped to the CTG the whole time and have to stay in bed?"

OB: "The baby will be monitored continuously, but we can allow you to walk around and still be monitored"

ME: "I have heard that some hospitals don't allow you to have certain types of pain relief, like an epidural, for a VBAC because you wouldn't be aware of the pain of uterine rupture, is this true?"

OB: "That's very outdated information. You can have any sort of pain relief that you would like. Waiting for pain as an indicator of uterine rupture can often be too late".

ME: "If I do decide that I would prefer to have a c-section, how many weeks would I be when I'm delivered?"

OB: "39 weeks or as close to it as we can get. There are specific days for c-sections, Wednesdays and Friday" and she picked up the phone and booked me in. She also said, "we can easily delete you off the list if you don't want a c-section".

ME: "If I attempt a VBAC, how far away from the theatres am I if something goes wrong?"

OB: "Practically across the corridor. The hospital was set up so that we're closely located to the theatres. If something were to go wrong, we'd be able to have you there very quickly, and just hope that there's a theatre available, or that all the operations in progress are more than 1/2 way through so we wouldn't have to wait very long".

ME: "If I decide I want to attempt a VBAC, and go into labour on my own, then have a complete mental breakdown or freak out, can I have a c-section?!"

OB: "Yes, you can change your mind at any time, but you need to be aware that just because you ask for a c-section, doesn't mean we'll be able to whisk you in for one straight away, provided there's no signs of distress etc, you'll have to wait until a spot is available"

She explained that I will have a pre-admission appointment with the anaesthetic team and there'll be some sort of tour where I'd get to see where everything happens to prepare me. She also explained what will go on on the day of the c-section - that they'll insert the anaesthesia, put in the catheter, get the baby out within 1-5 minutes of starting the op. I'll be the first to have contact with the baby before she's taken away by the midwives to be checked and rugged up. Hubby (or in my case, sister) will be allowed to hold the baby while I'm being stitched up, which will take from 15-30 minutes. Baby will go to the ward with hubby while I'm being stitched up and will be weighed/measured/injected etc (although I am going to ask that they wait for me to come back into the ward before they do this, or if it can be done in the theatre). I'll spend about 30 minutes in recovery then I'll be allowed up on to the ward.

So I've walked away from the appointment yesterday with new-found confidence in my OB and the protocol of the hospital. I'm really happy that she's supporting and respecting my decisions. I still have no idea which way it will go, but I'm going to attempt to keep an open mind and try to research as much as I can about both labour and vaginal births as well as c-sections. OB agreed with me that any hang-ups I have going in to the birth aren't ideal and could hinder progress.

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