Sunday, November 2, 2008

37 weeks.

37 weeks!!!!

A baby is considered full-term if born any time after 37 weeks!


There are no midwife appointments this week, so I will be seeing a Registrar on Friday morning with Kate. I'll be informing them of my decision to go with an elective c-section.

It's something I've thought long and hard about and I'm glad to say that so far, the people I've told have been supportive. I composed an email to send to family & friends about my reasons etc, I'll post it at the end here too.

My feet swell every day. Saturday I had to ask my Mum to go to the shops and buy me some new slippers because I couldn't get my feet into any shoes! My lovely inlaws are also going to put some Xmas presents on layby for me today because it's all too hard for me to get to the shops these days (particularly with Isla in tow) so I only have 1 person to buy for now (and the IL's too, but I think I know exactly what I'm getting them). Feels good to know Xmas is sorted!

It's 9.39am and I've already been up for 5 hours and I'd really like to go back to bed, but Isla has only been awake for about an hour or so, so the chances of her going back to sleep are non-existant!

Anyway, this is my lengthy email:

I've made up my mind what I'm planning on doing with the birth of this baby. I'm just letting you know so that we're all on the same page.

I've decided to go ahead and have the elective c-section. There's a few reasons why I'm choosing to have this, and I'll share them with you so that you can understand and hopefully support my decision.

The main reason I was originally swayed by a c-section was because of Isla's special needs. I am particularly terrified of something/anything going wrong with a natural delivery, specifically, foetal distress, the cord being wrapped around the baby's neck etc. For me, the choice to have a c-section was set in stone last night when I found this piece of information, which was published in the New England Journal of Medicine in December 2004. It's the results of 46000 women attempting a VBAC (vaginal birth after caesarean section)

Among infants whose mothers chose this "trial of labour," the frequency of hypoxic ischemic encephalopathy (HIE) - another serious complication-was increased. While only 12 cases of HIE occurred with "trial of labour" cases, there were no cases among women who had elected to have a repeat caesarean delivery. Seven of 12 cases of HIE, including two neonatal deaths, followed uterine rupture. Maternal morbidity, endometritis and blood transfusion were all more likely among women who chose VBAC than among those who chose repeat caesarean delivery”

HIE = newborn brain injury due to lack of oxygen

The specific risk is 1 in 2000, which I know is a slight risk, but given that I already have a child that has HIE (specifically Periventricular Leukomalacia) the risk is just too great for me to willingly take just so I can have a particular kind of birth. Part of me is sad that I won’t be able to experience a “natural” birth, but I have to put the well-being of the baby before my needs. I know that if there’s a 1 in 2000 chance that something will go wrong, then there’s a 1999 in 2000 chance that everything will be fine but still, I am confident in my choice. I also know that any birth resulting in a healthy baby is successful and that’s what my focus will be.

I spoke about this with the Dr at the High Risk Clinic, and she is happy to support my choice and while Bankstown Hospital actually has the lowest c-section rate of any hospital in NSW, she said, it’s not up to her to single-handedly lower the Country's c-section rate, so if I want one, I can have one. I know that the Birthing Unit is co-located with the operating theatres (I studied the floor map on Tuesday night) it is literally across the corridor, but, what if something goes wrong and all the theatres are booked? I would never be able to forgive myself. The Dr did say that they could get me into theatre within 5 minutes and have the baby out within 1 minute - assuming that there’s a free theatre. I also know that if the brain becomes compromised if it is starved of oxygen for more than 11 minutes.

There are also other limitations surrounding attempting a VBAC that have influenced my decision.

:: I would need to go into spontaneous labour by 41+3wks otherwise I’d have to have a c/s.

:: I would have to make very specific progress in labour, ie I would have to dilate 1cm per hour, they aren’t keen on giving syntocin to help speed things up, so failure to progress would mean a c/s.

:: If there’s staining in the amniotic fluid , I will be taken for a c/s straight away.

:: If there’s any sign of foetal distress, I will have a c/s straight away.

So, that’s where we are at. Should I go into labour on my own, I need to ring the birthing unit and tell them I’m scheduled and they’ll ask me to come in and I’ll be slotted into that day’s Caesars. I am hoping that I will be able to have the c-section before going in to labour as I will have enough recovering to do from the surgery, but we'll wait and see what happens.

I am hoping to have either a epidural or spinal block, but I will discuss that with the Anaesthetist at the clinic in the coming weeks. Kate will be coming with me for the c-section because Ian doesn't feel he'll be able to cope inside the operating theatre, and I respect his decision. He will spend time one-on-one with the baby when I am in recovery.

A few people said to me the other day “you’re mad for having a c-section” and you may feel that way too, but I ask that nobody judge my decision, because it ultimately is my decision, which I have made based on a lot of research. If you feel the same as the people above, I ask that you do not bring it up with me, I’m not interested in being converted to the natural birth camp or being judged, I would prefer to have the support of family and friends.

I also ask that you are patient with us after the birth, in terms of visiting us and us visiting other people. We’ll contact you when we’re ready for visitors as we want to spend some family time together when the baby arrives, so we can all adjust to our new arrival, Isla particularly. Similarly, with visiting people so they can meet the baby, we would like to take our time to settle in to home life, especially as I will be in hospital for 5 days.


Al & Ian

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