Wednesday, September 8, 2010

The Final Doctor Appointment

I had my final appointment this morning, at 39.5 weeks. I went in having mentally conceded that the c section was the right decision for me...UNLESS I have made cervical progress. If I suddenly was dilated/effaced/etc. and an induction now looked like it would have a reasonable chance of success, I would go for it. I had a lot of contractions and pressure last night and thought there was a possibility something had changed.

The verdict: No progress. She could feel the head and said that maybe I was a little softer, but nothing that would lead her to consider it a favorable induction at this point. She'll even check me before the c section on Tuesday just in case something dramatic has happened but she said that is really unlikely this late.

So a c section it is. 5:30 pm on Tuesday (the 14th). I have to be there at 2:30 because she thinks she can get me in a little early.

I have made some peace with it, feeling it is the best decision I can come to. I guess I will always wonder what would have happened had I tried the induction, but I can live with it.

Last night I finally broke down and took a Sudafed (I try to avoid anything while pregnant but it is on my doctor's list of "OK" if you have to). It allowed me to sleep for the first time in 3 days. I desperately needed that for my sanity and feel much more human today. Most importantly, Bryan's parents were kind enough to take Nathan and Kenna all day yesterday, overnight and today so I could recuperate. I couldn't be more grateful. They are so incredibly generous with their time. When I woke up this morning and realized I didn't have to get the kids up and find the energy to entertain them today, I just about cried. Seriously. It's gotten really tough to manage 21 month old twins while super duper pregnant. :) So today is a better day. Some clarity with the decision to just do the c section, cold is starting to improve, I had sleep finally, and I have a break from the kids. If I can just make it to Tuesday everything is going to be OK. :)

Monday, September 6, 2010

39 Weeks Pregnant...With a Cold...Very Cranky :(

Well, here I am...39 weeks pregnant...no signs of labor at ALL...and I have a horrible cold. I want to go bury myself in a little hole and wake up next month.

When I first found out I was pregnant I was very sick with a cold also. I had a horrible anxiety attack because I couldn't take my standard cold medicines and couldn't breathe. I was pacing the hall all night. I immediately started feeling anxious about being "trapped" being pregnant, that a baby was going to have to come out in 9 months, etc. I'm extremely claustraphobic and not just in a physical environment way...situationally as well, as in this case. I always knew that I would probably be very scared and feel trapped if I were pregnant, though it was always more important to me to have kids so we continued to try everything. Periodically throughout the pregnancy those feelings of strong anxiety about not being able to just "get out" of the situation at any time have emerged and I have quickly worked to subdue the thoughts knowing I had a long road to go. Purely survival.

I now feel like I have no more energy to suppress this underlying anxiety. I have so much fear about giving birth, no matter the method, that it is overtaking me. With my physical strength now being down due to the cold I feel like I am just plain out of steam to mentally deal with all that is happening. It's the worst thing that could have happened to me right now. In fact, one of my prevailing thoughts when I was sick when I found out I was pregnant was, "what if I am sick when I give birth and can't breathe?" (Being claustraphobic, anything that produces the actual or perceived sensation of not being able to breathe is the end of the world.) They always say that anxiety leads you to produce the worst case thoughts and they rarely happen. Well, it has happened. I feel like someone has taken a two by four to my spirit right now and I can't get off the ground!

Thank God that I moved the c section from tomorrow so I have time to at least get some better. If it were still tomorrow I would just be hysterical. I can only hope that I make it to next Tuesday's c section with the cold being better. I tend to have long colds so I don't know, but it should at the very least be BETTER than now. ALL I can think about is that my nose will be stuffed up while lying flat on a surgery table and I will suffocate.

I continue to struggle between the planned c section on the 14th and an induction a few days later. I feel very certain I'm not going into labor on my own. The hardest thing for me is knowing that the vast majority of people would choose the induction, but in my heart of hearts I know that I would handle a c section much better and that the mental and physical stress of a long hard induction with an "unripe" cervix and 60% chance of eventual failure is something I'm just not prepared to deal with at this point. I wish I could just accept that I have some different considerations than most people and ignore the fact that many people seem to feel a c section is the end of the world. But when so many people feel differently than you do it makes you question your own judgement. I know people who thought a c section was just awful and others who thought it was just short of a breeze. Who knows where I would fall on that spectrum? There is no way to know.

It's weird. I've all but forgotten there is even a baby involved at this point. The next week or two seem like a giant mountain to climb, after which I would rather just crawl into a cave on the other side and recover from the emotional and physical toll this has all taken.

Tuesday, August 31, 2010

Small update

I spent all day yesterday researching, asking people online, asking people here on my blog, asking personal friends, etc. to help make a decision. (Thanks so much to all of you who responded! I read everything multiple times! lol) Bryan was gone all day so I had to wait to talk to him until after all this had transpired.

I was definitely impacted by the fact that pretty much everyone everywhere said they didn't understand why the doctor would push for a c section on Tuesday when baby is probably head down now and there is no reason to believe I won't go into labor. Even though most people said they would just go for the induction period, it was the most common thought that even if I personally wanted a c section over that, I should just move the c section later to see if I go into labor naturally. This was something we never really discussed at my appointment but after much thought, I decided to call and see if it was a possibility.

I talked to my doctor's assistant and explained I was interested to know if I could delay the c section until the days after my due date, that I wanted more time to go into labor, etc. I told her I was still considering the induction instead but wanted to know if this delay was even an option in my considerations. She went and talked to the doctor and called me back...to let me know they had just moved it a week later to September 14 (40 weeks and 2 days)! I was a little stunned because I said I just wanted to know for decision making purposes, but I knew pretty much at that point that I didn't want to force it on this Tuesday so I thanked her and hung up. Of course I didn't mention it at that point, but I knew if I slept on it and wanted to cancel altogether today I could just call back.

Bryan and I talked about things last night and we agreed that moving the c section was the best thing for now. We also discussed the fact that though most people might prefer an induction, it would in all likelihood be a very bad experience for me personally. Even if I could physically do it and end up with a successful one, I would be going into it with so much fear and tension about being forced into labor (and the resulting c section that would be worse than a planned c section) that it would hurt my chances anyway. (I read a whole study on this yesterday that showed that women going into labor, especially induced labor, with a lot of fear and anxiety have an even higher failure rate - up to 75%+.) We both know me very well and know that it would just not be the right thing given my anxiety. Sure, regular labor can fail too, but I wouldn't be going into it thinking that, unlike with the induction. I know this morning that if I canceled the c section altogether yesterday and was waiting for a likely induction, I would be absolutely miserable for the next two weeks with fear (more fear than the planned c section - the way I see it, either is a c section given my likelihood of induction failure as stated by my doctor, but EVERYONE says the recovery from an unplanned c section is way worse so I would be putting myself in the worst possible situation).

Probably the best thing that came out of my conversation with Bryan last night was that I do have a regular 39 week appointment on Wednesday of next week. If I do have progress by then they can't FORCE me into a c section the following Tuesday. I would tell them that I wanted to cancel and wait for labor/or induction. I wouldn't worry about the induction if my cervix were making progress - those inductions are very favorable. The whole reason for concern is that I have had no progress to date, and I have to assume that may remain the case up until induction. SO, I really bought myself a week to see if labor happens OR any new signs of labor happen, in which case I may still cancel the c section. But I do believe that if by next Wednesday nothing has happened to my cervix, I will take the c section on September 14 rather than face an induction with a highly unfavorable outlook.

Monday, August 30, 2010

The latest in the saga

Things couldn't be more unclear after the appointment today.

Ultrasound showed...baby head down. Again.

No effacement. No dilation.

Based on what I've told the doctor about feeling the baby being transverse a lot of the time, she thinks the reason for no effacement/dilation is that she is slipping back and forth between head down and transverse. For other people at this point she said she would think that the lack of progress was due to something else more temporary and that she wouldn't question going into labor, etc. In my case, based on what I've been feeling, she said that I may well not make progress at all because the baby is so inconsistent. That's why she said that if I did an induction, I would have a high likelihood of failure (ending in c section anyway). So she gave me to options.

1. Keep the c section on Tuesday.
2. Cancel and schedule an induction in my 40th week (probably September 15 or 16).

She really couldn't recommend either way. She said it is really up to me and how important it is to try for a vaginal birth. She said that I should consider what is my worst case scenario - if a c section is the worst, wait for induction. If a failed induction is worst, go for the c section.

I HAVE NO IDEA! I basically left it with her that if she didn't hear otherwise, I will be there for the c section next Tuesday. If I decide on the induction, I have to call tomorrow to schedule it and cancel the c section.

I truly have no idea what to do. I'm less freaked out than just annoyed at this point. Here are some considerations:

1. I asked her if my endometriosis could cause complications with the c section. She said it could if I have adhesions she has to cut through but she has no idea until she gets in there. It could mean the risk of damage to an organ or something is higher. But she said she wouldn't consider this a major consideration and she would think about the other preferences first.

2. What if all this time I've been thinking the baby is transverse and I've been WRONG?! If the baby truly went head down a couple of weeks ago and has been head down since then, it would be considered "normal" and I don't think she would be so worried about a failed induction. So all this concern is based on what I THINK is going on in there? I have NO confidence I know at this point! What if I'm on the road to a normal labor and have a c section instead based on my own misinformation?

3. It's very tempting to just do the c section next week because I want to be done being pregnant more than anything in the world. But I also want to make the best choice.

4. My worst case scenario is a failed induction. My best case scenario is just going into labor. But in order to schedule a c section in advance you can't just wait until after your due date, decide the baby isn't coming on its own and call for a c section the next day. If you could, that's what I would do. It's basically next Tuesday OR induction. (Assuming I don't go into labor first.)

5. I have no idea the likelihood of going into labor on my own between now and the induction. But if I choose the induction date and have to actually be induced I would be really really freaked out about it. It's not like you can just change your mind that morning and say, "nope, want a c section!"

If anyone has an opinion, please comment. Because I seriously don't know what to do. Your guess is as good as mine.

For what it's worth, I did get to see a lot of Alexa on the ultrasound. She had a cute little face and was sucking when I saw her. I got measurements on her for the first time and she is measuring about two weeks behind. They weren't concerned at all, she's just a smaller baby. She might be built very differently than Nathan and Kenna, who are both tall! Her estimated weight is 6 pounds 3 ounces.

Sunday, August 29, 2010

9 days until c-section...

Well, tomorrow morning is the last ultrasound to check for position. I'm not even sure why we are doing it at this point...even if she is head down at the time of the ultrasound, the doctor said we would "talk about an induction while we can catch her in that position" but it would have a 60% chance of failure due to no cervical progress to date. Well, if that is still what she tells me, I will request the scheduled c-section. So head up = c section, head down = c section. I already know she is still flipping around all day long, so the ultrasound to me is doing nothing but looking at position at that particular moment.

That said, I've been reading a lot online about dilation, etc., and it seems to me that it's not unusual at all to have no dilation/effacement/etc. with your first baby before labor. I had concluded from my doctor that this meant an induction was 1) necessary and 2) likely to fail. So there is a small doubt in the back of my mind about what she is giving me as choices. Honestly at this point I don't really want choices because it's too stressful. I've been wrapping my head around the c section once again and it will almost be a relief tomorrow if the ultrasound makes it clear she is still not in the right position because then there will not be any discussion about ambiguities with next steps. As far as I'm concerned, I'm just counting down 9 days until c section.

I've been praying, praying, praying for peace about the whole thing because I've been so stressed about the surgery. I've been feeling some better the last couple of days so I hope that continues and I can confidently arrive at 7:30 am Sept 7 without bawling hysterically, which is my natural tendency. :)

In the meantime, I seriously can't figure out how I can be pregnant another week. lol I can hardly walk at this point, have aches and pains all over, have to rest half way up our stairs, wake up every two hours all night, and of course I continue to throw up every morning. I know, woe is me. :) But really, I'm trying to look forward to the c-section so that I know I will be on the path back to normalcy very soon. I'm disappointed that the recovery will be so long, but I'm using Halloween as my mental benchmark. By Halloween it will be a couple of days off from 8 weeks and by all indications that should be a full recovery if there are no complications. I LOVE the month of October so I'm hoping that during that time period I will just be happy with fall, college football and planning costumes for Halloween! I'm already reading about good post c-section exercise plans and am feeling very motivated to get into better shape than ever. I have to say that I'm not someone who has embraced the giant pregnant belly, so I'm thrilled to get back to my normal size. I HATE exercise normally but I'm hoping that getting back to normal as fast as possible will be a better motivator than I've ever had. :)

More news tomorrow...

Tuesday, August 24, 2010

Another turn of events

I went to the doctor for my 37 week appointment yesterday. She did my first cervical check. She couldn't feel the head, and there was no cervical "progress" (dilation/effacement). She wasn't certain but she thought the baby was transverse or breech again. I had a sneaking suspicion as of that morning. So the c section schedule remains on Sept 7. I have another ultrasound on Monday. If the baby is not head down, the c section goes forward the following week. Otherwise, we will have to talk about whether or not to induce while head down to try to catch her while in a good position. Even so, because she hasn't been head down enough to put pressure on my cervix and cause "progress" the doctor thought I would still have a 60% chance of normal labor failing and needing a csection.

So, yeah. I spent ALL day yesterday crying. No, really. ALL day.

Sunday, August 22, 2010

Full term today!

Today I'm exactly 37 weeks pregnant. It's very hard to believe! I'm so glad we are nearing the end though. It's been an incredible journey that we are even at this point, but I'm looking forward to getting to the new phase of a family of five and feeling back to my old self.

Last week things took an interesting turn. I had my regular doctor's appointment (which was actually with the nurse practitioner this time). When she asked about kick counts (how much I'm feeling the baby move) I admitted it has slowed down and that really, I've never felt all that much movement. That seemed to concern her, and coupled with my fears about there being a reason for the baby being breeched, I finally agreed to have her send me to the hospital for some monitoring.

They started with an ultrasound. I informed the nurse that she was breech before we started. She looked at the screen and said, "She's not breech! She is head down now!" Literally that morning at the doctor's office I could feel her transverse - head on one side and butt on the other. In the intervening 3 hours she had gone head down - I was floored. The nurse said she didn't think she would turn again at this point and since then I'm pretty sure she has stayed down. I'm absolutely floored by this as I was all geared up for a c section, but to be honest have been elated that I can try for the vaginal birth now. Not because I want that experience, just because I know recovery will likely be so much easier. Everything looked great - I had more than enough amniotic fluid, baby moved all the time, had the right heart rate, etc. I hardly felt anything while she was moving on the monitor, so that answered my questions; the nurse said I'm one of the rare people who never feel that much - probably because I have a lot of amniotic fluid and an anterior placenta combined.

I was also having contractions every 10 minutes with a lot of intermediate "irritability" (small contractions). She said that would cause me to not feel as much movement too, because I have so many small contractions all the time.

On Friday I had a TON of contractions - almost constant. I thought maybe that was going to be it. But they eventually subsided and I've not had too many since. I must admit that it's a bit more exciting now wondering when labor will happen rather than waiting for the c section. Before I was SCARED of labor starting before the scheduled c section but now I can look forward to it. Interestingly I don't feel the fear I did at one time about going into labor. I think I can handle it much better than the c section at this point. My how my perspective has changed! lol

I have a doctor's appointment tomorrow and I'll post an update after that.