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Mixed news from the midwife.
35-week midwife appointment this evening. Briefly, everything is swell for me and the baby, but my chances of having the kind of birth I want are not looking great.
Let's start with the good news: the L'il Critter is doing so well. She has indeed dropped, and has her head pressed against my cervix. She has a strong heartbeat which speeds up appropriately when she moves, as the midwife determined by poking her little hands and feet. Estimated weight: five pounds, which would put her at about seven pounds on her due date. And of course, she's nicely active - which I knew already, thank you very much.
I'm doing well, too. I'm gaining about a pound a week. My blood pressure is a beautiful 110/68. I have a tiny bit of swelling in my calves and ankles, but nothing to worry about - especially considering that it was an evening appointment. I'm not spilling any protein or sugar. My miscellaneous symptoms are all normal for the third trimester. My cervix is still closed, but it's about 25% effaced (which means that it's starting to shorten and thin for delivery). The baby's head pressing against my cervix should help that process along.
The main event for this visit was the pelvic exam. The senior midwife wanted to examine my pelvic architecture (which is abnormal because of my hip surgeries) to see if I had enough room in there to deliver vaginally. This is the part that didn't go so well.
Here's the verdict: the left side of my pelvis is just gorgeous. On the right side, there is a substantial bony prominence which juts way out, almost to the midline. Picturing my pelvic X-rays, I know exactly what she's talking about: it's the result of surgery I had when I was nineteen to try to correct my misshapen hip joint. (Surgery that failed, but let's not dwell on that now.) Depending on the baby's size and agility, she may or may not be able to get around the bony prominence. If she gets around it in front or on the left, everything will be cool. If she gets hung up on it, or is just too big to get by, I'll need a C-section. The senior midwife estimated the chance that I will need a C-section as "high." I don't get the impression that she says that very often.
The other thing she had to say was that I will probably find it very painful to have the baby's head knocking against that bony prominence. Painful enough that she thinks I should consider an epidural. That's another thing I don't think she says very often. I told her that I probably wasn't a candidate for an epidural because of my spinal fusion surgery, and she said that we should talk to the anesthesiologists and see. She also said there would probably be things we could do with positioning.
I asked - and I can't believe I really asked this - whether it would be a good idea to consider inducing labor early, to try to keep the baby's size manageable. And she said yes, which is a third thing I don't think she says very often. She said we could consider an induction starting at 38 weeks. In the meantime, she wants me to start taking evening primrose capsules once I hit 36 weeks (this Sunday), which apparently stimulate prostaglandin production and thus might hasten things along naturally.
She wants me to call the hospital and try to schedule a consult with the chief of obstetric anesthesiology, so we can talk about what my anesthesia options are if I do need a C-section - or if I want an epidural. She pointed out that not all the anesthesiologists will have the same skill level, or the same comfort level with doing spinal anesthesia on someone with a spinal fusion. So we might need to try to schedule things (like an induction, for example, or a scheduled C-section if I go past my due date and the baby gets big) so that the right anesthesiologist is on duty. It's an issue because the alternative would be general anesthesia, which would mean not being awake to see my baby born. I really don't want that. I don't want that at all.
I really wanted to avoid induction. I really wanted to avoid a C-section. It's looking like doing one might be my best chance of avoiding the other, and that feels... messed up.
The funny thing is that, for years, I assumed that I would have to have a C-section because of my hip surgeries. And I was okay with it. I just wanted a baby, you know? And I was just glad that my orthopedist thought I could carry to term. But somewhere during this pregnancy - maybe when I did the research and found out that 70% of women with my surgery have vaginal deliveries, maybe later on when I started researching and preparing for childbirth - I got very attached to the idea of a vaginal delivery. And especially when that spine surgeon I saw last November told me that I wouldn't be eligible for spinal anesthesia, and I realized how much I didn't want to be unconscious for my birth. Somewhere along the line, I no longer felt perfectly okay about a C-section. And now I'm so disappointed and sad.
I'll get over it, and we'll figure out what the best thing to do is. I trust my midwives very much. I trust that, if they tell me I need a C-section, it will be because I really need one and not because they're being overly cautious or trying to avoid the extra work of coaxing the baby out vaginally. I trust their advice about how to handle this. And I trust that they're going to make it all as easy as they can.
Michael keeps reminding me that, no matter how I deliver, at the end we will have a baby. And he's right. I'm trying to keep my eyes on the prize. I'll be okay.
But tonight it's hard, and I'm sad.
Let's start with the good news: the L'il Critter is doing so well. She has indeed dropped, and has her head pressed against my cervix. She has a strong heartbeat which speeds up appropriately when she moves, as the midwife determined by poking her little hands and feet. Estimated weight: five pounds, which would put her at about seven pounds on her due date. And of course, she's nicely active - which I knew already, thank you very much.
I'm doing well, too. I'm gaining about a pound a week. My blood pressure is a beautiful 110/68. I have a tiny bit of swelling in my calves and ankles, but nothing to worry about - especially considering that it was an evening appointment. I'm not spilling any protein or sugar. My miscellaneous symptoms are all normal for the third trimester. My cervix is still closed, but it's about 25% effaced (which means that it's starting to shorten and thin for delivery). The baby's head pressing against my cervix should help that process along.
The main event for this visit was the pelvic exam. The senior midwife wanted to examine my pelvic architecture (which is abnormal because of my hip surgeries) to see if I had enough room in there to deliver vaginally. This is the part that didn't go so well.
Here's the verdict: the left side of my pelvis is just gorgeous. On the right side, there is a substantial bony prominence which juts way out, almost to the midline. Picturing my pelvic X-rays, I know exactly what she's talking about: it's the result of surgery I had when I was nineteen to try to correct my misshapen hip joint. (Surgery that failed, but let's not dwell on that now.) Depending on the baby's size and agility, she may or may not be able to get around the bony prominence. If she gets around it in front or on the left, everything will be cool. If she gets hung up on it, or is just too big to get by, I'll need a C-section. The senior midwife estimated the chance that I will need a C-section as "high." I don't get the impression that she says that very often.
The other thing she had to say was that I will probably find it very painful to have the baby's head knocking against that bony prominence. Painful enough that she thinks I should consider an epidural. That's another thing I don't think she says very often. I told her that I probably wasn't a candidate for an epidural because of my spinal fusion surgery, and she said that we should talk to the anesthesiologists and see. She also said there would probably be things we could do with positioning.
I asked - and I can't believe I really asked this - whether it would be a good idea to consider inducing labor early, to try to keep the baby's size manageable. And she said yes, which is a third thing I don't think she says very often. She said we could consider an induction starting at 38 weeks. In the meantime, she wants me to start taking evening primrose capsules once I hit 36 weeks (this Sunday), which apparently stimulate prostaglandin production and thus might hasten things along naturally.
She wants me to call the hospital and try to schedule a consult with the chief of obstetric anesthesiology, so we can talk about what my anesthesia options are if I do need a C-section - or if I want an epidural. She pointed out that not all the anesthesiologists will have the same skill level, or the same comfort level with doing spinal anesthesia on someone with a spinal fusion. So we might need to try to schedule things (like an induction, for example, or a scheduled C-section if I go past my due date and the baby gets big) so that the right anesthesiologist is on duty. It's an issue because the alternative would be general anesthesia, which would mean not being awake to see my baby born. I really don't want that. I don't want that at all.
I really wanted to avoid induction. I really wanted to avoid a C-section. It's looking like doing one might be my best chance of avoiding the other, and that feels... messed up.
The funny thing is that, for years, I assumed that I would have to have a C-section because of my hip surgeries. And I was okay with it. I just wanted a baby, you know? And I was just glad that my orthopedist thought I could carry to term. But somewhere during this pregnancy - maybe when I did the research and found out that 70% of women with my surgery have vaginal deliveries, maybe later on when I started researching and preparing for childbirth - I got very attached to the idea of a vaginal delivery. And especially when that spine surgeon I saw last November told me that I wouldn't be eligible for spinal anesthesia, and I realized how much I didn't want to be unconscious for my birth. Somewhere along the line, I no longer felt perfectly okay about a C-section. And now I'm so disappointed and sad.
I'll get over it, and we'll figure out what the best thing to do is. I trust my midwives very much. I trust that, if they tell me I need a C-section, it will be because I really need one and not because they're being overly cautious or trying to avoid the extra work of coaxing the baby out vaginally. I trust their advice about how to handle this. And I trust that they're going to make it all as easy as they can.
Michael keeps reminding me that, no matter how I deliver, at the end we will have a baby. And he's right. I'm trying to keep my eyes on the prize. I'll be okay.
But tonight it's hard, and I'm sad.