rivka | Mixed news from the midwife.

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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.

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Many hugs, sweetie. As you know, I really can relate to where you're coming from on this one. If there's anything I can do, just let me know.

Keeping your eyes on the prize is important, it's true. But I know I faced a real sense of loss when my hopes for a vaginal delivery were destroyed, and it was really important to me to process that loss and work my way through it. I found it really annoying and demeaning when other people tried to invalidate those feelings and that process.

Thanks, Tammy. I knew you would understand this very complex position I'm in - I was telling my mother about your birth last night.

Right now the question I'm really wrestling with is how far I should go to try to avoid a C-section - specifically, if I should try an induced labor before dates. Michael and I are both researching our options and asking lots of questions. Of course it will depend in part on what's possible for me in terms of anesthesia, if we do have a C-section - so the anesthesiology department is going to be my next call.

I think you mentioned that you had a C-section-specific birth plan. Could you possibly send me that? I think at this point it would be really helpful to see. Also, my midwife recommended a book called The Cesarean Birth Experience - have you read it? Were there other resources you used to prepare for your C-section?

Thanks again for your comments, and your support.

My birth plan:
http://www.livejournal.com/users/tammylc/276736.html

I have not read the book you list. There's a c-section support thread on Mothering.com, and that's where I got most of my information and support. It was really difficult to find useful stuff on the web - it was all focused on what to do to avoid a c-s, or how to VBAC. Very little that addressed "so you have to have a c-s, here's how to make it as good as it can be."

Mostly I just journaled a lot, and talked to friends a lot.

Thanks, your plan is very helpful. I would not have thought of things like specifying that I wanted to wear my glasses, but of course standard hospital protocol would be to make me take them off.

I just got off the phone with one of the anesthesiologists at the hospital. He said that I should "probably" be okay to have either an epidural or a spinal, because my fusion is relatively high in my spine. He also told me that I could stop by the hospital for a consult, with my X-rays, if I wanted a more definite answer. So I think I'll camp out over there on Tuesday morning until someone can see me. I'm feeling somewhat better just from that - I definitely have fewer problems with the idea of a C-section if I can count on being awake.

Well, that is definitely hopeful news on the anesthesia front. Sounds like camping out for a consult is certainly worth the effort.

*Hugs offered* I'm very glad you have a team of professionals around you whom you trust to do the very best for you and L'il Critter.

Oh sweetheart... I'm sorry things don't look so good for all you had hoped...

but hey, Baby!

*sympathy*.

Oh Rivka, I'm sorry. Having had two of each kind of delivery, I can tell you that an uncomplicated vaginal delivery is by far the best. But you knew that. On the other hand, a difficult natural labour, followed by an emergency C-section is possibly the worst option, so it sounds like you are getting good advice about avoiding that. In my experience, recovery speed is the most important thing, and a scheduled caesarean tends to be less rushed and therefore less brutal, making a recovery easier. Especially if you haven't already exhausted yourself in a difficult labour.

I breastfed and bonded successfully after my two c-sections (one with twins), as after the two natural labours. You've thought about all this so thoroughly that I'm sure you and Lil Critter will do well whatever happens. The disappointment will fade. Good luck with sorting out the best option for you. If it would help to know more about my experience, Jae has my email address

Emma

***hug***

I wish I had more to offer you.

*hugs* I know it's hard: my first two had to be induced, so I was so thrilled that I went into labor naturally that I was angry when complications arose that made me need a C-section for the third. Michael is right, but honoring your sadness is important too.

I'm sorry you're sad.

However it happens, critter's birth will be the way that critter enters your life, so however it happens it will be the right thing.

I'm sorry. I was really hoping that you would be able to get what you wanted. But, as other people pointed out, what you want is a baby and the ability to take care of her, and that you get.

Thinking of you.

Sorry about your disappointment and sadness now, even though you and the baby and Michael will be okay.

I'll keep my fingers crossed that you get to deliver in the best and safest way for you and the Lil Critter. And I hope it all turns out the way you want it.

Somewhere along the line, I no longer felt perfectly okay about a C-section. And now I'm so disappointed and sad.

Yeah. A person would be, especially after having hopes of the other option.

I'll get over it, and we'll figure out what the best thing to do is.

Yeah. Doesn't make the disappointment and sadness vanish, though.

Life keeps doing this mixture of joy and tears thing.

Hugs enclosed for all of you.

The disappointment is completely legitimate. It's something you wanted to do with the baby. {hug}

I'm glad you trust your midwives. It at least takes off the burden of second-guessing.

Looking forward to meeting the Critter, however she arrives.

i'm sorry for your pain. [giant hug]

i don't *know* it, but i *empathize*. i can imagine how hard that must be.

but i also know that you are being given the options early enough that the birth can happen in the *least* traumatic way for you, the Critter and Michael, that is nothing but a huge blessing.

n.

I am sorry that you may not get to have the birth experience that you want. I will continue to hope for the best for all three of you.

Your midwives sound great. I can see why you trust them.

*hug* I'm sorry you're feeling disappointed.

I had a C-Section, too, and there's a little grief there that I went through because I wanted a vaginal delivery, too. So much of my labor experience was NOT how I planned or wanted.

But, really, Eddie makes it all worthwhile. Delivery is such a small part of parenthood that now it's hard to remember why it was so important at the time.

*hug again*

I'm sorry you're disappointed. At least you can plan ahead. It's a good idea to plan on needing to recover from a C-section, even if it turns out you don't need one. A C-section is major abdominal surgery. You won't be able to lift anything for weeks (including the baby), it will hurt to climb stairs, you definitely won't be able to vacuum or sweep. On the plus side, you'll have lots of time for sitting still and holding the Critter and bonding, yay! So, plan on both you and Michael needing to take more time off than you had thought you'd need. Baby, squeeee!

Oh, I'm sorry to hear you might not get to have the birth you want to have. *hug* At the same time, I'm so glad you're in such capable, caring hands with your midwives and that you know *now* so you can plan in advance to do whatever is required to be awake when your daughter is born.

Of course you know you get a baby at the end but it's perfectly reasonable and normal to be sad right now. At least you can get the disappointment out of the way now so that the day your daughter is born will be just about the joy.

Also, did you know there was a Carter outlet right by my hotel in Williamsburg? Did you further know that the forces of cuteness in that store make it utterly impossible to leave without purchasing tiny cuteness to bring home with you? Let me just say that I hope you really do have a girl!

{{{{{Healthy baby, healthy Rivka}}}}}

I think you're really fortunate in your midwife.

i'd most rather have a healthy baby and a healthy rivka, but shortly after that i would like a rivka who is happy with the way that the baby appeared in the world.

i hope you get all of that, whether that means the critter getting all agile and swooshing past the bump or whether that means you getting more used to one of the other options.

*hug*

I'm sorry things aren't going as you had hoped, but glad that all is well otherwise.

Best wishes for high agility and whatever else may be needed to get past the problems...and best wishes for coming to terms with whatever must be.

Again, bright blessings.

I had two vaginal deliveries with no complications, so I can't offer any ideas or suggestions. It does sound like your midwife is excellent :-)And she is absolutely right regarding the varying levels of skill and competence of anesthesiologists (sp).

Sending you sympathy and support. Your baby is so lucky to have someone as thorough, careful and loving as you are :- )

I am so sorry it's turning out like this. I have some idea of how hard it is, ish, I think.

In your position, I think I would - yes, even having gone through what happened - opt for an early induction as a first option, because that way even if you did need an "emergency" c-section in the end you could schedule the induction for when you have the right anaesthetist available, eliminating the unconsciousness element. That's the bit that would bother me most, I think. It's not something I've had to face, so I'm guessing.

I absolutely promise that you, particularly, can get over any kind of birth that ends up with a healthy baby. You have the tools you need for that. And the loss of The Perfect Birth *is* worthy of grieving over. It really is.

And if you want to talk about it, before or after, I'm listening. I haven't been where you are now, but I did wave goodbye to the perfect birth...

A.
Who has been wondering if her Evening Primrose Oil capsules against PMS are the reason her breasts are *this* full of milk. Owie.

Augh.

Hugs offered.

Drop me a line if you'd like to hear about my (technically elective, but not really) C-section.

I'm so glad you're surrounded by professionals with empathy and skill.

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.

And you're entitled. This is not what you wanted, and not what you hoped for, and that's painful.

I'm thinking of you, for what that's worth. Of you, and of

curiousangel, and of all the others involved (including the baby, whose LJ I expect to friend inside six months of their birth).

Ow.

I *am* sorry to hear this news.

Whatever the birth method is, may it go well.

Oh, what everyone has said, and especially Kalmn's:

>i'd most rather have a healthy baby and a healthy rivka, but shortly after that i would like a rivka who is happy with the way that the baby appeared in the world.<

I was staring a c-section in the face with Colin (premature, over 24 hours since water broke, signs of infection starting) and Kate (who was firmly breech at 38 weeks), but managed to dodge both at the last minute. I know that particular horror, when you've done all the research and the classes and found the right doula and the right midwife and DAMMIT you've done it all .... and baby and body decide not to cooperate and it all starts to go south.

And I don't have your physical history.

I hope so much that you get to birth your child the way you dreamed of .. and if not, that at least you are surrounded by support and love, and that it is, in the end, worth every ounce of angst.

A year ago tomorrow, I delivered my daughter via C-section after about 30 hours of labor. She was in bad shape - she had severe meconium aspiration - and the C-section saved her life.

I was incredibly self-righteous and cavalier throughout my pregnancy about what kind of birth I wanted - and I was determined that it was going to be natural and affirming. It was so important to my feminist sensibility that it be that way. I never even had an ultrasound - it was the no-intervention pregnancy.

But then at almost 41 weeks, my water broke at home, and it was full of meconium, and I knew instinctively that I was not going to have the kind of birth I wanted. The midwives were terrific and let me labor naturally as long as I could before they started getting really concerned about the little one's heartbeat. I ended up having more than one epidural, and it was, as our childbirth educator had said, "a compassionate use of painkillers."

All of this is not to dwell on my experience but simply to say: you will not be any less amazing as a mother because of how you deliver. Nor will you have sold out your politics to have a C-section. You trust your caregivers, you trust yourself, and you know that you'll do the right thing for you and for the little one. But getting over the disappointment is tough going. And it doesn't help when the editor of Mothering magazine and others like her squarely put the blame for the rise in C-section rates on the mothers themselves.

Incidentally, if you think you might have a section, bring some Gas-X to the hospital. The cramping afterwards is pretty rough.

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Mixed news from the midwife.

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Re: Mixed news from the midwife.

vaginal vs caesarean (yes, that's how we spell it)

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Mixed news from the midwife

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