Thursday, November 21, 2013

30 week appointment & some answers to my VBAC questions

I apologize in advance, this will be long!

I wasn't too sure I wanted to write this post tonight.  Nick and I decided to buy an iMac for our Christmas gift to each other. It was delivered today.  I can't get use to the keyboard.  I keep pushing the wrong buttons and when I try to push the delete/back button, I can't ever find it!  Hopefully I will get use to it soon.

I'll talk about the regular appointment stuff first, and then go into the questions I had that I wanted to discuss with my doctor. 

  • Blood pressure was great-119/65
  • My heart rate was high at 96 (I've been getting palpitations often) And I've had many dizzy spells and almost passed out 4 or 5 times.  This is all relating to the fact that I'm just really dehydrated.  I'm always really bad at staying hydrated.  (I stopped by sonic on my way home and got a bag of their ice.  That helps keep me drinking water throughout the day and munching on ice)
  • I've only gained 11 lbs.
  • Wesley's heart rate was in the 160s
  • He is head down!
  • And I finally brought up the awful pain I have in my butt hip. My sacroiliac joint is so loose.  Which means the bones in my pelvis rub against each other and cause a lot of pain.  The relaxin that is produced in pregnancy is to blame.  I have trouble getting off the floor after playing with Tanner, or stretching my back.  My hip locks and I literally get stuck.  It hurts so bad.  My doctor gave me two names of chiropractors that he personally uses and trusts.  Tricare does not cover a chiropractor but they usually have cash plans and work with military families.  I'm just not sure if this is an expense I'd like to have right now. (Chiropractors can help patients have successful VBACs, too!)

I had butterflies about this appointment. I was planning on discussing a couple questions with my doctor that I was worried about.  And now, I should have known it would all be okay. I mean, the first words out of his mouth at my first appointment this pregnancy was, "So, are you going to have this baby the right way this time?".  

My worries were coming from the research I've been doing.  I've been reading and following a VBAC Fact page on Facebook.  It's a bit scary to see the huge differences between many hospitals and doctors around the country, and worldwide.  And it's even scarier when the majority of the doctors are not following evidence based research, and instead are spreading unnecessary fears.  Here is a recent post I wrote with some VBAC facts.  It's actually safer for the majority of women to have a VBAC vs a RCS (repeat c-section).  The statistic for a uterine rupture is less than 1%! It's about the same chance of a cord prolapse.  So many doctors completely refuse to allow them.  And if they say they are VBAC "friendly", they put so many restrictions on the patient that a RCS usually ends up happening.  

I had all these horror stories in my mind when I went to my appointment.  After getting all the regular appointment things done he asked me if I had any questions.  Thankfully he wasn't in any kind of rush and really talked to me about things.  My first question was about the hospital and if there were any policies on continual monitoring on laboring VBAC mothers.  Many hospitals countrywide require continuous monitoring.  Which means the mother has to be fairly still as to not make the monitors move and stop reading the heart rate.  This also means no laboring in the tub.  The thought on continuous monitoring is that a change in baby's heart rate can be an indicator that a uterine rupture is about to happen.  But it's not reliable in the least.  When I brought this up to my doctor I had my mind convinced that he would say my hospital would be one of those that require it.  Boy was I wrong.  He said they have absolutely no policies like that.  This brought up my second question.  It wasn't one I was planning on asking but I was curious about it so I'm glad it came up.  

I told him I don't have a very high pain tolerance, but I am wanting to wait a little longer to get the epidural than I did with Tanner's pregnancy.  That's why I wanted to know if I would have to be continuously monitored.  I want the option to get up and walk, sway, and get on all fours to cope during contractions.  This is when he mentioned that he would prefer that I get an epidural because if I were to rupture, I would already have the pain relief and we could go immediately into surgery.  If I did not have it and I ruptured, I would be put to sleep.  Which would put Wesley to sleep.  And lots of other problems.  It's not really a big deal to me, as I mentioned, I was planning on getting an epidural at some point.  (Even though I secretly would love to go med free! But I'd rather have an epidural and a VBAC than a c-section) So my tentative plan is to labor at home as long as possible, and then go to the hospital and reevaluate how I feel about the epidural.

My last question was one I thought I was going to have to fight him on.  He told me at my first appointment that they usually schedule RCS at 39 weeks but since I wanted to attempt a VBAC he would let me go to my due date.  I am almost 100% sure my due date is off by 5-10 days (later).  That's a huge difference when it comes down to major surgery.  I began the question stating how I know the ACOG (American Congress of Obstetrics and Gynecology) states a normal, healthy VBAC patient can wait until 42 weeks before induction is discussed. But I personally do not feel comfortable with that.  And how I also don't feel comfortable only going to 40 weeks, either.  He said they don't like to have patients go past 41 weeks because the chance the baby passes meconium from 41-42 weeks goes up a substantial amount.  He said the chance baby aspirates meconium is slim, but if it happens it can be a very bad situation.  So the risks to mom aren't what they worry about as much (a slight increase in the chance for rupture from 41-42 weeks), but the risk to baby is.  This made me feel great.  The biggest reason I wanted to wait until 41 weeks and not 42 was for this reason.  I don't want to have to be separated from my baby like I was with Tanner.  6+ hours is ridiculous.  I want my baby immediately after he is born.  

He did mention a few months ago that we could try an induction, using a very low dose of Pitocin to get things moving.  But there is also a small increase in the chance of a rupture.  And I just don't personally feel comfortable with that. (Not to mention Pitocin is the devil drug!)   So we have a RCS scheduled for early February, at 41 weeks.  I'm okay with this.  Surprisingly.  I'm still hoping and praying with all my might that I go into labor on my own, though.  

Once I get closer and closer to February, I'm going to start discussing the possibility of keeping Nick and Wesley with me in recovery.  Nationally accredited hospitals in breastfeeding have "Family Centered C-Sections", which is just that.  The baby is with the mother at all times, immediate skin to skin and breastfeeding.  This would be my dream! (Second to a VBAC, of course)

So I feel at peace with my decision.  And I'm very thankful for that!

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