Wednesday, November 30, 2011

Preparing well in advance

In brief: This is a post about pregnancy, or rather childbirth, and
the shadow cast over it by IF baggage. I could use some input (if
you're comfortable giving it).

But first - I'm 27 weeks now and all is going well. Another 3 weeks to
go before my next appointment with the ob/gyn.

A while back, I was talking to a friend of mine, about parenting,
pregnancy and childbirth. Our conversation made me realize something I
had been trying not to think about.

Childbirth. I'm terrified of it.

It's not so much the pain (which I'm sure is awful), but is
essentially temporary. I'm terrified something might go horribly
wrong.

Let me rewind a bit. You may - or may not - remember that Linnea was
born by planned C-section. No way was I attempting a breech delivery.
Secretly, I was relieved at getting a C-section. Emotionally, it felt
like the least risky method of giving birth. Natural delivery seems so
... unpredictable.

So why don't I just get another planned C-section?
My doc informed me that a VBAC (vaginal birth after c-section) is more
or less the standard course of action. (I gather this is not so in the
U.S. and Canada?)

Perhaps I could switch ob/gyn again, because some doctors agree with a
C-section after a C-section more easily. But I don't see it as my best
and first move.
A VBAC has its charms. I wouldn't have to recover from abdominal
surgery. Perhaps, just perhaps, it might jolt my body into making
some milk this time (if I can do without the epidural, so I'm told).

Which brings me back to my terror of (natural) childbirth.

The word 'natural' in connection with anything to do with
'reproduction' puts me ill at ease. Nature hasn't been all that
cooperative, though admittedly the pregnancy phase has gone smoothly
so far.

Another sign of post-traumatic stress, I think, and not so surprising
either. Or am I clinging to my IF history unnecessarily?

I've made an appointment with a midwife to talk about my fears, and to
ask her how I might deal with it.
Lots of information is what I need, no? What to expect. Who will be
there, what will they do. Will I be allowed to walk around or stuck on
the bed ... What will they monitor? How fast can they get me into an
operating theater if needed?

If it does go wrong, will I ever forgive myself for not having
insisted on a c-section?

Any suggestions on how to face my fears?

12 Comments:

At 30 November, 2011 22:33, OpenID tragicoptimist said...

I'm not sure that I have any good suggestions, but I wanted to say just how much your post resonates. Zoe was born via c-section (also for being breech, though it wasn't scheduled since her water broke early). I ended up having a vbac with Hazel, not because I have some strong desire for natural childbirth, but because for Zoe's sake, I didn't want to be recovering from a c-section when her sibling arrived. I wanted to be able to pick her up and hug her and carry her as soon as possible. And I did.

But that didn't mean it wasn't scary. And what you wrote about "natural" and "reproduction" just not going together for me. I had a friend talking about her son's birth in a tub at a birth center, and I remember at one point in my life that that was an ideal for me, but now, that idea just leaves me feeling cold.

Vbac in the US are not the norm, and so it is often associated with the natural birth movement. Which I really don't have a problem with, as I mentioned, at one point, that was what I wanted. But, mine was pretty medical, done in the hospital, with an epidural. But in the end, a nicer birth than Zoe's, I got to hold Hazel earlier, I got to eat right away, and I got to pick up my 5 year old a couple hours later.

I don't say that to try to sway you to a vbac. I think that you being comfortable with the birth is the most important part. When my OB went over the risks of c-section vs vbac, and when I did my research, too, it came down to both being pretty equally safe. The chances of something going wrong will unfortunately always be there, but those chances are small. I ended up choosing to have my vbac at the hospital that was connected to the children's hospital and that had a high c-section rate, and that helped me feel better to know that if something went wrong, they would be able to operate quickly, and the baby wouldn't have to be transferred far away.

Do you have to decide now? Could you "act as if"? That is, for now, act as if you are having a vbac, ask all your questions and really see if you can feel at peace with that choice. And if you can't, then look at having a c-section.

 
At 30 November, 2011 22:47, Anonymous Anonymous said...

I had twins by c-section, then a vbac for my next baby. She was 3.6kg and 9 days overdue, came naturally the day her c-section was booked. I was terrified that as every day went by she was getting bigger and harder to push out. I thought I'd labour AND have a c-section, which was my scariest thought.
Definately in bed for monitoring - no hot baths or walking around for me, which sucked.
On the plus side, once it was over, it was over. I got up and resumed my life (albeit with a little pain), but it was no where near as debilitating as a c-section in terms of a recovery.
Just my two cents :)

 
At 01 December, 2011 01:12, Blogger Esperanza said...

I don't feel qualified to give you advice either way, I would just say that I don't think there is necessarily less chance of complication or negative outcome with a vaginal birth than with a c-section. Horrible accidents happen during both, but they are just that, horrible accidents. If something is going wrong during a vaginal birth they can always easily prep you for a c-section (if you're really worried about that, having an epidural actually makes it easier for them to start a c-section as you are already numb from the waste down).

I guess I'm just saying that I think your fear of a vaginal birth being more risky is unfounded. Unfounded is the wrong word, it is not unfounded, I understand why you feel the way you do, but I don't think data would support it. A c-section is a major surgery, there are probably as many possible negative outcomes, if not more, to a c-section than a vaginal birth.

I hope you figure out a plan that feels right for you.

Good luck.

 
At 01 December, 2011 03:42, Anonymous It Is What It Is said...

No, it is not SOP to have a VBAC in the US, in fact, it takes a bit of wrangling if one wants to attempt to do so.

I believe that women should be entitled to have their baby in whatever manner they chose. C-sections get a bad rap when they are forced upon women who would have otherwise waited it out in the hopes of a more 'natural' birth.

So, I'd say, rather than talk yourself in or out of something, consider what is important to you during childbirth and if you see delivery as nothing more than a means to an end (vs. some other connection to your baby as s/he enters the world), then by all means push for the c-section if that will make you more comfortable.

 
At 01 December, 2011 03:56, Blogger Rachel said...

I think that you already have the right idea: get as much information as possible. I really wanted a "natural" (no pain meds) delivery as a response to all of the medicalization of IF treatments, but I had the option of doing so in a birthing suite (complete with jacuzzi and rocking chair) smack dab in the middle of a major hospital. I think that feeling comfortable for me included knowing that I was 60 seconds away from the OR if necessary.

I would talk to the doctor and midwife, ask as many questions as you want, talk to someone who has used the actual hospital you'll deliver at, etc. I will say that there was a scary moment during the first labor (possibility of a serious heart decel, which was probably just a faulty reading since the fusspot came out just fine and is now a healthy 3 year old) and that was really scary, but I am sure the same thing can happen in the OR. I will say that after 2 unmedicated deliveries I was able to come home the same evening and happily up and doing things by the next day.

 
At 01 December, 2011 19:34, Blogger Anna said...

Hi Lut,
I've read your blog for a while and comment sometimes. I know you've stopped by mine as well, which I appreciate. I haven't updated lately. We're all busy, happy and healthy, for which we're all grateful :)

I wanted to offer my observations for you to take into account in your decision making. I am a professional medical illustrator. I have illustrated cases of VBACs gone wrong, either on the part of the doctor not ordering a repeat C-section in the case of placental abruption, or due to a rupture of the uterus in the location of the previous incision. While these occurrences are rare, about 1 in 100 births, if you are the one then that makes it 100%. After 3 hours of pushing without progress in the birth of my son, my doctor recommended a C-section. The baby wasn't in any distress, so I said, "Yes! By all means." My goal was a healthy mother, healthy baby. I was truly grateful to have that goal realized.

While we are done with having children, I would go with a repeat C-section if we were to be so blessed as to have another child. Without hesitation. The 1% statistic is not worth the risk for me. Knowing that the baby could die, or live but with a hypoxic brain injury; or that my life could also be threatened isn't worth the risk. For me. Clearly, other women have commented on very successful VABCs! Which is wonderful! I think you should speak with your doctor. For some women, vaginal delivery might not be the best option for them. 100 years ago, these would have been women who died during childbirth, not terribly uncommon before more information was available. In my case, I had pre-eclampsia and dramatically "increased vaginal tone." He was only 7 pounds, my pelvis seemed wide enough, but as God as my witness, I could not push that little guy out!! Thank God for an attentive doctor and good care.

Listen to your instinct. Do what feels right for you. Ask lots of questions! You've already started with great ones: put them to your doctors.

The only other thing I feel compelled to point out is awareness of jaundice and kernicterus. Again, something else I've learned on the job. Kernicterus is the permanent damage that results if elevated bilirubin levels are left untreated. Jaundice is so easily treated that it's shocking that kernicterus still occurs, but it does. So, for your new little one, just make sure they check the bilirubin levels. If they're elevated and your baby has jaundice, make sure it's treated and resolved promptly. That's it. :)

The more knowledge you have, the more empowered you will be. I wish nothing but the very best for you and your family!! I was so pleased that you became pregnant again (after MUCH effort!!). I am so happy for you. Be well, enjoy the remainder of your pregnancy and I hope your delivery is smooth and uncomplicated. Hugs to you! :)

 
At 01 December, 2011 19:34, Blogger Anna said...

This comment has been removed by the author.

 
At 02 December, 2011 01:07, Blogger Hopeful Mother said...

I totally get what you're saying - I had a c/s with the twins that was "planned" - the Dr. recommended it, knowning how paranoid we were during pregnancy about anything going wrong. Even though the twins ended up both head down, after all it took to get pregnant I was not going to do anything high-risk for those babies. I too, was completely terrified of labor and didn't think I could do it, especially knowing another mom who had gone into labor at 35 weeks, pushed for hours and got one baby out and then had to have a c/s for the other who was breech and then would not come out.

If we were to have another child (we're not planning any and very unlikely to ever happen on its own) I would totally be fine with another c/s. Like a previous poster said, in the US it is tough to fight for a VBAC, due to many hospitals/Doctors' worries about malpractice.

That said, it IS totally your choice and perhaps you can try to warm yourself up to the VBAC idea and talk with other moms who have done either option with their 2nd and see how it feels to you... you have to be comfortable with whatever it is you choose.

Hugs to you - can't believe you're already 27 weeks!!

 
At 02 December, 2011 05:44, Blogger Sara said...

First of all, it's incredible that you're at 27 weeks already! I'm glad everything is going well so far.

As for your birthing choices, there really isn't any right or wrong answer here, obviously. You just need to make a decision and then hope for the best.

My experience with a vaginal delivery was that on the one hand it WAS horribly painful, it was also one of the most interesting things that has ever happened to me (despite the fact that billions of women have done the same thing, sigh!). Most of the first 27 hours of the process felt awful, but the end was amazing. Really. I, personally, think that the post-partum joy and the ability to resume normal activities pretty much immediately, was worth the pain. I'd do it again in a heartbeat, especially with an older child to consider. On the other hand, it would be awful to go through labor and still have to have a c-section in the end. So, I can certainly see why some women opt out of the whole process!

Whatever you decide, the bottom line is that you are giving birth and that's fantastic! I'm so happy for you and hope that you are able to enjoy the rest of your pregnancy.

Good luck making the decision.

 
At 05 December, 2011 08:52, Blogger jjiraffe said...

This is such a tough call. I wholeheartedly agree that when I hear that "natural" childbirth has been getting this right for thousands of years, I'm like: tell that to all the mothers who died in childhood before the 1950s. I've only had a c-section (twins transverse and breech) so I don't know much about VBACs, but in the US they are not done much. Listen to your gut feeling. Choose what makes you feel comfortable. Good luck :)

 
At 07 December, 2011 23:44, Anonymous statia said...

I had two planned c-sections due to my vestibulitis. I was told it was a 50/50 shot that it could make it better or worse, which for me was really crappy odds. So I don't know what natural childbirth was like. However, I DID have pretty moderate vaginal burning for years, and the surgery I had to correct it was uncomfortable. It was painful, but less so than I thought, and in comparison, forgotten compared to the years of burning that is forever etched in my brain. I compared my surgery to what "natural" childbirth must feel like. I can't say 100% that it is, because I was knocked out for the hard part, but hopefully that makes you feel a little better. They say the recovery is less harsh than a c-section, but having a planned one, I felt that it was pretty easy in comparison to laboring and THEN being exhausted only to have to have an emergency c. You can do it.

 
At 13 December, 2011 12:23, Blogger Bea said...

Well, assuming you've examined your options with your ob and are satisfied that vbac is the least risk overall (as is no doubt the opinion of your ob) you could go the crunchy crunchy yoga and hypnobirthing route. I find the language sometimes gets a bit airy fairy for me but if this is also the case for you I'm confident you can translate. The best way I can explain it is it uses relaxation and sports psychology techniques applied to the physical process of childbirth. So that's one suggestion.

Bea

 

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