What's the big deal anyway? Right?
I know not everyone really knows why this is so important to us, and I've been wanting to post more about that. It's not that I feel like we have to "explain ourselves," but this is something we've been learning more about lately and want to share some of that info. As we learn more, we see things differently, which is impacting our decisions. It's like the Maya Angelou quote...When you know better you do better. And after learning so much about this topic, no way can I simply opt for a scheduled cesarean; I just can't do it. It's not what is better for either me or a child.
It's frustrating to feel we have to do so much research on our own in order to be able to tell doctors what kind of care we want and need. It's exhausting to have to do so much advocating for ourselves. I don't know that it's had such an affect on my husband, but I know I've had many nights where I've had a very difficult time getting to sleep, and once asleep, I've had many crazy but very realistic dreams about meeting with doctors and fighting for or working toward a VBAC. I've had physical responses to the stress and anxiety before appointments to discuss what I want because I'm worried a doctor won't respect it. Should it really have to be this challenging and stressful?? (There should be an easy answer to that: NO. Unfortunately it's not so easy...)
I'm going to put up a series of posts and try to keep it simple and sweet. There are many components to our decision...the risks/benefits of c-sections (and repeat c-sections) for mother and for baby, risks/benefits of vaginal birth for mother and for baby, and complications when it comes to finding a doctor who is truly supportive. There's more to it, but we're going to try to explain some of the risks/benefits of each delivery method. For us, seeing those listed out makes it a really simple answer, but the thing is, many people aren't aware of the risks/benefits of them both. Doctors don't always really go through all the information clearly. Not one single doctor has talked with me about how many c-sections are too many or even any real risks with having scheduled and repeated cesareans. Nobody has discussed a VBAC as even a possibility or has shared with us benefits of having a child vaginally. So, we had to seek out the information for ourselves. Fortunately, it does seem that there are wonderful VBAC-friendly (truly VBAC-friendly) providers out there; unfortunately it seems as though they are harder to come by and you have to do some work to find them.
I will say, our information will by no means be all inclusive. We've done research, sure, but we haven't spent years researching this, and we only have what we've read/heard/learned recently and our own personal experience. We won't have all the stats stating how often each thing/risk/etc occurs (and we often see different stats because it all relies on reporting and definitions that aren't always very specific). And with some things, it's hard to know how often they occur, as well as how much can be attributed to the delivery method, even while research shows something might be more likely to occur with certain delivery methods. So, realize that we're just a couple looking up information via different resources and sharing them on here. We feel like we know a lot about what we're getting into at this point, but we are aware we are not experts, and we're not offering any sort of medical advice. Anyone who knows something we should change with the information we post (I know we have some doctor/nurse friends out there), please share that with us. :)
First up... Cesarean sections and risks to mother and baby.
Showing posts with label VBAC. Show all posts
Showing posts with label VBAC. Show all posts
Sunday, March 6, 2011
Thursday, March 3, 2011
VBAC Update and New Plans
If you read my post from last week, you know we're wanting to go for a VBAC with our next baby (that is nonexistent at this point). We met with a dr within our network that had said they would "allow" us to do this, and we posted about the consultation. I'm not sure if my emotions showed through with that post; I really tried to keep them out. A main reason is because I wasn't having such great emotions in regards to the meeting. While the doctor said a lot of things we liked, there were a few things we did not...and my gut was not really feeling it. I walked out of there feeling uneasy and hesitant. After letting some of my feelings stew for a while and discussing things with Ryan, we both felt this OB office was not the one for us. We believe, and strongly, that if we stay with this office, our odds of having an emergency or scheduled c-section would be much too great.
For now, we have some good news and some bad news.
The good news is, we have found a place we really like, one that we feel is our best chance at a successful VBAC. This practice is well-known in the community/state for being very VBAC-friendly, and they have plenty of experience in this area. It's also at another top hospital in the area (one of the two that we would consider - I'm sure it's an easy guess if you know where we are located). Not only that, but their philosophy toward pregnancy and delivery are way more in line with my own, which is awesome. I spoke extensively with a lady about my entire situation, including my hesitations about the other office, and she totally agreed with our concerns. Everything she had to say to me was exactly what I would want to hear (and at this point, I KNOW what I want to hear and am not easily misled), not only when it came to VBACs but also just regular care. She was so validating of what I felt (concerns, what I wanted, every little thing), which was a wonderful thing to experience.While speaking with her, I had this amazing sense of calm come over me, this sense of "this is where I am meant to be." I had to hold back tears during the call. Now, maybe all of that doesn't make sense to some people, and I'm not going to put my entire medical care in someone's hands SOLELY on my gut and intuition...but I also will not discount those feelings. They're there for a reason. Besides, I had my gut feelings AND factual information all in my favor here.
The bad news...this office is not in-network, so our insurance will not cover care there. We spoke with the insurance company and were told to write a letter explaining our reasons for requesting a benefit exception. Did we really expect them to make this allowance? Not really. We were hopeful but we were also realistic. We wrote an extensive letter that laid out the reasons we should be treated at this other out-of-network provider. We included all the ways this would save them money - because it would save them a LOT of money, really. We haven't received our actual response via email/postal mail...I'm hoping they will at least give their reasons in the response, but I'm not sure if they do that or not. I called earlier today and was given a quick (and not the most polite) response: DENIED. I was told they had emailed, but um...we've received nothing, and that was over six hours ago.
So, what does this mean? Well, it means we wait, though we're not 100% sure yet what all that means... We are waiting to see what their response is before we know if we can appeal and give them other specific information they request from us. Or we wait until we can change insurance providers. Open-enrollment, when we can elect to change insurance providers, is in the fall. We'll make the switch then to an insurance that we know will cover our care at this other practice. It will mean a higher monthly cost, but it will get us what we want and what we need. This isn't just us wanting something that is over the top. This is us wanting quality care that we need and deserve. It also means waiting a heck of a lot longer to get pregnant than we were planning. This is not really what we want, but as the chance at a VBAC and having a supportive doctor are crucial to us, if we need to wait, we wait. There are all kinds of emotions tied up in that; I won't lie. It's been a tough week and a half. There have been many hours staying up unable to sleep, many wild dreams about meeting with doctors, being pregnant, and all sorts of things. It's not been easy. But we're going to be realistic, logical, and we're going to do what it takes to get what we need. Even if that means waiting.
Now, I know some of you are wondering what is so important about having a VBAC anyway. I intend to address that. We aren't going into this because of some selfish desire for me to "experience" natural childbirth. Sure, I would love to go through that and deliver a baby on my own, the way my body was made to do. But no, that is not the reasoning. This is all for the health of a baby. We've done our research, we know the reasons for vaginally delivering a child, the risks and benefits of that versus any risks/benefits of having a cesarean section.We're going to put up some posts looking at all of that and explaining why this is so very important to us. But rest assured it's all about what is best and safest for baby (and what is safest for mother, too). Nothing selfish...unless you consider wanting the safest possible delivery selfish.
For now, we have some good news and some bad news.
The good news is, we have found a place we really like, one that we feel is our best chance at a successful VBAC. This practice is well-known in the community/state for being very VBAC-friendly, and they have plenty of experience in this area. It's also at another top hospital in the area (one of the two that we would consider - I'm sure it's an easy guess if you know where we are located). Not only that, but their philosophy toward pregnancy and delivery are way more in line with my own, which is awesome. I spoke extensively with a lady about my entire situation, including my hesitations about the other office, and she totally agreed with our concerns. Everything she had to say to me was exactly what I would want to hear (and at this point, I KNOW what I want to hear and am not easily misled), not only when it came to VBACs but also just regular care. She was so validating of what I felt (concerns, what I wanted, every little thing), which was a wonderful thing to experience.While speaking with her, I had this amazing sense of calm come over me, this sense of "this is where I am meant to be." I had to hold back tears during the call. Now, maybe all of that doesn't make sense to some people, and I'm not going to put my entire medical care in someone's hands SOLELY on my gut and intuition...but I also will not discount those feelings. They're there for a reason. Besides, I had my gut feelings AND factual information all in my favor here.
The bad news...this office is not in-network, so our insurance will not cover care there. We spoke with the insurance company and were told to write a letter explaining our reasons for requesting a benefit exception. Did we really expect them to make this allowance? Not really. We were hopeful but we were also realistic. We wrote an extensive letter that laid out the reasons we should be treated at this other out-of-network provider. We included all the ways this would save them money - because it would save them a LOT of money, really. We haven't received our actual response via email/postal mail...I'm hoping they will at least give their reasons in the response, but I'm not sure if they do that or not. I called earlier today and was given a quick (and not the most polite) response: DENIED. I was told they had emailed, but um...we've received nothing, and that was over six hours ago.
So, what does this mean? Well, it means we wait, though we're not 100% sure yet what all that means... We are waiting to see what their response is before we know if we can appeal and give them other specific information they request from us. Or we wait until we can change insurance providers. Open-enrollment, when we can elect to change insurance providers, is in the fall. We'll make the switch then to an insurance that we know will cover our care at this other practice. It will mean a higher monthly cost, but it will get us what we want and what we need. This isn't just us wanting something that is over the top. This is us wanting quality care that we need and deserve. It also means waiting a heck of a lot longer to get pregnant than we were planning. This is not really what we want, but as the chance at a VBAC and having a supportive doctor are crucial to us, if we need to wait, we wait. There are all kinds of emotions tied up in that; I won't lie. It's been a tough week and a half. There have been many hours staying up unable to sleep, many wild dreams about meeting with doctors, being pregnant, and all sorts of things. It's not been easy. But we're going to be realistic, logical, and we're going to do what it takes to get what we need. Even if that means waiting.
Now, I know some of you are wondering what is so important about having a VBAC anyway. I intend to address that. We aren't going into this because of some selfish desire for me to "experience" natural childbirth. Sure, I would love to go through that and deliver a baby on my own, the way my body was made to do. But no, that is not the reasoning. This is all for the health of a baby. We've done our research, we know the reasons for vaginally delivering a child, the risks and benefits of that versus any risks/benefits of having a cesarean section.We're going to put up some posts looking at all of that and explaining why this is so very important to us. But rest assured it's all about what is best and safest for baby (and what is safest for mother, too). Nothing selfish...unless you consider wanting the safest possible delivery selfish.
Wednesday, February 23, 2011
VBAC Consultation
Well, we had the big appointment yesterday. We went to visit the new OB office that had stated they would be supportive of a VBAC-2. We had a consultation, and friends and family that knew about our appointment are wondering how things went. This is the easiest way to share.
The couple days leading up to the appointment, I noticed myself getting more and more anxious. Nervous. Worried. All sorts of feelings. I didn't want to go in and have a dr say they would "allow" me to VBAC and then feed me all of these scare-tactics - or act great about it now and then try to scare me at the last minute. The day of the appointment was getting tough, and I sat myself down while Aiden was taking a super early nap and looked over some Bible verses to try to calm myself. This one kept jumping out at me, and it gave me what I needed to refocus and get to the appointment with a better frame of mind.
I think we're still trying to process everything from the appointment. We were there for 45 minutes, and there was a lot of information. A lot. I can easily say that most of it was what we wanted to hear. Was all of it? Not necessarily. But MOST of it was.
We went into our appointment with a list of questions. We were quite prepared. I've done a lot of reading, and Ryan has been trying to keep up and do some of his own. This isn't something we enter into lightly. Not at all. The doctor even said he could tell I was a reader (this did not sound at all like he was being condescending), and he seemed to really appreciate the fact that we completely understood all aspects of what we were considering and that we were highly motivated.
One of the first questions the doctor asked me was what is my main concern. Really - I told him my BIGGEST concern was finding a provider that was supportive of doing a VBAC. It's true. And hopefully that won't be such a concern now...
Here were our questions, and some of the answers...
The other thing we didn't LOVE was the fact that he said they would want me to have an epidural during the labor. I really want to do it naturally, no epidural. I understand the logic. If there is an emergency, they want me already medicated and want to be able to easily add more to numb me for surgery. At the same time, I also know that having the epidural automatically puts me at higher risk for having a c-section, for many reasons. So, we're not thrilled about this. He did say I could control the amount and could use the least amount possible during labor. We still want to discuss this farther and make sure we understand exactly what they would require and think about it more ourselves. Ryan thinks he heard the doctor say, after I explained I wanted as natural a labor as possible and that I was hesitant about an epidural, that they would just need to have me ready for it, have everything in, and that way they could just administer the actual epidural if a section was suddenly needed. I am not sure I remember hearing that. BUT if they can have it in and he's told me I can control the amount before they *need* it for a surgery, it would make sense that they could also just have me prepped and not actually inject it until the time...right? We're going to try to ask about this sooner than another appointment, maybe emailing him, if he will respond.
Another problem with the epidural, which I totally didn't think about while in the office (seriously, if I don't have it written down, it doesn't get said!) is that epidurals/spinals make me EXTREMELY sick. I threw up all through Camden's surgery and the next couple days. I was pumped FULL of Zofran during Aiden's section, but during recovery the nurses always waited until I was on the floor throwing up before giving me more (how fun do you think that is when you've just had abdominal surgery?!), even though I would tell them while I was still in bed how sick I was. It was horrible, and I don't want to have to worry about throwing up the entire time I'm in labor and for days afterward. I know they can also give me the Zofran with the epidural, but I also don't want to be so medicated (or medicated at all)! So, we'll also need to mention this to him... Ugh. Just thinking about it is making me miserable. I was so loving the thought that a natural labor would mean not having to deal with all of that awfulness.
So, there are two things we were told that we didn't completely LOVE. For the most part, we were very happy with what we were told, though. But those two things are bugging us and giving us plenty to think about for a while. We already have a list of questions for the next time we go in...which could be a while b/c we won't be due back until we are actually pregnant. I suppose we could call or email, but talking in person is best with this kind of thing. Actually, some of it we might email about - parts that we want to be clear we understand.
Another concern we had, knowing this was a large office, was how other doctors in the practice would feel about us doing this VBAC-2 and would some be more likely to push for a section once in labor, especially if we weren't progressing as quickly as they wanted. Of course, some will be more section-happy than others, but he thought as motivated as we were, with me being a good candidate, etc, etc, that we shouldn't have a problem with that. He also stated that, as head of the department, he would have a say in how they treated us and would let it be known we are to be supported in trying for a trial of labor and delivery. Really, he was very pro-VBAC. He never made it sound like anyone in the office would be against the VBAC - just that some might push a surgery after a prolonged labor sooner than others. We never felt like we were trying to convince him; from the start he was very supportive and encouraging. It was such a positive experience. I was really nervous about the consultation beforehand, but the second he started talking, I immediately felt much better about the whole thing.
He even gave me an article to read....and this wasn't an article trying to show how dangerous VBAC-2s were; it's a review with a meta-analysis (a research article that uses information from multiple studies, looking at various components, etc) that compares the risks/success rates/adverse outcomes with VBAC-1, VBAC-2, and RCS (repeated c-sections, specifically a third c-section for this article). It was actually very interesting, especially when it showed that there were no significant differences in all three groups when looking at neonatal unit admission rates and asphyxial injury/neonatal death rates. I appreciate a doctor who is trying to back up the safety of what I'm trying to do with others' research instead of trying to use scare tactics to get me to do something else.
Here's a snip-it from the article, if you're interested. This is from the abstract, so it's brief. Interesting stuff. I kind of felt like I was back in college/grad school reading this article. ;)
Aside from VBAC/c-section stuff, we also asked how they treat Hyperemesis Gravidarum (HG), knowing going into the next pregnancy that I have this condition, which is known for being worse with each pregnancy (yay...). He first said to start taking Vitamin B6 before getting pregnant. Get Unisom once pregnant. I've heard a lot about using both of these for HG, so I wasn't too surprised. I appreciated this b/c he didn't automatically jump to medicating like the other office we currently visit have - they say to just get right on Zofran. And yes, this still means taking supplements/medication...but it's the lowest level before going on other medications such as Zofran, which I was on during the entire pregnancy with Aiden (that and phenergan). I would rather try what he suggested first and hopefully not have to take Zofran or maybe at least put off taking it or not have to take it as long as before. He also discussed eating and drinking...being sure to drink caloric beverages but not to worry about eating if I couldn't. Maybe, he said, we're really designed not to eat much during that time and that's why we get so nauseous; that first trimester is when so many important things are forming in a baby, and it's when toxic ingredients, chemicals, etc, will be most dangerous. This is a whole other topic, BUT we really appreciated how he answered. Learning what his approach is to various things was helping us feel we could trust him more. He did say if we needed medication, we needed it. And I agree, but we'll start with these other things first. (My fingers are crossed! How I would love to not have to take medication for another entire pregnancy...)
So, for the most part we were very pleased. We do still have a few things to ask about. I forgot to ask how they feel about me having a doula around, in case we want to go in that direction, which we are considering. He happened to mention they are looking into having midwives working with them, and I really liked hearing that. Like he said, having a midwife there with us will help increase our chances with a VBAC b/c midwives are typically very against any unnecessary c-section. (He spoke about this in a positive way, which is good. Some doctors are pretty against having doulas or midwives around.) And we want to ask more about the post-date stuff and get more information on the epidural aspect.
But overall - fairly positive. I hope the rest of the doctors are as personable and assuring as he is. We really liked how he spoke with us and what his approach seemed to be. (He wasn't crazy about the fact that we don't get the flu shot, but that's a whole other topic. And just because he thinks it's a good idea doesn't mean we have to do it. Because we won't. But I digress...) We're looking forward to asking some more questions and seeing him in the future. And if it comes to it and we don't feel comfortable, we have one more avenue to explore - another office that we hear is very VBAC (and VBAC-2) friendly...but there might be some issues with insurance and navigating that would surely be a lot of fun.
If any of you know some things to share about VBACs, suggestions, questions, or whatever, please comment away. We would love to hear what they are! Please keep it nice, though. We're seeking support here. Anything that's pushy in the opposite direction will not be appreciated. Not to say that if you have genuine concerns or questions you can't share that, but we would appreciate no rude remarks. :) Thanks so much!
Oh, and if you're curious about WHY we're hoping for a VBAC-2, I'm happy to explain. But that's a topic for another post. This one is long enough. ;)
The couple days leading up to the appointment, I noticed myself getting more and more anxious. Nervous. Worried. All sorts of feelings. I didn't want to go in and have a dr say they would "allow" me to VBAC and then feed me all of these scare-tactics - or act great about it now and then try to scare me at the last minute. The day of the appointment was getting tough, and I sat myself down while Aiden was taking a super early nap and looked over some Bible verses to try to calm myself. This one kept jumping out at me, and it gave me what I needed to refocus and get to the appointment with a better frame of mind.
So do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help you; I will uphold you with my righteous right hand. (Isaiah 41:10)I needed that reminder that God is with me and has a plan for me. He tells me not to fear, and sometimes I just need to stop and listen to that.
I think we're still trying to process everything from the appointment. We were there for 45 minutes, and there was a lot of information. A lot. I can easily say that most of it was what we wanted to hear. Was all of it? Not necessarily. But MOST of it was.
We went into our appointment with a list of questions. We were quite prepared. I've done a lot of reading, and Ryan has been trying to keep up and do some of his own. This isn't something we enter into lightly. Not at all. The doctor even said he could tell I was a reader (this did not sound at all like he was being condescending), and he seemed to really appreciate the fact that we completely understood all aspects of what we were considering and that we were highly motivated.
One of the first questions the doctor asked me was what is my main concern. Really - I told him my BIGGEST concern was finding a provider that was supportive of doing a VBAC. It's true. And hopefully that won't be such a concern now...
Here were our questions, and some of the answers...
- How many VBACs/VBAC-2s have you attended? Well, plenty. No number, but they obviously do it. This doctor appeared to be very practiced in this area and seemed like he had plenty of experience with everything we discussed. We're not worried about that.
- What is your success rate? He guesses around 70%, which is what is to be expected, from what we understand. Anything much lower would be a red flag.
- How many uterine ruptures have you witnessed? He differentiated between the different kinds...a small tear/rupture, which is basically a hole and would be found while doing a c-section and could be repaired easily and then a catastrophic rupture, which if addressed quickly enough can be handled well. He's seen both, not as many of the catastrophic but "a handful" of them. I was pleased that he differentiated between the types and didn't lump them together and make me feel like ruptures happened often and were all terrible. He made it sound manageable, even if there was a rupture, while also being very clear about the possible dangers, even with the catastrophic ones.
- Do you have any standard VBAC protocols that differ from a non-VBAC mom? Only attending can order pitocin.
- How do you handle post-date pregnancies (going over 40 weeks)? Another thing we aren't thrilled about but want to ask more questions now that we've been home and have been thinking more about it. (This is one of the two things he said that we didn't LOVE.) He did say they wouldn't want me to go too much over 40 weeks....but if I went over, it would depend on if I was showing signs of labor, etc. If I was, they would give me a bit more time. If I wasn't doing anything, they might want to then schedule a section. They will *not* induce (which is exactly what we want to hear - induction is not desired, esp with a VBAC). I would rather have a dr that would allow me to go a week or even longer over a due date, assuming everything with mom and baby. This does not make me a glutton for punishment; it means I am aware that a due date is an estimation and my body and the baby are better at knowing when the time is right versus a date someone marks on a calendar. We'll discuss this more with him/other doctors later on to hear their reasoning. He did seem to be fairly flexible and not wanting to just rush to a c-section the second I would turn 40 weeks, but still. Something we want to consider more.
- What is your philosophy on big babies? This is in there b/c some doctors think if you have a "big baby" (which is hard to determine - guesses are often wrong) that you should automatically have a section. He seemed to not think this and is not scared by the fact that my first baby was 11lbs and my second was 8lbs11oz. Actually (and surprisingly), that 11-pounder works in my favor in this case! As he said, he would be a bit more hesitant if I had pushed for so many hours and had not been able to push out a 7lb baby...but it's easy to understand why I couldn't push out an 11-pounder after several hours. Anyway, big babies don't seem to scare him. That's good.
- What kind of monitoring do you require? IV. Just in case. I won't be able to walk around hallways, but I can move around in the room as long as I'm attached to that. They'll obviously want to monitor the baby more closely, just to be aware of any possible signs of distress. Not something I love, but I do understand.
- Do you perform an automatic c-section if waters have been broken for more than 24 hours, even if there is no evidence of infection and mom and baby are fine? He said they don't base it on a certain time schedule, it all depends on whether or not the baby is in distress and I'm progressing at a decent pace without stalling. What I wanted to hear.
- Do you have a time limit on how long my labor can be before you c-section me? Same answer as above. What I wanted to hear.
- What is a reasonable length of time for VBAC labor if I'm healthy and my baby appears to be healthy? Can't really tell; it's dependent on factors other than simply time. Mostly same answer as above. These questions are mostly to determine if the dr will be quick to section if the labor isn't moving quickly. We don't want that. We want a dr who will allow the labor to go as it naturally will, assuming mom and baby are healthy. This doctor does NOT seem to be trigger-happy for surgery. We even discussed why some doctors might push for a c-section, and he let me know that shouldn't be a problem there. (Some reasons can be having to do with time. Would the dr rather have a nice easy, scheduled section at 8am or have to stick around for a day and a half while mom labors? Money... C-sections obviously cost more. Resources. VBACs require a lot of resources on hand in case of an emergency section, which also means everyone is on high alert. Yes, a lot of resources are needed for a planned section, but when they're worried about a rupture and a baby being in danger, they want to be prepared and have ALL of those resources at the ready. You could tell he didn't agree with some of these reasons - the first couple that were more convenience-driven. And at Duke and with this office who deals with riskier pregnancies, they also clearly have the resources right there.)
- Do you require IV or helplock? Yes. IV.
- Am I permitted to move and deliver in my position of choice? Seems to be fine, as long as I'm still on the IV. Also what we wanted to hear. Lying on one's back is actually the least effective mode for pushing, and I want to be able to do whatever position my body works with best and whatever position helps to reduce chances of a stalled labor leading to a c-section. Who knows what that would be, but I don't want a dr who tells me I have to be on my back simply b/c I'm a VBAC.
- What do you think are my chances of having a successful VBAC-2, given my childbirth history? He thinks I'm a great candidate and will likely fit into the 70% that are successful. Odds are in my favor at *this* point, based on history and my current health, motivation, etc. Aside from my motivation and health, my history helps - the reason for my first c-section, the scars that I have (or how minimal they are) and how easy it was for the dr performing Aiden's c-section to get in quickly. The fact that I'm not large or overweight also helps a lot. Why? Because if he has to very quickly get in for a c-section, in case of emergency, a lot of excess weight (just like extra scarring) can hinder him being able to do that quickly. Basically, I don't have much working against me. Let's hope it stays that way. They will monitor me closely in regards to my placenta placement (multiple c-sections make it more likely my placenta could cover my uterine scar, which is not good, and they also can increase my chances for issues such as placenta previa and abruption).
- What can I do during my pregnancy to help increase the chances of a successful VBAC? He looked at Ryan and told him that *he* would like this answer... As often as possible during the last trimester. Haha! But really...just staying healthy and motivated. Both of which I won't have a problem with doing.
The other thing we didn't LOVE was the fact that he said they would want me to have an epidural during the labor. I really want to do it naturally, no epidural. I understand the logic. If there is an emergency, they want me already medicated and want to be able to easily add more to numb me for surgery. At the same time, I also know that having the epidural automatically puts me at higher risk for having a c-section, for many reasons. So, we're not thrilled about this. He did say I could control the amount and could use the least amount possible during labor. We still want to discuss this farther and make sure we understand exactly what they would require and think about it more ourselves. Ryan thinks he heard the doctor say, after I explained I wanted as natural a labor as possible and that I was hesitant about an epidural, that they would just need to have me ready for it, have everything in, and that way they could just administer the actual epidural if a section was suddenly needed. I am not sure I remember hearing that. BUT if they can have it in and he's told me I can control the amount before they *need* it for a surgery, it would make sense that they could also just have me prepped and not actually inject it until the time...right? We're going to try to ask about this sooner than another appointment, maybe emailing him, if he will respond.
Another problem with the epidural, which I totally didn't think about while in the office (seriously, if I don't have it written down, it doesn't get said!) is that epidurals/spinals make me EXTREMELY sick. I threw up all through Camden's surgery and the next couple days. I was pumped FULL of Zofran during Aiden's section, but during recovery the nurses always waited until I was on the floor throwing up before giving me more (how fun do you think that is when you've just had abdominal surgery?!), even though I would tell them while I was still in bed how sick I was. It was horrible, and I don't want to have to worry about throwing up the entire time I'm in labor and for days afterward. I know they can also give me the Zofran with the epidural, but I also don't want to be so medicated (or medicated at all)! So, we'll also need to mention this to him... Ugh. Just thinking about it is making me miserable. I was so loving the thought that a natural labor would mean not having to deal with all of that awfulness.
So, there are two things we were told that we didn't completely LOVE. For the most part, we were very happy with what we were told, though. But those two things are bugging us and giving us plenty to think about for a while. We already have a list of questions for the next time we go in...which could be a while b/c we won't be due back until we are actually pregnant. I suppose we could call or email, but talking in person is best with this kind of thing. Actually, some of it we might email about - parts that we want to be clear we understand.
Another concern we had, knowing this was a large office, was how other doctors in the practice would feel about us doing this VBAC-2 and would some be more likely to push for a section once in labor, especially if we weren't progressing as quickly as they wanted. Of course, some will be more section-happy than others, but he thought as motivated as we were, with me being a good candidate, etc, etc, that we shouldn't have a problem with that. He also stated that, as head of the department, he would have a say in how they treated us and would let it be known we are to be supported in trying for a trial of labor and delivery. Really, he was very pro-VBAC. He never made it sound like anyone in the office would be against the VBAC - just that some might push a surgery after a prolonged labor sooner than others. We never felt like we were trying to convince him; from the start he was very supportive and encouraging. It was such a positive experience. I was really nervous about the consultation beforehand, but the second he started talking, I immediately felt much better about the whole thing.
He even gave me an article to read....and this wasn't an article trying to show how dangerous VBAC-2s were; it's a review with a meta-analysis (a research article that uses information from multiple studies, looking at various components, etc) that compares the risks/success rates/adverse outcomes with VBAC-1, VBAC-2, and RCS (repeated c-sections, specifically a third c-section for this article). It was actually very interesting, especially when it showed that there were no significant differences in all three groups when looking at neonatal unit admission rates and asphyxial injury/neonatal death rates. I appreciate a doctor who is trying to back up the safety of what I'm trying to do with others' research instead of trying to use scare tactics to get me to do something else.
Here's a snip-it from the article, if you're interested. This is from the abstract, so it's brief. Interesting stuff. I kind of felt like I was back in college/grad school reading this article. ;)
VBAC-2 success rate was 71.1%, uterine rupture rate 1.36%, hysterectomy rate 0.55%, blood transfusion 2.01%, neonatal unit admission rate 7.78% and perinatal asphyxial injury/death 0.09%. VBAC-2 versus VBAC-1 success rates were 4064/5666 (71.1%) versus 38 814/50 685 (76.5%) (P < 0.001); associated uterine rupture rate 1.59% versus 0.72% (P < 0.001) and hysterectomy rates were 0.56% versus 0.19% (P = 0.001) respectively. Comparing VBAC-2 versus RCS, the hysterectomy rates were 0.40% versus 0.63% (P = 0.63), transfusion 1.68% versus 1.67% (P = 0.86) and febrile morbidity 6.03% versus 6.39%, respectively (P = 0.27). Maternal morbidity of VBAC-2 was comparable to RCS. Neonatal morbidity data were too limited to draw valid conclusions, however, no significant differences were indicated in VBAC-2, VBAC-1 and RCS groups in NNU admission rates and asphyxial injury/neonatal death rates (Mantel–Haenszel).
Aside from VBAC/c-section stuff, we also asked how they treat Hyperemesis Gravidarum (HG), knowing going into the next pregnancy that I have this condition, which is known for being worse with each pregnancy (yay...). He first said to start taking Vitamin B6 before getting pregnant. Get Unisom once pregnant. I've heard a lot about using both of these for HG, so I wasn't too surprised. I appreciated this b/c he didn't automatically jump to medicating like the other office we currently visit have - they say to just get right on Zofran. And yes, this still means taking supplements/medication...but it's the lowest level before going on other medications such as Zofran, which I was on during the entire pregnancy with Aiden (that and phenergan). I would rather try what he suggested first and hopefully not have to take Zofran or maybe at least put off taking it or not have to take it as long as before. He also discussed eating and drinking...being sure to drink caloric beverages but not to worry about eating if I couldn't. Maybe, he said, we're really designed not to eat much during that time and that's why we get so nauseous; that first trimester is when so many important things are forming in a baby, and it's when toxic ingredients, chemicals, etc, will be most dangerous. This is a whole other topic, BUT we really appreciated how he answered. Learning what his approach is to various things was helping us feel we could trust him more. He did say if we needed medication, we needed it. And I agree, but we'll start with these other things first. (My fingers are crossed! How I would love to not have to take medication for another entire pregnancy...)
So, for the most part we were very pleased. We do still have a few things to ask about. I forgot to ask how they feel about me having a doula around, in case we want to go in that direction, which we are considering. He happened to mention they are looking into having midwives working with them, and I really liked hearing that. Like he said, having a midwife there with us will help increase our chances with a VBAC b/c midwives are typically very against any unnecessary c-section. (He spoke about this in a positive way, which is good. Some doctors are pretty against having doulas or midwives around.) And we want to ask more about the post-date stuff and get more information on the epidural aspect.
But overall - fairly positive. I hope the rest of the doctors are as personable and assuring as he is. We really liked how he spoke with us and what his approach seemed to be. (He wasn't crazy about the fact that we don't get the flu shot, but that's a whole other topic. And just because he thinks it's a good idea doesn't mean we have to do it. Because we won't. But I digress...) We're looking forward to asking some more questions and seeing him in the future. And if it comes to it and we don't feel comfortable, we have one more avenue to explore - another office that we hear is very VBAC (and VBAC-2) friendly...but there might be some issues with insurance and navigating that would surely be a lot of fun.
If any of you know some things to share about VBACs, suggestions, questions, or whatever, please comment away. We would love to hear what they are! Please keep it nice, though. We're seeking support here. Anything that's pushy in the opposite direction will not be appreciated. Not to say that if you have genuine concerns or questions you can't share that, but we would appreciate no rude remarks. :) Thanks so much!
Oh, and if you're curious about WHY we're hoping for a VBAC-2, I'm happy to explain. But that's a topic for another post. This one is long enough. ;)
Wednesday, February 2, 2011
VBACs, Migraines, and other fun stuff
So, yesterday wasn't the most fun day ever. Could have been worse, I'm sure, but I'm certainly glad it wasn't. It started off with a small headache and just got worse from there... This post isn't just to gripe, though. It's about something I'm hoping to experience and to explain what a blessing my family is. My boys, all three of them, are incredible. :)
I had a dr appt in the morning, which means driving far from home because all of our doctors are at least three or four cities away...driving is often an hour or so, each way. Fun. I went in for a follow-up. Things were fine, but the doctor mentioned at one point (about a cyst on my ovary that wasn't changing any) that when we got pregnant again, I could just have the doctor take a look at it during the c-section. She knows I've had two and so it's assumed any more with also be sections. Well, that was a good segue into a topic that I wasn't really planning on bring up right then but would come up eventually, so I went on and brought it up... VBACs. (For anyone that doesn't know, VBAC means Vaginal Birth After Cesarean).
The problem is, not only have I had one section...but two. The first was absolutely necessary. While baby fat might squish, baby heads can only get so much smaller and no more. Camden had a very large head. After a very intense and painful labor and a few hours of pushing, an emergency c-section was necessary because his head literally would not fit through. Aiden's section...was planned. (And my what a difference between an emergency and planned! Wow.) They heard how big Camden was (11lbs - what's the big deal?) and said no way to a VBAC. At that time, we were not sure which way to go, and so we went along with what they said. Now that I know more, I wish we hadn't. But we did. What's done is done. Aiden wasn't nearly as big as expected. He still came in at 8lbs 11oz, but that's no 11-pounder. And not a big head. The big head comes from Camden's dad, so there's obviously no concern about that from this point on. The weight comes from my side, but I'm not concerned about that, either - remember, it squishes. The head was the problem.
While many places will attempt a VBAC after one section, depending on the reason for the surgery, it's harder to find people that will go for a VBA2C. My dr said they did attempt VBACs (after 1) but she didn't think they did them after 2, and on the way out, she ran into another dr in the practice who said, nope, they don't. I walked out feeling really defeated. Really. Some people will say, what's the big deal? There are risks to having VBACs. Well, yes, but there are more risks to having multiple c-sections. I want to at least have those risks weighed, look at all pros and cons of either possibilities, see what not only affects me now but also when it comes to possibly having more children, etc, etc. I might go into this more (the reasons, risks, etc) in another post at another time. But it's important to me to be given the opportunity if it is possible. There are a number of reasons. And having that option taken away...well, like I said, I felt very defeated.
On the way home, headache was getting worse. It started out a headache, now it's getting to migraine status. Quickly. We haven't decided why yet, but I've been getting them a lot lately (as in over the last six months or more - took me a while to realize they were migraines, and they've continued to get worse lately).
Then Aiden falls asleep on the way home. This is not good. Sometimes he'll go to his bed after falling asleep; sometimes not. If you saw the post on his night terrors, you know why his nap is important. Now I'm regretting having the appt so close to lunchtime, but there really wasn't a choice. And...of course, he doesn't nap once home. We tried. Really tried.
By then, my migraine was getting really bad. It soon reached the point where it might very well be the worst I have ever had. By the time Camden gets home from school, I'm lying on the couch, pretty much not able to function. He was the sweetest thing ever, trying to take care of me. He offered me something to eat about every five seconds, which was a tiny bit annoying...but I'll take that over ignoring me. It really was sweet, though, and he was so caring. I love being reminded of what a great kid he is. Aiden, who can't stand anyone to lie down (or pretend they're sleeping), finally got the hint that mom didn't feel well and showed a bit of sweetness, too. At one point, he was climbing to sit next to me, and he bumped my head really hard with his - right where my head was throbbing. I covered my face so he wouldn't see me crying about it (man, it hurt!), but he did notice after a while. He patted my face softly and said, "Oh, I'm sorry, Mommy. I'm sorry." (Sniff! Sweet child.) When Ryan called to say he was on his way home (you know mama is sick if she asks him to come home...and without even hinting about it first, too!), Camden took the call. I lifted my head up to hear something over speaker-phone, and Aiden gently tried to push my head back down and said, "No, go to sleep." Seriously, how sweet are my kids?! This is totally unlike Aiden, so he must really have understood I wasn't feeling well. It did take a while...first he kept shoving toys in my face and trying to play on top of me or tell me to get up. But still.
Ryan got home around 5:00 or so, and I went up to bed. Thank God I have an awesome husband that is willing (and able) to come home a little early and just take over with everything. I didn't get to sleep until 10pm or later, but it still was nice to lie in bed, in the dark. Aiden came up for his bedtime to nurse, and then he just stayed there and slept next to me. Since he didn't nap, we were worried about a bad night, and I didn't want to have to get up in the middle of the night. He actually did fairly well. A couple times he moaned some and kicked his legs around, tossed and turned some. I was worried it would get worse, but it really didn't. Maybe he should just start out in bed with us more often...
Anyway, it was a rough day. Worst headache ever. I even had nausea with this one, and I never have that. Woke up with a tiny bit of a headache this morning, but it was the kind I can ignore and still go on about my day. That's good because it was my turn to host a playdate, and I really didn't want to cancel! So, we were able to have friends over and have a great time. Aiden is now napping right on schedule. Today is a much better day.
Now, back to the VBAC issue... I love our ob/gyn office. I really do. And so I was very disappointed to have my bubble burst before leaving. But later the dr emailed me saying that some folks over AT Duke *would* consider letting me labor and try for a natural delivery (no induction, though, which is fine with me). The practice I see is affiliated with Duke but not located in the hospital. This other group is associated with the high risk ob dept, I believe. So, hopefully we can soon set up a prepregnancy appointment and see if they can do a risk-analysis and see what they say. (Um, don't assume this means much of anything. We are not pregnant right now. We're big on planning ahead. And this is not something you want to discuss and plan AFTER getting pregnant...) I'm not betting yet that this means I definitely will get to try for a natural delivery, but I'm hopeful that it might mean I have a chance. I know other things could get in the way, too, such as a chance of placenta previa (which I dealt with during both previous pregnancies), etc. Hopefully none of that will be a concern, but you never know. We'll just have to wait and see what they think after hearing my history, etc. Not sure how soon that will happen, but I'll update.
I had a dr appt in the morning, which means driving far from home because all of our doctors are at least three or four cities away...driving is often an hour or so, each way. Fun. I went in for a follow-up. Things were fine, but the doctor mentioned at one point (about a cyst on my ovary that wasn't changing any) that when we got pregnant again, I could just have the doctor take a look at it during the c-section. She knows I've had two and so it's assumed any more with also be sections. Well, that was a good segue into a topic that I wasn't really planning on bring up right then but would come up eventually, so I went on and brought it up... VBACs. (For anyone that doesn't know, VBAC means Vaginal Birth After Cesarean).
The problem is, not only have I had one section...but two. The first was absolutely necessary. While baby fat might squish, baby heads can only get so much smaller and no more. Camden had a very large head. After a very intense and painful labor and a few hours of pushing, an emergency c-section was necessary because his head literally would not fit through. Aiden's section...was planned. (And my what a difference between an emergency and planned! Wow.) They heard how big Camden was (11lbs - what's the big deal?) and said no way to a VBAC. At that time, we were not sure which way to go, and so we went along with what they said. Now that I know more, I wish we hadn't. But we did. What's done is done. Aiden wasn't nearly as big as expected. He still came in at 8lbs 11oz, but that's no 11-pounder. And not a big head. The big head comes from Camden's dad, so there's obviously no concern about that from this point on. The weight comes from my side, but I'm not concerned about that, either - remember, it squishes. The head was the problem.
While many places will attempt a VBAC after one section, depending on the reason for the surgery, it's harder to find people that will go for a VBA2C. My dr said they did attempt VBACs (after 1) but she didn't think they did them after 2, and on the way out, she ran into another dr in the practice who said, nope, they don't. I walked out feeling really defeated. Really. Some people will say, what's the big deal? There are risks to having VBACs. Well, yes, but there are more risks to having multiple c-sections. I want to at least have those risks weighed, look at all pros and cons of either possibilities, see what not only affects me now but also when it comes to possibly having more children, etc, etc. I might go into this more (the reasons, risks, etc) in another post at another time. But it's important to me to be given the opportunity if it is possible. There are a number of reasons. And having that option taken away...well, like I said, I felt very defeated.
On the way home, headache was getting worse. It started out a headache, now it's getting to migraine status. Quickly. We haven't decided why yet, but I've been getting them a lot lately (as in over the last six months or more - took me a while to realize they were migraines, and they've continued to get worse lately).
Then Aiden falls asleep on the way home. This is not good. Sometimes he'll go to his bed after falling asleep; sometimes not. If you saw the post on his night terrors, you know why his nap is important. Now I'm regretting having the appt so close to lunchtime, but there really wasn't a choice. And...of course, he doesn't nap once home. We tried. Really tried.
By then, my migraine was getting really bad. It soon reached the point where it might very well be the worst I have ever had. By the time Camden gets home from school, I'm lying on the couch, pretty much not able to function. He was the sweetest thing ever, trying to take care of me. He offered me something to eat about every five seconds, which was a tiny bit annoying...but I'll take that over ignoring me. It really was sweet, though, and he was so caring. I love being reminded of what a great kid he is. Aiden, who can't stand anyone to lie down (or pretend they're sleeping), finally got the hint that mom didn't feel well and showed a bit of sweetness, too. At one point, he was climbing to sit next to me, and he bumped my head really hard with his - right where my head was throbbing. I covered my face so he wouldn't see me crying about it (man, it hurt!), but he did notice after a while. He patted my face softly and said, "Oh, I'm sorry, Mommy. I'm sorry." (Sniff! Sweet child.) When Ryan called to say he was on his way home (you know mama is sick if she asks him to come home...and without even hinting about it first, too!), Camden took the call. I lifted my head up to hear something over speaker-phone, and Aiden gently tried to push my head back down and said, "No, go to sleep." Seriously, how sweet are my kids?! This is totally unlike Aiden, so he must really have understood I wasn't feeling well. It did take a while...first he kept shoving toys in my face and trying to play on top of me or tell me to get up. But still.
Ryan got home around 5:00 or so, and I went up to bed. Thank God I have an awesome husband that is willing (and able) to come home a little early and just take over with everything. I didn't get to sleep until 10pm or later, but it still was nice to lie in bed, in the dark. Aiden came up for his bedtime to nurse, and then he just stayed there and slept next to me. Since he didn't nap, we were worried about a bad night, and I didn't want to have to get up in the middle of the night. He actually did fairly well. A couple times he moaned some and kicked his legs around, tossed and turned some. I was worried it would get worse, but it really didn't. Maybe he should just start out in bed with us more often...
Anyway, it was a rough day. Worst headache ever. I even had nausea with this one, and I never have that. Woke up with a tiny bit of a headache this morning, but it was the kind I can ignore and still go on about my day. That's good because it was my turn to host a playdate, and I really didn't want to cancel! So, we were able to have friends over and have a great time. Aiden is now napping right on schedule. Today is a much better day.
Now, back to the VBAC issue... I love our ob/gyn office. I really do. And so I was very disappointed to have my bubble burst before leaving. But later the dr emailed me saying that some folks over AT Duke *would* consider letting me labor and try for a natural delivery (no induction, though, which is fine with me). The practice I see is affiliated with Duke but not located in the hospital. This other group is associated with the high risk ob dept, I believe. So, hopefully we can soon set up a prepregnancy appointment and see if they can do a risk-analysis and see what they say. (Um, don't assume this means much of anything. We are not pregnant right now. We're big on planning ahead. And this is not something you want to discuss and plan AFTER getting pregnant...) I'm not betting yet that this means I definitely will get to try for a natural delivery, but I'm hopeful that it might mean I have a chance. I know other things could get in the way, too, such as a chance of placenta previa (which I dealt with during both previous pregnancies), etc. Hopefully none of that will be a concern, but you never know. We'll just have to wait and see what they think after hearing my history, etc. Not sure how soon that will happen, but I'll update.
Subscribe to:
Posts (Atom)