Showing posts with label c-section. Show all posts
Showing posts with label c-section. Show all posts

Friday, May 17, 2013

I Changed Five Years Ago. . .

I was heavily pregnant five years ago.  My son had inexplicably turned breech right at the very end of that text-book easy pregnancy.  My dream of natural, drug-free vaginal birth was in jeopardy and I was suddenly facing the possibility of a c-section.  Sure, plenty of women have had breech vaginal deliveries. . .but that wasn't what ended up happening with my delivery.

I can still remember the day that I was lying on the couch in the living room and my abdomen began to resemble that famously gross scene from the movie Alien.  I could not believe the movement that was going on inside my body.  It was creepy to watch, somewhat painful to feel, and I ended up feeling beat up on the inside.  At my next appointment, my doctor was startled to discover that my baby had found a way to turn breech.  His expression was one of pure shock and he spat out, "Is that your baby's head?!"  Why, yes, yes it was his head. . .suddenly lodged up near my breastbone.

My doctor attempted to turn the baby in his office.  I believe he truly tried to flip that baby and can say that it was very uncomfortable from a physical standpoint.  Being so very near the end of pregnancy and so full of baby in my belly. . .ugh, it really kinda sucked and I was so upset that the baby was not turning even with a grown man pushing full force on my abdomen.  I'd be 39-weeks on the weekend and he was scheduled at the hospital that Saturday so he told me to come to L & D so he could try to turn baby there.  The reasoning was that we could head directly to the OR for a c-section if anything truly distressing happened to the baby while he was attempting to flip the baby. 

On this night five years ago, I prayed fervent prayers.  I prayed for my baby to turn, for me to avoid a surgery, for all to work out according to my wishes.  Well. . .my baby did not turn, I did not avoid a surgery, but it ultimately did work out. 

My amniotic fluid was low enough at that point that attempting the version was not on the table.  My doctor said that he was there, I was there, I was at term, and the baby was breech.  He offered the c-section right then if I wanted it.  I burst out that I thought he'd flip my baby back down and I'd have a vaginal birth and that I thought my delivery would be what I wanted.  I realize now that he & my husband exchanged a look (confirmed by speaking with my husband) and I think both of them thought I knew I was walking into that hospital for a c-section that day. 

I did not know. 

I was so thrown for a loop that I actually left my shoes in that L & D room and walked off without ever finding them again.  It was many many hours before my surgery was actually performed.  Hours that I spent feeling uncomfortably hungry and thirsty.  Oh, man, I have NEVER felt so thirsty.  Starting the IV helped a little, but my mouth positively ached for liquid refreshment.

I was there for over eight hours. . .waiting for the surgery that I did not want. . .hoping that I could somehow avoid this (in my view) unnecessary surgery. . .praying that I could keep the baby in for one more week so that my mother could be near me. 

My in-laws were there nearly the entire time. . .I remember my mother-in-law sitting in that room with me, trying to keep my mind off my anxiety and fears, being a solid rock of support for me.  It's a kindness that I can never repay.

At some point I inquired if it wasn't time for my doctor to go home and if that meant I'd get to go on home too.  The L & D nurse was a treat, so very well suited to the job, and she let me know that if my doctor said he'd be there for my surgery that he absolutely would not be leaving until I was stable in recovery no matter how many more "emergency" c-sections showed up.  I still remember that nurse by name and she is one who I made sure to give a special gift to weeks later when I was up for returning to the hospital with my new babe.

I had never been admitted into a hospital prior to this birth.  I'd never had a major surgery.  I'd never delivered a baby.  To say I was anxious would be an understatement.  I was scared to death. 

It was a day of firsts.  It was a day that I held my heart - outside of my own body.  The first time that I was able to hold a child of mine.

The surgery was perfect and looking back it was as good as could be hoped for in a surgical delivery.  The recovery sucked and I didn't see my new baby for two hours as I desperately tried to move my legs enough while in recovery to be sent up to my room to be reunited with my baby.  There are only three or four post-op photos of me holding my first son while we were in the hospital.  One that painfully tugs at my heart is one where I was on the phone with my mother who was 3,000 miles away and I was crying while holding the phone and cradling my new baby for the first time.

So much has changed in these five years and I can say that it has flown by in the blink of an eye.  I can't believe that the baby who nuzzled at my awkward breast is now a five-year old who is on the cusp of Kindergarten.  I should have cherished those fleeting early baby days. . .those impossibly exhausting early baby days.  They will never return that that boy will only continue to grow and mature. 

What do I hope for my dear first son?  I hope that he keeps his kind and loving heart.  He is so sweet and empathetic.  I hope that his spirit is free when it can be, but that he learns when it's advisable to reign in his head-strong nature.  I hope that he remains a fundamentally good human being.  I hope that he finds a special someone who appreciates and admires him for who he is and that his spouse is a generously loving helper who isn't emotionally wounded.  I hope for the best for my dear boy. . .he's smart and can be so charming.  My darling son. . .I love that boy so much that words fail.

So much has changed in the last five years.  I earned a new title:  Mother.  I know there are times that I miserably fail, but I do aim to bring honor and respect to that title.  I became responsible for a human being who needs me to grow and thrive. . .who needs my guidance to learn how to thrive and succeed in society.  I really can not believe my son is now five years old.  It honestly does feel like it was only yesterday that I first held that beautiful baby with the dimpled chin.  Only yesterday that I put my nose in his hair and nearly wept over the joy of his smell.  Only yesterday that this newest chapter of my life began.  I was living before. . .but I was finally alive.

Thursday, May 2, 2013

Healthy Babies ARE NOT All That Matters!

Most people who read this blog know that I developed Intrahepatic Cholestasis of Pregnancy (ICP or sometimes just called CP) near the end of my last pregnancy.  That diagnosis, along with the bleeding I experienced throughout each trimester, effectively made it my last pregnancy as my husband & I are not willing to experience another roller coaster ride of a pregnancy.  Besides, we're old and it was time to stop cheering for Team Babyworks.

I mention ICP because early delivery is the standard practice with those pregnancies.  That is, delivery no later than 38-weeks.  The reason is that fetal outcomes are not as favorable with longer gestation.  That's a very delicate way of saying the one thing that strikes fear in the heart of every single pregnant mother:  longer gestation in an ICP pregnancy is linked to increased chance of stillbirth.

There is a broad swing in what is considered a full-term pregnancy - anything between 38- and 42-weeks.  Generally speaking, baby is better off baking in your uterine oven as long as possible.  That means that delivery (via induction or, as is a fairly common outcome for induction, a c-section) that is scheduled just for the sake of not being pregnant anymore, to choose your baby's birthday, or because your OB is going on vacation near your actual estimated due date are generally agreed upon to not be good reasons to evict your fetal stowaway.

Regardless of the reasons why your baby is born early, you might second guess your decision to deliver so soon.  You may well do this if your baby is perfectly healthy and it's nearly guaranteed that you will if your baby does not fit your mental picture of healthy perfection.  Mother's Guilt is strong, whether it's warranted or not.  Frankly, it seems to me that the ones who have the least to feel guilty about are the ones who agonize the worst.

Witnessing a loved one or a fellow mother beat herself up emotionally over decisions that can't be undone is hard.  Well-meaning people may say things like, "Well, your baby is healthy and that's all that matters."  Or, "Baby was born and his here now and that's all that matters." 

These lines, and those like them, have always bothered me.  I don't think most people are trying to be hurtful when they say things like this, but it is hurtful.  These statements are dismissive and demeaning.  These statements completely invalidate the mother's feelings.  It's like saying that not only is she wrong for feeling uneasy about her decisions, but it's also saying she's wrong for having the feelings in the first place because having the baby here now is all that matters. 

I struggled with years to make peace with my first son's c-section.  My feelings of inadequacy and outright maternal fraud were surprising to me, but they were very real and very painful.  My baby was healthy and I still ached over making the wrong choice.  Was it the wrong choice?  I don't know, but it's the one I made.  I can't undo it.  It took years, but I no longer feel an intense longing when I think of his birth.  I made the best decision I could with the information I had.  Would I make the same choice today?  It doesn't matter, but I would.

Hearing nearly everyone I know and love tell me that, "You're okay and he's okay so it all worked out and that's all that matters," did not help me.  Being told that I'm just as much a mother as any other mother didn't help.  Listening to one c-section story after another didn't make mine feel any more "normal."  Time was probably the greatest source of healing.  Well, that's not entirely true.  It was time and having an experience that made my body feel even more broken.  Having my last baby (high-risk pregnancy, advanced maternal age, early delivery and all), restored me in more ways than I could have possibly imagined.

Healthy babies are the ultimate goal, but they are not all that matters.  Healthy mother matters too. . .physically, emotionally, and mentally.  If she's wounded in any of those areas, it matters - and don't try to tell her otherwise.

Have you struggled to make peace with your birthing experience?  What helped?  What didn't?  Please share in the comments if you'd like and accept a big ol' virtual hug from me.  I know it's hard and I'm sorry that you're struggling.  {{{hug}}}

Wednesday, February 1, 2012

Cholestasis of Pregnancy

In a final F-You to me, my pregnancy ended in a spectacularly bizarre fashion.  It wasn't bad enough that I was high risk from the start.  It wasn't challenging enough that I BLED or spotted through the first trimester and I had spotting off & on throughout the entire pregnancy.  It wasn't enough of a bummer that my pregnancy with my first son was textbook perfect and this one, likely my last, was one problem after another.  No, I ended up with a pretty serious problem right at the end.

I suddenly began experiencing severe itching around 36-weeks.  I casually mentioned it on Facebook and a friend cautioned that symptom could indicate liver problems and suggested that I call my doctor right away.  I initially dismissed the idea because itching doesn't seem all that dangerous and I hate bugging my doctor since I'm sure that I'm already his most annoying patient.  I ultimately decided to mention it to him because it's his job to deal with me, however annoying I may be, and the thought of having a liver problem scares the heck out of me.  You know, because you need a functioning liver in order to do things like live.

His response was that itching is most likely caused by dry skin, but he was concerned that it was my hands & feet that were so itchy.  Specifically, my palms & soles.  Now, when I say that my palms & soles were itchy, I don't mean that I randomly scratched every now and then.  The itching intensified at night and I would be awake and scratching at myself for hours every night.  I'd use a rough washcloth and rub it against my hands & feet for hours on end.  A few times I scratched myself with my wig brush because the stiff bristles felt good even if they made my skin red and sore.  Nothing gave me any relief other than eventually passing out from exhaustion. . .and, even then, I'd wake up scratching.

The doctor mentioned that itchy hands and feet could be a symptom of cholestasis of pregnancy (CP or ICP) and he wanted me to go to the lab right away to get blood drawn.  My liver function, as indicated by enzyme levels, and my bile acid levels were what he specifically wanted to see.  I went to the lab late that day and the results indicated that a specific enzyme was four times over the upper normal level.  I saw that number and was like, "Oh sh*t!"  Seriously, liver problems are something that I really fear and that number scared me.

Based on that test result alone, my doctor decided to proceed as though he had all data and had me begin to take a handful of medicines to manage the symptoms of ICP.  He gave me scripts for Actigall, Atarax, and hydrocortisone lotion.  So much for being the hippie who doesn't like to take medications while pregnant.  Now I was forced to do so for my own health and sanity and for the health of my as-yet unborn baby.

Why did he not have all the data to make a firm diagnosis?  There are only a handful of labs in the country that run bile acid tests.  Why?  I have no freaking idea other than ICP is a fairly rare complication of pregnancy.  So, naturally, that's exactly what I ended up diagnosed with once those bile acids came back.  Oh sh*t indeed!

Of course, I spent plenty of quality time with Dr. Google and what I read only freaked me out all the more.  Did you know that mothers with ICP have a significantly higher chance of having a stillbirth later in pregnancy?  As in, the last couple of weeks of pregnancy.  Having had 36-weeks of emotional turmoil, I wasn't expecting to face the possibility that I may not be able to hold this baby and take him home.

My c-section was initially scheduled for 39w5d and my doctor bumped me up to 38-weeks on the nose along with ordering twice-weekly NST visits at the hospital and telling me to go to Labor & Delivery (L&D) if I notice it takes more than one hour to feel ten fetal movements instead of the standard two hours.  By the way, non-stress test (NST) is a total misnomer because you're only there if there is a potential problem so I'd say all moms to be are stressed in that room.

My itching never improved, even with meds, but my liver enzymes did drop down some and that was encouraging.  The problem was, as one would expect, the very real risk of stillbirth.  It's standard protocol to deliver prior to 38-weeks because the risk of stillbirth significantly increases at the end of pregnancy.

I became so fearful for my baby that I'd try to force fetal movement throughout the day so I could have some assurance that he was still living.  One night I fell asleep and woke with a start when I realized that I hadn't felt any movement in the last hour.  Sure, he may have been sleeping. . .but he may have been dead.

That's the emotional cruelty of ICP.  Your bile acids can spike to dangerous levels with absolutely zero warning.  Those bile acids get high enough and your baby dies.  You have no idea that it's about to happen or even that it's happening.  You just show up to your NST and the RN isn't able to find a heartbeat or you can't seem to get the baby to move during your fetal kick counts and you go to L&D only to discover that it's not a living baby you'll be delivering.

So I spent my time bargaining and pleading with God for my baby.  I'm holding my 6-week old baby in my lap as I type this and just remembering those fears makes me feel sick and brings tears to my eyes.  How I worried that I would lose this baby!  I became convinced that this baby was going to die; his little heart would stop and my heart would break.

I had a meltdown early one morning and cried to my husband that I couldn't take these fears any longer.  I was 37w3d and I couldn't understand why we were waiting for me to reach 38-weeks other than to increase the chances that the baby wouldn't need to spend any time in the NICU.  I said the thing that was rattling around in my brain:  I'd rather have a baby in the NICU than a baby in a box in the cemetery.

I showed up to my NST that morning and the RN asked how I was that day and I burst into tears.  Well, I didn't just cry.  I was pretty hysterical.  I told her that I couldn't take losing another baby, not this close to the end, not now, not this baby.  I couldn't sleep, couldn't concentrate, couldn't think of anything else besides the fear of losing my baby.  She simply said, "It's time." 

She phoned my doctor, spoke with the perinatologist and the hospital, and the OB currently on duty at the hospital.  All agreed that I could deliver that day.  And that's exactly what happened.

The good news is that my baby was perfectly healthy and didn't even spend one minute in the NICU, my liver is functioning perfectly well now, this harrowing experience is over and I have a beautiful baby in my arms.  The bad news is that I'd have a significantly higher chance of developing ICP in a subsequent pregnancy (60 to 90% chance, depending on the source) and that it tends to manifest earlier and more severe in subsequent pregnancies.  My husband was already not a fan of hearing my talk about wanting a third baby and this bit of knowledge slammed the door on us having a third.  He flatly refuses to consider a third baby and a part of me understands. . .but another part of me still wants a third baby.

Why write this down?  I don't know.  I guess it's a good reminder that even the weirdest symptoms could indicate serious problems.  I shudder to consider what could have happened had I not mentioned this crazy itching.  I think it's also a good thing to explain just how emotionally difficult it is to get an ICP diagnosis.  It's not just itching and whining.  The itching was horrible, but the fear of losing your baby right at the end of pregnancy is so much worse. 

I still would like to write down something about my delivery and my recent bouts of second guessing myself about breastfeeding (bizarre, but true), but my time is pretty limited these days if I want to use both hands to type so it might be a few days or weeks.

Friday, August 5, 2011

Decisions, Decisions - Childbirth Edition

At my appointment a week ago, my OB asked if I'd given any thought as to how I'd like to birth this baby and the fact is that I'm just not sure at this point in time.  Thanks to the way Kaiser staffs OBs in their hospitals, he doesn't have any vested interest in pushing either method of delivery (surgical or vaginal) and I truly get the impression that it doesn't make a difference to him one way or another.  The only thing that he had a definite opinion on is that he asked that I decide how I'd like to birth this baby by the 7th month or so and I'm hoping that I'll have an answer by then.

I hate feeling this way, but I fear that my body won't do what it's supposed to do if I choose to have a VBAC.  I feel like my body has already failed me in terms of pushing out a fetus so I have zero confidence in my ability to vaginally birth a baby being born at term.  I know myself well enough to realize that I will feel like a personal failure if I go for the VBAC and still end up with a c/s and the last thing a hormonal new mother needs to feel like is a failure.

On the other hand, I felt like I was hit by a freaking bus after my c/s.  I really don't relish the thought of such a painful recovery while caring for a newborn and my son.  I also would like to spend as little time in the hospital as possible and I'm pretty much committing to three-days if I go the c/s route. 

Adding another wrinkle to my decision making process is that I'd prefer to have my doctor do the honors if I have to have someone slice open my abdomen.  I know it sounds kooky and I'm sure the other OBs on staff are perfectly competent, but I have absolute confidence in my doctor's competence and I don't want some stranger to cut me.  Going back to the way Kaiser staffs their OBs at the hospital, the only way I can be sure that my own doctor will be the one rifling around in my insides will be if I schedule the c/s.  Well, that and it would be important to know if he'll be scheduled to work in the hospital at some point when I'm at term.

At the moment I'm leaning toward having an elective repeat c-section and it's only the weeks of pain that I know I'll experience if I go that route that is keeping me from outright saying that my baby will be cut from me rather than naturally released.  I feel so emotionally scarred from my failed natural miscarriage that I don't think a VBAC is right for me under any circumstances.  I can't even visualize a VBAC without thinking about that painfully heartbreaking day and I'd hate to cloud this baby's birth-day with memories of such sadness.  Of course, my thoughts may be totally different on another day so my decision is far from being made.

Did you have a c/s and end up having another child afterward?  What did you choose?  Why?  What was your outcome?  Thoughts, advice, and opinions are welcome and I only ask that all comments are kind and respectful.