The 13 Week Gynea Visit

We went for our 13 week visit at Dr H on Tuesday.  

Everything is great with the new babba, growing nicely & Dr said it will be a tall baby again - the legs are again measuring taller than average. 

He tried very hard to get a look but he couldn't tell us if it was a boy or a girl.  So now I have my fingers crossed again that it might be another girl.  I would love to have two girlies.  

At the end of the consultation, he asked if we had any question and this was the perfect opportunity for me to bring up my concerns about having an elective cesarean and VBAC.  I was overjoyed to hear that he does support VBAC and if I feel I would like to try than he will give me a trial of labour.  He said we could see how far we are willing to push out booking a cesarean and if it is safe to do so we can go to 40 weeks.  

I was overjoyed to hear this because if my doctor would allow me to at least try then I would feel much safer doing it under his nose than going to Genesis.

I am still comfortable with booking an elective cesarean as the doctor said the risk for baby and mom is less than with an emergency cesarean.  He also said the danger with VBAC is of course the 1% chance of uterine rupture, and even though it is small, if it does happen that puts baby and my life in a lot of danger and the emergency cesarean then will be much more traumatic.  

It's interesting though, before I even said anything about midwifes, he said that he knows Genesis is one of the places that does do VBAC and he knows that they have lost babies with their attempts.  He said he does not know if they have got an NICU now but he has heard of cases where mom and baby have to be rushed to Parklane hospital.  So bottom line he would not recommend I go to Genesis.  

I am just too happy that should I go into labour before 40 weeks and the conditions are right I can still try to have a VBAC.  I really was very apprehensive about leaving my gynea should I really still wish to persue a TOLAC and wether or not I would be willing to trust a midwife above an obstetrician.  I just never quite felt at ease with the idea.  Midwifes are assistants, and sure they might have a lot of experiences etc, but they do not have the knowledge and the background that I believe an obstetrician has.  I know my gynea is very good and I trust him with the most important thing in our lives.  I am even more happy to stay with him now as he definitely is as understanding and accommodating as I perceived him to be.

The Birth Disappointment

I came across a blog yesterday that I even shared in the VBAC support forum.

It is about birth disappointment and for the first time I felt that someone was acknowledging the way I was feeling and that my feelings were legit!  And that has made such a big difference to me!  I will highlight some parts of it as I don't like to post links.  Links are always gone when you want to click on them years from now.

Dealing with feelings of anger, shame, sadness, or disappointment regarding your birth can be difficult.  Well-meaning family and friends remind new mothers that they have a healthy baby despite the experience, and while the sentiment is meant to make the mother feel better - after all, what better prize is there? - it generally only makes her feel worse.  Often the mother feels judged, as though others see her as ungrateful or selfish.  However, the feelings associated with birth disappointment are valid.

 I remember trying to explain to Dad how I felt after Isabella's birth, and this is exactly what he said to me:  "but look at what we've got!"  referring to our perfectly happy, healthy and beautiful daughter.  Yes, I know but...I didn't know how to explain it further so I left it and never mentioned it again.

Having birth disappointment means:
- A mother experienced unplanned, and often undesired, interventions.
- A mother may have experienced an undesired outcome, such as a cesarean section or episiotomy.
- A mother's birth memories elicit undesirable emotions such as anger, fear, or sadness.

It does not mean:
- The mother does not love her child.
- The mother was uneducated or poorly informed.
- Interventions were not necessary.

Now that I feel like I am allowed to feel what I have been feeling, well it takes so much of the hurt and guilt away! I realise that it is not only  moms who have undergone emergency cesareans after having their hearts set on normal birth, but anyone may feel that the birth went a way that they did not plan or want.  That takes me back a few posts ago (remember The Doula that gave birth?) where I judged a mom for saying that she felt disappointment for giving up her hypno-birthing method and pushing, causing her to tear.  I didn't understand it because if you had natural and normal birth you were not allowed to feel disappointment with you birth, because it is something that I will never experience!

Its funny, I never felt anger, fear and sadness when it comes to my first birth story.  I always tear up remembering it because I felt like it was beautiful and I definitively did not hate the experience.  What I do feel though is disappointment that I did not dilate or have a chance to try and push out my baby like I always believed I was meant to, or even the chance to experience a somewhat normal progression of labour.  Mentally I was so ready for this! I feel like my body failed me somehow.  I felt frustrated when I thought that I am stuck with cesarean forever now and I do not have a choice.  Now I know it is not true and I do have the option of again attempting a natural birth.  That alone makes the decision of rather having a repeat cesarean easier because I feel like it is my choice.

Thank you to theconnectedmom.com for sharing her birth disappointment and writing the post.

The Tiredness

I have continued reading articles, reading blogs, reading forums and talking to people, and now I am tired.

Tired of the over-thinking, tired of the obsessing, lying awake wondering, arguing with myself, Dad & debating with others.  I am done now.

I am now just going to enjoy the rest of my pregnancy and my growing baby.  I hope that I will be healthy in this pregnancy & that baby will be perfectly healthy as with my first pregancy.  I love telling people I am pregnant & I love the fact that already my tummy and midriff is expanding!  I look forward to our doctors appointment in less than two weeks time so I can see how much our little peanut has grown!

 

The Reason Behind Wanting a VBAC

This is the part where I ramble on a bit.....

I have been wondering, within myself, why is it that I along with so many other women feel the desperation, like I felt at first, to have natural labour and birth a baby vaginally?  Why do we feel cheated out of having a natural birth?  Why do we so desperately want to be in control of this birth experience like we felt we weren't the first time?

Many moms that I have spoken to that had emergency cesareans felt exactly the same way I did.  They all had repeat cesareans which they felt were a much much better and fulfilling experience than their first birth.

Perhaps it has to do with your mind set and the fact that you really wanted to birth naturally but then something happened and it was better and safer for baby to be born via c-section.  There is the disappointment.  Not because you gave birth a certain way but because it wasn't what you expected or how you imagined it would be.  Enter depression & self-reproach & feelings of being a 'failure'.  It is really silly isn't it?  You are holding your healthy beautiful newborn yet you feel guilty for somehow failing to live up to what you had in your mind to be perfect.  You will always opt for the emergency cesarean; not because you blindly obey what your doctor suggests or 'bullies' you into as some women put it, but because instinctively you will want to protect and do what you also believe is safest for your unborn child.

Perhaps it has a lot to do with me feeling like the choice was taken out of my hands and all of sudden I felt like everything was out of my control!  And that is I think what makes the experience so terribly disappointing and frighting.  You had no time to prepare for this!  Neither mentally nor physically and therefore a lot of what-ifs came in the few months after I had had my little angel. What if I had been induced differently?  What if I had waited longer?  What if I had gone to an active birthing clinic instead of a hospital?  What if I used a midwife instead of a obstetrician?    

I suppose giving natural birth, from what I have heard and read, gives a woman a feeling of self-fulfillment in the sense that you feel you are strong for enduring the pain of labour (if you do it without any pain medication), feeling like you are capable of doing something that is unique to being a women (other than baring a child and breastfeeding?).  The question is though, is your baby capable of handling the birth like you and your body is?  Sometimes not.
 I hate it when people say "but women have been doing this for centuries, we are made to birth a baby vaginally, you cannot grow a baby too big...."blah blah bah.  Women and children mortality rates were a lot higher in the old days.  With modern medical intervention people are surviving!  People had 15 children because chances were that all your offspring would not survive.  Why do people then not have so many children anymore if they have been doing it for centuries?  People also forgot it has a lot to do with genetics & there are a lot of factors beyond our control....anyway that is a debate for another page.

I am still a firm believer that, should you have a normal uncomplicated and healthy pregnancy and be capable of having a normal birth, it is best. There is merit in some theories surrounding how and why natural is best for baby and mom, but it is not healthy to build your entire belief regarding birth around this.  It is ridiculous how some women condemn cesarean & women who have had it - elective or emergency.  Should a mother feel she would rather opt for elective cesarean first time round she must be free to choose so without judgement from others!  Natural birth should never ever be at a cost of the mother and/ or baby!  Do people realise this??  I just recently read again about a baby dying due to uterine rupture & another where a mother died bleeding to death following a home birth.  With the first case the doctor said she would make the same choice again.  She said the mother's uterus was salvaged and can bare another child easily.  So, that makes it okay then?  With the second, the midwife said the mother had a wonderful pregnancy and a beautiful natural birth and she hopes the husband (and motherless baby?) can appreciate this.  It just blows my mind how some people forget what it is about!  "I would rather have a damaged mom and baby and have a natural delivery than opt for medical intervention."  It truly is bizarre to me.

Having a cesarean always scared me more than having natural yet painful labour.  It still does.  But this time I know what I am in for and my mind set is different.  Again all I hope for is for both of me and baby to come out after the birth healthy and without any complications. Now I know I would not have done anything differently the first time.  No more what-ifs.

The Comparison Between VBAC & RCS

I discovered the following list that I drew up while I was still reading through all the information the midwife sent me and seriously considering VBAC as one of my only options:

VBAC
PROS	CONS
Recovery is much quicker	Chance of epesiotomy/ tearing that will have to heal anyway
No major scar to heal	No guarantee it will be successful & could end up with a repeat EC with possible adverse effects
Pick up Isabella	Bigger risk of death of baby
Go home quicker	Unfamiliar surroundings & further from home than hospital
Less risk for future pregnancies	Chances of VBAC not very high
Less risk of baby coming out before ready (lung maturity)	No NICU care at Genesis should it be necessary

RCS
PROS	CONS
Will have Dr O'H as primary caregiver	Risks associated with surgery & anethesia
Hospital is much closer to home	Not being able to stand up straight away and care for baby
Birth can be planned better to some extent - care for Isabella	Longer recovery
Knowing to some degree what to expect this time
Less risk for baby
Hospital has NICU & facilities to deal with infant care
Extended rest time in hospital and with new baby

The Friend Who Recently Had a Baby

I went to go visit my friend yesterday who had her baby just over three weeks ago.  The most beautiful little boy that I have ever seen.  Really he is just so perfect.

She gave birth to him vaginally. Her doctor feared that the baby was getting too big and suggested that they induce the day before her due date, otherwise they would do a cesarean.  She went in on Monday morning, got induced, laboured for three hours until she got to 4cm's dilated, had an epidural, and two hours later she pushed out a healthy 3.4kg boy.  She had minimal tearing.

Two work friends of hers also came by while I was there, with their little ones in tow.  So we started talking about everyone's birth experiences, mostly because I asked.  One women has a 5 month old girl that was born via elective cesarean that turned emergency cesarean & the other women had a cesarean 10 days before her due date because her boy was getting too big.  He was 4.7kg when he came out.  Wow!

The women that wanted an elective cesarean was scheduled at 39 weeks.  She went in on the Wednesday before the scheduled date (the Friday) and the doctor saw that she had absolutely no amniotic fluid left, so baby had to come out right then.  She said that she was a little upset because the doctor had seen her two weeks prior and said she only needed to see her then again (which was two weeks later).  Next time she would insist that she go for weekly checks at the end.  She said her birth experience was great and she has no regrets, she never wanted natural labour.  She was able to breastfeed beautifully & she said she expressed so much milk she still has some in her freezer.  She stopped breastfeeding at 4 months when baby went to chréche and took a pill to dry up her milk.  She said it was three days of agony whilst waiting for her milk to dry up.  Her baby suffered from re-flux in the first 6 weeks and cried a lot but is good as gold now.

The other mom didn't really say too much, just what I had mentioned earlier.  She is in her late 30's already and quite a big and tall women.  She mentioned that in her family all the babies are 4kg babies.  She is from Dutch decent and she herself was a home birth in Holland.  She mentioned that, I'm not sure if it's an Aunt or someone else in her family, pushed out her 4kg + baby & it completely ruined her body because she was a smaller women. She apparently applauded her for having a cesarean & not trying natural like she was forced into. She mentioned it is very common practice in Holland to give birth at home with a midwife & the infant mortality rates as well as the rate of retarded and brain damaged babies are soaring.

I must mention that her little guy is such a good boy.  He is 11 months old and he sat there on the carpet playing and did not make a sound.  When you talk to him me smiles at you and carries on.  She said he just doesn't cry ever & is such a calm baby.  She didn't mention much about breastfeeding but I thought I heard her say that she wished that she could have breastfed because she wanted to.  She would sit and try and express for half an hour and get 10ml out, so it sounds like she gave it a good go...but I'm not sure.

My friend stopped breastfeeding at around 3 weeks.  She didn't have enough milk at the beginning and after 10 days he was still only weighing 3kg (remember he was 3.4kg at birth but babies always lose a percentage of their weight in the few days after birth).  She started topping him up with formula & tried everything to increase her milk supply; expressing, tablets, some herbal thing I think she called Jungle Juice, feeding him more often, but nothing.  She said she really wanted to breastfeed him for as long as she could.  He has colic & was battling with constipation from after he passed his meconium, which was strange because at that stage he was only getting breast milk.   

I don't think I ever mentioned about me breastfeeding. I breastfed wonderfully up to 4 months.  Battled a bit, okay a lot, with latching & cracked nipples in the beginning but I got advise, read up and persevered.  At 4 months I wasn't producing enough milk for her needs anymore, even though I was at times feeding every hour, so I started topping up with formula (after talking to her pediatrician) & started solids.  My milk dried up completely within a couple of days.  I missed it and did want to breastfeed longer but on the other hand I was completely fine with not having milk anymore & being able to bottle feed her now.  This meant Dad could start doing feeds as well, because I was never able to express enough for him to do night feeds.  He really enjoyed it and still does the last bottle feed before he puts her down for the night.

Okay so, four different women in one room and four completely different experiences.  All very healthy and happy babies, except for my friend, who seems a little despondent about her boy's colic at the moment but we all assured her it does pass even though it feels like it will never end now.  Why I mention the breastfeeding is that this to me just proves once again that going through labour & having vaginal brith means absolutely nothing and has no relevance to how you will breastfeed & weather or not you will have a colic baby.

Another friend of mine, the one with the ADD theory, gave birth vaginally with the help of a midwife and Oxycontin after going into spontaneous labour at 39 weeks.  After 13 hours her 2.2kg baby girl was out.  She said she had lots of colostrum & a lot of milk, expressed lots, fed beautifully with the aid of nipple caps & at 5 months she told me her milk just dried up completely.  She does not have a drop left she tells me sadly.  At 4 months she wasn't producing enough for her baby's needs and started her on solids - the créche she started her at told her that she's hungry during the day & needs more food.  Now she has formula only & solid foods.  I remember her bragging about how she would exclusively breastfeed for 6 months and be able to do so because she had natural labour.  I won't remind her of this, that would be ugly.

Once again I conclude it does not make a difference in the large spectrum of things how your baby comes into this world; whether you push it out through your vagina, choose to have a cesarean or end up with an emergency cesarean or a planned cesarean despite the fact that you actually wanted natural birth, your baby will still be the same baby.  It is your unique body and the way it functions can never be predicted, your capabilities and instincts as a mother as well as the nature of your baby that counts.  Women seem to forget that genetics have  a lot more to do with reproduction than how you birth your baby.

My baby slept through at 8 weeks (from 6pm to 5am, no jokes!) and now sleeps from 7pm to 7am and 8am on weekends sometimes.  Everyone with kids tells us how jealous they are of us.  My ADD theory friend still gets up twice a night for her baby (who is almost 6 months) & battles to get her to sleep. I thought baby's pushed through your vagina are suppose to be little perfect angels.  Their not, they're babies, just like everyone else's.

The Information Overload

My head is going to explode!

For the past two weeks, every opportunity I get at work I google VBAC, C-section, Repeat C-section....forums, articles, research....

There are so many stories & so much information out there.  I've also come to quite enjoy Dr Amy's blog http://www.skepticalob.com/

I have come to the realisation to TOLAC or not to TOLAC is a very personal decision.  A lot of women out there, it seems to me, are looking for other women in exactly the same situation as them, with the same circumstances, want to know what they decided and how it turned out.  Unfortunately a lot of Forums are one-sided and incomplete and you never get to know how things turned out.  Even the VBAC support thread I am still following on moomies.co.za; I have asked two women who previously posted on the thread, for their stories whatever it my be, with no response.  I can only assume they do not check the forum anymore or do not get the correspondence.

So here is my decision.  I am very much at peace with having a repeat elective cesarean and was almost tempted today to cancel my midwife appointment.  I still think, however, that it is a good idea to talk to her and get yet another point of view.  The biggest reason for me for going with this decision this is I am not really prepared to accept the risks associated with VBAC and the complications that could or could not occur.  There is no guarantee that I will go into labour & I might very well end up with a repeat emergency cesarean which I fear will be even more traumatic.  There are too many 'if's' and 'but's' and variables for my analytic nature.

I am very fond of my gynea and I trust him completely.  Netcare Sunninghill Hospital where I birthed my first little one at is a fantastic and a very well equipped and staffed hospital.  I like the comforting feeling that that familiarity gives me.  Another reason is I know that this is what Dad feels the most comfortable with as well.  This is not only my child but his as well and therefore not only my decision.  I always joke and say that I only have 50% shares in what is growing in my uterus.  I love him dearly and I would hate to put him through any kind of trauma.

I am still so early in my pregnancy - 10 weeks this week - and a lot can happen still, but in my heart I know that this is the right decision for me and for everyone in my family, not for anyone else who might read this, or might feel they are is a similar situation or have similar circumstances.