Sunday, November 25, 2007

I figure I may as well come clean...

...and announce that I am having a repeat c-section for the Bean.

I'm not quite sure who I am writing this for - to assuage my own grief over not persuing a vaginal birth, a response to the faceless participants on on-line message boards who seem to have all the answers, or to my unborn son who I want to know that I did the best I could with what I had.

We've put a lot of thought (and tears) into our decision, and yes I do mean "we" since my husband had a part in creating this life and therefore should have some input on how he arrives. The climate for VBAC in this country is very hostile and given that so much of obstetrics as we currently know it has very little to do with evidence-based medicine, it would seem to be a miracle that any VBAC's happen at all.

My first strike is the fact that I am morbidly obese - not just overweight, but the kind of fat that I am damn lucky my care provider hasn't been ordering monthly GTT's and doing any number of the horrific fat-phobic things that do still really happen out there. I count myself lucky that my OB doesn't seem to have a fat-phobic bone in his body, and not dealing with that stress is a very important thing to me. Yes, this is the OB who pushed me into a section with Michael for suspected (and confirmed) macrosomia, but not dreading stepping on that scale every month and praying that I don't get a lecture about weight gain has been worth it. My current weight (only up 16lbs from pre-pregnancy - woo-hoo!), Michael's size at birth, and the fact that this babe seems to be following in his brother's footsteps are enough for a care provider to decide at the last minute to pull the rug out from under me. I've read of many similar situations arising for VBAC moms, and it's something I choose not to expose myself and my family to ('cause like it or not, something this big affects them too).

I could have interviewed a dozen midwives to find one who didn't have a fat-bias, but that segues into my second reason - time. As many of you know, my son is Autistic and I do not have a car. Interviewing care providers takes a lot of time and travel to accomplish - something that I again chose not to put myself or my son through. Yes, I've heard fantastic things about two midwifery practices out there, but both require a good 1-2 hours commuting time to get to their offices and the hospital they both deliver at is also a good 45 minute drive or commute. My current OB and hospital is a 15 minute bus or cab ride. Am I selling myself short for not even looking? Perhaps. Given the amount of life that has happened these past seven months, and it's been a lot, the time and stress involved with tracking down a VBAC is energy that I didn't really have to spend in the first place.

Then there is, what seem to be, the answer to everything birth-related - unassisted child birth. I am very attracted to the to idea of UC and even day-dreamed a bit about it. There are two big obstacles in my way. Firstly, as much as I might desire that lovely UC birth, I know I don't have the faith and trust in my body in order to accomplish it. I've come a very long way in my growth as a woman and mother since Michael was conceived, but I'm still not there yet. I have tremendous admiration for women who are able to take that plunge, but I know that I am not one of them. The second obstacle is my husband's unwavering fear of UC. To many, this would be a non-issue and maybe they are right, but for me it is a deal breaker. I do believe my partner should have some input on how our child comes into this world, not veto power mind, but input. I can't say for sure, not having experienced labor, but my gut says that I would want and need his support at that time. I am confident he could give it to me in a hospital setting, but at home his mind would be forever divided between supporting me and worrying about worst-case scenarios. Birthing in an atmosphere of coerced support is not something I want to experience.

All of that said, Michael's birth was no walk in the park for me. I did have quite a bit of trauma and we've already started discussing these issues with my OB. I've done a lot more reading and I'm also better equipped to stand up for myself this time 'round. We will be presenting a cesarean birth plan with some very specific instructions for the birth itself. I'll also be having an actual consult with anesthesia this time so we can have a good discussion about what type of anesthetic I want and the fact that a resident is to come nowhere near my back with a large needle. I am praying that the chiropractic care I've been getting will prevent that horrible nerve pain I had for three months postpartum with Michael, or at least that the chiro will be able to do something to get rid of it so I don't suffer as long.

The surgery itself is scheduled for first case on a Monday so I don't have to deal with the 2nd shift Friday-night nursing staff who felt it was easier to just leave me in bed than to help me start moving. I will have a breastfeeding kit with me - my Isis pump all clean and ready, one of those extra-long boppy pillows (or more likely one that I've made myself), and a nipple shield in a container of sterile water ready to go if we can't get him to latch even after drawing my nipples out with the pump. I got so much conflicting information from the nurses and the three IBCLC's I saw (oh no, your nipples aren't flat - my ass!). When we went to see an LC one week postpartum, that's when I got confirmation of what I pretty much already knew - I had inverted nipples, and I was finally given a nipple shield which allowed me to nurse my son well for the first time ONE WEEK POST-PARTUM! (still a little angry about that)

There's also going to be none of that waiting for someone to help out thing this time. We'll be sending off a time chart for the first week to family, telling them when we need help and asking for them to fill in the blanks for what works for them. I'm not going to care about nursing in front of visitors of having the babe snuggled up against me as much as possible - there will be plenty of time for them to hold the babe and besides, his older brother could definitely use some more lovin'. I actually have friends who have children of their own - knowing that I have the support and love of those very special women in my life is going to make a world of difference - it's not just going to be the three of us alone this time.

I think that last bit is the most important one. We had a ton of visitors while I was in the hospital, but once we got home we were pretty much on our own. I still have to have "the talk" with my mother about that last bit since I have a lot of unresolved anger about it (don't worry - it'll be happening next week). This birth, while it's almost definitely a surgical one, will be much different than my first. Even if I have all the same pain and even heartbreak that I had with Michael's or a completely new set of issues to cope with, the fact that I am taking ownership of the birth makes a huge difference in my feelings about it. Yes, I've read the statistics and I know how much riskier a repeat surgical birth is than a VBAC. I also know that I'll probably be having another pelvic laparoscopy down the road to remove adhesions if last summer's pelvic-lap was any indication. To others, my reasons for a repeat section my seem selfish and uninformed, but they are my own and, to use what some of the faceless masses consider a cop-out, what is best for me and my family.

I sit here, reading over my missive to the internet, feeling the Bean kick me in the pubic symphysis (which *really* hurts, by the way) and day dream about getting to meet him in eight weeks. I'm sure there will be many upsets and twists and turns, but such be life and for one of the first times in this pregnancy I am truly at peace with my decisions.