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Friday, January 18, 2008

33 weeks and counting

This week, I passed the gestational point with this pregnancy—32 weeks and 4 days—at which Stella was born. Throughout the day on Monday, I thought: this is the point that day when they started the Pitocin; this is the point when Stella became distressed; this is when they said I’d need a C-section; this is when they put me on oxygen; this is when she was born; this is when I lay in bed, alone, without her inside me.

Often in September, the details of my pregnancy with Stella and her traumatic birth pop unexpectedly into my mind. The heat or the light or the leaves beginning to turn yellow will suddenly remind me of those days of fear and the trying months that followed. But it was different to live the whole day of 32 weeks and 4 days over again this week. I alternated between feeling weepy and anxious and feeling utterly relieved. It was as if I was in two time zones, living two lives, at once.

Tuesday morning I woke up more pregnant than I have ever been. How many people did I say that to throughout the day? More than were actually interested, I’m sure.

Now, I am 33 weeks pregnant. I didn’t really think I’d make it this far, but I told myself that if I did, I would start thinking about birth options—a VBAC versus another C-section. So here I am, worrying about something new.

I know there are plenty of people out there who are militantly pro-VBAC, and I understand why. I understand that the U.S. has obscenely high Cesarean rates. I understand the benefits to a baby’s respiratory system when it is born vaginally. But I also understand the 1-2% chance of uterine rupture with VBACs, and though I could read this as 98-99% success rate, I just can’t. There is a 1-2% chance of catastrophic results. And if I insisted on a VBAC, and then the baby died or was injured, could I live with myself? I couldn’t.

On the other side: I don’t want to be sliced open again. Spinal anesthesia scares me, even though I had it when Stella was born. (There is always that slight chance of paralysis, looming.) And I hate the thought of a long recovery period.

Maybe the question I need to answer is how important is to me that I have a vaginal birth. Do I feel I need to experience this? I’m not sure that I do.

The truth is that I still have post-traumatic stress surrounding Stella’s birth. I haven’t even let myself think of the actual birth of this baby, and now that I am thinking about it, I can’t stop the flood of images from my labor and ultimate C-section with Stella. I can’t stop the images of the NICU, of my baby with tubes and wires snaking from her body. I can’t stop the image of me, rubbing antiseptic foam in my hands under bright light, the numbers on the monitor up and down, up and down.

So here I am, going back and forth, worrying again, still. Here I am with a decision to make. But making a decision means owning the results, and I’m too scared to own anything. I don’t have enough energy left to own anything.

16 comments:

Erica said...

I just went through the same thing in my post pre-e/HELLP pregnancy. As my son was fairly large, my doctor didn't feel I was a good VBAC candidate anymore, and I didn't have to decide. As I understand it, the benefits to vaginal birth on the baby's respiratary system are minimal at 39 weeks but more significant before that. You might want to ask your doctor about it. My planned c-section (at 38.5 weeks) went beautifully. I healed well, and my son has had no problems and has breastfed well since 2 hours after his birth.

I have read that one way to decide on VBAC is this. If you try for a VBAC and end up with a c-section anyway, will you be glad you tried, or would you wish you'd gone with the scheduled the section? And, in addition, for me, I thought, if I get preeclampsia at 40 weeks, would I wish I'd scheduled the section?

Good luck on your choice, and congratulations on reaching your milestone!

kate said...

Erica, this is really helpful, especially coming from someone who had pre-e. Thank you.

kristen said...

Kate, I can't speak directly to your decision or what you should or should not do. I just want you to know I'm sending a hug. I think whatever you decide will be the right choice for you. And your baby.

Special Needs Mama said...

Life is just a series of Sophie's Choices, is it not? I think Erica's words are very wise. I know you will choose the right path, and there is no wrong answer.

Ines said...

Congratulations again. This time on reaching 33 weeks!!!

*camerashymomma* said...

whatever happens or whatever you choose, will result in healing the wounds of your previous birth. each day, you are healing those memories that play the constant reminder (sometimes with each hour that passes as you described.) it's very real and it won't ever go away. those visions, reflections, smells, and sights...it's stored deep in the cells of your mothering body. but let this heal you. this baby came to you and your family for a reason. congratulations on 33 weeks and big hugs to you over the next weeks too. take care.

kyra said...

congratulations on reaching 33 weeks!! it seems to me that it makes perfect sense that this is floating around in your mind, body, and heart. i trust that you will find a place that feels right for you and for this baby.

Sari said...

Congratulations!!!

VBAC Lady said...

Your story is so poingant and personal. Thanks for sharing it, and congratulations on reaching this milestone!

As the self-proclaimed "VBAC Lady", obviously I feel strongly about the topic. I wanted to let you know a couple of facts - with the understanding and respect that ultimately, the decision is 100% yours and yours alone.

1- The standard accepted rate of uterine rupture is about .5-1%, which is lower than you cited. Use of pitocin, or other labor augmenting medications, may increase the likelyhood of rupture.

2- That rate of rupture actually encompasses a broad spectrum of what is defined as rupture - meaning, a rupture can be anything ranginging from a small dehesince that is pretty much nothing, to the catastrophic rupture with many variables in between. More often, ruptures are not catastrophic, and if complications arise, appropriate interventions can occur in a timely and safe way.

3- Unless you are crowinging (and even then, maybe) you can *always* opt for a cesarean. Even in labor,it will always be on the table. So, if you choose VBAC and in the throws of labor you change your mind about giving birth vaginally, you can do it. That's not an option if you are lying in the OR and surgery has begun.

There are wonderful resources about VBAC at www.ican-online.net, if you choose to explore that option more. Whatever you do, please make sure you have all the information - women who feel they have made a truly informed decision typically feel better about their births than women who discover "new" information after the fact.

Good luck to you and your baby!

ta said...

On the bright side, isn't it a wonderful choice to have to make. Ok, that was an annoying thing to say. When I was pregnant I was so opposed to having a C-section. So of course, I ended up having one. It all happened so quickly I was too shocked to protest and worst of all I had general anesthesia, so I wasn't even awake when my son was born. So many strangers saw him before I did. Honestly, I really don't remember seeing him for the first time because I was so drugged up. I have thought about the VBAC/C-section question as we have talked about having a second child. Some mothers will think I'm insane to say this, but I felt cheated because I missed the whole birthing process. I also felt like I hadn't actually given birth. I know that's crazy. I think I would want very much to do the VBAC, but I also think that Erica makes a great point. I would have opted for the planned c-section over the emergency. I don't know what I would do if I get a second chance. I know I'm babbling, but one last thing. It's good to hear that you re-live your last pregnancy, too. I don't think a day goes by when I don't think about some aspect of the experience. Best of luck on your decision. I know that I don't know you, but I'm thinking good thoughts about you all the time!

Lisa said...

This post brought me to tears. For Ta, it doesn't sound crazy at all. I had the same experience with an emergency c-section and general anesthesia and the lingering feeling of having been cheated. I can't be objective because I can only think that the thing that's most important is choosing a path with the least amount of risk and that gives you the least amount of anxiety. How I feel for you, unable to stop that movie from playing in your head. xo

Bryan said...

Sometimes your posts make me cringe, Kate, but in a good way, a necessary way. The phrase "uterine rupture" was a new one for me, and it made me reach for my stomach and tense up, even though I don't have a uterus. But that's just it - as painful as it is to read sometimes, I appreciate the fact that you put me bluntly inside an experience that I otherwise would normally never give a second thought. I mean, all of the women in my family have had trouble-free births; all the movies I watch, the kid just pops right out. What do I know about birthing babies? But ever since you introduced the word "rice bag" to my vocabulary, I've been keenly aware of the toll childbirth - even a "routine" one - takes on a woman's body, and the difficulty of the decisions that sometimes need to be made. So, in short, I'm happy you're doing well, and mothers are awesome.

Emilie said...

A friend of mine recently shared the link to your blog, and I just wanted to tell you that I'm contemplating a VBAC, too. Unlike you (when you wrote this post, anyway), I've already made my decision: I'm going to go for it. Like you, I have a bit of nervousness and fear about the risks. And I have to admit, your post made me second-guess myself for just a split second. But I don't think there's any turning back for me, unless some unforeseen complication makes another c-section necessary. (My baby is due around April 1.) I do worry about a uterine rupture, especially since it was less than a year before I became pregnant a second time — something the doctors warned made me a slightly higher risk factor. (I was comforted, actually, by the comments on uterine ruptures from VBAC Lady.) But I also worry about the many risks of complications from another c-section. And having already had major abdominal surgery during this pregnancy, I really, really don't want to have another surgery anytime soon.

Anyway, my background, fears and other "stuff" are different from yours, so I know only you can make your decision. I just thought I'd share. Thanks for writing about this!

Sheri said...

oh, this is such a hard one. i've known women who have gone both ways and i don't think any of them looked back. know you will make the right decision. you will. it's hard, and i'm sorry it's not easier.

info said...

Hi!

Congratulations for making it to 33weeks! I had a wonderful HBAC (home birth after cesarean) a little over two months ago and it was incredible. For me, it was the absolute best decision. I felt such an sense of accomplishment. It was a HUGE decision - to VBAC and then to do it at home, but I was confident in the research. You can read my birth stories, why I chose a homebirth, as well as a ton of info on VBAC on my website vbacfacts.com.
Best of luck with your decision! :)
Jen

Curly Hair said...
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