Monday, October 4, 2010

Kermit Update

I am now 26 weeks along. That magical potential-viability-outside-the-womb stage. About to enter the third trimester. Less than 100 days left to go. Things are really moving along!

On the GD front, I can finally say that I don't have gestational diabetes. My entire medical team finally agrees. I've said this from the very beginning. My OB agreed with me early on, but wasn't allowed to remove the diagnosis without buy-in from the endocrinologist. The endocrinologist said that she didn't think that I had it, either, but wanted to monitor me anyway, just to be sure. So I've been meeting with the nurse every month or so, to go over my food records and monitoring numbers, and at this month's appointment she finally threw up her hands and said, "Yeah, I don't believe that you have gestational diabetes." I'm at that point where, if you have gestational diabetes, it's going to be running rampant by 26 weeks. But my numbers right now are actually lower than they were back at 10 weeks, which completely supports my claim all along that pain and stress from the stupid car accident was artificially (and temporarily) elevating my blood sugar.

This past month, I've ignored the GD diet guidelines on a regular basis. I gave in to a craving for donuts at breakfast one morning. I've had fruit smoothies. I've had big bowls of pasta. I've been drinking more milk and eating more fruit, including at breakfast and bedtime, which are supposed no-no's. Yet my blood sugar numbers remain at the low end for normal non-pregnant people. On Friday, I even repeated an A1C test, which measures average blood sugar over the last three months, and it came back not just normal, but even a little lower than last time. So, the nurse told me to just eat whatever I want. Test myself occasionally, but don't worry about it. She said to try to do a full week's worth of monitoring before my next appointment with her (more than a month from now) but between now and then, don't bother much. She called me an anomaly. I'm not sure that it counts as an anomaly if I can scientifically explain what's going on, but whatever. It's good news.

All other pregnancy-related health signs are looking good as well. I'm ever-so-slightly anemic, almost exactly the same as this point in my pregnancy with LL. Last time, I was told to eat more hamburgers and spinach, because it was too borderline to warrant any more heavy-duty intervention. Which is fine with me, I like spinach. And Kermit is regularly kicking up a storm, much more targeted than LL ever was. In particular, Kermit keeps kicking my cervix, which I don't remember LL ever doing. What's up with that? Trying to dig himself out?

We also settled on a skeleton of a labor plan. Dr. M is supportive of trying a VBAC, but only under certain conditions. For one, I need to go into labor on my own (no induction) and I need to progress entirely on my own (no pitocin augmentation) because the use of augmentation drugs dramatically increases the risk of uterine rupture during VBACs. This might be a hurdle for me, because I never went into labor with LL, and even when I was 8cms dilated and my water had already broken, my contractions would disappear when they turned down the pitocin. I'm a little hopeful, because I'm already having Braxton-Hicks contractions, which never really happened with LL, so maybe my uterus is actually prepping for something this time!

The other condition that we'll need to meet is that I need to go into labor before 39 weeks or so. LL's c-section was necessary because of a rare condition called CPD, in which the baby's head is too big to fit through the mother's pelvic bone. A number of factors probably contributed to the CPD (LL's gestational age at delivery, which was 41w3d; LL's enormous head; my apparently narrow-ish pelvic bone; a lack of elasticity in LL's skull). This time around, we can't be sure how many of these factors will be present. My pelvic bone is likely to have spread a little more, since this is a second pregnancy, which will hopefully help. On the other hand, Kermit's head is so far measuring even bigger than LL's. Kermit's head might be more elastic, which would help a lot, but we won't know until I start pushing. (Most babies' heads deform to fit through the birth canal; this is why they often have cone heads for a day or two after birth. Even after hours of pushing out LL, his head remained nice and round and didn't deform at all.) The only thing that we have any control over is gestational age, which is why Dr. M won't let me try a VBAC too late into the pregnancy. Basically, he and I both want to avoid a situation where I have another full trial of labor, several hours of pushing, and then end up with another c-section. That outcome might not be entirely avoidable, but we can minimize the odds, and one way to do that is to set an eviction date, a scheduled c-section.

Right now, we've scheduled a c-section for January 3, when I'll be 39w1d. Which is a hair less than 3 months from now. I might try to push it back a few more days, to 39w4d, just to give myself a few more days to go into labor. (Dr. M originally scheduled it for 38w5d, but I wasn't comfortable with it being that early, so he agreed to wait a few more days.) But basically, that's the plan.

I've been giving a lot of thought to the VBAC question since before I was even pregnant with Kermit, and I'm happy with this plan. When LL's birth ended in a c-section, I was disappointed, but not as crushed as some other women seem to be. I felt like I had missed out on the experience of giving birth, but goodness knows that 23 hours of active labor certainly gave me a sense of what that experience would be. And I resented the longer recovery period and incision pain, which was compounded by the long trial of labor and pushing before eventually having the surgery, but it's not like a vaginal birth would have avoided pain and recovery. At the same time, I definitely know in my heart that the c-section was unavoidable. I don't have any "what-ifs" in mind where I think that the c-section could have been reasonably avoided. I wasn't "pushed" into it by over-eager doctors, I wasn't rushed in any way. Every decision we made, I would make again. So even though I didn't want the c-section, I know that LL would never have been born without it, and there's a certain peace that comes with that.

I've poured over the data on the risk of VBAC complications in various settings, and I feel like trying the VBAC in a supportive hospital setting with trained doctors and nurses who assist with them all the time will bring the risks down to a level that is comparable with other types of birth. If I don't go into labor before the eviction date, I will be a little disappointed. But I also feel like, by the time I'm that far along, the odds of a successful VBAC will have dropped enough that it probably wouldn't happen, anyway, and I'd have the same double recovery as last time. So this plan seems right to me.

In the mean time, we're trying to step up the preparation for actually having Kermit in our lives come January (or, let's be honest, possibly late December). The odds of us moving into a larger house between now and then are shrinking rapidly, so we're strategizing about where to put things in our current house. Bassinet in our bedroom. New rocking chair, also in our bedroom. Changing table in a location TBD. Nursing stool next to an existing chair in our living room, so that I can nurse somewhere without waking up S. Kermit's clothes stored in our closet. No crib or dresser purchased for Kermit until 5 months old or we're in a new house, whichever comes first. Boxing up all non-essentials in our office so that the room is de-cluttered enough that my mom can sleep on the hide-a-bed in there for a while after Kermit is born.

There are a few things that we'll need to buy, but not much. New rocking chair, new changing table. Bouncy seat. New boppy. New stroller. (Probably a sit-n-stand, like this one, since I don't think we'd need a full double stroller for very long, but might want one for the first 6 months or so. If anyone has experience with these, please let me know, because I've barely done any research on these yet.) Not much else.

Oh, and we do still need a name other than Kermit....

4 comments:

  1. Okay so did you feel like screaming a big fat "I told you so" at that nurse when she finally agreed you don't have GD???

    We finally threw in the towell and bought a sit and stand type stroller. It is very versatile though and both girls can sit in it too. It was like $70 off Craigs List.

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  2. Yay for beating gestational diabetes!!! Very much hoping to follow in your footsteps.

    Your VBAC plan sounds exceedingly reasonable. One question it might be worth asking your ob/gyn is if there are any natural induction techniques which he approves of? We were given a c-section date of my due date with the fusspot (for liability rather than medical reasons) so we tried just about everything ... and despite immense skepticism I do think acupuncture helped some (and maybe stopping prenatals, which we were strongly advised to do at term. There is a theory that the high dose of vitamins can interfere with the hormones necessary to start labor. And anyway, there is no downside to stopping for a week or two).

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  3. Hooray! I am glad you got sprung from the GD.

    Potential-viability is also wonderful news.

    Did I tell you that Matt was in favor of the name Kermit for real if we had a boy?

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  4. Personally, I think Kermit is a fine name.

    (For someone else's child.)

    But hooray for no GD and yes VBAC! Only positive acronyms around here.

    Can't believe it's 26 weeks already. Time flies when it's not your pregnancy!

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