Monday, December 6, 2010

Labor Anxiety

People have started asking me whether I'm nervous about labor and delivery, and I'll admit that I've been giving it a lot of thought lately. I'm actually not all that nervous about the actual labor and delivery part. I feel like I remember a fair amount about my labor with LL, and I don't feel like I'm being selective about what I remember. I remember some goods things (the anticipation; the growing excitement as things progressed; a sense of adrenalin-induced empowerment that I didn't really expect to feel once I started pushing; the incredible sound of his first cry) and of course, lots of things that were perhaps necessary but not what I would classify as "good" (frustration at the slow progression of early labor; annoyance that I couldn't walk around much; fear and disappointment when we found out that a c-section was necessary; and of course holy crap I remember a whole lot of pain). Overall, though, it wasn't a process that I dread going through a second time, though I am hoping for some fairly significant differences this time around.

During my pregnancy with LL, I spent much of my third trimester consumed with thoughts of labor. I'm not sure the right word to use. Not fear. Not dread. Anxiety? Let's just say that I was really really worried about it, because everyone seems to rank it as the most painful thing in the world and you don't know how long it's going to last and I had no idea what the pain was going to be like so my mind started inventing all sorts of crazy scenarios. This time? I'm honestly not all that worried about the actual labor and delivery. I'm bizarrely looking forward to it, actually, since I'm so excited to possibly do it without pitocin this time. And maybe even successfully deliver a baby without a c-section! This time around, rather than something to bring about anxiety, it just feels like a challenge. I can handle a challenge.

Having said that, there is something that I am feeling completely anxious and panicky about: how LL will handle my time in the hospital. I'm getting very freaked out about this. I have never spent a night away from LL, much less 3 or 4. LL has been put to bed by other people (grandparents, babysitters) but I have always been there when he wakes up in the morning. Things that are currently keeping me up at night:

1. Making sure that LL is taken care without too much panic if/when I go into labor. The possibility of going into labor during the holidays is making this particularly stressful. My mom has agreed to fly into town when I'm just short of 38 weeks, so that she can stay at our house and care for LL if I do go into labor, which is fantastic, but now I'm obsessing about what happens if I go into labor before she arrives. It's ridiculous because LL had to be induced at almost 42 weeks, and I'm suddenly worried about going into natural labor at 37 weeks, but still... I can't get it out of my head. We have a few friends lined up to possibly come to our house and stay with LL for a few days, but it would be very stressful for LL and that makes it very stressful for me.

2. If I do end up with a c-section, I'll need to be in the hospital for four days. That seems like a very long time to be away from LL. More and more, the main reason that I'm hoping for a VBAC is just so that I can get home sooner.

3. Another problem with a repeat c-section: when LL was born, I wasn't able to pick LL up out of his bassinet for at least a week, possibly two. I wasn't able to change his diaper for the first week, either. Every time I wanted to hold him, to feed him, to comfort him, someone had to pick him up and gently hand him to me. That was annoying but manageable, because S stayed with me in the hospital and did all of the baby-lifting for those first several days. This time around, we think that it would be easier on LL if S spent nights at home, so that he's around for LL's morning routine. But I don't know how I manage to care for Kermit overnight, including all those night feedings and diaper changes, if S isn't with me. As far as I can tell, my only option will be to let the nurses bring Kermit to the nursery after S leaves, but that kills breast feeding. So I'm kind of at a loss. If I have a c-section, it seems like S will have to stay at the hospital, and I worry about how LL will handle us both not being there in the morning.

4. I can't decide whether LL should visit me in the hospital or not. Does that make things easier or harder? On the one hand, I'm sure that he'll want to see me (and I'll want to see him!). On the other hand, what happens when he realizes that he needs to leave with Grandma and I'm not coming with him? Will that just make it harder?

5. Last week, I had an evening filled with lots of suddenly strong contractions. They eventually died down, and I was fairly certain the whole time that they were Braxton-Hicks and not the real thing. Nevertheless, they were shockingly strong and frequent, and I had to carefully breathe through them. I wasn't yelling or anything, but I was grimacing from the pain. And WOW, it freaked LL out. He kept coming over to pat my leg and talk to me and give me kisses, but mostly he just stared at me with a frightened look on his face. I kept reassuring him that Mommy was fine, everything was okay, but he was really very concerned. So now I'm worried about how he'll handle it when I'm in real labor but haven't left for the hospital yet. I guess from this perspective, it would be best if I went into labor in the middle of the night while he was sleeping, so that he wouldn't have to see me in pain, but I hate that then I won't be able to say goodbye to him before we leave.

So, yes, I'm worried about labor, but not for any of the reasons that I was worried the first time. And when I write them down, even these things seem very minor. Women manage to have babies without completely scarring and traumatizing their toddlers all the time. Things just work out. But I'm agonizing about it nonetheless.

4 comments:

  1. About VBAC, have your doctors reviewed the pros and cons? I am wondering because although i have not had a baby I did have a surgery which mimics a c-section and ALL the gynos I have talked to as we prepare for kids have advised me to avoid VBAC.

    Just wondering about how you came to this decision.

    -regular reader commenting anon for privacy :)

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  2. Oh, I totally get it. I have to go to a party this weekend and I am mostly just panicking about leaving Elizabeth at night. So I imagine that you have those feelings, but times a hundred since it is such a bigger deal.

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  3. Anonymous -- The trouble with researching VBAC risks is that there have been a bunch of studies with conflicting conclusions about risk rates, and all the studies have serious methodological problems, so it's very hard to judge. The prevailing wisdom at the moment is that VBAC is overall healthier and less risky for mom and baby, but ONLY if certain conditions are met. Most of the conditions have to do with the mother, but there are also requirements about the availability of doctors and staff for an emergency c-section during a VBAC attempt, and many US hospitals aren't equipped to meet those conditions. Thus, doctors at those hospitals will always advise against it. So some of it depends on where you're located.

    However, if you're delivering at a bigger hospital with experience with VBACs, the only variables will have to do with you and the baby. For example, the location of your incision is huge. If the internal incision in your uterus is low and horizontal, VBACs are fine. If your incision is higher up, or if it's vertical, the rate of uterine rupture during VBAC skyrockets, so it is not advised. Most c-sections are low horizontal incisions, but if you had a different kind of surgery, you may have a different type of incision, which would definitely affect whether VBAC is recommended for you or not. (Note that the external scar does NOT always follow the uterine incision, so you would need to check your surgical records to be sure of what kind of incision you have.) Same with the purpose of your surgery -- if it was because of certain kinds of uterine abnormalities, you may also be at increased risk for uterine rupture.

    In my case, I meet all of the suggested conditions so far, so I am at very low risk for uterine rupture. The remaining conditions are out of my control (I need to go into labor spontaneously, and I won't accept any drugs like pitocin to augment labor once it begins). If those conditions are also met, I'm good to go with the VBAC, and it should theoretically carry fewer risks than a surgical delivery.

    Hope this helps! Or feel free to email me with more questions.

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  4. The problem with a repeat C section is a toddler. Not being able to put Jillian in her crib for a couple weeks was definitely a pain. In my case DH was around to help almost all of the time. That was a real life saver especially at nap time. However since ours was planned we at least got to plan when Hayden would arrive (since she wasn't early) so that made child care easier.

    My MIL brought Jillian to the hospital to see her sister and it was fine. She was a little shy but as long as there was somebody there besides DH and I to keep track of her it wasn't really an issue.

    Hang in there. One way or another you'll be a mom of 2 very soon!!!

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