Wednesday, December 22, 2010

The Odds Are Definitely Against Us

We had a bit of a scare on Tuesday. The ultrasound on Monday was uneventful, but apparently that was only because the tech isn't allowed to tell us anything. We had a regular 37-week appointment on Tuesday morning, and that was when Dr. M went over the actual results, which weren't that great. The ultrasound had been ordered just to assess Kermit's approximate size (weight and head circumference) so that we would know how likely we would be to succeed at a VBAC. But since they were looking around anyway, they took a bunch of other measurements, too.

The alarming one was something that I would never have even thought to be concerned about: amniotic fluid levels. According to Monday's ultrasound, there was shockingly little fluid. A horrifyingly dangerous low amount. Really bad. Dr. M explained the situation very calmly, then said that he wanted to verify the measurement himself before we did anything else. So, he did his own ultrasound, and ... my levels were completely normal. Above average, actually. He checked and re-checked just to be sure. And the change was so dramatic, with less than 24 hours between ultrasounds, that Dr. M says it is impossible for the condition to have corrected itself, it had to have been an erroneous reading to begin with. Still, to be on the safe side, he ordered me to dramatically cut back on my activity level for the rest of the pregnancy. Not bed rest, but he wants me sitting with my feet up, conserving energy and drinking as much water as I can stand, the majority of the time.

Dr. M also had me come back for an NST Tuesday afternoon, to verify that Kermit was still doing well. And he passed with flying colors, which would be nearly impossible if the measurements from Monday were at all accurate. So we all got to take a big sigh of relief. (Though we're still going to keep an eye on it, just to be sure.) (It also gave me the confidence to ignore the "rest with your feet up" thing, and I spent today frantically cleaning the house, because damn there's a lot of stuff that I want to finish before Kermit arrives, and apparently I am running out of time.)

Once Dr. M became convinced that the technician in Monday's ultrasound had to have made a mistake, he looked around and verified everything else as well. Which brings us to bad news number two. I've spent the last eight months convinced that, to succeed with a VBAC, I "only" needed to worry about going into labor spontaneously, progressing normally, and keeping Kermit from getting too big. Those were the ducks that needed to be in order. Know what I didn't consider? He's breech. And not a simple foot-first breech, where we'd still be able to try a vaginal delivery. Nope, my kiddo is transverse breech -- he's completely sideways. Impossible to deliver a baby that way.

There is a procedure that some doctors do, where they push on your stomach to sort of massage the baby into the desired head-down position, but it's a bit risky (and also has a fairly low success rate). Dr. M said that he would be hesitant to try it in someone who has had a previous c-section, and he absolutely would not do it in someone who has had a low amniotic fluid scare. Put those things together, and it becomes way too risky for him to try to turn the baby manually.

LL was breech for much of my pregnancy with him, and we started to worry about it around 32 weeks. But he had turned head down by 34 weeks, so we were fine. You really want the baby to be in position by 35 or 36 weeks, because after that, they start getting cramped enough that they don't have room to flip around anymore, and by 37 weeks, they're usually "stuck" in whatever orientation they're in. And here I am, past 37 weeks, with a transverse baby. It's still possible that he'll find a way to turn on his own, but the odds are dropping each day, so we are likely looking at a repeat c-section regardless of whether everything else goes my way or not.

Dr. M told me that if I do go into labor, every single conversation I have with a medical person other than him needs to start with the first words out of my mouth being, "This is a VBAC attempt, and as of Tuesday, the baby was transverse breech." He kept repeating that I was not allowed to say anything else until I was sure that they understood both of those things, because that particular combination would change everything else that happened from the moment I call the hospital to say that I might be in labor. No messing around. Which is kind of scary.

So... right now I'm 37w3d pregnant. My amniotic fluid levels might be periodically suspiciously low. My baby is stuck in a transverse breech position. He is measuring a bit big for his gestational age. That VBAC is fading more into fantasyland every day.

4 comments:

  1. I'm sorry that your VBAC is slipping away. But I am very glad that the fluid seems to be okay and that everything is looking nice and healthy with Kermit.

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  2. There is a website called "spinning babies" about things you can do to get your baby into an ideal position. You might want to take a look at it. Too baby you weren't aware of this earlier! But babies definitely do move right up to the last minute. Sometimes labor contractions get them to move.

    Frankly, when I had one who wanted to stay sideways, I found where her head was and shoved it down myself. There are undoubtedly risks to this.However, I had my VBAC and all was fine. That baby, when she grew up and was pregnant, did the same thing, then her baby didn't move for hours and she was terrified. However all was fine; that baby is now 8 and enjoying her new American Girl doll!

    I don't quite understand your doctor. He admits that the low fluid thing was a mistake. So why is he referring to it as a reason not to do an external version? They sometimes do them under sonography, so they can see what is happening. Or they do them monitored, so they can see if the baby's heartbeat is affected.
    But if he won't, he won't.

    So try going to spinning babies, anyway.

    ACOG says the risks of VBAC are only minimally increased after two C sections. So if this baby won't turn, maybe the next time.

    Good Luck!
    Susan Peterson

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  3. Here is a link to that website.

    http://www.spinningbabies.com/baby-positions/all-positions/sideways

    Again, good luck!
    Susan Peterson

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  4. If it makes you feel any better, my son was in the perfect head-down position from like 28 weeks on, until I went into labor. Then he decided to flip sunny-side-up and give me back labor for 23 hours. And he was 8lbs 14oz, no small cookie.

    So my point is just that you still have a chance. If that baby wants to move, it will move, regardless of cramped quarters.

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