Monday, April 25, 2011

The VBAC Consult

Okay. I promise this is my last post for awhile. Thanks for keeping up with me. Just so much to write about this week!!!

I had my appointment in Winston with Dr. Dorn. It was AWESOME!!! He went over my surgery notes and current prenatals and determined I was a great candidate for a VBAC. He said based on all the information he has received, he really doesn't think I was given a good chance to labor. Knowing the history of my family genes (big babies and long labors), he said the baby probably just wasn't ready to come, i.e., in a high station since I was laying flat pretty soon after my water broke. I mentioned to him about the thought of scar tissue and he said, any person can have constricted dilation if the baby isn't imminent.

He was very encouraged by several things:

1. My mom's ability to deliver 5 babies, two of them over 9 pounds. He said this is a great factor to determine if I'm able to do the same. Thanks mom for good genes!!
2. An ultrasound determined the thickness of the uterine wall at the incision site was optimum. Minimum is 3 cm. Mine was 7 cm. There were no open windows at the incision site.
3. Weight gain is perfect. Vitals are perfect. He felt I was a very healthy candidate at this point.
4. An ultrasound showed the baby to be HEAD DOWN!!! Thank you Lord!!! Thank you thank you thank you! Thank you to all who prayed, and please amend that prayer to include a prayer of thanks and request for him to stay put. I sincerely appreciate you all! I have some mighty prayer warriors and I am so blessed to have you petitioning on my behalf!

We were in the office with him for over an hour. He was just great. Very very supportive of VBACs and my desires to deliver naturally. The appointment went better than I imagined, thanks to your prayers. I received an unexpected blessing at this appointment, outside of the baby turning down. Dr. Dorn said he felt bad for us having to drive so far to deliver a VBAC. He couldn't believe there were no hospitals in our area who would support that. He asked how well I worked with my current OB, Dr. Horton. Dr. Dorn said he would be completely fine if Horton continued seeing me until 37 weeks since the checks would be mainly vitals until then. And then at 37, he said he would see me every other week as he is not a huge believer in frequent cervical checks towards the end - because you're dilating doesn't mean the baby is coming any sooner. People can walk around at 4 centimeters for weeks. I just couldn't believe that he would support that, meaning he would miss out on the money he would receive for those appointments.

Another blessing was his open communication with Johannes. When he found out Johannes is from South Africa, he immediately started in on the rugby chat as he lived in New Zealand at one time. That was the moment I knew that Johannes was completely sold. ;-)

So the concerning factor: He did an ultrasound to take a look at baby Slabbert because I had mentioned he was positioned breech and said he may be able to turn him easily at this point. So obviously, that part wasn't the worry. The measurements were a little concerning, though - at least for mama. The thigh bone is how they accurately measure the gestational age at this point. He was right on target at 31 weeks. The head and torso, however, were a different story. He is measuring at 35 and 36 weeks for both!! At first I was thinking, he is disproportionate and something is wrong. But he said the measurements only indicate that the baby is going to be a big one. He is measuring 5 weeks ahead at this point and believes that I will have a 9 or 10 pound baby! Ahhhhhhhhhhhhhhh. At this stage, babies should weigh around 3 1/2 pounds. Baby Slabbert is measuring 4 1/2 pounds. Dr. Dorn wasn't much surprised based on Vivienne's weight and my mother's pregnancy history. They say that baby boys and second babies are both bigger, so that has definitely been confirmed.

And in regards to meeting the doula:

She was as great in person as she was on the phone. We heard her birthing stories and her comparisons of the hospitals in the area and doctors. It did nothing but confirm it for me AND Johannes. Johannes thinks I'm going to kick myself for not having an advocate and support in the room should things go south quickly. He knows me too well. His support of the doula was crucial for me because typically, the main people who have problems with the doulas are not the docs -- they're the husbands. I could write on and on about her... she was really great.

In regards to the new hospital policy on doulas. She believes it will not be a problem and said they can't kick her out if she is my "friend". She also works very well with Dr. Dorn and he was really upset about the new policy, so if anything, he would be the advocate for MY advocate. Dr. Dorn is very supportive of midwifery and labor assistance. Something that also impressed me about her is that she would give me a name of a DONA certified doula in case that was an issue for me. She said the important thing is that I have the support, no matter who it is. I feel this is especially important in an unknown hospital, and should Dr. Dorn be out of town when I go into labor.

I am so so tired that I am barely holding my eyes open. It's been quite a day. But I had to write about it while it's fresh on my mind. This is totally an answer to prayer and I recognize the importance of recording it. God has been really good to us. Even if things change, I am so thankful to really know and understand this process. I feel a great deal of peace and I'm so thankful for all the support.

30+ hour labor or not, this baby will come. I recognize the importance of physically being ready - I really need to walk more and exercise. I need to be on a healthier diet - not cutting calories, but cutting out junk. If the labor is long, I'll need stamina and energy. So here we go. I'll post again when there is something new to tell. :-) Hopefully that won't be anytime soon.

Saturday, April 23, 2011

Your Physician and Advocate

I have a doctor's appointment scheduled with Dr. Dorn on Monday, and meeting the doula immediately afterwards. It's going to be a big day. We will know on Monday if he officially accepts me as a VBAC patient.

I don't feel as nervous about the consult as I do about meeting with the doula. I just found out that the hospital where Dr. Dorn delivers has banned all non-DONA certified doulas from assisting with labor and delivery just last month.

DONA - Doulas of North America

This particular doula that I'm talking to has so many great qualities. She has had 4 VBACs herself, two of those were homebirths. She has assisted over 200 deliveries. She is a member of the Christian Doula Association. I feel very comfortable talking candidly with her even over the phone. She has invited me to meet her in her own home, which was a comfort to me as well. She said one of the reasons she chose not to be DONA certified is because she could not agree to the required scope of practice, which includes stipulations like not recommending herbal teas and etc., and not being able to go against a doctors opinion. So I asked a very important question - will they kick her out of the labor room, even if she was a "friend" rather than doula? She didn't think so, but couldn't guarantee it. We are going to discuss this in great detail when we meet. In our few phone calls, she has been a huge encouragement to me and I'm already sold. I hate going back to square one on that.

Something else I had to tell you is that I found out that Dr. Dorn does versions even on VBAC deliveries.

"version" = External Cephalic Version: A procedure used to turn a fetus from a breech position or side-lying (transverse) position into a head-down (vertex) position before labor begins. When successful, version makes it possible for you to try a vaginal birth. Version is done most often before labor begins, generally around 36 to 37 weeks. Version is sometimes used during labor before the amniotic sac has ruptured. This can be a good time to use version, when labor is constantly monitored and a cesarean delivery (C-section) can be done right away if necessary. But the chance to do the version can be lost if labor speeds up or the amniotic sac ruptures.

A scheduled cesarean is used to deliver most breech births if a version doesn't work.1 But trying a version at 36 or more completed weeks of pregnancy may increase your chances of being able to deliver vaginally. (WebMD)

The version "success rate" is anywhere between 58-65%.

Some good news: The baby is now side-to-side, which has strengthened my hopes that things can change at any time in the next 5 weeks, and that some of my breech exercises have worked, i.e., elevating my pelvis up high for 15 minutes when I feel him active and while on an empty stomach. I'm also going to start prenatal swimming excercises with the group at our local hospital. If not just for breech, I will appreciate the weightlessness! We'll see what happens at the end of the day. I'm not totally resigned yet.

So Monday will tell... I will update by Tuesday to give you the 411. I can't believe I'm almost 8 months pregnant.

I hope the above has given some mommies-to-be some ideas on labor preparation. Again - I can't say this enough. It's not always the doctor. Check into hospital policies and procedures where you will deliver. Ask these questions to determine if you need an advocate in L&D:

1.At what point do you recommend that I come to the hospital/birth center?
2.How soon after I come to the hospital will my OB see me?
3.Am I allowed to get out of bed to labor and what are the circumstances in which i won't be allowed?
4.Will I be IV'd, and when?
5.How much time will the health care provider spend with me during labor? (note that nurses can make or break this experience because they spend more time with you than the doc, and one nurse can be completely opposite than another - I had 4 throughout my labor and only one served as a huge support to me)
6.If I write a birth plan, will it be honored?
7.How often are vaginal exams performed during labor? (If you've read your stuff, you'll know that this is very important!)
8.Are showering and bathing allowed during labor?
9.How many people are allowed to be with me during labor and delivery? How many people are allowed to be with me during a cesarean delivery?
10.What is the birth center or hospital's policy regarding other children attending the birth?
11.Are eating and drinking allowed during labor? (Key question!)
12.Is video taping allowed?
13.Can my partner cut the umbilical cord?
14.How long will I be able to stay in the hospital? Can I leave earlier if I want to?
15.How long does the baby need to remain in the hospital after delivery?
16.Will my baby be able to stay in the room with me throughout the stay?

I think the list can go on and on, but these are the key questions you need to ask. If you don't know why I've mentioned some of these, then you need to read about it or ask someone who knows. Please don't go to the hospital unprepared. Questions #3 and 4 changed everything for me and I had no idea it would have been such a big deal.

Happy Easter everyone. He conquered death so that we can have eternal life. I hope you know who your TRUE Advocate and Great Physician is. He is all-powerful and all-knowing. Trust in Him. He will NEVER fail you.

Tuesday, April 19, 2011

My Day Full of Surprises

160 bpm, and... BREECH! Not side to side breech. Head up, feet down. We had an ultrasound to see if it was true, and yep.

I knew it.

Sunday night was horrible. I was up all night. The baby was moving and it was hurting. I was having a lot of contractions, but not the painful kind. I would doze off and wake up about 30 minutes later trying to shift sides because I felt something stretching my innards to the max. At 3:30a., I gave up and cleaned until it was time to go to work. Vivienne was up throughout the night as well with nightmares. It was an awful night.

I kept having these weird feelings and started to wonder if the baby had shifted to an entirely different position. I noticed that the movements were very distinct in certain places, and it has stayed there the past two days.

Mom and Dad have been in town and she wanted to go to the appointment with me. I thought, "great". This is my mom, the one who thinks a VBAC is a horrible horrible thing and questions why I am going forward with it. She has been trying to talk me out of it since before I was pregnant.

I decided I was not going to talk about it with Dr. Horton if she walked back to the exam room with me. When the moment came and the nurse asked if she wanted to go back, I thought my heart was going to stop. She said "okay!"


As soon as Dr. Horton walked in, he said... well, I have some good news. We are going to go ahead and send you out to Winston as the high risk group we work with has moved up their "week" in regards to starting VBAC care. Great! Well, moment of truth... I had a huge smile of course, but my mom just started pounding him with questions. It turned out to be a good thing! Dr. Horton encouraged the VBAC and said he would do it himself if hospital policy allowed. He said the risk for uterine rupture is .7%. The risk for complications in a c-section is much higher. After she drilled him, she just looked at me and said, "Whatever!" Dr. Horton started laughing, but he was so great. What an answer to prayer.

"Dr. Horton. Would you be offended if I am interested in going to a doc in High Point instead of Winston?" He looked at me and smiled and asked why. I asked him if it's true that I probably won't see the same doc twice and probably will be delivered by a resident. He said, you most likely will be delivered by a resident, and yes, you are correct. I'm not sure who you will see and know you won't have much say on it. I told him why I wanted to see Dorn (see previous post). He said, you know what? Schedule a consult and feel him out in person, and if you want to do it, then I think it's a great idea! He encouraged me to schedule the appointment asap - within 2 weeks - as a consult visit, not a prenatal one. If I'm not comfortable with him, he said to call him back and he would schedule the first appt with the docs at Forsythe.

So then the exam. I'm right on target in uterine size and that's when he asked where I was feeling the movement. I told him very specifically and when he found the heartbeat, he said.. hmmm... I think this baby is upside down!

I laughed and said, "Seriously? Seriously???" He said, let's go do an ultrasound just to see. I asked him what it means in regards to the appointment scheduling. He said he can still turn... and he told me about his wife.

At 34 weeks, her baby turned from the breech position. Dr. Horton couldn't drive because he had worked an all-nighter, and they were on the side of the road for 30 minutes because she thought she was in labor.

"Are you serious?"

"Yep. That's what I meant by 'noticeable'."

Well, I'm not as far along as she was, but still. It doesn't feel like there is much room in there for the baby to turn around.

I need you all to pray again! :-) Are you tired of me asking you this??? Haha. I know all things work together for good to those who love God. And I do! And I know He has a great plan for me and this baby.

So the good news if he stays breech... Dr. Horton said I can do a few visits in Winston or High Point and if he stays breech at 36 weeks, I can return to Wilkes for prenatal and delivery. Takes an hour off the drive, right? Scheduled birthday. That's good... I guess. No surprises. All my family can be here. No unprepared overnights for Vivienne. Well, let's look at the good. Gosh, this is hard... but I am going to be at peace with this, as I've said all along.

Surprisingly, I was fine with the news. I know it's not official official, but I was surprised at my reaction. I asked God for peace throughout this journey, right?

Man, God is good.

In the meantime, I am SO excited! I saw my baby boy's face again. I did not have to have the awkward appointment. And now I can go check out Dorn just in case. Things are at least moving forward. Maybe God is preparing me now for what's to come in regards to the baby's positioning. I am thankful. But still prayerful.

Can't wait to tell you all about Dr. Dorn in the next post!

Friday, April 15, 2011

Lions, Tigers, and Doctors... oh my!

30 weeks. A lot has transpired the past two weeks in regards to preparing for delivery. I wanted to share with all of you, particularly those who are considering or planning on a VBAC… and especially those who live in my area.

Since the pregnancy began, I’ve read two HUGE books, done a ton of research online on natural delivery, explored ICAN’s website, checked out local doulas, and have recorded every Baby Story episode on DVR and found about 4 in regards to VBACs and drug-free labors. Through all of this, I’ve really learned a lot. I’ve been encouraged, and I’ve been educated. I would say that the theme of every successful delivery is relaxation and patience. Knowing how it went with Vivienne, that’s almost impossible to imagine, but something you can train and prepare yourself for when the time comes.

I have had some amazing conversations this week and I mainly wanted to update you on where I stand.

My first call was to a doula I found online. Her name is Cortney. She has had 4 successful VBACs herself, and specializes in assisting VBAC mothers. I told her my story and my desires and she told me her story is similar… but almost all are. She was encouraging and positive and said she was planning to send me a packet in the mail. Problem #1 – Cost. For two prenatal home visits, her assistance through my entire labor, delivery, and hospital stay, and a follow-up visit, we are talking $550. In the scheme of things, it’s not a lot of money. Break it down to hourly pay, distance traveled, and being my advocate… it doesn’t seem a lot. But it is. I am going forward with it if I’m transferred to the high risk group in Winston.

When I began to realize that I really need to get a plan in place in regards to labor assistance and situational matters, Dr. Henry Dorn kept coming to my mind.

Several months ago while exploring the web, I found a lone soldier… a true advocate of a mom’s right to deliver her baby. Dr. Henry Dorn. He is a promoter of “The Unnecessarian” and specializes in VBACs as well. He supports natural labor but also administers drugs if needed. He watches closely for true signs and symptoms of needing a cesarean. He has delivered babies after FOUR c-sections. FOUR. (Ladies, it’s never too late to explore this option!!) I was mostly impressed recently when he posted an article about doctors pushing sections to get home at the “end of workday”. He gets it. He has a team of midwives in his practice as well.

Since my first e-mails and calls to him several months ago, I haven’t been able to shake the idea off my mind. Here are some challenges: 1. Location – he is in High Point… 20 minutes further than Winston. I’m already looking at a 2 hour drive. But for those of us in western North Carolina, this is awesome. It is rare to have a physician like this within driving distance. Ladies, keep him in mind. Check him out. 2. Telling my doctor. My current OB works with a high-risk group where he was going to transfer my care. I want to continue my regular care with my current OB after all is said and done. I really do feel comfortable with him and he is truly supportive. But I don’t want to offend him. The nurse at Dorn’s office suggested that I tell my current OB that I would like to go to High Point instead of Winston – to leave out the reasons behind my desires to change particular doctors. It’s a good idea!

I have checked out this high risk group, and there are several concerning factors. There is no guarantee that I will ever see the same doc. They operate out of the hospital and not an office. There is no personalization of care because they see such a large number of patients. No offense against residents, but I was told by a nurse in the labor department that the group works with a team of residents who assist in labor and delivery. That is scary to me to have all these people in and out. I mean for sure… I would not do this without a doula. There are too many unknowns to let me relax. (Remember my first paragraph?) I can only imagine if I had a long labor again how many doctors AND nurses would be coming in and out.

So that keeps pushing me back to Dr. Dorn. So I decided a few days ago that I was going to call again. For awhile, I thought I was speaking with the receptionist when she interrupted me to tell me that she is the nurse and wanted to hear my whole situation including fears, concerns, etc. So I did. It was a good long conversation. And after hanging up the phone, I was 90% sure I was going to go forward with talking to my current OB about moving my care to Dorn’s office. She put me at ease. She said in their office, they are a team. Dr. Dorn sits down with every patient and LISTENS and advises. She said I need to schedule a consult and bring my hospital notes from last delivery and he could give his recommendation. I have to do this. And plus… if I transfer care there, it’s like having a team of your own personal labor assistants. It wouldn’t be necessary to hire a doula when I already have the support and encouragement from my team.

So Tuesday, I have my 30 week appointment with my current OB. We weren’t supposed to discuss transfer until week 32, but at that visit, I’m scheduled to see the alternate doc in our practice. A lady physician who thinks I’m crazy for wanting a vaginal delivery, which is odd to me. So I haven’t talked with her at all about this throughout the appointments. If I don’t handle this now, then I’ll have to wait another month to talk to my OB and then transfer care at 36 weeks. I just want to move forward.

I want to do THIS!!! I want to relax and wait for the baby to say, “Mom… I’m ready to come out now.” There are millions of women today who do drug-free deliveries, some of those without an option. Don’t tell me I’m not capable. I may change my mind in the middle of it, but I am capable. We are all capable. God designed us to be able to do this. It’s not bad if you have a c-section, and it’s not bad if you decide to go for the drugs. But I’ve had the c-section and I say no thank you to #2 – at least I’m not signing up for it. And as for the drugs… I just don’t want anything to be a factor in leading up to another c-section. I do have to note here that I labored 14-15 hours without drugs and did not progress, even on pitocin. However, with two IVs and not allowed to get out of bed, I can’t help but think that the gravity would have helped some. No drugs = freedom to walk around and something to preoccupy my mind.

So I’ll let you know how the next appointment goes. I’m thankful for the support of my co-workers and some of you reading along. I’ve been given some STRONG opinions on how I’m a horrible person for trying a risky VBAC and that things will go horribly wrong…. Please. Please. Just pray. If the Lord doesn’t want me to try, then I won’t. The best thing you can do instead of telling me how horrible I am is to encourage me through prayer. Please pray that His will is done!

PS - WE HAVE A NAME! And we aren't telling. :-)

Friday, April 1, 2011

3rd Trimester

I am happy to announce the FINAL COUNTDOWN to baby boy Slabbert's arrival. :-) I have finally reached the last few months and I'm so excited as I look forward to seeing his sweet face.

I've had a pretty good 2nd trimester. I haven't been too uncomfortable. No pregnancy issues or concerns. Doctor's appointments went well and he is certainly growing. He is most likely settled in the birthing position by now, which is head down. He can always turn, but the doctor said it will be very noticeable if it happens at this point. Let's pray it stays! I constantly feel kicks near my ribs on the right side. The other night, I felt a knee or heel on the palm of my hand, and he quickly moved it away. I have definitely felt a little butt and I'm glad to know it wasn't his head that I pushed down out of my rib cage. Sorry baby.

The body pillow has been a life-saver. For all you new and growing mommies, you need to get one. Johannes hates it - I mean, absolutely hates it. I cannot go to bed without one.

There have been a lot of changes in mindset since my first pregnancy. Things that seemed so important to me have not crossed my mind. "Will I be ready? What happens next? When is this baby coming?" I now know the answers are... no, anything, and at some point! I find that in my first pregnancy, I was mostly focused on the pregnancy itself, with little thought to the afterwards. I found myself completely unprepared for breastfeeding issues, adjustment in the house, and wished I had read those life-saving books earlier, such as BabyWise and Happiest Baby on the Block. I remember spending my time reading the pregnancy week-to-week books, being very worried if I missed taking my vitamins, worried if I ate the wrong things, worried at every sign, symptom, and movement... and lack thereof sometimes.

I have to sadly admit that I have not touched a pregnancy week-to-week book since the first trimester... I consume several things that you first-timers might scream about... I think I took my vitamins last night... but it might have been the night before.. or Monday? I'm not totally sure. Sometimes I forget I'm pregnant and find myself on the ground before I realize it. A little off-balance these days. :-)

Let me tell you what my mind has been on:

1. Lord, please don't let Vivienne feel left out when I'm in the hospital.

2. Two day care expenses at one time - oh my word.

3. Please God, don't let me have two in diapers.

4. Summer maternity leave = summer vacations... finally!!!!

5. What in the world are we going to name this child????

6. Where am I going to put stuff? My house is getting cramped!!!

Things have changed. I think before, I would have passed out if the baby came before 37 weeks. Now my arms are open and my heart is ready if he wanted to arrive today. Let's not do that, baby boy. You still need a name and some time to gain weight! But just know that your mommy can handle it.

And the big event itself... you all know from previous posts where my heart is in regards to delivery. As mentioned, I have given this to the Lord, and I'm giving Him complete control of my mind and heart. Yes, I want to deliver him as God intended women to deliver babies... but I am so thankful that God has given us great docs who recognized the signs and symptoms of danger and need for immediate delivery. In about 4-6 weeks, I will be assessed and recommended to Winston, or they will keep my c-section date which has already been scheduled. I have a great support system medically and personally. I have no doubt that the right decision will be made and complete awareness that things can change no matter which path is chosen for me at that time. I am already praying now for peace later. I think peace is something that can expire quickly. Though I'm at peace now, I have no idea how it will be in those final moments. I need your prayers. I do not want to be laying strapped on that table, screaming inside. If I have to be on that table, I want to be excited, not nervous... I want to be fully aware of the outcome of this pregnancy, and not the procedure itself.

Finally, I want to give some praise to whom it's due:

1. Thank you Lord for a healthy baby.

2. Thank you Lord that you have given us this child.

3. Thank you Lord for your peace.

4. Thank you Lord for working out a maternity leave replacement so that I can have some help the last month and be worry-free the time that I'm out.

5. Thank you Lord for the things we have been given, loaned, and handed down.

6. Thank you Lord for Vivienne's sweet demeanor throughout this pregnancy.

7. Thank you Lord for tolerance and grace through the two stomach viruses, croup, bronchitis, ear infections, and surgery (includes family) this winter.

8. Thank you Lord for my support system in regards to delivery wishes.

9. Thank you Lord for a husband who has always gone above and beyond to help with Vivienne.

10. Thank you Lord for my heritage so that we can instruct our children in Your ways.

Hope to update again later with news of a new doctor, or a scheduled birth date. No matter what, I'll have something to write about, for sure. :-)

And something fun... here's the crib (ours is in a cherry finish which is a bit darker):