And then. And THEN, I went this morning for my ultrasound. I agreed to one because my midwife really wanted a good sense of fetal size and the age/health of my placenta. Apparently higher than average blood sugar can age a placenta faster than normal.
Baby is big (keeping in mind that ultrasound is not an accurate measurement of size; but I know that it is bigger than average). I knew it, but I was hoping for a bigger-than-average as opposed to a Monstrous. 95th percentile. Argh. So frustrating, after all the work and diet and exercise and cutting of carbs down to miniscule amounts that really actually aren't that healthy, being too small of portions~any less and I'll starve my fetus (after several weeks of overfeeding, ha!). But it does confirm that my decision last week was the right one: start insulin.
The doctor who did the ultrasound was predictably conventional. We *need* ultrasounds every two weeks to monitor the well being of your baby. We will *need* to induce you at 39 weeks to avoid the risk of unexplained stillbirth (not associated with GDM, but rather women who are diabetic prior to getting pregnant: PLUS, dude, you had to play the dead baby card). You *need* to keep your baby small or you have a high risk of shoulder dystocia and your baby could die (oh look! Dead baby card reappears!). I didn't argue with her because she's not my care provider and it doesn't matter what she thinks we *need* to do~but there's no way in hell I'm agreeing to an induction with a VBAC scar. Sorry. Data is clear there: 400% increase in risk of uterine rupture (and high risk of fetal death if that occurs catastrophically, which with inductions it generally does). NOT SAFE. I think she saw in my face that I wasn't buying it even though I didn't argue.
But the hardest news was that my placenta is LOW, implanted down near or covering my cervix. A placenta covering a cervix is incompatible with vaginal birth, both baby and mother are at risk of severe bleeding. You can see how one cannot give birth THROUGH the placenta. The doctor wanted to do a vaginal probe ultrasound, but I wasn't fully prepared to do that immediately without thinking about it~I believe it's necessary, I just have issues with foreign objects in my vagina. I need mental preparation if it's going to happen. So I booked another appointment for 2 weeks from now; the position of the placenta is so low it's impossible to see if it is beside or over my cervix from a regular abdominal ultrasound. Marginal placenta previa can resolve itself as the uterus grows and lifts the placenta away from the opening of the uterus. PLEASE PRAY that this is what I have, because the only way to give birth to a complete previa is by cesarean section. This is a loooooong way from HBAC water birth, I gotta tell you. I feel like I've been hit by a torpedo; a little bit numb, a lot of diffuse pain, and mostly a sense of deep disbelief. Like THIS is what railroads my hopes for this birth? Not ruptured uterus, or shoulder dystocia, or failed induction, or large baby, or anything related to VBAC or GD: but placenta previa? WHAT ARE THE CHANCES, PEOPLE?! My kharma is really F*&^%$%ing crappy right now.
My midwife called this evening after she read the faxed report and WOW does she ever make a difference in my mental health. She said she was glad we had had an ultrasound, which I am too, because otherwise this may not have been recognized. She also reassured me that she's never had a client with complete previa who did not have any bleeding by 28 weeks: I'm 34 weeks (nearly) and have had no bleeding at all. Not an absolution, but a grain of hope. She talked to me about the vaginal probe ultrasound and, as I know, said it's important. She also reassured me that in any case, everything will be okay, and I'll be well supported and receiving evidence based care.
At this point I've reached a rock bottom line mental state; similar to my bloggy friend Rachel's pregnancy, all plans and all bets are off, and I'm at the absolute basic bare bones of my birth plan. All I really want is for this baby to come out my vagina. I don't care where it is, I don't care how, I don't care when, I don't care if it's drug free, water free, standing on my head in the OR with 50 obstetricians in the room and no husband to support me. Vaginal birth. That's the rock bottom for me, all else has been stripped away and even that might be a fading dream. There's nothing like a little drama to make you realize what REALLY matters to you. And you know what? Healthy baby in arms is incredibly important to me, but it's not the only thing that matters. I can't explain it eloquently, but I can say it's not comforting when people reassure me that a healthy baby is all that matters in the end. It isn't all that matters to me. I don't value vaginal birth ABOVE the health of my baby, but I also highly value physiological birth.
Pray long and hard.
And oh my GOSH is this hard.