Monday, January 17, 2011

And The Shit Hits The Fan...

So. I started insulin last week. It was a relief by the end, to begin, and to admit defeat and to accept a treatment I am convinced I need, and especially one which would increase my chances of a successful natural non interventive BIRTH~which is far more important to me than a non interventive pregnancy. So far, I haven't found the magical amount of insulin to completely control my morning fasting sugar, but it's coming down and I'm getting closer. Also, I've determined I need some daytime insulin as well.

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 hard.
Pray long and hard.
And oh my GOSH is this hard.

14 comments:

amy frances said...

I will, I promise. I'm so sorry, Mel.

I understand. The health of your baby and route by which s/he enters the world aren't mutually exclusive, nor are her/his health and your experience of the birth. It sucks that the establishment can't recognize that.

[praypraypraypray]

ms emili louann said...

Praying, as always. Harder and longer.

I was graced with the "at least a healthy baby" thing over and over after Elijah's section. It is frustrating to look back on, though it's something I bought into for a while. Baby's health IS important, but mother's mental and physical well being should be taken into account just as much. For some reason, these things are too often placed by the wayside.

I am thankful you have such a stellar midwife who seems to get it.

*huge HUGS*

SANDRA said...

Giving birth is such a strong memory for life and I know how important a vaginal birth is to you. We are praying! <3

Caryn Ouwehand said...

SHIT-BALLS Mel. Shitty Balls.

Okay, what the heck is up with bodies that fail us...??? Makes me what to hit my head on the wall for you.

...here wait a sec...

Yup, just totally banged my head repeatedly on my office wall for you.

Man, that little lady in there is going to have some explaining to do when she gets here.

Deb said...

Caryn - did you just say SHE? I think you meant she...I mean...

Oh never mind...

Tonya said...

So sorry to hear all this Melissa. We will be praying!!!

tamie said...

Alright, Mel, I'm circling the prayer wagons. E-mail me your number and I'll call you. It's in my phone which is in my dearly beloved's pocket and he is in New Mexico and I am in New Hampshire so you see the problem.

Yes, how you give birth to this babe MATTERS. It very much so matters. And yes, the babe's health does matter more. But like, just because something else matters more doesn't mean that other things don't matter. This is fundamental logic, people.

Is there anything you can do to convince the placenta to move over? And will the insulin slow the babe's growth now? I'm so sorry that the exercise/dieting was for naught, although actually not for naught because the exercise at least probably helped you be healthier? Yes? I don't know.

You're going to figure this out, Mel. And you're going to be hella supported along the way. Keep keeping us posted, okay?

Praying! And loving you!

tamie said...

P.S. Shit is hitting fan in my life too, and this keeps in perspective for me what's really important. Which is life and love and relationships. So thank you for that reminder.

Ruchi said...

so sorry things are not working out the way you had hoped. I am being reminded over and over in my life that we are not in control, as much as we would like to be. Sending you positive vaginal birthing vibes

Louise Chapman said...

Praying for great results at your next doctors appt...that the placenta is actually off to the side. I know how incredibly important this is to you.

Roboseyo said...

shit:fan:hit=rob:mel:pray

hang in there, my sister. me and mine will pray for you and yours.

Rachel Clear said...

SHITSTORM!

It matters. It matters a lot, and I am aching for you.

I know there isn'ta silver lining here yet, and the fat lady hasn't sung, but I do feel so strongly that all of this is going to make you a kickass midwife. You have seriously been through it all, girl.

I'm so glad you have a good midwife, an awesome mom, and lots of support.

Prayer wagons: circled.

nancy said...

I linked the Fogs to your blog - so the old time prayer warriors at on it!

Jen said...

Oh Mel. Sucks sucks sucks.

I am praying, my dear friend.