Looking for opinions on a sensitive subject

I'll start off by saying I am absolutely not looking for a
pro-choice/pro-life debate. I just want to get as many opinions as
possible on what others would do in my shoes. I know the decision is
ultimately mine and my husband's.

My history is rather complicated, but here it is in a nutshell:

pregnancy #1 - Clomid pg in 1998, m/c around 6 weeks

uterine septum resection in 1999

pregnancy #2 - IVF/ICSI twin pg in 2002, lost at 19 weeks due to
incompetent cervix

pregnancy #3 - IVF/ICSI twin pg in 2002-2003, Macdonald cerclage @ 13w +
strict bedrest, delivery via classical c-section at 26 weeks following
PPROM @ 25 weeks. Twins now 4, one developing typically, one with mild CP.

pregnancy #4 - surprise singleton pg in 2004-2005, Shirodkar cerclage @
10w + modified bedrest, delivery via c-section (unclear on incision,
probably classical) at 35w2d following episode of vaginal spotting.
Apparent pending uterine rupture/scar dehiscence noticed at delivery. My
son spent a few days in the NICU for mild respiratory distress and is
fine now, turning 2 in a few weeks.

So colored me shocked to find out this past weekend that I am pregnant
again, due to an apparent birth control failure. I am scared to death of
uterine rupture and went to see my OB. He basically made a list of all
the reasons that pregnancy would be too risky: two previous classical
c-sections, the septum resection, risk of accreta, history of irritable
uterus, advanced maternal age (I just turned 35) and on and on. He is
recommending termination.

The only thing sadder to me than terminating this pregnancy would be
leaving the kids I already have without a mom. I've been researching
uterine rupture for 2 days, and it seems that maybe my OB is being
overly pessimistic. The mortality and morbidity rate seems pretty darned
low, especially with a scarred uterus, which I definitely have. He also
didn't seem particularly willing to discuss things like 17P, tocolytics,
or home monitoring. OTOH, maybe my view of his pessimism is just wishful
thinking on my part. I was starting to get used to the idea of another baby.

I am almost 6 weeks now, and a medical termination is only an option for
a couple more weeks. After that, I would require a surgical termination,
which I desperately want to avoid.

We did not plan on any more children, but we have the emotional and
financial resources to handle one more. I plan to talk to the
maternal-fetal specialist who cared for me during my pregnancy with my son.

So, opinions? WWYD?

Thanks in advance.

pj wrote:

So, opinions? WWYD?

I'd go get a second (and maybe a third) opinion from
a high risk pregnancy specialist before making a decision.
Especially when it comes to a complicated situation like this,
you need someone with the expertise to weigh out the situation.
I think it's particularly important that you talk to someone
who is a high risk specialist. Their view is often quite
different from someone who largely handles normal or near-
normal pregnancies.

Best wishes,
Ericka

pj wrote:
I'll start off by saying I am absolutely not looking for a
pro-choice/pro-life debate. I just want to get as many opinions as
possible on what others would do in my shoes.

I second Ericka's suggestion to talk to a
high-risk obstetrician.

What direction is your incision, vertical
or horizontal? Vertical is what they call
"classical incision" and that is the one
with some elevated risk of rupture and I've
had 2 of them. I had 5 months of bedrest
with the first pregnancy and the second was
fine. I totally understand your fear. You
need to talk to a specialist who sees
high risk pregnancies all the time.

-- Anita --

Irrational Number wrote:

What direction is your incision, vertical
or horizontal?

I know the first one was vertical, and we're 99% sure the second was,
too (OB couldn't find his post-op notes in my chart, grrr).

I am definitely going to call my old perinatologist and get his take.
Could be interesting to get past the gestapo they have at the front
desk, but I will camp out in the parking lot if I need to.

Thanks to you both for the input. It's hard to find a lot of relevant
data for my situation, since a) most c-sections are low transverse, and
b) most research is geared toward TOL/VBAC. Obviously, I'm not even
thinking about VBAC. I just don't want my uterus to explode without
warning at 30 weeks.

just so you know, I do know who you are, I don't know whether you wish to be
anonymous or not, so I'll say no more.

I think the real question is do you want this baby?

Medically it is risky, but you will also need to be watched very closely,
the scar can be checked via ultrasound for any early sign of dehiscence, it
may be prudent to have you in hospital for a couple of weeks before the
expected time of delivery (my guess, 34 weeks).

It's true there is a risk of accreta and other placental problems, but it's
not high, I don't know if it varies with the incision type, but even if it's
highest with classical incision, it's still likely not more than 2-3%.

You can minimise the risk from that by giving prior consent to a
hysterectomy if necessary, or as a way of completely avoiding more children
even considering a planned caesarean hysterctomy. Death from accretas and
the like are much more of a problem when someone has had a vaginal birth and
is in bad shape from blood loss before they get on the table.

My take is you have to decide if you want this child, then you have to find
someone who can provide you the best possible care. Caesarean is guaranteed,
as is some degree of prematurity, you just need someone who you are
confident in to minimise the prematurity without compromising you in any
way.

Cheers

Anne

"pj" wrote in message
m...
I'll start off by saying I am absolutely not looking for a
pro-choice/pro-life debate. I just want to get as many opinions as
possible on what others would do in my shoes. I know the decision is
ultimately mine and my husband's.snip So, opinions? WWYD?

Thanks in advance.

What a tough decision. I have no idea what I would do. Definitely get a
2nd and maybe even a 3rd opinion.

Wishing you the best of luck with your decision.


--
Nikki, mama to
Hunter 4/99
Luke 4/01
Brock 4/06
Ben 4/06

I would approach the high risk doctor as though you plan to have the
baby and want to know how he can help you do so safely. I think you
will get more realistic answers that way than if he thinks you are on
the fence and could be scared out of going forward with frightening
stories.

I would also do my own research so that you can verify what you are
being told. IME, doctors are notoriously overly concerned about
rupture, given the facts.

I'll pray for you and hope you will let us know how things go.

Leslie

Anne Rogers wrote:
just so you know, I do know who you are, I don't know whether you wish to be
anonymous or not, so I'll say no more.

I appreciate that. I figured there may be some here who would know who I
was -- my history gives it away, but changing details would make it
difficult to get honest feedback. I didn't want to use my real name and
I set up a new e-mail addy because I have a bit of an IRL stalker. I
doubt she reads this group, but I wouldn't be remotely surprised if she
searches on my name/e-mail at Google Groups from time to time.

The question of whether we want the baby is actually kind of
complicated. Initially, my reaction was that I did not. I'm very happy
with my life as it is. The idea of another baby wasn't something I'd
entertained before, but it has grown on me in the past week. I'm
terrified, though, which makes it hard to get too excited. When my OB
recommended termination as the best course of action, it broke my heart,
which sort of tells me which way I really want to go.

I really do appreciate the input. I'm not telling people IRL about this
unless we decide to move forward with the pregnancy, but it's just not
my MO to make a decision this huge without talking it all out.

On May 10, 11:41 am, pj wrote:
I plan to talk to the
maternal-fetal specialist who cared for me during my pregnancy with my son.

I would probably do exactly what you are doing -- agonize over the
decision and seek a second and maybe even third opinion from a
perinatologist. I would have two major concerns, the cervix which
could lead to very premature birth and the complications relating to
that outcome for the baby and your family, and the issues with your
uterus that could affect your health/life as well as the baby's. Your
specialist should be able to talk these through with you, I hope he/
she provides you with more data to help you make this very hard
choice.

Good luck,
Elle

I spoke with my perinatologist today, and we have decided to go ahead
with the pregnancy. He was very encouraging and said that it's simply
not even a question for him that we will be just fine with the proper
care. I trust him very much; he took excellent care of me both medically
and emotionally during my last pregnancy.

He is also going to make some suggestions for a different OB, since I
can't feel comfortable seeing my old one this time. (I'm sure he will
probably prefer that as well.) I have an appointment next Thursday to
get an u/s and make an action plan.

I feel so much better. I did not want to terminate, at all. It's going
to take some time to get used to the thought of adding another child to
our family, but everything will be OK.

Thanks so much for the feedback!