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I'd appreciate any wisdom on type of birth...



 
 
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  #1  
Old November 3rd 08, 09:55 PM posted to misc.kids.pregnancy
Anne Rogers
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Posts: 1,497
Default I'd appreciate any wisdom on type of birth...

OK, I know ultimately this is a decision only I and my husband can make.
I have a vague recollection from after I last gave birth that even
some of the natural minded amongst you were pretty surprised I'd not
ended up with a c-section.

The list of diagnoses of damage done at that delivery are as follows :-
labral tear in the left hip resulting from hip dislocation or subluxation
grade 2 rectocele
"broken" coccyx (it's a bone that's already in pieces, but historically
it was throught to be only one and the word broken when it really means
disruption seems to have persisted)
disruption of sacroiliac joints
probable rupture of symphysis pubis ligament
tear to the lower sling of pelvic floor muscles that remains separated
damage to the upper sling that was still swollen 2 years after delivery

With that list, I sometimes wonder if I am even nuts to consider a
vaginal birth, then I think back to my first birth and if it were that
easy again, I'd be nuts to consider anything else. The thing is though,
he was an IUGR baby and thus had enlarged fontanelles, they were about 3
inches across, when 1 inch is normal for a full term baby, about the
size of a quarter. Another IUGR baby wouldn't be great and may not have
such extreme fontanelles.

Another consideration is timing of delivery, with DD I was in horrific
pain the final month, the obsetric community tends towards symphysis
pubis pain not being a condition where damage is occuring, the
orthopedic community pretty much seem to say that is rubbish and any
time there is dysfunction of a joint there is going to be swelling and
often other mess as well and if they do end up doing surgery, the first
thing they have to do is a thorough clean up. Based on that, the
obstetric community see no difference in delivery at 37 weeks and 42
weeks, whereas there's a possibility that this extra month could make
quite a difference in terms of the amount of inflammation that needs to
calm down. In the UK at that time there was a big drive to do elective
c-sections at 39 weeks or later, whereas I get the impression here that
most doctors are more open to doing amnio for lung maturity and
delivering earlier if that comes back ok. That could be a significant
benefit to us.

I also wonder how I'm going to cope emotionally with the unknowns of
planning a normal delivery, it could go fine, I think it would be
unlikely to be as bad as last time, but it could easily be somewhere in
the middle. With the amount of pelvic floor damage I have any
gynaecologist would be recommending c-section, but would also admit that
worsening of things isn't guaranteed. One of the problems for me is that
as soon as I start considering emotions I start to think that I should
not be driven by them, in my book emotions are the wrong reason to
choose a c-section.

There is another big fear too, I'm really not very good with wounds, I'm
not sure how I'd cope with a wound across my tummy, I wouldn't exactly
be able to avoid looking at it! Also I have a quirky reaction to local
and regional anesthetics, it's entirely possible that they wouldn't be
able to numb me up enough and even if they did, I'm one of the worst
people at coping with feeling wierd tugging and pulling, I'd probably be
a quivering wreck.

Does anyone have any suggestions? Any questions I need to ask myself or
ask other people? Thanks for listening.

Anne
  #2  
Old November 4th 08, 10:21 PM posted to misc.kids.pregnancy
Nikki
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Posts: 486
Default I'd appreciate any wisdom on type of birth...

Wow,

That is a lot to think about. If you start with a vaginal delivery will
you know or feel if things are to difficult or do you not know the
extent of the injury until afterwards?

I'm wondering if you can explain to the doc and just try the vaginal but
switch to a section if you start feeling like things are not going
smoothly. Of course - that depends on if you can actually feel the
injury before/during and not just after.

Best of luck with your decision.

--

Nikki
  #3  
Old November 5th 08, 12:01 AM posted to misc.kids.pregnancy
Anne Rogers
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Posts: 1,497
Default I'd appreciate any wisdom on type of birth...


That is a lot to think about. If you start with a vaginal delivery will
you know or feel if things are to difficult or do you not know the
extent of the injury until afterwards?

I'm wondering if you can explain to the doc and just try the vaginal but
switch to a section if you start feeling like things are not going
smoothly. Of course - that depends on if you can actually feel the
injury before/during and not just after.


Well I did last time, but the thing is, I seem to have fast labours, DS
was 1.5 hrs 1st stage, 16mins pushing. DD, was still fast in the grand
scheme of things, I didn't really have any warning of labour, just hit
transition straight away, I was already in the hospital and was up to
delivery in 15 mins or so, already vomitting and shaking, I was 6cm, 2
hours later I was fully dilated, but may well have been for up to an
hour given how I was feeling. But it was heading towards 2.5hours in 2nd
stage when I finally got her out and there were clear warning signs, I
was asking the midwives to call the doctors, but they were clock
watchers and didn't until the two hour mark, by which stage we were
pretty much at the point of no return and they just hung around in the
room to see things did continue to progress. From what I'm reading about
birth in the US, the nurse can have a lot of influence on what goes on,
sometimes to the extent of going against doctors orders, not calling
them even if they've been ordered to if certain things happen for
example, I know that is probably extreme, but I have a hard time putting
myself into the hands of a stranger as in my mind that is a lot of what
went wrong last time and as far as I can tell finding an ob doesn't
equate to having someone you know in the delivery room, I read somewhere
that the average attendence rate at births for obs was 30% and if you
are unlucky and get the nurse who things she knows best etc.

For that reason we've already booked a midwife, I think they will give
me the best chance at a happy, healthy pregnancy and if I do birth
vaginally I want someone like that present, it's just that the way
everything is with midwives and doctors, it makes deciding in labour
harder, though it is something I will talk through with them.

I've already decided if there is a malposition I will almost certainly
go for a c-section, though I may get a scan and check the AFI as low AFI
was probably part of what meant DD didn't turn, though with the strong,
powerful contractions I had, she may have been being pushed down too
much, though others have said that it's the force of the contractions
pushing the head against the pelvic floor that makes the baby turn, so
having a strong pelvic floor is important!

Cheers
Anne
  #4  
Old November 5th 08, 12:48 PM posted to misc.kids.pregnancy
betsy
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Posts: 234
Default I'd appreciate any wisdom on type of birth...

Anne Rogers wrote:

Well I did last time, but the thing is, I seem to have fast labours, DS
was 1.5 hrs 1st stage, 16mins pushing. DD, was still fast in the grand
scheme of things, I didn't really have any warning of labour, just hit
transition straight away, I was already in the hospital and was up to
delivery in 15 mins or so, already vomitting and shaking, I was 6cm, 2
hours later I was fully dilated, but may well have been for up to an
hour given how I was feeling. But it was heading towards 2.5hours in 2nd
stage when I finally got her out and there were clear warning signs, I
was asking the midwives to call the doctors, but they were clock
watchers and didn't until the two hour mark, by which stage we were
pretty much at the point of no return and they just hung around in the
room to see things did continue to progress. From what I'm reading about
birth in the US, the nurse can have a lot of influence on what goes on,
sometimes to the extent of going against doctors orders, not calling
them even if they've been ordered to if certain things happen for
example, I know that is probably extreme, but I have a hard time putting


This is where bringing a well informed midwife or doula with you could
help. You already had a history of precipitate labor. You now have
more history of fast labors. Having someone else who can quickly convey
this and your other needs to the nurses using medical abbreviations can
make a big difference.

myself into the hands of a stranger as in my mind that is a lot of what
went wrong last time and as far as I can tell finding an ob doesn't
equate to having someone you know in the delivery room, I read somewhere
that the average attendence rate at births for obs was 30% and if you
are unlucky and get the nurse who things she knows best etc.


Picking a family practice physician can change that. Family practice
doctors tend to attend their own patients births, while obs tend to go
by a schedule and whoever is on call comes. Some family practice
doctors do their own C sections while some do not.

I am guessing that your midwife would be able to reach a doctor even if
the nurses chose not to call. You could ask about that.


For that reason we've already booked a midwife, I think they will give
me the best chance at a happy, healthy pregnancy and if I do birth
vaginally I want someone like that present, it's just that the way
everything is with midwives and doctors, it makes deciding in labour
harder, though it is something I will talk through with them.


Does your midwife do hospital births too? If not, does she stay on as
a doula if you have a hospital birth? I would feel uncomfortable with
having a midwife who wouldn't necessarily be present for the birth in
some capacity.

With my second baby, I went through the whole pregnancy doing both the
midwife's and the doctor's standard prenatal care. This was more
expensive, since it was double care, but much less expensive than trying
to fix problems after the birth.

One thing my doctor did that was helpful was to write all planned
deviations from standard procedure directly on my chart. Even though no
one had time to even think about the birth plan, the nurses did glance
at my chart after they received the call I was coming in. When
something is written on the chart by the doctor, it carries more weight
with the nurses.

--Betsy
  #5  
Old November 5th 08, 01:05 PM posted to misc.kids.pregnancy
betsy
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Posts: 234
Default I'd appreciate any wisdom on type of birth...

Anne Rogers wrote:

With that list, I sometimes wonder if I am even nuts to consider a
vaginal birth, then I think back to my first birth and if it were that
easy again, I'd be nuts to consider anything else. The thing is though,
he was an IUGR baby and thus had enlarged fontanelles, they were about 3
inches across, when 1 inch is normal for a full term baby, about the
size of a quarter. Another IUGR baby wouldn't be great and may not have
such extreme fontanelles.


What about considering birth on your knees to open things up more
easily? I think I remember that you didn't last time because of
shoulder problems. I've seen pictures of women birthing on their knees
with their upper bodies propped to avoid arm/shoulder strain.

In my personal experience giving birth, my hands and knees deliveries
have made a world of difference in avoiding the pounding to my pelvis
and resulting injury.

Another consideration is timing of delivery, with DD I was in horrific
pain the final month, the obsetric community tends towards symphysis
pubis pain not being a condition where damage is occuring, the
orthopedic community pretty much seem to say that is rubbish and any
time there is dysfunction of a joint there is going to be swelling and
often other mess as well and if they do end up doing surgery, the first
thing they have to do is a thorough clean up. Based on that, the
obstetric community see no difference in delivery at 37 weeks and 42
weeks, whereas there's a possibility that this extra month could make
quite a difference in terms of the amount of inflammation that needs to
calm down. In the UK at that time there was a big drive to do elective
c-sections at 39 weeks or later, whereas I get the impression here that
most doctors are more open to doing amnio for lung maturity and
delivering earlier if that comes back ok. That could be a significant
benefit to us.


While the obstetric community may see no difference between delivery at
37 and 42 weeks, some people in the breastfeeding community find that it
is often more difficult to get breastfeeding off to a good start with a
37-38 week baby. Another breastfeeding thing to consider with a C
section is that your milk may not come in as soon.

I'm not bringing these things up to say that a C section is the wrong
choice, but just as factors for you to research. All those well
meaning people who say "All that matters is a healthy baby," bother me.
I think the health and happiness of the mother are very important for
her own sake and for her baby's sake.

--Betsy
  #6  
Old November 5th 08, 06:15 PM posted to misc.kids.pregnancy
Anne Rogers
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Posts: 1,497
Default I'd appreciate any wisdom on type of birth...


Picking a family practice physician can change that. Family practice
doctors tend to attend their own patients births, while obs tend to go
by a schedule and whoever is on call comes. Some family practice
doctors do their own C sections while some do not.


My family practice doctor does do births, I haven't asked her what
percentage she attends, but I know it's pretty high as they will happily
cancel appointments if she needs to be over at the hospital and as she's
part time, she usually then works an extra day to fit the appointments
she missed in ASAP. She doesn't do c-sections though. The main barrier
to this is I really have no intention of birthing in hospital if it's a
vaginal birth, mostly because of not being able to do it in water - this
is important to me as I think it's the only way I would be able to be in
a good position, although you remember rightly I've had shoulder
problems, I don't think it was that that stopped me kneeling, I tried a
lot of positions kneeling was one of them and I couldn't get comfortable
and do any effective pushing, I ended up on my side with my knees pulled
right up to my chest either side of the bump, essentially squatting, but
assymmetric, I suppose that could have put the stress all into one hip,
but I don't think it would have changed all the pelvic stuff. I think
kneeling maybe didn't work, because with her being OP, I needed my legs
pulled right up to get her through the pelvis (I found out later this is
common), the position I ended up in wouldn't have been possible for
kneeling. I did also find that with severe SPD that kneeling for more
than a very short amount of time was very painful, though I can imagine
it would be a good position for less severe SPD.


Does your midwife do hospital births too? If not, does she stay on as
a doula if you have a hospital birth? I would feel uncomfortable with
having a midwife who wouldn't necessarily be present for the birth in
some capacity.


This is a question I have to ask, I know they did in the past as she
told me about a woman who was planning to go to hospital and she met her
at home found her fully dilated and suggested staying at home as they
wouldn't have time to transfer. Turned out baby was OP and it took a
while and the father thought the midwife was collaborating with the
mother as she had wanted to be home and it was him leading the go to
hospital thing. However all the paperwork and questions asked have been
home or birth centre.

With my second baby, I went through the whole pregnancy doing both the
midwife's and the doctor's standard prenatal care. This was more
expensive, since it was double care, but much less expensive than trying
to fix problems after the birth.


I totally agree, though there an awful lot of things I feel the need to
avoid with doctors care and possible arguments I don't want to get into,
I also need to check my insurance details.

Cheers
Anne
  #7  
Old November 5th 08, 06:22 PM posted to misc.kids.pregnancy
Anne Rogers
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Posts: 1,497
Default I'd appreciate any wisdom on type of birth...


While the obstetric community may see no difference between delivery at
37 and 42 weeks, some people in the breastfeeding community find that it
is often more difficult to get breastfeeding off to a good start with a
37-38 week baby. Another breastfeeding thing to consider with a C
section is that your milk may not come in as soon.

I'm not bringing these things up to say that a C section is the wrong
choice, but just as factors for you to research. All those well
meaning people who say "All that matters is a healthy baby," bother me.
I think the health and happiness of the mother are very important for
her own sake and for her baby's sake.


I always do weight that attitude against what a doctor says, which is
why this is such a tricky decision as pretty much any doctor is going to
say c-section. One advantage for me is that at least I've already fed an
early baby (DS was born at 37+4). Obviously not all babies are alike,
but there is also the hope that some of his problems were due to IUGR
rather than gestation. Part of the problem with him was not knowing what
the problems were, he latched basically ok, needed a few tricks, but he
got the hang of it, the main issue was weak suck and eventually that
made me have supply issues. Having fed DD since then, I now know what a
normal suck feels like and have plenty more tricks up my sleeve for
maintaining supply - anticipating supply issues I basically convinced my
body from the start that I was nursing for one and pumping for one and
got a bit of a reputation as a milk cow, at one point I barely had to
switch the breast pump on to overfill both bottles, getting 12oz in less
than 5 mins. I'll do that again, even though a lot got wasted last time,
the insurance of having it there wasn't wasted.

Cheers
Anne
  #8  
Old November 5th 08, 07:05 PM posted to misc.kids.pregnancy
NL
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Posts: 444
Default I'd appreciate any wisdom on type of birth...

Anne Rogers wrote:
snip

anticipating supply issues I basically convinced my
body from the start that I was nursing for one and pumping for one and
got a bit of a reputation as a milk cow, at one point I barely had to
switch the breast pump on to overfill both bottles, getting 12oz in less
than 5 mins. I'll do that again, even though a lot got wasted last time,
the insurance of having it there wasn't wasted.


Just FWIW: you can bathe kids/adults in breastmilk and it's totally
awesome for the skin, so instead of wasting the milk, pour it into the
bathwater ;-)

cu
nicole
  #9  
Old November 5th 08, 09:14 PM posted to misc.kids.pregnancy
betsy
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Posts: 234
Default I'd appreciate any wisdom on type of birth...

Anne Rogers wrote:


she missed in ASAP. She doesn't do c-sections though. The main barrier
to this is I really have no intention of birthing in hospital if it's a
vaginal birth, mostly because of not being able to do it in water - this
is important to me as I think it's the only way I would be able to be in
a good position,


Have you looked into whether you can have a water birth in a hospital?
I know someone who rented a birth tub for her birth at Swedish a few
months ago. As you probably know, Swedish isn't exactly known as the
place to go for a natural experience, however with very good preparation
and a supportive doula, they managed it despite a labor that was longer
than all 4 of mine added together.

The question may be whether you can get a tub filled and warmed in time
anywhere.

--Betsy
  #10  
Old November 5th 08, 09:37 PM posted to misc.kids.pregnancy
Anne Rogers
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Posts: 1,497
Default I'd appreciate any wisdom on type of birth...


Have you looked into whether you can have a water birth in a hospital? I
know someone who rented a birth tub for her birth at Swedish a few
months ago. As you probably know, Swedish isn't exactly known as the
place to go for a natural experience, however with very good preparation
and a supportive doula, they managed it despite a labor that was longer
than all 4 of mine added together.

The question may be whether you can get a tub filled and warmed in time
anywhere.


I've more against vaginal birth in hospital than just water birth,
though I do accept it may well be the best choice for me. At home, we'd
try and hire a tub that had a lockable lid that you keep warm and change
the water weekly and we might do that anyway as the warm water would be
useful for pain management as well I think. The tub at the birth centre
is fairly small, so it shouldn't take long to fill and it should be
ready to go at any time, but I'll add it to my list of questions!

Given the history of precipitate labour, I wouldn't fancy the journey to
Swedish, if everything did go smoothly, I suspect I'd be birthing on
I-90! Which is another reason to plan homebirth, if baby is well
positioned, it will probably be quick and if it isn't, then I don't rate
my chances of waiting and not going for an elective c-section very
highly as there is way to much fear in me about labouring with a
malpositioned baby - if my research is correct, posterior is the most
birthable of malpositions and we know that was too much for my body. I
suppose there is the possibility of baby being LOP but having a nuchal
hand or being face or brow presentation, but they are much rarer
malpositions anyway.

Cheers
Anne
 




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