hello - delurking and asking for feedback

One thing I found out on that page that makes me really angry, that
doctors would take it upon themselves to attempt to scare a woman *they*
don't deem worthy of having any more children (because of weight,
socio-economic situation, etc.) into being sterilized. I've had doctors
ask me this same question with all three births - do you want us to
sterilize you during the surgery?

Is this something the rest of you have experienced also? Is it a
standard question? Or am I just one of those women doctors don't
consider *worthy* of children because of my weight?

Oh dear god ! Dont get me started on this. I too experienced this type
of pressure from the surgeon. I told him to stick it (diplomatically
because he's going to have his hands inside you and who knows how well
he washed his hands...) but basically, I was deeply offended by the mere
suggestion and I told him so. When I then went to the family planning
clinic for a Mirena, they once again asked why I had not opted for
sterilisation during the C-Section. Frankly, I cant even begin to
understand why they would suggest an elective sterilisation for a woman
of 28! I mean, what the hell are they thinking! I can only think that
this is a way of quiet social engineering. Why dont they just paste a
swastika over the door and be done with it. At least the Nazis were
honest about it.

Wookie

I am sure a couple of people here will remember that I was extremely
uncomfortable during the final 3 months because of SPD and was on
crutches. I also required pain killers to control the pain.

Don't beat yourself up about weight and SPD and pain, it is possible that
being lighter in weigh would have reduced this, but a reasonably high chance
it wouldn't. You and others will be familiar with my equally dire end of
pregnancy with SPD and other pain, but not knowing me in real life will mean
you've no idea whether I'm fat or thin. Well I'm pretty thin at my normal
weight and I started pregnancy at my normal weight, for some reason I don't
gain much in pregnancy, so delivery means I lose all but about 4lb of weight
gained, which can entirely be accounted for by the still increased size of
the uterus and breast enlargement. With the immobility I experienced, I then
put on weight in the early weeks of breastfeeding and slipped into being
technically overweight, not obese, I think my BMI maxed out at 27, then,
whenever I saw a doctor, my weight would always be mentioned, as if losing
weight would be some magical cure, well I'm finally back down at around the
prepregnancy weight, with a healthy BMI of around 23, with no improvement of
pain, the weight loss came after improvement of pain allowed some increase
of activities, not the other way round.

Although I had a C-Section, this was for a sound medical reason but to be
honest, I would have been happy to have her the normal way. The C-Section
was performed to limit damage sustained in the previous pregnancy and to
stop that damage from becoming any worse. I plan to have a further child
in about 5 years time and I am absolutely certain that I will not submit
to another C-Section regardless of the risk of 'ruptured womb' etc.

Just to note here, am I recalling correctly that your c-section was due to a
history or 3rd (or was it 4th) degree tears, not SPD etc.

Regarding the future, I don't think that the risk of repeat bad tearing
changes all that much with increased gap between pregnancies, so if that
risk was enough for you to agree to a c-section this time, then what has
changed? Maybe the comparison of healing of your tear v. healing post
c-section means you are prepared to take the risk of a severe tear (I think
with you history it falls in the 10-20% range), is worth taking compared to
the guaranteed need to heal from a c-section. I don't recall what the
severity of your symptoms were post tear, but it is worth bearing in mind
that if they were on the milder end of the spectrum for the degree of tear,
things could be a lot worse, including temporary or permenant anal
incontinence. Don't want to scare you here, but it may be something you
would want to talk through with women who have actually been through it,
I've come across women who have chosen both routes, either elective
c-section, or vaginal birth and in both groups most seem happy with it, but
it may be that those in the elective c-section group had worse post tear
experiences so have a worse experience to compare it too. It may be that you
also had a bad c-section experience and that some of the resources online
about planning a good c-section could be helpful. If you did go the vaginal
birth route, make sure you talk about episiotomy as this may well be offered
as a solution to avoid worse tears, in an unscarred perineum this is
definitely false, but even with a scarred one, it doesn't seem like it's
routine use produces good results, but studies do vary.

Another thing that I would not want to not mention (iyswim), is that there
does seem to be a link between SPD and malpositions, the research evidence
isn't there, but nor is it in the opposite direction, but the anecdotal
evidence is strong. Then, if the baby is birthed in the malposition, which
is also more likely with SPD, there is a well known link with increased
incidence of severe tears, when you combine that with a scarred perineum,
you're in a danger zone. I had a 2nd degree tear first time, my 2nd baby was
born in the OP position (back to back), despite a very slow and controlled
birthing of the head, which would ordinarily not have resulted in any
tearing, the 2nd degree tear reopened, whether that was intrinsic poor
healing in my body, or related to the position, it's impossible to tell, but
it's a cautionary tale!

One more thing you might need to think about, is with the severity of your
SPD and the fact you also had SI instability, there is a strong possibility
you have an underlying connective tissue disorder. Collagen is part of
connective tissue and part of scar tissue, which raises the issue, if you
have defective collagen, what is the revised risk of uterine rupture in
c-section and no one really knows, but when I look at scars on other parts
of my body (I know I have a connective tissue disorder), I really don't
think I could put a uterine scar in that condition through labour, but I
wouldn't know whether it was in that condition, not all scars on my body are
in such poor condition, though more are than aren't. Thankfully it's
basically a non issue for me, I still dream of another child, but only one,
so birth decisions for that one would be for that one alone and that
wouldn't be a decision that would be able to be taken absolutely until late
pregnancy, though everything would point to a c-section being the more
likely route, so I'd plan for that and be pleased if multiple factors all
lined up right for a vaginal birth being the best route.

Anne

On Jan 21, 3:19 am, Desi wrote:
pregnancy progress naturally, and when her baby was finally taken by
C-Section he had hair down to his shoulders, long fingernails, cerebral
palsy due to the fact he wasn't getting enough oxygen during the end,
was legally blind, mentally disabled, and her water was green because it
had begun to rot.

For what it's worth, it was green because it likely had meconium (baby
poop) in it. Amniotic fluid does not rot. The body re-absorbs it, and
makes new fluid continuously.

Cathy Weeks

On Jan 21, 3:19 am, Desi wrote:
pregnancy progress naturally, and when her baby was finally taken by
C-Section he had hair down to his shoulders, long fingernails, cerebral
palsy due to the fact he wasn't getting enough oxygen during the end,
was legally blind, mentally disabled, and her water was green because it
had begun to rot.

For what it's worth, it was green because it likely had meconium (baby
poop) in it. Amniotic fluid does not rot. The body re-absorbs it, and
makes new fluid continuously.

Cathy Weeks

On Jan 17, 9:15 am, Desi wrote:
Hi everyone!,

So here's where I stand at the moment - 38, still very heavy, three past
C-sections (no complications), am facing a possible hysterectomy as a
means to control chronic anemia (very heavy periods all my life) - and
want another child before something like that happens.

I'm very concerned about going through another pregnancy and being
morbidly obese, and have put myself on a lifestyle change/healthier
eating diet. Thus far this has been successful and I've lost twenty
five pounds but have a long way to go.

Desi,
Please read the book _Eat to Live_ by Joel Fuhrman. I would read that
book, follow it's recommendations, excercise, wait 6 months and THEN
see how you are doing.

The reason I say this is that losing weight during a pregnancy isn't a
good idea. Because when you burn fat, you release any toxins that were
stored in the fat, thus exposing the developing baby to those toxins.

So it's probably better to get to a more desireable weight first, then
go through pregnancy, holding your weight steady. I don't think you
need to get down to a perfect weight by any means, just lower than it
is.

Hope that helps.

Cathy Weeks.

Anne Rogers wrote:
I am sure a couple of people here will remember that I was extremely
uncomfortable during the final 3 months because of SPD and was on
crutches. I also required pain killers to control the pain.

Don't beat yourself up about weight and SPD and pain, it is possible that
being lighter in weigh would have reduced this, but a reasonably high chance
it wouldn't. You and others will be familiar with my equally dire end of
pregnancy with SPD and other pain, but not knowing me in real life will mean
you've no idea whether I'm fat or thin. Well I'm pretty thin at my normal
weight and I started pregnancy at my normal weight, for some reason I don't
gain much in pregnancy, so delivery means I lose all but about 4lb of weight
gained, which can entirely be accounted for by the still increased size of
the uterus and breast enlargement. With the immobility I experienced, I then
put on weight in the early weeks of breastfeeding and slipped into being
technically overweight, not obese, I think my BMI maxed out at 27, then,
whenever I saw a doctor, my weight would always be mentioned, as if losing
weight would be some magical cure, well I'm finally back down at around the
prepregnancy weight, with a healthy BMI of around 23, with no improvement of
pain, the weight loss came after improvement of pain allowed some increase
of activities, not the other way round.

Although I had a C-Section, this was for a sound medical reason but to be
honest, I would have been happy to have her the normal way. The C-Section
was performed to limit damage sustained in the previous pregnancy and to
stop that damage from becoming any worse. I plan to have a further child
in about 5 years time and I am absolutely certain that I will not submit
to another C-Section regardless of the risk of 'ruptured womb' etc.

Just to note here, am I recalling correctly that your c-section was due to a
history or 3rd (or was it 4th) degree tears, not SPD etc.

Regarding the future, I don't think that the risk of repeat bad tearing
changes all that much with increased gap between pregnancies, so if that
risk was enough for you to agree to a c-section this time, then what has
changed? Maybe the comparison of healing of your tear v. healing post
c-section means you are prepared to take the risk of a severe tear (I think
with you history it falls in the 10-20% range), is worth taking compared to
the guaranteed need to heal from a c-section. I don't recall what the
severity of your symptoms were post tear, but it is worth bearing in mind
that if they were on the milder end of the spectrum for the degree of tear,
things could be a lot worse, including temporary or permenant anal
incontinence. Don't want to scare you here, but it may be something you
would want to talk through with women who have actually been through it,
I've come across women who have chosen both routes, either elective
c-section, or vaginal birth and in both groups most seem happy with it, but
it may be that those in the elective c-section group had worse post tear
experiences so have a worse experience to compare it too. It may be that you
also had a bad c-section experience and that some of the resources online
about planning a good c-section could be helpful. If you did go the vaginal
birth route, make sure you talk about episiotomy as this may well be offered
as a solution to avoid worse tears, in an unscarred perineum this is
definitely false, but even with a scarred one, it doesn't seem like it's
routine use produces good results, but studies do vary.

Another thing that I would not want to not mention (iyswim), is that there
does seem to be a link between SPD and malpositions, the research evidence
isn't there, but nor is it in the opposite direction, but the anecdotal
evidence is strong. Then, if the baby is birthed in the malposition, which
is also more likely with SPD, there is a well known link with increased
incidence of severe tears, when you combine that with a scarred perineum,
you're in a danger zone. I had a 2nd degree tear first time, my 2nd baby was
born in the OP position (back to back), despite a very slow and controlled
birthing of the head, which would ordinarily not have resulted in any
tearing, the 2nd degree tear reopened, whether that was intrinsic poor
healing in my body, or related to the position, it's impossible to tell, but
it's a cautionary tale!

One more thing you might need to think about, is with the severity of your
SPD and the fact you also had SI instability, there is a strong possibility
you have an underlying connective tissue disorder. Collagen is part of
connective tissue and part of scar tissue, which raises the issue, if you
have defective collagen, what is the revised risk of uterine rupture in
c-section and no one really knows, but when I look at scars on other parts
of my body (I know I have a connective tissue disorder), I really don't
think I could put a uterine scar in that condition through labour, but I
wouldn't know whether it was in that condition, not all scars on my body are
in such poor condition, though more are than aren't. Thankfully it's
basically a non issue for me, I still dream of another child, but only one,
so birth decisions for that one would be for that one alone and that
wouldn't be a decision that would be able to be taken absolutely until late
pregnancy, though everything would point to a c-section being the more
likely route, so I'd plan for that and be pleased if multiple factors all
lined up right for a vaginal birth being the best route.

Anne



Wow, Anne, thanks for the long reply.

OK. The typed word is so imprecise. I'm not beating myself up about
weight gain and SPD, honest injun, but I have to acknowledge that weight
does play a part in the strain placed on the joints. In my case, it
started years ago with a childhood spent playing outside, climbing trees
and occasionally falling out of them too. These old injuries weakened
certain joints, namely both knees, the sacro-illiac and lumbar regions.
Then I gained weight to my present size and THEN, I decided to compound
the problem by conceiving two children in 3 years. I was taken aback by
the severity and debilitation of the SPD, but also accepting of it as a
price to pay for my daughters. However, since this was originally
directed to the other lady, she asked the question whether she could
*carry* a baby given her weight and whether this was advisable. I was
just pointing out the problems that I experienced...

You are correct, the C-Section was due to the history of a 3/4 degree
tear (BTW, the doctors cant seem to agree which it was, either 3rd or
4th, but either way, the damage was extensive)..However, by the end of
the pregnancy, with the SPD, it did play a part in my decision making. I
was still prevaricating at 07:30 in the morning of the C-Section. My
personal inclination is to let nature take it's course. I see any type
of intervention as largely unnessesary and that the situation would
probably have resolved itself in time. I know this is a gross
oversimplification, but from what I have seen/heard and experienced in
two pregnancies, doctors are far too keen to perform a cut and shut for
the sake of expediency. For instance, when speaking to a locum midwife
just weeks before the C-Section, I explained my problem and that I didnt
want the C-Section but understood the risks involved etc. She said, that
given more staff and more time, she would see this as a challenge and
whilst could not guarantee another tear wouldnt happen, she could would
make a damn good stab at making sure. My problem with the C-Section was
that although there was a risk (and no doctor could give me a decent
indication, somewhere between 4 and 10% was the range I heard), they
would not put me on a sort of 'at risk' register which would have meant
a midwife paying special attention to me and helping me control the
labour better than last time. If only that had happened, I would have
been more than happy to have Marley naturally and take the risk. The
reason I chose the C-Section was a combination of the following..

a) Extreme pain from SPD (Just get this over with...)
b) Doctors giving me scare stories (You'll be incontinet for the rest of
your life, on your own head be it, so there, yade yade ya)
c) Lack of midwife cover (I couldnt get a guarantee that I wouldnt be
doing this all on my own in a broom cupboard again)
d) Unwillingness of doctor to examine me and give a definitive yes or no
to the state of the perineum.
e) Although C-Section is major operation, it is largely routine,
controlled and there are good drugs available.
f) My husband (bless him) firmly believed the doctors and urged me to
listen to them.

Faced with all of those points, I was more or less manouvered into it. I
dont like doctors, I dont honestly trust their motives and frankly, I
feel cheated. If I had known what a c-section was going to be like, I
would not have done it. I was in extreme pain for at least 3 days, more
or less helpless for the remainder of the week and it took a further 3
weeks for me to get somewhere aproaching normal. When I plucked up the
courage to go get showered and take the dressing off (which I had to do
in order to get released and go home), I found to my horror that I was
allergic to micropore and half my skin came away with the bandage
leaving gaping sores where the blisters had been. Taking the clips out
was excrutiating and I am still (12 weeks on) very tender in the abdomen
and I can feel a line where the internal incision was made.

In contrast, although the original tear was bad, I had lidocain gel to
use. It was uncomfortable but no-where near the pain of a c-section. I
was back to normal in about a week. Although the tear needed to be
re-done because it had healed wonky, it wasnt too bad at all and
basically, I just kept using the gel and treating myself gently for a
week or two afterwards. My surgeon was very skilled and had taken great
pains to get the second incision to heal straight and true. I had no
problems with sex after the second surgery other than what your would
normally expect for a few weeks until it had healed properly, and since
then, no problem at all.

I take your point about an underlying connective tissue disorder and
would tend to agree with you. Basically, a doctor once told me that I
was incredibly fit and therefore, the ligaments stretch more easily than
normal. I do not know and probably never will why the SPD happened. I
jokingly said to my husband that I'll end up in a wheelchair next time
and I suspect that this will not be far from the truth. If we do have
another (and this seems likely) then I am going to take the lessons I
have learned and speak to a doctor before hand (one that I trust),
explain the issues and see where we go from there.

Once again, thanks for your long reply, I hope this has not been too
involved for you.

Regards

Wookie

Cathy Weeks wrote:
On Jan 21, 3:19 am, Desi wrote:
pregnancy progress naturally, and when her baby was finally taken by
C-Section he had hair down to his shoulders, long fingernails, cerebral
palsy due to the fact he wasn't getting enough oxygen during the end,
was legally blind, mentally disabled, and her water was green because it
had begun to rot.

For what it's worth, it was green because it likely had meconium (baby
poop) in it. Amniotic fluid does not rot. The body re-absorbs it, and
makes new fluid continuously.


I stand corrected. I wasn't there, was five years old at the time, got
my news secondhand from my aunt (the mother, not a medical doctor), who
got it from her doctor, so... there we are.

I speculate she heard him say the amniotic fluid had an odor and color
and assumed this was so because it was rotten, which I believe is a
natural thing to assume, considering. Odd color, bad smell does often
mean a thing has gone 'round the bend.

Cathy Weeks wrote:
On Jan 17, 9:15 am, Desi wrote:
Hi everyone!,

So here's where I stand at the moment - 38, still very heavy, three past
C-sections (no complications), am facing a possible hysterectomy as a
means to control chronic anemia (very heavy periods all my life) - and
want another child before something like that happens.

I'm very concerned about going through another pregnancy and being
morbidly obese, and have put myself on a lifestyle change/healthier
eating diet. Thus far this has been successful and I've lost twenty
five pounds but have a long way to go.

Desi,
Please read the book _Eat to Live_ by Joel Fuhrman. I would read that
book, follow it's recommendations, excercise, wait 6 months and THEN
see how you are doing.

The reason I say this is that losing weight during a pregnancy isn't a
good idea. Because when you burn fat, you release any toxins that were
stored in the fat, thus exposing the developing baby to those toxins.

So it's probably better to get to a more desireable weight first, then
go through pregnancy, holding your weight steady. I don't think you
need to get down to a perfect weight by any means, just lower than it
is.

Hope that helps.


Hi again Cathy,

Since writing that post I've lost another 25 pounds for a grand total of
50, thus far without the help of a book, although I'm a firm believer in
sharing info else I wouldn't be here.

Right now I'm changing my lifestyle - eating differently (not starving
or following a diet - more veggies and fruit, less bread and red meat,
etc.), cutting out the things that are obviously bad for me, not too
much salt, sugar, fat, exercising more, no smoking (quit in '00), no
drugs (never did them) and I don't drink. (I have been known to cuss
and/or spit, but that's another post...)

I've heard about toxins being released from fat during weight loss. When
my gynecologist and I discussed the possibility of another pregnancy
considering my weight and age, she seemed less concerned about my weight
than my age and anemia, and given my first two easily conceived
pregnancies and my last which took five years, gave me a six month time
frame in which to conceive.

I know the final decision is mine and I do see the sense in your advice.
I'm attempting to identify the risks for both scenarios and trying to
decide what is the best plan at this point. Off the top of my head:

Pros for conceiving now:

-anemia will solve itself temporarily and give me a nine month reprieve

-during the delivery I can have my uterus removed, eliminating the need
for a second surgery and hospital stay, solving the anemia permanently
with the added benefit of sterilization (I know my limits and four is
enough)

-the odds for birth defects occurring grows higher with every year I wait

-I would like to have my last two children as close together in age as
possible

Cons:

- toxins released during weight loss, which will be inevitable even
without my trying because I have 24/7 nausea for nine months and will
find it difficult to eat

(I do eat, I force myself to, but it comes right back up and so far the
plan has been to hold down as much as I can for as long as possible
before it does. So far I've had three pregnancies without complications
arising from weight loss, which has been anywhere from 20-30lbs. with
each @ 170, 230, and 290lbs. respectively.)

-conceiving and carrying at a heavy weight is difficult and can be
potentially dangerous - 'potentially', not definitely

If anyone is interested in adding their thoughts to this list, please
feel free. I'm sure there are more I haven't thought of yet. So far it
looks to me like conceiving now will have the greater benefits.

Elfanie wrote:
On Jan 21, 3:19 am, Desi wrote:
pregnancy progress naturally, and when her baby was finally taken by
C-Section he had hair down to his shoulders, long fingernails, cerebral
palsy due to the fact he wasn't getting enough oxygen during the end,
was legally blind, mentally disabled, and her water was green because it
had begun to rot.

postmaturity doesn't cause cerebral palsy....hypoxia does.


Did I suggest it did? I thought "cerebral palsy due to the fact he
wasn't getting enough oxygen during the end" was clear enough.

This seems to be a very precise newsgroup. I will have to watch what I
post in the future. Apologies to those I offended with my inaccuracy.



amniotic fluid doesn't "rot"....the water was green because baby had
passed its first stool, meconium. Extremely common.


Hmmm... while I never professed myself a specialist I wasn't aware
meconium was green. In my experience it's always been black. Learn
something new every day. I'd also been told a baby passes stool during
delivery because it's in distress. Is this true or false?



as for hair down to his shoulders...you sure that he didn't have hair
ON his shoulders? Lanugo is also extremely common....although much
less so in postmature babies.


Here's one I do know, thank goodness. No Lanugo. His hair was long and
the tips of it touched his shoulders, according to my aunt. I imagine
(but will never know, of course) it wasn't coarse or full like an
adult's, but I have seen babies born with hair long and straight, in
real and in photo. I've not seen one with hair long enough to touch the
shoulders, though.





Stephanie Soderblom CLD CCCE CD(DONA) CBC
Mommy to Mikael 5/9/95 - Kerstyn 8/6/99 - Kevin 8/30/02
Megan 5/16/05 - new baby due 8/07
Senior Apprentice Midwife/Doula/Childbirth Educator/Breastfeeding Counselor
Mesa, AZ
www.AZDoulas.com
www.birthdiaries.com


I really enjoyed this site. (birthdiaries)

On Feb 7, 4:09 pm, Desi wrote:

Hmmm... while I never professed myself a specialist I wasn't aware
meconium was green.

It's a greenish black, and when it's diluted with amniotic fluid, it
can appear a dark green.

In my experience it's always been black. Learn
something new every day. I'd also been told a baby passes stool during
delivery because it's in distress. Is this true or false?

It's both true and false. Often when a baby is in distress, it will
pass a stool. But sometimes they pass a stool even when *not* in
distress. Sometimes babies who are very overdue (like more than 2
weeks) will poop prior to delivery, just because they've got more in
their colons due to it building up. It's not the pooping while in
utero that's the danger, it's the danger of breathing it deeply into
their lungs upon birth that's the problem. When they are first born,
that's when they take a very deep gasp (unlike the shallow "breathing"
they due prior to birth), and it can go in deep, and causing a very
serious lung infection.

My daughter passed a stool while she was being born, (being born is a
stressful event in and of itself), but it was after her head was out -
I forget what that's called. It's evidently very common.

As for precision, we are ultraprecise for a very good reason - many
old wives tails about birth exist, causing fear and worry - so we try
to correct any wrong information out there, so that no one gets
misinformation.

An example - my grandmother *insisted* that she had a "dry birth" -
claiming that her body didn't make any amniotic fluid during birth,
thereby causing it to be much more painful. While I don't doubt that
there was something going on that made it a very painful birth, "dry
birth" is basically non-existant - the body makes amniotic fluid until
the baby is out. Pregnant women have enough to worry about without
adding old wives tales to the mix. ;-)

So, it's not that anyone was offended - no one was - but we did want
to correct the inaccuracies in your stories. Hopefully *you* were not
offended. I know it was not my intention. :-)

Cathy Weeks