Saturday, August 15, 2009

Pregnancy Update

It was an interesting visit with Dr. Wonderful. The best news is that the abruption is healing nicely. The scary part is that the lake that was so large (the fluid between the walls of the placenta) is no longer there. A lake isn't supposed to heal so that was actually part of the abruption too. I'm glad we didn't realize that on Monday. I am still off my feet until there is absolutely no spotting for 3 full days. I might have said that in my post on Monday, but then I was hopeful that meant 3 total days of bed rest. I am still waiting to go more than about 6 hours. We are at 5 days now. Oh, well, it is nothing in the grand scheme of things and I am very lucky to be pregnant at all. Plus, Dr. Wonderful said in all likliehood the abruption will heal completely.

We also saw the baby move - a kick, a punch and even what looked like a little shake of the head. We watched blood (well, red light the u/s machine showed us as blood) moving through the umbilical cord. We could then follow the main artery from the placenta into our little Dish Mate's heart. It was all quite amazing.

Before all this happened, we had a good discussion about the risks of doing a VBAC (vaginal birth after cesarean). Specifically, a VBAC at home. Current research, according to Dr. Wonderful, puts the risk of uterine rupture during labor at 0.4% or 4 out of one thousand. About one out those four will die or have serious consequences, the other 3 will probably be ok. That is, if the person is in the hospital and can get an emergency c-section as soon as the rupture is detected. If we have a rupture at home, Cathy, my midwife, could start an IV going on the way to the hospital to save time, but really the liklihood is that the baby won't survive.

Of course it is scary and the odds don't seem that high unless it happens to you and then they might as well be a 100%. I can only imagine how unbelievably painful it would be to have your insides tear open like that nevermind knowing the child you carried for 9 months in dying while you drive.

But that is the unlikely situation where a rupture occurs at home. I don't know, but I suspect, that a hospital rupture is more likely because often labor inducing or augmenting drugs are used which put more strain on the uterus. Obviously, no studies have been done on drug free VBAC's because there just aren't that many people who choose to labor drug free. Addtionally, there are other precautions we can take to avoid an abruption. We can monitor the baby more often than usual (although I think Cathy checks pretty often anyway) and transport at the first sign of fetal distress. Dr. Wonderful said that is the first sign of a impending rupture - even before the contraction monitor goes flat. We can also be conservative about how long I labor before transporting for either the additional monitoring and preperation that can take place in a hospital or simply plan on having another cesarean upon arrival.

Dr. Wonderful promises to be there if we transport too. I will keep asking him to come to my house for the birth since I went to his place last time. I know he won't, but it is fun to ask him. I like him and he is comforting to have around. Still, in labor and birth, it is Cathy who I want in charge - especially at home. No offense to Dr. Wonderful, but I wonder if he has ever even seen a completely natural birth.

Thank you to every one who commented and checked in on my status. I feel so grateful to have so many people who can support me especially since many of you are still working on that first miracle baby and I am (hopefully) well on our way to our second.


Sunny said...

Kicking and punching... the abruption healing nicely... it all warms my heart!!!

I am so impressed that you are doing a natural VBAC at home. You go girl!

battynurse said...

Glad things are moving along well and hope that the bleeding/spotting stops soon.
My friend Bleu at Soulbliss managed recently a VBAC I think without meds. I know she didn't get pit. She did go to a hospital but was discharged I think the same day. I hope you get the birth you've been longing for.

Geohde said...

Whew. Glad things are improving. Good luck with the birth, when the time comes, and however it happens.



Summer said...

Such good news! Hope that abruption is completely healed soon.

Thanks for sharing what you are learning about VBAC. I'm thinking about attempting it should we get a #2. Do you know if the timing of the second birth affects your risk of uterine rupture (ie. waiting longer decreases your risk)?

Sara said...

I am not commenting either way on the wisdom of a VBAC at home, since I have no expertise in the area, but I do know that doctors generally do NOT induce VBAC patients in hospital births. In fact, the need to induce or use pit is considered to be a contraindication to a VBAC, and generally leads to a c-section birth in the hospital (I have several friends who have had or attempted hospital VBACS, and among their doctors, this rule is universal--VBAC=no pit. Period.). So, I don't think you can blame those 4 on the pit, since the risks with pit would be even higher.

I'm so glad to hear that the abruption is healing and that everything is otherwise looking good. Hooray!

Me said...

It literally fills my heart with happiness to read your happy updates.

AwkwardMoments said...

Glad to hear that it all seems to be going ok. I hope it continues to get better

Sarah Andrews said...

I am SO thrilled to hear that the lake has disappeared! Thank GOODNESS!

Hopefully you are not up and off of bedrest. But even if your not - it's totally worth it.

Panamahat said...

Glad to hear all this good news!

Thanks for your comment on my recent post. I may change my mind about my womb, you are right. Maybe it does still work. But right now I feel like I never want anything in there again, because it just hurts too damn much to lose it. Yes, we are getting karyotype done on the embryo - is that what you meant? We both have normal karyotyping ourselves, got that done ages ago. Not sure it will give us much in the way of answers, but whatever- nothing to lose.

Lorraine said...

Sounds like things are going well, despite the ongoing bed rest.

As for the home VBAC - I think as the time nears you'll have a better sense of what seems right. I always knew I wanted a natural birth, but as I got near 40 weeks I did agree to at least a hospital setting and a hep-lock just in case my oddball heart-valve kicked in and I needed specialists immediately.

In the end, I had no drugs, no heart problems and all the nurses on the floor asking how it was to labor without an epidural - doesn't happen much these days!

I hope your birth experience is exactly what you feel is best for you and your little one!

Working Girl said...

I hope everything is ok and that your hanging in there!!!

MrsSpock said...

Using Pitocin is generally contraindicated with a VBAC. I've known one or two OBs that might try a whiff of Pit to augment, but they were outside the norm. Pit does increase your risk of rupture.

I hope things turn out the way you want them this time!