Wednesday, January 18, 2012

Compliments and Normalcy

David did really well during his home speech therapy this afternoon. His therapist - typically VERY reserved with compliments said a few really remarkable things after the session:

David is becoming much much easier to understand AND his vocabulary (as it turns out) is amazing!- she predicts he will quickly surpass expected average vocabulary for his age once his annunciation gets a little better.

She feels his improvements in the short few months she's been making weekly visits are impressive and he's doing very well!

I'm so excited and proud of my little string bean guy!

I went to my regular OB later this after noon for an ultrasound and check up (aka - chat with the doc). Uncle Sean got to tag along as he's in town visiting for a few days. My cervix remains normal - over 4 cm. very closed and very stable. The baby is growing beautifully - just above average at 1 pound 7 ounces...that's right, kiddo number 4 is already bigger than his or her siblings' birth weights. (Mary Louise was 1 pound 6 ounces / 12 inches; David was 14 ounces and 10 3/4 inches and Kuylen was 10 ounces and 9 3/4 inches just as a refresher). The baby's heart rate was 157 - normal and average for him / her. The position was head down facing toward my back which I found odd and unsettling at first - but I was quickly assured that it's very normal and the fluid and everything else about the ultrasound was just fine - and really, the way this kiddo has been kicking and dancing, an odd position isn't all that surprising. The doctor felt the ultrasound was totally unremarkable (having nothing to say in medicine is typically a GREAT thing). My blood pressure was good - a little higher than it normally runs at home but within normal limits just the same. A little higher in office after being moved around a number of times for ultrasounds and change of rooms isn't really surprising anyhow.

So, things are coasting along right now. My cervix is no longer a concern for the OB and he has cleared me to not only stop seeing perinatology if I choose but also come back in 4 weeks to see him!! A whole month?!?! crazy! I discussed keeping my appointment with peri in 2 weeks and then stopping with them. He (my regular OB) feels that's very reasonable and is confident that he can handle my care from there.

I spoke with the doctor about delivery. I hadn't wanted to bring it up with all of the other monitoring going on but it seemed appropriate to discuss today. I have a classical uterine scar from my previous section and wanted to understand the risk vs. benefit of another c-section. It was an interesting conversation really...

Apparently, the risk of uterine rupture when attempting a VBAC (vaginal birth after cesarean) is about 1 to 2% for BOTH classical and low transverse cesarean scarring. So, no increase in risk with my type of scar. However, 1 to 2% when considering there are 10's of thousands of births everyday is a considerable number. My doctor used to do and encourage VABC's until 6 years ago when he happened upon a rupture in progress while rounding on the L/D floor. The woman had a cesarean for her first birth, then 2 subsequent vaginal births - remarkable because it has long been an opinion that one successful VBAC would mean risk of rupture on future deliveries was lowered significantly - almost negligable. It just so happened that this woman already had an epidural in place, and the section suite was available and directly across the hall. Baby and Mom were saved simply because things happened that way - but had she not been in the very right place and the very right time, things could have easily turned out tragically different. (story of life right?)

So, my doctor no longer recommends VBAC's - but seemed to want to leave the final decision up to me (well, he wanted to, and legally, he sort of has to). At any rate, he seemed to genuinely understand and respect my concern, questions, and history...

I have never really discussed the babies' delivery in detail - and won't now - but to say that the very very short story is, the annesthesia did not work. If I said that wasn't a small concern of mine in going into another section, I would really be lying. But my biggest concern is, by far, the safety of the baby.

So, we have found a middle ground:

My doctor has said from the beginning of even discussing another pregnancy that he would "allow" things to progress as naturally as possible as long as we (the baby and me) are stable. He would love to see 39 weeks of pregnancy before scheduling a delivery. I am ok to go into labor naturally - but he would advise against allowing my labor to progress further than the beginning of regular contractions. This would mean that the baby is definitely "ready" and the subsequent surgery (section) would significantly reduce our risk of emergency.

So that's that. I'll continue to take things one day at a time and appreciate every thump and wiggle of our little one. But the tentative best case scenario plan is something that I really needed to wrap my mind around  - and I feel at peace with it all after our discussion today.

24 weeks on Sunday! Of "legal" age little one! Keep it up!


Oh and P.S. thought you might enjoy my facebook status from this morning: My wake-up courtesy of Mary Louise: ‎5:45am: Mary Louise sits up in bed, grins, and "performs" The Wheels on the Bus complete with hand motions and 2 verses- the wheels go "wound" and "up and down". Life's sense of humor: demonstrated daily in giving me the most extreme version of "morning babies"...what can I do but laugh?

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