Preparing for a Caesarean

I still have a few more boxes to unpack, stuff to sort out, pictures to hang, on top of taking it easy, staying on top of work-related projects, and running a household, but I feel like I’m getting a handle on things and have a sense of what the next couple of months will be like.

I had my OB appointment yesterday and, right off the bat, Dr. D said she’d spoken to Dr. W — the perinatologist who reviewed my follow up ultrasound — and in their opinion the placenta won’t move in time to allow for a vaginal delivery. She delivered the news gently, knowing that I had had my heart set on a birth center delivery.

I think I surprised her with my response: But we don’t want it to move, because that would mean the lobe’s blood vessels would move closer to or over the cervix, and that would cause vasa previa…

I said I’d been doing a lot of reading on how to make a caesarean a wonderful experience and wanted to know what would be possible. (Hey, much of this research came from stories and links that a lot of you shared — so thank you very much indeed, OFT readers!)

Here are my questions; her answers (not verbatim):

1. Does an anterior (front position) placental lobe require a vertical incision? No, we still do the bikini cut.
2. Will you have to cut through the placental lobe? Yes.
3. So that means a lot of bleeding, therefore a “gentle caesarean” won’t be possible, because you’ll have to deliver her quickly? Yes. But don’t worry, we cut through placentas all the time.
4. Is there anything I can do to prepare for a caesarean now, like taking extra iron? We can do a CBC panel in a couple of weeks’ time, when you come to get your RHogam and pertussis shots.
5. Can I — due to my very sensitive skin — request that my pubic hair be shaved wet, rather than dry? We don’t shave you, we clip the hair very close to the skin. Yes, you can do this yourself at home.
6. You said Baby would be delivered between 36-37 weeks; Dr. W said between 37-38: can we deliver her closer to 38? The goal would be to deliver her between 37-38 weeks, but it could be earlier if we decide Baby would do better outside than in.
7. If she is born before 37 weeks, what is the likelihood she will spend time in the NICU?Not too high. If she did, she would probably have to spend 24 hours in the NICU, mainly to make sure she’s breathing okay on her own.
8. I’ve been reading up on caesarean birth plans and would like to know if any of the following are possible:
   • Can DH cut the cord? Not exactly. We need to keep the space around the incision sterile, so we make the cut that separates baby from placenta. But he can cut the cord after Baby has been evaluated. It will be about a foot long, so it needs to be cut again, and he can be the one to do that.
   • Can we do skin-to-skin Apgar testing? Baby will be immediately evaluated to make sure she’s breathing okay. As long as she’s breathing okay, we will immediately place her on your upper chest. It’ll only be a couple of minutes.
   • Can we do delayed cord clamping? No. Mainly because of the anterior succenturiate lobe.
   • Can you do double sutures, in case I’d like the option of a VBAC in future? We do that as standard.

Seems like a lot of gentle caesarean options aren’t available to me because Baby will have to be delivered quickly. I’m happy that Dr. D values skin-to-skin contact and breastfeeding soon after delivery. Knowing this (and that UCSD has a baby-friendly hospital designation) makes me trust more that the first priority is making sure Baby is okay. Her birth will be so very far from anything how I’d ever imagined, but it’s out of my hands. I feel similarly to how I did when I was told that IVF would be our best shot. Less shocked, and more calm, but with the awareness that there is nothing I can do. With being told we’d need IVF came something like relief that I wouldn’t have to go through monthly cycles of timed sex, BBT charting, and disappointment.

Accepting that Baby V will be delivered by caesarean brings some relief. We can choose a date. It’s a controlled environment. I won’t have to worry about her being in distress or tearing or whether I need an episiotomy or fetal monitoring. Yes, I miss out on the earth mother hippie birth I always wanted, but a CB will be special. It’s the birth of my daughter. My rainbow baby. The child I have fought so hard to have and am doing everything I can to protect. How she arrives in this world doesn’t matter really. It’s not about me anymore.

I acknowledge my disappointment. I know the recovery will be tough. I don’t care about having a scar, I will wear it with pride. I know I will be dependent on DH and his mom for the first few weeks, but they’re on board. I, we, can do this.

♥

We moved on to discussing my Inhibin levels and HCG levels, which were borderline high at the second round of blood tests. As I explained before, high levels are markers for growth restriction, pre-eclampsia, and pre-term labour, so I will continue to have ultrasounds every four weeks. The doctors will monitor not only the position of the placenta, but also baby’s growth.

If the placenta moves and I develop vasa previa, I will be put on hospital bed rest.

If Baby’s growth slows down (so far she’s fine) then I will be put on bed rest, to see if that helps. If it doesn’t, then I will be put on hospital bed rest. If that still doesn’t help, at some point they would make the decision to deliver her even earlier than 37 weeks.

Pre-eclampsia seems unlikely given the excellent results of the uterine arteries’ blood flow.

As usual, nothing is ever straightforward with me.

Even my mood is complicated. It’s like I’m in a brightly lit room. Everything is okay, not perfect, but I’m content. But there is one corner that’s very dark and I’ve given up trying to shine a light on it. Whatever I do, the corner is dark, so I acknowledge it and ignore it. From here on in, it’s better to focus on staying positive.

Because, intense fears and anxiety aside, I am so hopeful about meeting this baby in a couple of months’ time, so determined that I be the best mom I can. I’m trying to remember that it’s no longer about ME. My feet are killing me, thanks to my over-pronation that is exacerbated due to weight gain (16 lbs and counting!) and a change in gait, but it’s all for a wonderful reason. (Lucky me, that’s my only physical complaint)

I’ve thrown myself with gusto into researching baby stuff, and even DH referred to her by her name for the first time. I take joy in all of her movements, even the ones that cause me discomfort, like when she kicks my cervix or ovary… I am especially fond of hiccups, rhythmic, like the tap-tap-tapping of an index finger on the inside. It’s so freaking adorable, my heart melts every time. DH got to feel them the other night too. He also got to feel her as she had one of her Disco Mermaid dance parties — total pandemonium in three corners of my belly that keeps me awake until 1am. I described it to Dr. D as like she’s having a seizure, but Dr. D reassured me that, yep, it’s perfectly normal.

And I’m even able to predict some of her movements. If I roll onto my side, I know she will move too. When I sit down to pee in the night, as I lean forward I feel a kick all the way to my upper thigh. If I laugh and laugh and laugh, as I did today, it’ll wake her up and she’ll bounce a couple of times.

DH and I still talk about the past, this journey, but we’re now looking towards and imagining the future — one with a baby. But we always come back to the present: just who is this marvellous creature inside me?