Wednesday, October 15, 2014

The weeks leading up to Wesley's birth

It is so very hard to believe just how much my views on childbirth have changed. It's funny to go back and read Noelle's birth story, which you can find here. 

The weeks leading up to Wesley's birth are such an important part of the story, that I can't put it all in one post.  This one will focus on weeks 38-40, and I will write about the actual birth in a separate post.

Around week 38, my blood pressure started to go up.  This was very similar to what had happened with Noelle at the end of pregnancy, it was just happening a week early.  My blood pressure that day was 140/82.  Nothing to warrant immediate induction, but we did need to keep a close watch on it.  I tried to chalk that reading up to inaccuracy.  I had just carried my sleeping toddler in from the car, layed her on the waiting room couch, then transferred her once again to the chair in the room where the blood pressure was taken, all while she remained totally asleep!  This meant my blood pressure was taken on my right arm, while standing up, after having just carried 30 pounds of sleeping toddler around.

Unfortunately, my blood pressure was high again at 39 weeks.  This time 140/90.  The doctor I saw was the same doctor who delivered Noelle.  He once again mentioned needing to keep an eye on things, and wanted me to come in 3 days later for a biophysical profile (an ultrasound that looks at various criteria to judge the health of the baby), and he also wanted me to get bloodwork done that day to check liver and kidney function.

When I came back for the biophysical profile, my blood pressure was up once again.  It was 150/90.  Bad news.  The good news was that my bloodwork had come back great and the ultrasound was perfect.  In addition, none of my urine screenings indicated that there was protein in it.  This meant that I had gestational hypertension, but not preeclampsia.  The doctor I saw that day was a new doctor at the practice.  Her recommendation was to induce that day or the next.  She said that even though I didn't have preeclampsia right then, my blood pressure put me at risk for developing, and that those risks outweighed the risks of induction.  Major bummer.  We asked a lot of questions.  I explained that I had been monitoring my blood pressure at home, and that many of the readings were totally normal.  At this time, I consented to a cervical check to see if I was favorable for induction.  I wasn't.  I was maybe a fingertip dilated, not very effaced, and cervix was mid position.  I also asked if stopping work and taking it easy in an effort to lower my blood pressure would help.  She said that it may help, but that I was still at risk for developing preeclampsia.  We asked for time to think about the decision and she told us to call her and let her know our decision either way.

After a long lunch (with a lot of tears) with my husband, and a long phone conversation with our doula, we decided to not induce that day (it was a Thursday) so that I could at least try to get some rest, but we were still on the fence about inducing on Friday.  We called and explained to the doctor that we were still making up our minds about a Friday induction.  It was 4:15 and I asked what we should do if we could not make the decision until after 5.  She told us we could call the on call line and speak with the on call doctor, who fortunately, was the doctor who we had seen the first time my blood pressure started to rise and who we have a lot of trust in.  I called and spoke with him, which was a great decision.  He said that the doctor I had seen earlier that day, was absolutely correct in her recommendation from a text book standpoint.  However, he felt confident in me waiting until Monday because he was familiar with me, and this was all deja vu from Noelle, and because he "had been doing this forever."  He also felt that all the current testing I had done indicated that I would likely be fine for the weekend.  He suggested I call the office the next day to schedule either a Sunday night or Monday morning induction.

The next day, I called the office as instructed and asked to schedule an induction.  The nurse got back to me and said that there were no spots left for Sunday or Monday, so I was scheduled for Tuesday, 9/23, at 5 am.  In addition, I had another biophysical profile and office visit scheduled for Monday and they wanted me to collect my urine for 24 hours.  This was a really telling moment for me.  I "needed" to induce ASAP, but only if it was convenient for the hospital?

When we went in for the office visit, my blood pressure was a reassuring 130/82!  Not perfect, but much better!  In addition, my ultrasound once again looked perfect. I was 40 weeks and 3 days.  I saw the same doctor who had recommended induction the previous week.  I explained how I had tried to schedule for that day, but was put off until the next morning.  We had another discussion with her about whether it was necessary to induce.  Her recommendation was the same as before.  Even though my blood pressure was better, and everything still looked good,  she told me that I "still had the disease".  She was referring to gestational hypertension.  It was not her most tactful moment.  In addition, I was dilated to a 2 this time, and was a lot more favorable for induction! She also told me that I had the advantage of being a second time mom.  My risk for the induction not working and needing a csection was very low. While this was all phenomenal news, we still didn't want to induce when everything was looking good, even a little better than the week before.  Much to that doctor's dismay, we decided to cancel the next day's induction and scheduled another biophysical profile and office visit for Thursday.  That visit was also scheduled with a different doctor, the one who I have already referred to as knowing me better, and that we have a lot of trust in.

These weeks were really an emotional roller coaster.  It was really difficult to decide whether or not to go against the official medical advice to induce.  I really had to trust my intuition, which was telling me that I was healthy and that I could hold off.  But there's always that little voice saying "what if" and being scared that I could never forgive myself if something did go wrong.  I also HATE conflict, or even the threat of making someone unhappy.  While that one doctor did have a moment or two of not being tactful, I never felt like she didn't truly want the best for me.  I understood her perspective from a medical standpoint.  The chance of delivering a healthy baby with a favorable induction at 40 weeks and 4 days was high.  While there was a good chance that I wouldn't develop preeclampsia, the risk was still higher and preeclampsia can develop quickly.  However, the medical standpoint didn't take into consideration how difficult my last induction was.  I was really pretty sick after Noelle's birth.  I passed out in the bathroom, I was extremely weak, and I definitely did not have the amazing feeling that I heard a lot of people talk about after having a natural birth.  In my mind, these were risks to inducing that I had to at least consider.   It took a lot of prayer, talking with Phil, and talking to our doula, and going with my gut.  I think a lot of people would have made the decision to induce a lot earlier, and I think for a lot of them, that would have been the right decision for them.  But for us, we decided to hold off still longer. 

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