This week has been an important one for us!
I was FINALLY able to get in to see a regular OB this week!! With all the trouble I’ve had finding an OB who delivers at St David’s North, and then having to fight with my insurance to get them covered, it was a huge relief to finally get in (on time) for my 30 week appointment! So we got up early and headed to Austin for a 9:30 am appointment.
I was thrilled when we got there to learn that the office I would be seen at was “family friendly.” They had one corner of their waiting area that had toys for children and everyone made the biggest deal about how cute John was! A lot of OBs won’t let you bring children with you to your appointments, so right off the bat this office has made a friend in me! I checked in, and while Matt and John went to play in the waiting room, I went to pee in the cup. I waddled back down the hallway and waited patiently with my boys for them to call us back.
Dr Piparia was awesome! She was 100% upfront and honest with me, and I appreciated the hell out of that! She didn’t try to blow smoke up my butt and minimize the risks we’re facing, either. We discussed everything that we have going for and against us; Abbi’s non-functioning right kidney, her cord, the IUGR, and her heart defects of course. We talked about the fact that she’ll need to be moved to Dell Children’s Hospital for her first procedure, and when that might need to happen.
Between the two of us, we came up with a birth plan that we were both pleased with. We both agree that a vaginal birth is the best option for a couple of reasons. Not only will it be easier for me to recover from, it’ll be much faster too. If you have a C-Section at St David’s North, you’ll be in the hospital for a minimum of 3 days. That’s pretty standard procedure at any hospital. And ordinarily that’s not a problem, but given Abbi’s heart conditions it may very well present a HUGE problem. We know that within a week or so after delivery, little Abbi will need to be transferred to Dell Children’t Hospital for her first heart procedure. Exactly when she’ll need to be transferred will depend on the echocardiogram that they’ll do the day she’s delivered. There’s a chance that they’ll need to transfer her within the first 3 days of life. If I end up with a C-Section and she has to be transferred before I’m discharged – I’ll be stuck at one hospital, while my baby goes to another.
And that’s not OK with me.
Will I refuse a C-Section if it’s necessary? Of course not. That being said, I want to do everything in my power to avoid being separated from her for longer than I absolutely have to be. Emergency C-Sections happen even with the most perfect of pregnancies, which I do not have! Sometimes, little bitty babies with IUGR don’t tolerate being squeezed on during the labor process, and a C-Section is needed. And I know all of that going in. But I want to at least TRY a vaginal delivery.
Due to the severity of Abbi’s IUGR, Dr Piparia also feels that induction at 37 weeks (the point at which a pregnancy is technically considered “full term”) is warranted. While no Mommy particularly wants to be induced, I am in complete agreement with the Doc on this one as well.
While it’s not true for every woman, it is widely accepted that second babies tend to come quicker than first babies do. Most first time Mommies spend a full 24+ hours in labor and they tend to spend 1.5-2 hours in the pushing stage. Was I lumped into that category too?
My labor with John was 9.5 hours total, with only 10-15 minutes of pushing. He was actually born so fast that the my OB at the time almost dropped him!
Given that John pretty much shot out like he was being fired from a canon and the fact that second babies tend to come considerably faster than their older siblings, I am 10752087% happy with a scheduled induction. Since we live a full hour away from the hospital I’ll need to deliver at, the last thing I want to do is go into labor naturally and end up delivering this unbelievably high risk baby on the side of the road because there was traffic and we couldn’t get there in time, ya know?
The next thing I wanted to know about was the method she planned on using for the induction. For most OBs, the treatment plan of choice with regards to scheduled inductions consists of two medications. The first is a medication inserted vaginally called “prostaglandins”, which will help to ripen (or soften) and thin the cervix, both of which are 100% necessary for a vaginal birth. The second medication often used (more often than not, nowadays) during the induction process is called oxytocin (the brand name of this is called Pitocin®, very often shortened to just “Pit” by nurses and others in the medical field). Pit is given to a patient intravenously through the IV that they were given upon their admittance to the hospital. Pit is used in the labor process for three reasons. 1) It is used to “jump start” the contractions needed to dilate the cervix in a woman who is not in active labor, 2) it is often used to “augment” the contractions of a woman already in active labor when they are either not strong enough to dilate the cervix or are not coming regularly enough, and 3) it is occasionally given after the baby has already been born to cause the uterus to contract which in turn helps to slow/stop post partum bleeding.
*For anyone looking for more information about the induction process, you can click here to visit BabyCenter’s page on cervical ripening and dilation, and you can see what the March of Dimes has to say about the entire process here.*
Having done loads of research into it and having spent years talking with other women about their labor experiences with and without Pitocin®, I have come to one conclusion:
Don’t get me wrong, Pitocin® has it’s place in the medical field, and is a very effective medication used commonly in the birthing process. That being said, not one, not two, but EVERY woman I’ve ever spoken with about their experiences with Pit hasn’t had a single nice thing to say. The contractions brought on by Pit seem to be triple the intensity of natural labor contractions, and many women have said that it was due to their experience with Pit that they ended up with an emergency C-Section. What does all this have to do with MY induction??
I asked Dr Piparia if she’d be open to trying a drug-free induction. I was so shocked when she said “Sure!” that I had to ask her to repeat herself!! Her ideas on the subject are as follows.
• Obviously, the very first thing the nurses will do after I get checked in (and into my fancy-schmancy labor gown from Pretty Pushers) is check my cervix.
• If I’m not dilated at all, we’ll need to insert the prostaglandins, to begin the ripening and softening of my cervix. If the cervix is dilated to 1 cm, she will insert what’s called a “balloon” which is essentially a small catheter inserted through the cervix (between the cervix and baby) that has a balloon at the end of it. The balloon will then be filled with saline which causes the cervix to begin dilation; after the cervix has dilated enough, then balloon will fall out and labor continues on.
• If, when I get there my cervix is dilated to 2-3 cm, Dr Piparia will do what’s called a sweep/strip of my membranes. A membrane sweep is done only by an OB/MW. During this process, the doctor will attempt to insert his/her finger (or two) through the cervix, and “sweep” them across the bottom of your bag of waters. This sweeping motion separates the membranes from the bag of waters and the cervix, releasing prostaglandins. The release of the prostaglandins sometimes kick starts natural labor. I had it done the day I went into labor with John. Visit BabyCentre’s site to learn more about membrane sweeps.
• Once my cervix is dilated to 4 cm, my OB will break my bag of waters.
Basically, so long as my body cooperates, Dr Piparia is willing to let my body go into labor as naturally as it can during an induction. And I’m thrilled with that idea! Speaking to her further, she’s also on board with the possibility of doing “delayed cord cutting” as well, so long as Abbi is doing well immediately after birth. If she’s pink and perked up, they’ll allow me to put her skin-to-skin, and will delay clamping/cutting the umbilical cord until it’s finished pulsing, allowing her to receive ALL of the blood from the cord.
Taking everything into consideration, I was ecstatic leaving the appointment!! While we still have some major hurdles to jump with regards to the labor and delivery process, the fact that Dr Piparia is so willing to try and let my body do the work as naturally as possible sets my mind much more at ease. She does want me to come in for weekly appointments from now until delivery which sucks since we live an hour away from her office, but given the circumstances, she wants to monitor Abbi and I more closely than usual; I kinda half expected her to want to do that anyway.
Now if every OB appointment would go this smoothly…