Do You See What I C?

**Warning. Frank talk about c-sections, innards, and other woman-stuff details pertaining to pregnancy and delivery. And I use the word 'vagina.' Might be TMI for some people.**

My first pregnancy and birth were what my husband and I jokingly referred to as a "Mary Poppins pregnancy." No morning sickness, no stretch marks, no grody varicose veins. All my previous ailments went away - seasonal allergies, lactose intolerance, citrus allergy, migraines, clinical depression, carpal tunnel, acid reflux, etc. You name it, it either went away, or was severely reduced in effect (I got the acid reflux back the 3rd trimester, but it wasn't ever as bad as it had been before I started taking medication when I wasn't pregnant.) And apparently I was rockin' a mighty fine preggo body, judging by the dagger-stares and muttered cuss-words from my sisters when they saw me prancing around in my undies one time. And while I started dilating early, at about 7.5 months, everything went well and she went to term with no complications or bedrest and was only born 3 days early. And as an added bonus, I got a bunch of extra ultrasounds and non-stress-tests where I got to see and hear her, just to make sure she was still doing okay the whole time (which she was.) Scoooore!
One of my Grandmas had super-easy, quick, pain-free labor, and it appears I inherited something similar.
That combined with my wide 'birthing hips' and my cervix pointing the right way made delivery fairly easy. The only tough part was the back labor, but overall it was only 11 hours from when I started timing contractions (while finishing a dungeon in Warcraft!) until she was born.

So other than my inability to actually GET pregnant, my body is apparently designed to BE pregnant!

Which totally paid off with this one. We had so many freaky little complications going on in my uterus, I'm amazed nothing 'bad' happened. Truly. First up was the 12-week ultrasound (part of a new test called a Combi-screen, with a very painful finger maiming blood draw combined with a high-detail ultrasound at a specialty high-risk clinic. This guy does all my ultrasounds. He's a doctor, so I get the information right away, as he's seeing it, rather than the technician doing it then having the doctor come and consult me about it later. And this guy is GOOD. He can check for Downs Syndrome, Spina Bifida, Cleft Palate, even Club Foot!) He found a twin remnant, which was kind of sad and freaky, since I hadn't known that the other embryo had attached at all. He also thought he saw a velamentous cord insertion and maybe a little bit of placenta previa. He said we'd check again at the 20-week ultrasound. Now, I'm still not sure what exactly a velamentous cord insertion is, and I was advised by my sister not to look into it too much. My husband looked it up a little. Something about where the cord attaches to the placenta, which makes it more likely to have an issue, thus leading to lower birth weight, and a slightly increased chance of miscarriage. And during labor, if the cord happens to be between baby and the cervix, then a vaginal delivery is unsafe, as the baby could suffocate herself by pressing against the cord. Placenta previa I knew some about. It's where the placenta covers some or all of the cervical opening, which is a risk when you start dilating, as it could burst a blood vessel, causing baby and possibly Mom to bleed out. Bad news.

At the 20-week ultrasound, he confirmed both the velamentous cord as well as the placenta previa, which was now a 'full' previa (which I think means covers most or all of the cervix.) Plus, as an added bonus, my placenta was a freaky shape, resulting in a bi-lobal placenta. Basically, instead of one big grody lump, I had 2 smaller grody lumps, connected by a thin bridge of placenta. One of these lobes was on my cervix. Yay. The major complication with this condition is low birth weight. Luckily, she was holding firm at just a little under 50th percentile in size. Now, we still had another 20 weeks to go, and with the uterus growing, it was still possible for the placenta to move off of the cervix, thus negating the need for a planned c-section. One could always hope! Plus this meant I got an extra ultrasound at 30 weeks! Another chance to see my beautiful baby girl!

Well, it was all confirmed at 30-weeks, so I switched from my midwives to an OB I had seen in the past for a surgery to remove polyps from my uterus a few years ago. (Yeah. Fun.) Plus she delivered my youngest sister's first child, and my mom and other sister had seen her as a patient in the past as well. I joked that she's seen 2 generations of vaginas in my family! One of the great things about my new OB is that she's very much an advocate for women's health and her patients. She listens to her patients, and she would rather do some extra unnecessary tests rather than not do enough tests. Plus she really knows her stuff! She was asking about things I hadn't ever even thought of (plus some I had wondered why the midwives weren't doing too.) And because of all the fun placental and cord anomalies, she talked about possibly doing an MRI to look for placenta accreta (where blood vessels in the placenta are attached to the uteran wall and require surgery and cauterization to remove!) which no one else had thus far even thought about mentioning. Joy.
The down side is that because she's so awesome and truly cares about her patients (if one of her OB patients goes into labor while she's working, even if she's not on call, she does their delivery!) her schedule is packed, and she is usually running behind, which results in a loooooong wait under that little paper sheet!

At the tail-end of 36 weeks, we did an amniocentesis to see if Little E's lungs were mature enough to do an early delivery. Nowadays, any planned delivery earlier than 39 weeks pretty much requires an amnio. My OB had wanted to do my c-section earlier in the 37th week (12/19,) but the OR was totally booked that day, so I was put on a waitlist. The earliest opening that fit into her schedule wasn't until 37w5d, on 12/22. The amnio is usually done the day before the planned c-section, except I was waitlisted for a Monday delivery, and they don't do amnios on the weekend. So I went in the Friday before (12/16.) And as it turns out, despite the amniotic fluid looking cloudy and mature, she was considered 'transitional.' Which meant her numbers were higher than a definite 'not mature,' but not yet at a number that meant definitely mature. The amnio doc called me after hours (!!!) to discuss the results, and said that a delivery on our scheduled date of the 22nd should be fine. And then my OB called me after hours and said the same thing. So since I wasn't having any complications or reason for an emergency c-section earlier, I got off the waitlist for the 19th and we stuck with my scheduled time on the 22nd.

But despite these potential problems (and my previous history of early dilation,) my cervix stayed closed, there was no bleeding, and she continued to grow and thrive in there, as healthy as can be. My OB told me that with all the hot mess going on up in there, she was quite frankly amazed we got to wait until our scheduled c-section at 37 weeks 5 days.

Once I found out I pretty much had to get a c-section, everyone who'd had one tried talking them up. But no amount of someone else loving them was going to change my mind about not wanting one. I was WILLING to get one, for the safety of my baby, but I certainly would have preferred the messier, more painful, longer recovery, and less needle-y vaginal version! In fact, I almost managed to go needle-free with my first one! I caved after about 10 hours of back labor and not dilating (I had started at 4.5-5cm going in, from the extra month and a half of dilating on my own) and asked for an epidural, just so I could rest a little. During the 20-minutes on a lactose ringer IV to rehydrate me first, I banged out to 9.5cm and powered through without the epidural. Yay!

Anyhoo, no amount of 'Oh my recovery was SO easy!" or "It was so nice being pain-free" could convince me that I wanted a c-section. I have a needle phobia. Now, most people say that they are scared of needles. But for me, it's an irrational fear. Inside, I'm screaming. My fight-or-flight instinct kicks in. I have a physiological reaction which causes increased heart rate, cold sweats, dizziness, nausea, etc (called a vaso-vagal reaction, apparently.) With all the rigamarole involved in getting IVF (loads of blood work, shots, etc,) I've pretty much managed to man-up for routine stuff. But I really hate needles that stay in my body, like with an IV. And needles that go in freaky weird places, like my mouth at the dentist, or in my frickin' SPINE! And I especially hate having to be cool and cooperative. I prefer my surgeries to be the kind I get to sleep through. Then I only have to think about needles in my flesh for a short time before it's all over and someone's feeding me ice chips and juice.

The anesthesiologist told me that if I started freaking out too much he'd knock me out. Normally, I'd be a big fan of that. But it takes longer for the grogginess to wear off, and I wanted to be there for Little E as soon as humanly possible. So while I was totally freaking out inside (seriously. I almost lost it a few times,) I focused on breathing. And trying to eavesdrop on my OB and her assistant MD. Who were doing their level best to talk too quietly to be heard. Meanwhile the anesthesiologist and one of the nurses couldn't stop jabbering on about their kids or something, which was totally annoying. My husband and doula did their best to keep me distracted and breathing (my doula reminded me right at the start to breathe, thus earning her paycheck all on its own. I totally would have freaked out without her there reading my body language and knowing when to help calm me down and when to distract me.) I originally had lofty plans to hold baby skin-to-skin in the OR, while they were closing me up, but really it was all I could do to not start screaming and flailing around in a panic. I didn't have the energy to focus on anyone but me. So it was nice to have Hubby in there to hold her and make sure no one swapped her out or anything. And it was nice having my doula there to make sure my husband didn't bumble around ineptly, and to check on the happenings on the other side of the drape. And to make sure I didn't go stark raving bonkers and get put under.

Cons of Having a C-Section:

• Pretty much everything. 
• No food, antacids, or WATER for 8 hours before. So basically I had to lay there sitting up; hungry, parched, and acid-refluxy, all night. Well, okay. Until 5am, when I had to get up and get ready to go to the hospital. Between that and trying to share my childhood twin bed with my daughter at my mom's house (so we wouldn't have to get her up and out the door early to take her there that morning,) I got, like, 5 minutes of sleep total.
• The Shakes. I had the shakes pretty bad for a while after. My doula had disposable hot packs she was using to help warm me up, but it took forever for the shivers and shakes to go away after I was back in my room.
• Catheter. Oh yes. Did I mention that these involve catheters? Apparently they do. And actually it wasn't so bad... until they took it away and made me get up and go potty on my own after spending a day blissfully staying hydrated. Heartless monsters.
• She took my uterus out to make sure she got everything. Which apparently can cause extra cramping and gas. And, boy howdy, did it!
• Needles. 
• Needles in my spine. 
• An IV that apparently required three attempts to put in. And then she ended up having to put it on the side of my wrist, where it was very uncomfortable whenever I bent my wrist. Like when trying to hold my child, for example. And then I had to keep it in for an extra day, just in case. Two weeks later I still have a scab on my wrist from where the needle got ground around in my flesh for 3 days. *shudder*
• Slasher-flick on my abdomen. 
• Having to be awake and not totally freaking out throughout. Gaaaaah.
• Plus for the first two weeks, it felt like everything was put back in the wrong spots. Freaky.
• Did I mention that she took my uterus out of my body?!

Pros of Having a (Scheduled) C-Section: 

• Being able to make childcare plans for the older kiddo.
• Extra day at the hospital.
• Being able to sit without the aid of an inflatable donut for the first few weeks.
• It stopped looking like there was a crime scene in my pants by Day 5.
• She was already all up in that when they discovered that I had placenta accreta after all, and she had to do some emergency cauterization and other fun stuff to get the placenta out and stop the bleeding.

Would I do it again by choice? Hells no. But, as luck would have it, due to the placenta accreta, I now have scar tissue or something on my uterus. Apparently on the cervical area. So if I get pregnant again, and the placenta happens to attach at that scar tissue (which is likely, apparently,) then it's pretty much guaranteed that I'd lose my uterus. And since it would be on my cervix again, I'd need another c-section. And even if somehow magically the placenta grew somewhere else, if I started dilating or tried for a vaginal birth, there's a chance that the blood vessels near my cervix could rupture anyway or something. So I'd be safer going for a c-section again and not risking it. Gah.

But I would trade my monthly visitor and the probability of not getting to have more kids in a heartbeat in exchange for another little one! And if I have to be disemboweled one more time for the safe delivery of my little miracle, then it's a price I will, once again, pay gladly.

The $15k price tag to get pregnant again, however, might be a deterrent!