Juno has arrived

Well, I am no longer awaiting Juno, she has arrived, not in the way I lobbied for - elective cesarean at 39 weeks, but rather on her own without an epidural, after 5 hours of labour. She is a healthy baby who I love being a mom for...and my dissatisfaction with her birth is strictly limited to her birth and not the outcome. I have a healthy baby, but realistically I would have had a healthy baby either way. I am disappointed that the health system failed us, she waited until the surgery date, even the day after, but we got bumped and when she decided to come on her own, there was no anesthesiologist available due to other emergent surgeries. I'm coping with the aftermath, but also struggling with the need to continue to defend my original choice, even after it didn't materialize. I get no end of well meaning people telling me that it was for the best that I didn't get the csection. To that I say bullshit.

So what have been the consequences of having my autonomy completely disregarded and being subjected to a vaginal birth that I did not want?

1. I do not reflect upon her birth with happiness, rather I find such reflection stressful, my jaw tightens and I find it difficult not to get tearful. I associate it with being unprepared, being in immense pain, being out of control, and fear that things might go sideways that there might be long-lasting repercussions.

2. A sense of loss. Loss of autonomy, loss of experience, loss of the way I was.

3. Uncertainty around wanting a subsequent child - before this I thought I'd want two kids, now I'm not sure.

4. A sense of being let down by my care providers and the system.

Having experienced a vaginal birth, and having experienced open abdominal surgery, in hindsight I truly wish I would have been able to achieve the birth I had wanted. I wish my child would have been born in the calm environment of a surgical theatre, I wish I hadn't had to feel her passing through me - changing me in ways I didn't want to be changed, I wish I had felt in control of what was happening, I wish I had felt prepared for what would occur. I wish I could have stood on the other side of the experience, proud of the choice I made and it's consequences - but instead I stand on the other side somewhat alone as a woman who wanted the opposite of a natural birth who got a natural birth (fentanyl and gas do little for the pain of labour and delivery).

I love that I have a healthy daughter - however, I am not as well off as I would have been had I been able to achieve the birth I wanted.

Officially no longer @ work - let the last minute planning and prep begin!

Friday (June 25) was my last day of work at work. While I have this week off, I officially start maternity leave on July 4. So until July 2011, I am a 'free' woman. The weekend was like any other weekend, but it was odd not heading to the office Monday morning.

That being said, things are now getting done that haven't gotten done just because I haven't had time to do them. The master bathroom finally got cleaned out - with all of the expired and ancient (never going to use them) things thrown out. The laundry is actually 'caught up on' and our bed actually got fresh sheets and made. Further the floors got cleaned... The baby stuff is also all organized and I even have managed to buy some clothes for my step-daughter to get through the summer.

Even the miscellaneous administrative stuff is getting done. I might even get around to some of the other projects I've been meaning to get to (ie. wedding album and baby book) if this bean sticks to the plan.

A birthdate is set...

Well at about 39 weeks gestation the bean will join our family by way of a planned c-section! I'm quite happy to now have a plan with respect to her birth...and feel like I can now get all the details into place. Best of all, my biggest fear (being told that my decision to have my child by c-section wasn't possible) is now behind me.

35 weeks down - 5 to go

I now have a referral to an OBGYN and soon will know whether or not my request/desire for an elective-c will be respected or if I'll have to ask for another referral to another OBGYN. Although given the timelines (I'm now 35 weeks and 2 days and will be 36 weeks and 2 days when I meet with the OBGYN), I'm a little nervous.

The last prenatal went well - my weight was actually down a pound, which I guess means I haven't gained anything in the last 5 weeks - but overall I'm up 26 pounds from where I started and the doctor doesn't seem to worry. The baby is quite active and my energy levels have been good. Further, my blood sugars seem to be well controlled.

I've only got two more weeks of work to go...so soon that part of my life will be on pause although I would like to remain active in some capacity while on maternity leave.

Yesterday I bought the baby a long-sleeved onesie that says 'Bean' on it and next week the long awaited Bumbleride Indie will arrive into our home. It's hard to believe but this pregnancy is very nearly now done and soon our household will have one more person in it...

33 Weeks down 7 (at most) to go...

The prenatal appointments are now every two weeks, had the last one yesterday and all was well. I'm up a pound over where I was 3 weeks ago at my last prenatal appointment (I had been up 10 pounds over the previous 2 months, and I'm up 25 pounds over the course of this pregnancy). Baby's heartrate was 145 and my blood pressure was 122/80 so all is good.

I got a referral to an OB/GYN and am waiting to hear back as to when that appointment will be. I will have to have all my reasons for an elective c-section gathered for that appointment, along with all of my supporting documentation...and then cross my fingers that the OB/GYN will be supportive of my request. For all those who think it's about being "Too Posh to Push", they really haven't looked into the issue and how complex it really is. There are risks either way. There is pain either way. There really is no perfect way to tell which way is best for any given woman or any given child before the event and all that remains is what would be best in retrospect.

In this context, is it really possible to make a truly informed decision? I mean, I do not know for certain what a planned vaginal delivery would yield for myself and my child, nor do I know for certain what a planned c-section would yield for myself and my child but it seems that there is greater certainty of experience, comparable risks for myself and less risk of truly adverse outcomes for my child with a planned c-section.

Glucose Intolerance

So I flunked my 1 hour GTT at 30 weeks (a pass would have been a score of 7.7 (140) or less, I scored and 8.1 (149)), apparently many women do not pass this test. I met with the nice people at the VGH, as my doctor does not subject people to the 3 hour GTT and was set up with a blood glucose meter and spent some time with a dietician. I am to keep a log of everything I eat and my blood glucose readings (4x a day) over the next week or so. So while a diagnoses of gestational diabetes has not been made, I am 'glucose intolerant'. In general the diet modifications are pretty basic - more protein and less carbs at breakfast (no more big bowl of cereal in the morning for me - now its PB and whole grain toast or whole grain toast and eggs...actually more protein and less carbs in general and less fruit and more vegetables. Oh and of course avoid high concentrations of sugar - so no dessert for me and no more than a half a glass of juice per day. What's surprising is that diet pop is apparently better than mixing juice with club soda.

So far so good, with none of the numbers showing up as being inordinately high, but it has only been 2 days so far. I want to avoid an official diagnoses of GD - so I will likely try to behave myself as much as possible.

Oh and one other thing, my iron levels were low so now I'm on a iron supplement - which should help with my energy levels.

Aside from that the Juno bean seems to be doing well - she's most active first thing in the morning and last thing at night.

Personal reasons why I want an elective c-section

For myself, personally, I am confident that an elective c-section at term is the decision that maximizes my overall welfare and that of my child given my preference for certainty of my birth experience (a very strong desire to avoid a long labour that results in a c-section anyways), an improved ability to prepare myself both mentally and physically for the birth of my child and a desire to avoid damage to my perineum and pelvic floor. This decision is in the context of planned fertility that includes potentially no more than one future birth and research that shows no statistically significant difference in maternal morbidity or mortality for a healthy nulliparous woman giving birth at term and lower risks for the infant (Dahlgren LS, von Dadelszen P, Christilaw J, et al. Caesarean section on maternal request: risks and benefits in healthy nulliparous women and their infants. J Obstet Gynaecol Can 2009;31(9):808-17.). It is also in the context of the variability of birth experiences of my family and friends – I have friends who have had the fairy tale birth where recuperation is swift, I have also had friends who have had attempted vaginal births that have resulted in c-sections, those who have had elective c-sections for breech birth and those who have had difficult vaginal deliveries that required lengthy recuperations and subsequent surgeries. For myself, personally, I would feel disempowered and violated if I were told that my chosen method of birth (given an understanding of the risks and benefits involved) was not an option that was available to me. To be completely honest, at this point in time one of my greatest fears is that my request for an elective c-section at term (39 weeks or greater) will be denied and that I will be forced to undergo an experience that I do not desire with the potential to result in a birth experience that I would prefer to avoid.

The Many Reasons to Prefer an Elective C-Section

My mind still hasn't changed on this topic - I still want an elective c-section. I am hoping that this is an option and that my decision will be respected. My Dr. will be giving me a referral to an OBGYN at my next prenatal appointment (at 33 weeks). I hope that the OBGYN will be receptive, as frankly trying to find one who is when I'll be less than 7 weeks from my due date seems to be a daunting challenge. I want to avoid a vaginal birth as fiercely as many women want to avoid a c-section. The ironic thing is, that women who want vaginal births even in light of circumstances that are likely to merit elective c-sections (VBAC, breech) are likely to be more supported than the woman who wants a c-section in the absence of any medical reason.

So what do I perceive to be the advantages of an elective c-section:
1. Avoidance of pelvic floor damage and tearing.
2. Avoidance of going through an extensive labour and needing a c-section anyway.
3. Ability to mentally and physically prepare for the delivery.
4. Minimization of very adverse birth outcomes for my child.
5. Ability to organize support resources for my recovery.
6. Control over the experience.
7. Minimization of the risk of sexual dysfunction.

My understanding is that overall the risks (to the mom) of the two birth methods are relatively comparable, particularly in light of the fact that many planned vaginal births do not result in unassisted vaginal deliveries.

Thinking about blogging publicly...

Right now I blog anonymously - the blog is public but those who know me, don't know I blog. I'm nervous about letting the cat out of the bag and informing those who know me of my blog. In part I'm nervous because I know I hold some opinions that may be at odds with the opinions of others - and I also know that some of those opinions are on topics considered to be 'sacred cows'. I worry that I might offend or alienate some people who I truly value as friends and family.

On the flip side, a blog would be a great way to keep family and friends in the loop as to my life...

However, given that I like writing about the controversial, if I wish to keep my family and friends I would be best to keep my blogging quiet - as I am really not inclined to write more than one blog.

Bubble wrapped mommies - the 1st Batallion of the Pregnancy Police

I've discovered that by being a mom-to-be who is willing to take some risks where the dangers are very remote (ie. having the occasional glass of wine in late pregnancy, continuing to eat sushi and raw oysters from reputable places, indulging in soft cheeses from time to time, etc.), I'm unconventional.

There seems to be a growing contingency of moms-to-be who take a near religous vow against doing anything that might remotely pose ANY risk to their unborn child. They begin their parental sacrifices even before the first diaper is changed...and often they do these things in the face of statistics that clearly demonstrate that what they are doing is unlikely to be of any benefit to their child. They go through their pregnancies suffering from morning sickness out of fear that Dilectin might be Thalidomide in disguise, they refuse to take any cold medication because it might pose a risk and they do not investigate what options might be available to them to ease their suffering, they go through labour without drugs and fiercely resist c-sections, they give up all alcohol, coffee, raw fish and sushi. They refuse to eat anything that isn't organic and they won't go near a manicure/pedicure or hair dye. Moderation is not sufficient in their drive to be the perfect gestator and to give their progeny the absolutely best chance in life - no risk is too small to be avoided. It's amazing that many of these women don't spend their entire pregnancies in a riskless remote biodome.

And for the most part, I couldn't care less about the decisions these women make with respect to their pregnancies and their children-to-be - it is after all, their body and their child and their right to do so. The bit I have a problem with is that many of these women feel a need to look down upon those mothers who refuse to take the same approach to their own pregnancies. They view the women who do not make the same sacrifices or decisions as being lesser moms than themselves - and there is the rub.

Modern day bubble wrapping of children begins in the womb...after all its never too soon to start instilling the sense that the world is a very dangerous place that is to be survived by taking every possible precaution and refusing any experience that might bear some risk.

A Pregnant Woman IS Still Capable of Making an Informed Decision

One thing I've noticed since becoming pregnant is that EVERYONE is willing to offer you his/her advice on a topic and may become quite possessive over YOUR body. Don't get me wrong, I'm all for helpful information that helps me to make a better decision but at the end of the day I still want to make the decision for myself and I want to base it on information that I consider to be reliable. Perhaps I'm noticing this more than the average as I'm a somewhat unconventional mom-to-be.

I don't believe in bubble wrapping myself or ensuring that I'm a perfect gestator - rather, I believe in taking reasonable steps to a healthy pregnancy and baby. I believe in moderation. I believe in looking at what the evidence has to say (if it's reasonable to look at the evidence) before making up my mind as to what is best for me and my baby. By evidence, I mean scientific journal articles, experts or personal experience (my own). I also believe in still living my life and living it in the context of being a mom-to-be. My life hasn't been risk-free to date, but rather I have prided myself on taking calculated risks - ones where the value of the benefits (to me personally, in my own context) are likely to exceed the expected harms (to me personally, in my own context) and as a result I believe I have been a much happier and well balanced person who is more satisfied with the decisions I have made.

So at the end of the day, what does this mean for me and my bean? Well it means I still eat sushi (from reputable places) and raw oysters (again from reputable places) but I stay away from steak (I stay away from steak because the bean seems to reject it, not because of any other reason). It means that I have had up to 1 drink (and only one) on occasion with food since my 5th month of pregnancy - but that I drank very moderately between the time I knew I ovulated (no more than 2 drinks on any occasion) and the time I got the positive pregnancy test the day before my period was due and completely abstained from alcohol between the time I got the positive pregnancy test and the middle of my second trimester. It means I still eat cheese, soft cheese, delicious cheese - but I read the label to make sure that it's been pasteurized. It means I was more than happy to go to Europe with husband when I was 6 months pregnant and to Mexico when I was 4.5 months pregnant. It means I've decided an elective c-section is my birth plan of choice. It means I nap when I'm tired and eat when I'm hungry and stop eating when I get the one-bite warning. It means I still enjoy one cup of coffee from time-to-time. It means that when I have a question, I ask my doctor and follow her advice. It means that when I have heartburn (and boy does this Girl love giving me heartburn), I take something for it. It means that I don't stand in lines waiting for things without moving my legs and that I don't leave the house before I've eaten as I've discovered that I'm likely to black out in these contexts. It means that I still enjoy going out with my husband, even though we may be out late. The bottom line is, that I've enjoyed being pregnant and that I'm looking forward to meeting my child and that I haven't spent the last 7 months constantly worrying about every decision I've made.

I hope I can apply the same philosophy to parenthood...otherwise it might be a very anxious 18-20 years...

I would seriously prefer an elective c-section

I've read about 'normal birth', I've read about 'emergency c-sections', and I've read about 'elective c-sections'...after all that reading I've come to the conclusion that in the absence of riskless fetal teletransportation, I would personally prefer an elective c-section at about 39 weeks gestation (ie. in about 12 weeks time). I am part of a small minority (1%) of women who would like to request an elective caesarean section to deliver this child. This post is about the reasons why I feel it is a good choice for me in my personal circumstance (ie. healthy married woman, well-educated in early 30's, not planning on more than 2 kids, etc.)...

I want to start by saying that birth is an immensely personal experience between a mother, a father, a doctor, and a baby - and that what may be an appropriate choice for one may be an inappropriate for another. I think women should be empowered to make decisions regarding their birth plans that are best for them and their children.

First, I think I will go into why I really don't want a vaginal birth as much of my reasons for wanting an elective c-section have a lot to do with what I don't want my birth experience to be. I know women have amazing vaginal birth experiences in which their child is brought into the world and their abilities as women and mother are affirmed and they bounce back from their experience with amazing post birth recoveries. That they experience a delivery that while not free of the pain of labour and delivery, is relatively free of any other complications. After the birth, they instantly bond with their pink little bundles of joy and begin lactating within minutes. I know that this is a birth experience that some women experience - that what they plan for in terms of their birth experience is what they get. These are amazing women who really should go into the business of having babies as they do it remarkably well. So given this kind of fairy tale is possible - why in the world would I not be open to it?

REASON 1: Risk and Uncertainty - there is a substantial risk that what is planned for is not what is obtained in the world of planned vaginal childbirth. Many women plan uncomplicated deliveries and get labours that don't progress, umbilical cords that prolapse, fetuses in distress, 3rd or 4th degree tears, episotomies, pelvic floor injuries, emergency c-sections, exhausting labours, sexual dysfunction, etc. Yes the planned vaginal birth that goes off without a hitch is a beautiful thing but it is far from a certain thing and it is also far from reality for many women. I would never stand in the way of a woman who wishes to pursue this experience, despite the risk of being given an entirely different experience or other unwanted side effects of a vaginal delivery.

With an elective c-section I know what I'm getting into. Some risks that are higher than the fairy tale vaginal birth but some risks that are lower and eliminating the risk of an emergency c-section. I know that recuperation will take longer than with a vaginal birth...but I will be physically and mentally prepared for it. I know that the risk of sexual dysfunction is lower. I know the risk of urinary or fecal incontinance is lower. I know that the risk of pelvic organ prolapse is lower. I know that the risks of some birth traumas are lower. I know the risk of tearing is eliminated.

If I can choose to have a home birth, why can't I choose an elective caesarean? If I can choose to have any number of other elective surgeries with similar risk(all be it at a price) - why not c-section?

The 3-D Baby Bonus Ultrasound

This past weekend husband, stepson, myself and the bean went and had one of those 3D/4D ultrasounds done at the local 3D baby. Unlike a medical ultrasound, they can't give you any measurements or do anything diagnostic, but also unlike a medical ultrasound you can have more than your husband/adult other support person with you during the appointment *AND* you don't have to drink a gallon of water beforehand. The other difference is, you have to pay for the service - but given that we got a 20 minute ultrasound, 42 pictures on CD of our little bean, 2 printed pictures (a little on the small side, but with a photo printer at home its no biggie) and a DVD recording of the bean for $179 (plus tax) it really wasn't such a bad deal. My mom and my sister LOVE the in-utero pictures of their granddaughter/neice...

Our bean seems to be doing quite well at 26/27 weeks into the pregnancy...she's forming all those cute baby bits and appears to have all her fingers and toes.

The Backstory

So about 10 months ago we decided to become parents and my wonderful husband got replumbed to enable us to have a child together. He already had two kids and was half-way done the whole parenting thing (kids aged 8 and 12 at that time) - so I was and am very happy that he was open to starting again at diapers as I did not have any kids of my own.

He was under the very competent and capable hands of Dr. MacAuley and Dr. Taylor and while the hit to the bank account ($4800) was less than welcomed, the end result (should it succeed) would be more than welcomed. Note to anybody out there considering surgical sterilization - bank some, it's likely cheaper and less painful than undoing the decision later because while the medical system covers the vasectomy, when it comes to undoing it you are SOL. I was hesitant that it would work, or at the very least that it would work anytime soon, meanwhile DH was more than confident that he'd be impregnating me with nothing more than knowing glances across the room, I mean the first two kids he had weren't exactly planned. I was anticipating a year of trying before getting 'knocked up'...I was thinking well maybe by March 2011 I'd be bringing home baby W. Baby W is expected be joining us this July.

So the purpose of this blog is mostly to provide a place for me to type out my thoughts on new motherhood, stepmotherhood, pregnancy, parenting, life in general, etc. It's so that I can look back and know why I did what I did when I did it, and answer that inevitable question: What was I thinking?