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...