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06/01/2008

OH MY GOD THERE'S A SIX-INCH GASH IN THIS POST

It is a truth universally acknowledged, that a ridiculously bulbous woman in possession of a third-trimester fetus must be in want of some way to get that sucker out.

I am at that point myself.  At almost 31 weeks, I am being made aware, gently but insistently, by my care providers that sooner or later this baby is going to have to come out.

Improbably, in this respect my last pregnancy was easier.  Before 14 weeks or so, I hadn't been truly convinced I'd actually deliver a baby.  Between then and 20 weeks, I had no reason, when I was so bold as to consider it at all, to assume anything but a vaginal delivery.  After 20 weeks, at which time I was diagnosed with complete placenta previa, I knew I'd have no choice but a C-section.  No decisions.  Easy.  This time, not only do I seem to have the luxury of choice, I have the burden of it.

Off the top of my head, I've made a quick list of the pros and cons of each of the options available to me as far as delivery goes.  I am aware that it is not an exhaustive list, and, indeed, that it is a heavily biased one.  It is also, as it happens, a largely unsubstantiated list, since I'm on vacation and unable to add supporting links as I'd normally try to do.  Trust me...if you dare...especially when I tell you that I've based it on my own medical situation, my own personal neuroses, and my own highly specific areas of intelligence and ignorance.

Planned C-section
Pros: Predictable.  Overall risk to the baby, across the spectrum of all outcomes given my history, is minimal.  Risk to me ditto is minimal, except for the whole troubling OH MY GOD THERE'S A SIX-INCH GASH IN MY ABDOMEN thing.
Cons: Recovery would be more difficult and protracted than from an uncomplicated vaginal delivery.  Evidence that establishing breastfeeding can be more difficult after a C-section.  Possible respiratory problems due to gestational diabetes could be exacerbated in babies born without the healthful lung-squeezing benefits of a vaginal birth.

Spontaneous labor, vaginal delivery (VBAC)
Pros: I would be given a once-in-a-lifetime chance to reestablish my faith in my body's natural reproductive abilities.  Hahahahaha, ohhh.  How I do love to laugh.  No, it's this: My lifelong dream of an unattended home birth could be realized at last.  No, wait, that wasn't it.  I've got it now: OH MY GOD THERE'S NO SIX-INCH GASH IN MY ABDOMEN.  Healthiest, most desirable possible option for the baby and me...if possible.
Cons: Unpredictable.  Some risk of uterine rupture.  Some risk of injury to the baby, who is currently measuring in the 90th percentile for size, a risk that increases as he gets bigger.  Also, the possibility always exists that the so-called trial of labor -- which always reminds me of trial by fire, trial by ordeal, and trial by tying-a-giant-boulder-to-a-suspected-witch-to-see-if-she-can-float -- could fail, landing me with a C-section regardless.  And this is truly, truly a minor consideration in the grand scheme of things, but I would be remiss if I did not mention that OH MY GOD THERE COULD BE A SIX-INCH GASH IN MY NOT-ABDOMEN IF YOU KNOW WHAT I MEAN AND I THINK YOU DO.

Induced labor, vaginal delivery (VBAC)
Pros: Predictable, within certain parameters -- at the very least, they tell you what time to show up at the hospital.
Cons: Significantly greater risk of uterine rupture than with spontaneous labor, and the attendant risk to the baby that that entails. There is also the risk of losing my uterus entirely; when I asked about an induced VBAC, my OB paused and judiciously asked, "Well, what are your plans for future childbearing?"  Like, Are you looking to use your uterus for anything baby-related after this, or would it be okay for us to take it out, give it a quick once-over with a damp sponge, and give it to you to use as a stylish change purse?  Additionally, I have heard tell that induced labor isn't quite as much fun as you might think it is when you hear words like "excruciating pain" and "cervix no riper than a January melon" and "holy Jesus fucking Christ I asked you to do this!?"  The induction could fail, and/or the trial of labor could fail, meaning I could end up with a C-section on top of it all, exhausted, grouchy, and HEY WOULDJA LOOK AT THAT GASH.

Now, should I become ill — Feelin' fine!  How 'bout you? — and need to deliver swiftly, a neat and tidy C-section is obviously the way to go.  Under those circumstances I'm not at all apprehensive about surgery; getting the baby out quickly and restoring my own body to pre-pre-eclamptic equilibrium will be of far greater consequence than any missish reservations about a couple of weeks of postpartum inconvenience.  And given the fact that I've already had a C-section, and have gestational diabetes, my chances of needing a C-section this time around are greater than they'd be without these factors.  So in those respects, my options aren't boundless.  All things being equal, my very first, fondest choice would be for a VBAC after spontaneous labor.  But "all things being equal," or in this case, "easing seamlessly from a healthy pregnancy into a full-term but not-overdue labor with the baby in no distress, in the correct position, and juuust big enough but not too big" seems like asking an awful lot.

However, even taking the last option — induction — off the table completely, because I'm not comfortable with the elevated risk of rupture, it is strange and exciting to believe I have even a modicum of choice.  I know plenty of second-time mothers plan immediately for this or that depending on their previous experience, but I've enjoyed the unaccustomed freedom to turn these matters over in my mind for the last few months.  Even now — I was tempted to write "at this late date" because, damn, I've never been this pregnant before, but really it's not that late — I don't need to make a decision.  Overall, that's good, because I know perfectly well that this feeling of control is an illusion, given how quickly the game can change, and I don't intend to get too deeply entrenched in any one position.  But at the moment it's thrilling to imagine I still have options, that my preferences might actually matter, and to mull over them happily, and to revel in each day I can put off exercising any of them.

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