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07/09/2008
I think I will call him Dr. Iron Fist in My Velvet Glove for short
It is common for bloggers to refer to their doctors with colorful nicknames, both to maintain a modicum of privacy and to distinguish in their posts between "my doctor" — Dr. Pretty Sure He's God — and "my other doctor" — Dr. Also Pretty Sure He's God. I haven't done that much here, although I've done so in my head; when I've written about my treatment, I haven't really required differentiation between, say, Dr. Didn't Even Laugh at My Jokes Much Less Get Me Pregnant, Dr. Head Is a Mathematically Improbable Perfect Cube, and Dr. You Know I Really Like You and Think We'd Probably Be Friends If Circumstances Were Entirely Different and I Weren't Your Patient and I Didn't Feel a Flare of Fight-or-Flight-Style Panic Every Time I Think of You.
Which is a good thing, because I don't really feel I have the knack for this nickname thing.
Anyway, I had an appointment earlier this week with a doctor who gave me my first manual cervical check of this pregnancy, which is to say my first manual cervical check of any pregnancy. May I introduce you to Dr. Worked Me Like a Sock Puppet?
Like any good doctor, he told me what he was going to do before he did it, and I certainly understood the mechanics of the operation, but I did not know it would be done without the aid of any lubrication whatsoever, and although I thought I had a working understanding of the female reproductive tract, I guess I did not realize that my cervix is located somewhere in the vicinity of my aorta. But reach it he eventually did, wearing me like an eighteen-button glove, and he verified that there is nothing going on, not even rural electrification, in that remote uncultivated stretch of Upper Julie.
Which is also a good thing, even if it took quite some time for him to return with the news.
He also did me the favor of checking for group B strep — inarguably a very serious matter, as Julia of I Won't Fear Love writes at Glow in the Woods. This involves the brief intromission of one swab into the vagina and another into the rectum. Again, he warned me what to expect, so I was prepared for the onslaught. I was not, however, prepared for him to tear off his lab coat, shake out his mane of wheaten curls, and hit me in the delicates with that.
Which is yet again a good thing, because if I'd had any time to think about it, I would have felt awfully silly calling a well-respected medical practitioner Dr. I Already Know That Tan is Fake But Holy Shit What About That Package? (In the heat of the moment I simply settled for Dr. According to Johnson and Johnson That's Not Supposed to Go Alllllll the Way into the Ear Canal You Know.)
Finally he consulted my records, including my last couple of growth scans, looked at me with a practiced eye, and said, "You know a VBAC is probably off the table, right?"
This was not the first time my OBs — from Dr. Blue Eyes Made Perpetually Watery No Doubt by My Unparalleled Radiance through Dr. Marvels at My Bruises Every Time I Lift My Shirt Like I Get It Doctor I Am on Anticoagulants For God's Sake, on down the long, long line to Dr. Puts the Fun in Fundus and the Party in Parturition — have floated the probability of a C-section. Every time they have, I've made it clear that I am not averse to the idea, and that my first priority is the baby's well being, but that my preference is to wait as long as possible before making that call.
It is beginning to seem that the time for a decision is near — or rather that the leeway in which there's a decision to be made is dwindling. This baby, according to every growth scan I've had, is big, 95th percentile last time we checked. And while I am aware that ultrasound is a notoriously unreliable tool for gauging a baby's true size, especially in the third trimester, I have had enough scans to be reasonably confident that they haven't all been off by two pounds or more. (Speaking of the plethora of scans I've had, let me offer you some advice: If you want to feel like an asshole, ask the ultrasound tech to stop showing you 3D views of your baby's face because you're running late and you really need to get out of there, and besides, if the baby had an adorable button nose last time, you're comfortable stipulating that, yep, he probably still does. If you want to feel like an even bigger asshole, confess this jaded impatience to the entire Internet. Here endeth the lesson. You're welcome.)
So we're talking about a big baby. Macrosomia. And while that is certainly not in itself an indication for a pre-emptive C-section, macrosomia plus gestational diabetes muddies the waters a bit. Or bloodies the show. Or meconiums the amniotic fluid. Or oversaturates the sugar water many GD babies are given shortly after birth to stabilize their blood sugar. Whatever. The point is that in babies born to diabetic mothers, it is not necessarily the size of the baby that's the problem; it's the distribution of weight. (I was told by Dr. So Cute and Nice I Don't Know Whether I'd Rather Be Her or Date Her that this holds true even for smallish babies of diabetic mothers.) These GD babies can be larger about the chest and shoulders than their unaffected peers, incurring a greater risk of shoulder dystocia during vaginal delivery. The risk is not huge in the absolute sense, and the most dire effects of shoulder dystocia — permanent nerve damage, hypoxia, and death — are quite rare. But even the less dire effects — a broken arm, a broken shoulder, maternal hemorrhage, fourth-degree lacerations — are unsettling.
And of course an argument can be made that even those risks, which again are small, are not an absolute indication for a C-section. According to one Dr. Web Page I Googled and Cannot Currently Locate but Seemed Relatively Authoritative As These Things Go, it would take 153 C-sections of women in my circumstance to prevent even one case of shoulder dystocia. And I am, as Dr. Laughs Throatily Every Time She Looks at My Chart Which Strangely Enough I Appreciate observed, not especially narrow in my pelvic anatomy. And there is the niggling idea, of which I am slightly ashamed, that any doctor's aversion to risk comes from places both noble and ig-. (I couldn't really blame my doctors if that were the case. Would you want to defend that lawsuit?)
The trouble is that despite study after study, there appears to be no reliable way to predict who will be affected by this, except to make the generalization that as a GD baby's size increases, so does the likelihood of dystocia. And once you know you have the problem, once the baby's shoulder is implacably lodged behind the mother's pubic bone, it's too late to back out. And I cannot think of a single good reason for me — Julie, veteran of one C-section already, with as much investment in a good outcome for this pregnancy as any other mother-to-be, and therefore intent on forming no enduring attachment to the idea of vagina as egress — to take that kind of risk. Pushing a baby out is not that important to me when having a baby at all is such an improbable wonder.
Given all this, the current plan is to wait for Friday's growth scan and evaluate the baby's size then. If he is still above the 90th percentile, my OBs will stand firm in their recommendation of a C-section. Based on my weekly Doppler scans, which have consistently revealed that the blood flow to the baby has been uncompromised — another good thing — I'm not expecting his growth to have slowed, nor would I hope it has. So I am accustoming myself to the idea that a VBAC is, as Dr. Despite My Fear of Being Damned for My Lack of Team Spirit I Must Report That My Entire Body Might As Well Have Been One of Those Giant Foam Pointy Fingers Being Waved Around at a Junior High Hockey Game for All the Gentleness He Displayed said, probably off the table.
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mimimimimimimimimimimi....trying to not think too hard about the "used me like a sock puppet" comment...
Still - the fact that you made it to internal exams is a big stinkin' deal! You're having a baby soon! This is exciting!
I, too, got the "having a big baby" talk. I was told MANY times that my daughter was big - at least a nine pounder - and that I should get ready for a c-section. After many tries to get her to move down the canal, I went for a c-section anyway (her head was cocked) and she ended up being a whopping 6 lbs 8 oz...heh. So much for all those ultrasound predictions.
A vaginal birth isn't all that great. At least with a c-section they can vacuum you all out. No need to bleed all over the hospital room.
Seriously, how can you write about such unpleasant topics and still make me laugh hysterically??? Really, it is an amazing talent.
Thank you.
lol at cervical check. The first doc who gave me that will forever be known as Dr. Stubby Fingers. I switched OBs because I became convinced she was deformed. There was no other way to explain being fisted like that.
I had a big baby - 9 lbs 4 oz. I did the vaginal birth despite people thinking it might not happen. It takes a lot out of you. A lot more than nine pounds.
Damn, lady. You are so much funnier than I am at this. I met resident IronGrip last week, but even on my best day I don't think I could spin the it's a good thing I went to the bathroom just before opening this post or I would've totally needed to change all manner of clothing funny tale out of that the way you did here. I bow to the master. Err.. mistress.
For what it's worth, Dr.Friend, my friend who is also a high-risk OB, told me about the phenomenon Dr. Be Her or Date Her was talking about. And a recent NEJM paper shows a progressively increasing risk of shoulder dystocia for hyperglycemic mothers who are not diabetic (seems to be my current label) with the increasing level of hyperglycemia, and so we are also watching for size over here.
Best to you, on Friday and beyond, as you make your decision.
I had an enormous baby (as in I was asked if I had made it into the papers, and I live in a major metropolitan area, so we have plenty of actual news). Vaginally. But the enormousness wasn't the result of GD, and in any case, I don't believe you're using my body for gestation and delivery -- if you were, I'm pretty sure I'd remember that swabbing by Dr. Joe Picafabio.
But good luck, and thanks for the opportunity to laugh icky snorty laughs at the description of internal exams.
Hee! You're fabulous.
Hmmmm.... I actually find your nicknaming technique to be rather nuanced and literary. For whatever it's worth, I'm just glad you haven't let yourself get all wrapped up in one plan or the other, but are staying open until all the facts (or, rather, pieces of speculative evidence) are in. I'm sure that only means the best of all possible outcomes.
And... this delivery will mean that you're probably out of the nicknaming biz for good. So, that's good, right?
~A~
With my 2nd, I was desperate for an esteem-renewing VBAC.
Long story short, water broke, sepsis set in, c-section was had.
hours later, a woman in the throes of labor crawled past my suite, screaming and crying. really. crawling and "resting" by laying on the hallway floor. begging to die.
i had spent the 15 minutes it took for the csection cracking jokes with my OB.
i've never been more grateful for a csection.
I'm just so glad that your doc swiped your rectal as well as your vaginal for that GBS test. Some docs only swab the vaginal, and that just isn't as accurate.
I'd like to tell you not to over think this too much, but being an over thinker myself, I appreciate your delving thoroughly into your mind web and tangling it up nice and good on your blog.
I don't think you want horror stories, and it appears you are already leaning toward the repeat C, but I will briefly give my input, for what it's worth.
I was the mom who had the easy delivery the first time around - my 8lb 22" bundle practically fell out of me, not drugs at all.
Not so with #2. Induced at 37 weeks, no drugs, after 3 hours of pushing baby got stuck, broken arm, 10 lbs, 6oz, then he was flighted to another hospital for care of umbilical line due to low b/s from borderline GD.
Dr. and I felt comfortable delivering vaginally at 37 weeks. Maybe it was the stress of the induction, maybe my pelvis was too small, but if I could do it again, I would suck it up and go for the C.
Oh yeah, after 3 hours of pushing he finally came out and I then got the epi for my 1 1/2 hours of surgery on my 6 layer tear. Fun times. But nothing was worse than feeling like a horrible mom for doing that to my baby. That was 10 months ago and I am still tearing up when typing this.
Sorry, I promised no horror story and look what I did. Go with your gut, don't be a hero!
For whatever it's worth I had a MISERABLE birth with my daughter 2 1/2 yrs ago. Without going into unnecessary details about the specifics 4+ hours of pushing gave me a lifelong hemorroid problem.
In my second pregnancy the hemorroids were SO phenomenally awful I actually had to have SURGERY when I was 35 weeks pregnant to remove them. Despite practially begging for an elective c-section my OB convinced me to deliver vaginally again. Delivering my 9 lb 6 oz son did not help the tushy situation. He's 3 months old now and I'm FINALLY able to sit normally again. (As a total aside, I have to tell you the absolute best prescription anti-hemorroidal creams are named "Recta-gel" and "Anal-pram". Do you think their marketing departments had a sick sense of humor or what?!)
My 2 cents - take the c-section and save yourself a lot of potential ongoing agony in your downstairs section.
I am, for once, devoid of both ad- and assvice, but just wanted to wish you a safe delivery and healthy baby, by whatever approach you choose.
Glad to keep reading that the little guy is still inside. Awesome. But, as you have discussed poetically, he has to come out at some point. I would like to add my birthed-a-small-baby-and-still-had-fourth-degree-lacerations opinion. Don't do that to yourself or the baby. Stitches from a C-section are uncomfortable, yes (on my second, I had the C), but PEEING on a sewn up fourth degree tear sucks. Having a recto-vaginal fissure for a few weeks sucks even more (and not all of them heal spontaneously like mine). And the long term, um, unpleasantness of living with sphincter muscles that just never quite went back to normal is a big, long, lifelong suckfest. Sorry for the graphics when you are so close to the main event...
My "seven pounder" ended up being 9 pounds 10 oz. which I did deliver naturally. Yeah. good times. :) Those scans are notoriously wrong -- as you pointed out. But then, it doesn't really matter how the baby got here.. Just that they're here, right?
Dude.. you have NOT lived until you've met Dr. Skinny Fingers Yank the Cervix Around during Cerclage Removal so that The Cervix Actually Rips and Causes Permanent Damage and What Looks like a Stab Wound in the Cervix Which Freaks Other Doctor's Who Will Examine You in the Future and Causes You to Bleed Every Time you have Sex with your Now Frustrated Husband.
My son was huge on all the scans. 95 percentile plus on every. single. one. Came into the world at 37w 1d via c-section and was 9 lbs. 10 oz. At THIRTY SEVEN weeks.
Go with the section.
Yay for new baby boys!!
You are too damn funny.
I'm with you... doesn't matter how the baby comes out, just as long as it is healthy. For what it's worth, my second C Section was so much better than my first, and the recovery was so much quicker.
Hi - I am a fairly new reader but I, too, love your sense of humor and the way you write. Good luck with whatever you choose for your baby!
In view of the other comments, I can't help mentioning (mostly for other random readers like myself, not for the obviously-well-informed author) that vaginal births can be great fun and leave you feeling pop-out-of-bed-ten-minutes-later fabulous. HOWEVER, I admire the hell out of your dedication to your baby's well-being and your understanding of your doctors, and--like all your other online admirers--am psyched to read about you being still pregnant and so close to meeting your new person! Best of luck, however it goes down.
At least one of those risks I can report on: The fourth-degree laceration. Honestly, not as bad as it sounds. Not as bad as the way some of my friends described their C-section recoveries. Of course, I took _all_ the Vicodin prescribed. The whole sordid story is in the right-hand margin of my blog, under "birth stories."
"As a total aside, I have to tell you the absolute best prescription anti-hemorroidal creams are named "Recta-gel" and "Anal-pram". Do you think their marketing departments had a sick sense of humor or what?!"
Wow, genuine assvice! ;-)
Wow, that's quite a lot of nicknames - very charming and descriptive ones, if hard to parse the first time through... I'm thrilled you're still pregnant, and wish you best, no matter which exit the little guy ends up using.
Amanda Lynn
I have just added 'length of fingers' to my mental list of important attributes to look for in a consultant obstetrician.
I had a c-section with my 9lb 2 ouncer because he wouldn't fit past my pelvis and a VBAC with my 8 lb 13 ouncer (induced early so he'd be small enough) and I have to say the c-section was WAY nicer and easier to recover from. Vaginal birth ain't all that... It was an interesting experience but not something I'd want to do again...
Yeah, after the ten billionth ultrasound (I assume you've noticed the lack of punch cards and accompanying prizes?), I got tired of the "Oh! What a precious little face!" and started asking for pictures of feet. Hands. What I really wanted was a nice brain shot (Get a load of those hemispheres!), or a picture of Fitz-Hume clocking Millbarge in the kisser, but I could never find a technician with a sense of humor.
On the huge baby front, Charlie at 30 weeks was the same size as Fitz-Hume at 36 weeks. You build 'em big, lady.
Oh, and my first thought when you said they told you a VBAC was 'off the table' was "Dear God, are they expecting her to do it standing up?"
Well I nearly redecorated my monitor in a delighful shade of good-ol-british-breakfast-cuppa at Dr Sock Puppet (for short), at which point I put the mug down at a safe distance before I carried on reading.
My Drs near-bullied me into being induced earlier than absolutely necessary based on the size scans of my boy that were predicting he would be in excess of 10lbs, not helped by my OH telling me he was 10lbs 10oz when he was born (and he's 6'6" now) so I had the usual hellish labour that one gets with induction, followed by a close brush with emergency c-section until a very nice consultant tweaked him out with a ventouse. At which point I have to say I felt faintly cheated to learn that he was 'only' 9lbs 5 oz. Of course that put him firmly in the 98th percentile where he's stayed ever since, so at 22 months I have people asking me if he's 2.5 years.
Anyway, all birthing stories aside, I'm wishing you all good things for the rest of your time and whatever birth you go for.
We got the clear to start trying again this month and we have. After reading this, though, I'm double-thinking my decision to have children. That gladiator-style swabbing is pretty good birth control!
One word for you: episiotomy. The C-section sounds like a completely sensible option. Whatever you decide, I wish you a safe delivery and a healthy baby.
Section away. No tearing, just blissful NUMBNESS, well placed scapel, cleaned out ute, and best of all, in later years no peeing while laughing/coughing as the vayjay and bladder is in pristine condition :)
"Pushing a baby out is not that important to me when having a baby at all is such an improbable wonder."
Hands-down the greatest sentence every written. I bow to the Master of the Written Word.
How do you do that - make me go from crying tears of laughter to tears of joy for you, back to tears of laughter again. I'm with anon above. That is probably the most beautiful thing I've read in a long time. And Akeeyu - you kill me!
Huh, somehow I don't remember any swab venturing into the rectum. I thought the GBS test was only for the vajayjay?
Anyway, at least if you have the C-section, there is no possibility of having your membranes stripped (I mean, if you think the cervix check was unpleasant). Had that unfortunate experience twice. By the female Dr. Who Should Know Better Since She Herself Has Gone Through Childbirth 3 Times. I knew I should have been worried when she entered the room dressed as a dominatrix.
I've had two c-sections, would have preferred zero, but have two perfect boys and zero to complain about. Also, I think you're great and hope the best for you and your baby!
i'm with christine, the pp. i am all about not peeing on yourself. maybe that's because i am at the moment-everytime i sneeze.
I had GD, FVL and Protein S def. My son was born at 37 weeks, 2 days weighing a whoppin' 5lbs., 6.75ounces and I had a third degree tear. He was delievered an hour and a half before my c-section was to be done. Damn tiny hips.
Best of luck either way it goes, looking forward to meeting your new little one.
Oh yeah, that's one of those best kept pregnancy secrets. The swabbing hurts like a mother fucker. Everyone seems to tell you exactly how long you were in labor, but they don't tell you that someone puts a sheep on the end of a stick to do your vaginal culture.
Am I the only one who read "god-damned babies" every time I saw "GD babies"? (Yes, I know, gestational diabetes. But my way is much funnier.)
I too, found the first cervical fisting, er check, to be a rather rude awakening. I was picturing something not unlike the annual poke and prod, involving a speculum and a discrete visual inspection. Cervical check number 2 left me wondering how I'm going to tolerate labor if I had to employ deep breathing to get through the check.
And my group B did not involve an anal swab. yikes.
I'm a GD mom with a giant baby too and every week it's "well a vaginal would be better, but we're probably doing a c". Irritates the crap out of me. Hang in there!
Rock on with getting far enough for the cervical checks! I missed out on those with my first one and thoroughly enjoyed them with the second. He'd have his hand up in the ying yang while he's discussing fishing or hunting with my hubby. Nice.
Hoping the strep comes back negatory. And here's hoping tomorrow's scan is good.
I had GD with my second daughter (1st daughter was adopted from China) and the docs were on me the entire 3rd trimester about concerns of a big baby. I went into labor after having my membranes swept at 39 weeks (done to avoid the Pit) and birthed a normal sized baby after a super easy labor and no drugs. And you know what, I would love my daughter just as much if she had been born with a c-section. Anything can happen at any delivery, and any decision you make is the right one for you and your family.
"Pushing a baby out is not that important to me when having a baby at all is such an improbable wonder." absolutely my feeling as well!
assvice time: i had many growth scans before my son was born, showing a very large baby (and like you, i didn't think all of them, on different machines, could be that far off). despite my being of the mindset that live healthy baby and live mommy = perfect end result whatever the means to get there, my OBs kept saying but oh, the human body can do amazing things; we'll let you "enjoy the trial of labor" (wtf???) first since you never know (always with a slight giggle). after spontaneous water breaking, lack of useful progress, lots and lots of pitocin, a near-useless epidural, and me writhing and sobbing for hours in my fevered, infected state, finally they decided an emergency c-section was necessary. during which the OB said, oh wow, that 8lb 9oz boy was stuck SIDEWAYS! no WONDER he wouldn't come out your vaginal canal - and he might have gotten injured if we tried any longer! and you couldn't have figured this out a wee bit sooner, oh wise medical professional???
go with your feeling, julie. stay focused on that goal of healthy baby and you can't really go wrong. i am thrilled for you that you are still pregnant and get to play the my-baby-might-be-a-biggun game!!!
I've had GD with both of my boys. Both times they told me the baby was going to be "huge". We went through Ultrasound after Ultrasound on the subject. First one was 7 lbs 1 oz. Second one was 7 lbs 2 oz. Both were born on time and vaginally and both times the doctors were shocked by how normal the size was.
Can't trust the thrid trimester ultrasounds to determine size.
Do what your heart tells you! (Thats a ridiculous thing to say, I know but its true!)
PLEASE start posting a SPEW alert!!! I think this is the third damn keyboard you have cost me!!! I LOVE YOU!!! Hugs, and I can tell you from experience that have your Vagin as an egress is WAY overrated!! LOL :o) Good luck sweetie.
Rebel
Macrosomia mom vet here. Tried vaginal, stuck baby, emergency section. 30 hours after my water broke, the pulled my 11 lb 8.7 oz daughter out, no GD. If I had know (oh well there were the 10 ultrasounds warning me of LGA baby and the OB who begged me to schedule a section, but that aside) if I had known, I would have opted for the section.
also the sugar water did not work and we had a 4 day NICU stay to regulate sugars. Though to many NICU vets, 4 days would be a walk in the park....
I think Dr. Google totally has all of those other doctors beat. He's such a know it all.
:) Becky
http://www.stinkylemsky.typepad.com/
For those of us who never could calculate the weeks vs. months thing (it just doesn't work-and I was on the math team in high school-oops did I admit that out loud?)-could you please put what week you are at the end of the post (I have to keep going back to June and counting on my fingers!). Thanks!