So today we were supposed to get some answers. Answers about what keeps causing me to bleed and what our plan is for our birth (birthing center or hospital). So we went to the OB who is the back-up doctor for my midwife practice. Now, this isn't a doctor I've selected, she's just a doctor who agreed to act as the back-up physician in case of hospital deliveries. Why do I caveat that? Because...well, she's interesting. Her bedside manner leaves a bit to be desired, so to speak.
So we get to her office and I am armed with
my expansive medical knowledge what I gleaned from reading some medical journal articles about low lying placentas and vaginal births. I am prepared and determined to get answers. That determination started to fade away as I watched the minutes tick by in her overly crowded waiting room. Seriously, this is a solo practice and her waiting room was so packed there were pregnant women with nowhere to sit just standing around looking miserable. I think she triple books appointments.
Anyhow, I've been spoiled by our birthing center. Once I got escorted to a room, I found myself sitting on the cold exam table with a piece of paper wrapped around me (leaving my butt exposed to the door behind me) and paper sticking to my bare bottom underneath me and missing our spa-like experience with the soft blanket throw to cover me. Ha. Anyhow, so doctor walks in and I try to make some chit-chat but I'm not sure she knows what that is. She just starts doing the ultrasound. Ok. No problem. But what do we learn from the ultrasound? Nothing. The same thing we learned on Friday. The placenta is "low" (yes we knew that the whole pregnancy) and the baby's head is out in front of the placenta (which we knew that too and yes that is a good thing). I ask if she got the records from our perinatologist who measured the placenta to cervix distance before and deemed it to be "safe for vaginal delivery." She says, "Oh I think I saw something on my desk about that..." Then I tell her that I have read that it's better assessed via transvaginal ultrasound, so she whips out the dildo wand and jams that into me. Now, that has never hurt me before, but today it was really painful AND we didn't learn anything new. She says, "This is really better assessed between 25 and 30 weeks. I can't see anything now." And I said, "Well, those records I told you about were from an assessment at 28 weeks and he said we were fine in terms of the placenta location." So she looks at me, ultrasound wand still jammed up inside of me, and says, "Well what do YOU want to do?" Seriously? Seriously? So I made a joke about her asking me serious questions with an ultrasound wand in my vagina and she realized maybe that was not good bedside etiquette and pulled it out.
But then she starts organizing all of her papers and getting ready to leave the room. Again...seriously? She asked us to come in today so we could decide. How about she sits down and actually talks to us about it? So, we peppered her with questions about risks, possible outcomes, her recommendations, etc. And we got no clear answer at all. She basically said she had no idea what is causing the bleeding, she couldn't locate any specific risks, it was a good sign that the baby's head is out in front of the placenta, but there is no way to know what could happen during labor. She pointed out, "In any pregnancy you can have bleeding. In any delivery, regardless of placental location, you can have placental abruption, you just never know what could happen." Well thanks lady. Thanks for pointing out the risk factors of an out of hospital birth...which we obviously considered when we made the original decision! Finally, she says, "Hey, I'm biased. I delivery babies in a hospital, so obviously I'm going to say that's where I'd feel safer. But it's up to you guys.
And then she left. Oh! Oh wait! I forgot to tell you guys the best part. In the hospital on Friday, when she did a cervical check, it hurt so bad I wanted to crawl backwards away from her and the nurse had to remind me to "breathe." I felt like a wimp. So I made a joke today to the doctor about being nervous it would hurt again. And she looked at me weird and said, Oh. Well, I can be gentle this time." Um? Thank you? Shouldn't that just be standard procedure when sticking your hand into someone's cervix??? And guess what? Didn't hurt at all today. And she still was able to get the info she needed. No pain needed. Wow. Oh, and I haven't dilated anymore since Friday.
Ok, so we leave that appointment and have to head immediately to the midwife appointment. I am feeling distraught. I wanted clear answers. As in, someone to tell us that we are going to be "fine" or someone to tell us we need to be in the hospital. Either way. I hate this ambiguity. B keeps pointing out that really we are in the same boat as we were in before all of this...taking the chance that something could go wrong. Also, he pointed out that she could not identify any clear problems or risks and in fact said that the position of his head looks good and safe for delivery. I also pointed out that we had already been cleared by the perinatologist who had warned us more bleeding could happen and that it would be normal for me and not a risk to the baby. But then I got mad all over again. Why didn't she look at those records?? I was completely torn between my rational side that was telling me that nothing had really changed and my emotional side that was screaming awful things about blood and babies losing oxygen and....well, you know.
So, we get to the midwife appointment (after a quick stop at Taco Bell to assuage my dropping blood sugar...SHhhh don't tell the midwives!) and we get inside the room and I instantly feel better. So, of course, I start to cry. I tell her how I was feeling so excited and peaceful about labor and now I just feel fearful and fragile. We spent some time talking about my fears and then we got down to business of what exactly could go wrong. First of all, the midwife pointed out that the doctor, by not telling us we had to be in the hospital, had been giving us the green light for an out of hospital birth. In a litigious society, this is the best she can do. Then we talked details. According to the midwife, we will alter my plan so that I will not wait so long to go into the birth center (think 5-1-1 contractions or cm's dilated), but will either have a midwife come earlier to my home or will go over there earlier, so they can monitor me for bleeding and baby's heart rate. She explained that her main concern is not about the baby, but about me losing too much blood (exactly what the peri said to us). This is based on the fact that we really have no evidence the bleeding is coming from my placenta and actually have much more evidence it's coming from my cervix as it dilates (or, in previous episodes, in reaction to sex or exercise). We discussed hospital transfers and how we would do this quickly if needed, but more likely it would be just in reaction to slight decrease in baby's heart tones or my own fear holding me back from progressing in labor out of hospital. And basically, we just felt heard. We felt heard and I felt like someone finally considered all of the factors, the history, and possible scenarios. And we made a sound plan.
Most importantly, we spent the second half of the appointment (we were there for an hour and a half) discussing the fact that BABY IS COMING! And that we should focus on the excitement about that and not feel so fearful and apprehensive that something is wrong. Because, this bleeding is part of prelabor. It came in conjunction with bloody show and it's just part of my body's progress. She examined me and said that she anticipates we will have our baby within the week. She also cautioned me that I could still go past my due date, but that she doubted it at this point with all of these signs.
So here I am. Back to where we started. We are still planning a birth at the birth center. We are still expecting our baby very soon. And I am trying to focus my energy on feeling positive and peaceful again. I haven't had any other new signs since this weekend, with the exception of one stronger contraction that made me stop talking in the middle of a sentence. My mom gets into town next Tuesday and so anytime now would be just fine with me or if he wants to wait for Grandma I'm ok with that too.
To end, I will say that many of you reading this may have your own reactions about our decision. In fact, my original post about this decision had some of the most views and comments of any of my posts. And that is because there is no correct answer here, but everyone feels very strongly about it. I believe there are cultural aspects, personal aspects based on your own experience, and also, within the US, problems with the way the system is built that pushes us to go to one extreme or the other. I don't have a huge agenda here or preach to people about how I feel (hey...the hospital birth is very alluring to me in its safety and assurances), but I just feel right about this. Both times I have made this decision, I walk away feeling secure and grounded and right. It just works for me. I'm curious what others think... on both sides of the coin.