A Decision Made.... Finally

I saw Dr. R. again on Wednesday - she squeezed me in based on a request from the nurse who ran my NST (non-stress-test) on Monday and concluded that I and she were both a bit confused. She re-explained all the options to me.

I was amused that Dr. R. explained it to me with a decision diagram that looked remarkably like the one I had sketched out for myself the night before. (The main difference, of course, is that mine is slightly more legible.) I suppose there is something reassuring, at least, to feel like your doctor makes decisions the same way that you do.

I followed up with asking for her to spell out clearly the risks of a C-section, so that I would know that I was making that decision based on good data also. It isn't actually the risks that lead me to want to avoid the C-section; it is just that I have a different birth experience in mind. But, knowing the risks (real, not imagined) seems like a valid part of the decision-making process. So, what she laid out was:

25% occurrence of "minor issues" including: loss of ability to urinate (I assume this must be temporary if considered minor!), urinary tract infections from catheter, blood loss (typically double a vaginal birth), wound failing to heal properly.

Less than 1% occurrence of "major issues" including: blood clot, pneumonia, transfusion, and some sort of infection of endometria (can't read her writing here) that leads to high fever, IV antibiotics, and rehospitalization for several days.

Less than 1/1000 occurrence of very severe issues, neither of which I can read or recall.

So, actually, it sounds worse than I expected. But still, not the real issue in my decision.

Dr. R. then proceeded to give me all kinds of amusing advice.  "You don't really have a wrong choice to make here. Many of my patients would just choose the C-section - they actually prefer that for their birth experience. But I don't think that would be you." [Correct.] "You know, it is possible to think too much, and agonize too much, over decisions like this. Some people can easily make up their minds, and be 100% committed to that. Others (like you or me) always have that doubt - we can never get past about 97% sure. But, when I have patients in these situations, I find that they generally make the right decisions for themselves, so just go ahead and choose and trust yourself. I also find that about 50% of the time, nature intervenes and somehow makes its own choice, anyway. For example, you choose a scheduled C-section for 39 weeks and instead go into labor at 37 weeks. Or, you choose a vaginal birth but then show up in labor and breech and get a C-section."

After talking it over with her, I came home and talked with Jeremy. "Suppose the baby's platelet count is 100,000 or more...then we definitely would want to proceed with a naturally timed, vaginal birth. Suppose the baby is breech... then we would definitely choose a C-section, since this is not the right birth to take a chance on a difficult situation. Suppose the baby's platelet count is 10,000...then we would definitely choose a C-section." In the end, I decided that my fear of harm coming to the baby would likely cause me to be tense during labor and make the process harder, so just knowing the situation is important information. Also, since I would in fact prefer the C-section if the platelet count is low, then I need to know if it is low. So, I called to schedule the cordocentesis.

This ended up requiring yet another visit to the doctor, this time a consult at Maternal-Fetal Medicine. That made how many trips to the doctor this week for this pregnancy? Two on Monday, one on Wedneday, one on Thursday, one on Friday. Not bad. Fortunately, I think it was a valuable consult that I had this afternoon. I talked with yet again a new doctor (to me) in that practice, Dr. D. It turns out that she will be the one to do the procedure, so Dr. F. (whom I saw in December and had said Dr. S. would do it) thought I should meet with her.

Fortunately, I liked Dr. D, on the whole. She seemed perceptive and sensitive to my concerns and questions. She said the whole point of the consult was to be sure I understood the procedure and felt comfortable to proceed. She seemed a bit younger than I might prefer (probably younger than I am by a few years) but maybe that gives me the benefit of fresh training and steady hands. She seemed sympathetic to my desire to not have a C-section, and able to see that as a reasonable choice. She confirmed that the risks of the various options are all somewhat unknowable, but that I was making a reasonable choice under the circumstances.

I did ask the blunt question at one point: "I don't mean to offend you, but Dr. F said that Dr. S does these the most often. How often do you do them?" She claimed to do them the second-most frequently. She didn't come right out and say how often, which left me a bit nervous. At least, though, she did seem quite familiar with the process. I didn't get the impression that I would be the first case since her residency, for example.

She explained the process a bit more than I had heard before. I would have fairly extensive prep, but the procedure itself would be about 60 seconds or less. She would not plan to give me anesthesia, but would have the anesthesiologist standing by in case an emergency situation arose. I would be prepped as if ready for surgery, therefore (IV, drape, etc.). I would have a local/topical anesthetic for the needle insertion, but she couldn't numb the uterus, so I should expect some significant cramping, something like bad menstrual cramps. (Why is it that every medical procedure involving any part of me from the breasts down to the hips is reported to feel "something like menstrual cramps?" I have never even observed that these are a very universal experience of pain or discomfort.) I would need to lie perfectly still, so if I felt anxious at all the anesthesiologist could give me an anti-anxiety medication of some sort to relax me. She recommended that I not plan to drive myself home, just in case the cramping was enough that I didn't feel up to it.

Her perception of the risks? A 1% chance of an emergency C-section. NOT a 1% chance of loss, as I had been told by Dr. F and Dr. R. So that seemed more encouraging, and yet that 1% loss was for all situations, and mine was supposed to be much easier, so I was already assuming a much lower risk, so now that 1% seems high. She said that emergency C-section might be needed if there were a bleeding event (ruptured artery in the cord, for example) or if the baby's heart rate dropped and didn't recover (there would be constant monitoring of that). On the other end of things, there was a small chance of rupturing the bag of waters, which would require a delivery within 24 hours, though not necessarily an emergency c-section. And in between, which she thought more likely than either of those outcomes, was the chance that the needle would irritate things enough to put me into regular labor after the procedure. So, since I will be essentially full-term (36 weeks and 6 days), not a huge concern, fortunately.

All of that information actually made me feel less comfortable with the procedure somehow, but it didn't change my mind about it being the right thing to do. The unfortunate thing I feel in all of this is that I don't yet have the sense of "peace" that I have experienced in the past after making a difficult decision. Other times, I have made the decision, not always fully understanding it, but feeling confident that it was the right one, within God's will. I don't have that now. But, I didn't have it for the week when I was essentially deciding to not do this, either. So, maybe I just won't find that peace with this situation.

So, that is that, at least for now. I go into the Labor and Delivery ward at 2 PM next Wednesday. The procedure is set for 4 PM. I expect I should be out shortly after that, if all goes smoothly. Di has already offered to take the kids, so that Jeremy can come and stay with me. I don't know if they will let him in, but having him there makes me more comfortable, somehow, so that if something does go wrong, I know there will be a conscious advocate around for my baby and for me.

Now, to turn my mind away from all this for a while. What will be, will be.