Monday, October 22, 2012

Deep Sigh

I got a call from the OB office's coordinating nurse today, a voicemail that truncated mid-message but included enough info to let me know that she had A) miscommunicated to my preferred OB (the one I wanted to move induction up by one mere day to have on call) that I instead wanted to move it BACK and regretted to inform me that B) her hands were tied with regard to C) hospital policy D) yada yada yada. I called back with the intent of bitching her ear off over this stupidity. And that I did. I told her I'm tired of being told different things by different people due to poor communication and wished to only speak to physicians about these things from now on, since it's their clinical judgement and diagnoses driving all of this. Also, I may have mentioned something about losing my shit if I hear "hands tied" or "hospital policy" one more time. ("Say 'what' again...") So she had my favorite OB, who happened to be on call today, call me to chat. And chat we did. All the things I was saving for a diatribe at my appointment tomorrow, I explained to her. I asked for some clarity around these "hospital policies" and to know what exactly was on the table as a recommendation, based on what criteria, and what might end up being considered emergent if it comes down to it. She filled in the picture nicely. I do not have to have an induction if I really don't want one, as it's not even indicated for macrosomia (giant-ass baby). It's indicated for gestational diabetes, but if I really don't want it we can just increase the monitoring past 39 weeks and play it by ear. It's not that I am opposed to induction in and of itself, it's more about the fact that a near-majority of inductions end in C-section. So you get to labor for however long and then have surgery anyway. Worst of both worlds. I asked her if C-section would at any point be strongly recommended or otherwise considered necessary for safe delivery due to macrosomia or the GD, and she said that if the next ultrasound (done in 2 weeks at an appointment with her) shows that baby will likely be >9 lbs, she would offer a C-section but that I would not ever be coerced into having one. Whichever doctor is on call when I deliver would simply keep me informed of pros and cons with a vaginal delivery versus a C-section, and if we encountered difficulty with the baby dropping or maneuvering through labor we would make decisions in real time based on whether I wanted to keep trying to labor or throw in the towel. Then, the $60,000 question: would the OBs be willing to start doing internal exams and stripping/sweeping membranes at 37 weeks to get things going al la natural? Yes. Apparently it's even ACOG guidelines to "encourage" spontaneous labor to avoid intervention.

So. Whew.

(On the one hand, I feel like I might be a total drama queen about this shit, and I don't mean/want to be. On the other hand, it's all very new and undesirable and after a second pregnancy-cum-gauntlet, I just want a straightforward birth for this baby. It just can't be too much to ask. Right?)

36-week Appointment Follow-up: My OB was unusually helpful today. Guess my chart has an asterisk now. Ha. He confirmed baby is head down, fluid levels look good, NST and heart rate look great. Given my last labor, we're still optimistic spontaneous labor will happen within the next several weeks. And if not, when the 39-week induction date rolls around in 3 weeks (!) we can decide what to do based on NSTs, ultrasound, and what my cervix is up to. If it's starting to dilate but without signs of labor, induction will be a consideration, since it will probably work if my body is already starting to prepare. On the other hand, I could continue with NSTs and ultrasounds for up to another week to see if it progresses on its own to start labor or break water. I'm hoping we'll go ahead and do an internal check next week to annoy my cervix enough to think about getting started...

 

3 comments:

Lisa said...

Good for you for speaking up! When do you hit the magic 37 weeks?

jenicini said...

Right!

Lauren said...

This all sounds much better and so much more reasonable compared to what you've been posting about recently. I couldn't believe everything it seemed like they were "forcing" you into when so much of it wasn't even based on best practices or evidence. Good for you for speaking up!