Meeting with the new doctor!

Yesterday we had our first actual meeting with my new doctor.  I say "my new doctor" because now I'm officially a patient!  Chad took off for the appointment time and was able to go with me while the boys stayed at home with my Dad, so we could have the freedom to discuss things and not have the distractions that kiddos naturally bring.

Now for the details:

The Dr. T was very nice and has an excellent manner.  He is equally matched with a wonderful office staff.  I had a very thorough first appointment and I'd say he was probably in with us for the better part of 45 minutes and it may have been an hour.  I don't think I've ever had a doctor spend that much time just discussing things, ever.

He was completely upfront about Trial of Labor (TOL) and the risks and the higher degree of risk that I have having had two previous c-sections.  He was also upfront about my chance of a successful VBA2C and the possibility that even if I do attempt TOL, I still have a chance that I won't have a vaginal delivery which has nothing to do with the risks that are associated but have much more to do that I have not had a successful delivery yet, am short in stature, and we have no way of knowing now other variables such as the baby's size.  He has one of the lowest c-section rate of any doctor in the area at 8%.  The national average is 32%.  For me he estimates that my risk of attempting a TOL and ending in a c-section, is about 20% because of my history.  So that is an 80% chance of success which is still quite high when compared to the national c-section rate.

In addition to explaining the risks and probabilities, he explained his policy on being present for the birth.  Unlike most doctors, he doesn't work with an on-call group and he is solely on-call 24-7 unless he has to be out of town.  If that is the case, the on-call doctor at the hospital will be the one in charge and if that is the case I won't have the opportunity to attempt a TOL.  However, in the last two years (I believe that was the time period) he has only missed the delivery of two of his patients which comes out to a less than 1% chance that he won't be able to make it to the hospital if I go into labor.  Seems to suck for him but is wonderful news if you are the patient!  His wife works alongside him and it seems that they are committed to women's health as a couple and understand the intricacies and insecurities that women have in these most vulnerable and delightful times in their lives.

Chad and I both have mixed feelings about TOL and we honestly have no idea if we will attempt it or not.  The risks, though pretty low, are still significant enough to give us pause.  As the doctor pointed out, we are under no pressure to make the decision now and have about 10 weeks of thought to put in.  There are lots of things that might influence our decision as we near the birth as well.  At this point, we cannot know the size of the baby, if she will drop and engage, how my cervix will prepare, etc.  There are lots of variables that can change the course and make the decision for us.  For now, even being able to make the choice is very empowering for me.  Even if we do end up choosing RCS (repeat c/s).  I didn't remotely have the choice with my previous doctor.  So that's where we are right now.  I'm just happy to have a doctor that is open to it.  

29 years ago today

...my parents got married.  In memory of my mom, I bought Sugar-Free Coconut Cookies for me to drown my sorrows in since alcohol is off limits.  I guess it will do.

Mad at my mom or something like that

Well I guess the title isn't quite accurate.  I'm not really mad at her.  I'm just mad she's not here.  I think I have shared here before that I have two phases that I default to when I grieve.  Sadness and anger.  I really hate crying and do all that I can to avoid it.  When I start to think of something that makes me tear up, I change the subject in my mind.  I allow myself to be angry much more frequently.  Maybe that's not a good thing but that's how I deal with it.  So yes, I'm mad at my mom's absence.  It really sucks.  A lot.  And now I have anger and tears.  I guess that's good for me.  Anyway, what brought me to this point today, since I've become so good at repressing it, was something rather dumb.  Barbecue beef.  See, I told you, dumb.  Here's the whole path.  I decided to look for a recipe at CooksIllustrated.com (the parent company/magazine of America's Test Kitchen).  Chad has an account there because several years ago my mom gave him a subscription to Cooks Illustrated magazine for either Christmas or his birthday.  He loved it.  Eventually she transitioned it to the online subscription because of the greater access to recipes.  She always gave the best, most appropriate gifts (for the receiver), especially to Chad.  I can't explain why she was so in his head but she was.  They had a lot in common and why that is making me cry right now, I don't know.  Maybe I'm jealous.  But anyway, she really had a knack for giving him gifts. He really got into cheese-making before he started back to school and lost the time for it.  So, one year for his birthday, I believe, she got him some fresh goat's milk from a local farmer and my dad made him a cheese hanging apparatus.  I don't really have much more to say on this line of discussion other than she was an excellent gift giver for the boys, too.  I am so sad that they are all going to miss out on her thoughtfulness.  To be clear, it's not about the material things she gave, especially because monetarily she didn't have much to give, but it's all about the amount of thought and effort she put into the gifts.  It was extraordinary.  For some reason she had more trouble getting me things that fit my personality and interests.  I don't know why.  We talked all the time on the phone and had a very close relationship.  Maybe it was a case of not being able to see the forest because of all the trees (as in being so close to me that a larger more complete image of me was not visible).

Eh, I got sidetracked here, as usual.  Other than the fact that she was an excellent gift giver and that the Cooks Illustrated was a gift from her, I checked the subscription information because I knew it was probably getting time to renew.  Of course it was.  She died in April and had renewed it in February of last year.  I cannot believe she has been gone nearly a whole year.  I can't deal with this.  This was all supposed to fix itself and my mom should be back here to celebrate her 51st birthday on April 4th.  God this is unfair.  Jude will only barely remember her (about as much as remember my Grandma Janet that died when I was the same age he was when my mom died), Lennon will really only know what we tell him and what he can see of pictures of the two of them, and Emeline won't have any memories or even photos of the two of them to look back on.  I really hate this.  Nothing more to add now then tears.  

One step closer to VBAC!

Finally, after what has seemed like a month though it has been much less, I heard back from the prospective doctor today and he says my file looks good.  I have an appointment on Monday to meet with him.  I'm trying not to put too much hope in it all because I know that there is a chance that after our actual meeting that something might come up that might change the course.  I am really excited that I'm at least going to have the chance to meet with him and fully explore the process.  It's funny, having had two c-sections, I'm suddenly terrified of having to endure a c/s recovery again.  If I do end up having a c/s, the recovery is not something I'm looking forward to and I've had two very easy (by comparison) recoveries.

For those of you that are wondering, VBA2C (Vaginal birth after 2 c-sections) is a better option for some women than a repeat c/s.  There are lots of things that determine if a Trial of Labor is for you, such as the  cause of the initial c/s and the internal incision used.  For me, my first c/s was due to fetal distress caused by the cord being around Jude's neck.  My second c/s was a repeat because I had been unable to find a provider that would do a VBAC at the time.  All of the ones I had found either didn't practice at my hospital, weren't on my insurance, or had recently stopped performing VBACs because of pressure from the state's ubiquitous malpractice insurance provider (which made it's decision based in fear rather than statistical facts).  With Jude my water had broken and my body was doing everything that it was supposed to and I have good hopes that given the chance, I can deliver this baby without surgical intervention, though I'm obviously not opposed to it if it is medically necessary.

At my appointment with my regular doctor on Tuesday, she spoke highly of my prospective doctor and said he has a very high success rate.  She is just about as anxious as I am to hear what he thinks about my case.

I hope I have some good news to report on Monday! Until then, here is some facts from the American College of Obstetricians and Gynecologists on VBAC in case anyone is curious.

ACOG Press Release

ACOG Patient Fact Sheet