I need to harp on this issue just one last time
by Karla ° Thursday, November 30, 2006
The appointment with my Pediatrician on Monday reopened all of the feelings of worry and doubt that I was finally starting to make peace with about having this c-section before 38 weeks.

I know that “technically” a baby is considered to be full term after 37 weeks, and a normal pregnancy is anywhere from 37 to 42 weeks, but some babies born before they are fully “cooked” can have lung issues, and this is a concern particularly when no labour has taken place from a planned or “cold” c-section.

Basically, upon reviewing the course of action for delivering this baby, my pediatrician indicated some concern about lung maturity. Most of the time, a planned c-section will not done before 39 weeks and that is for the simple fact that the lungs are one of the last things to mature in an unborn baby. No matter what, because this is a cold c-section and because the baby will be born before 38 weeks, we have to be prepared for two possible issues, something known as wet lungs, or Transient tachypnea – newborn (TTN) and respiratory distress.

TTN is when a baby is born before term (less than 38 weeks) and does not respond as well to the chemical signals released during labour leaving more fluid in the lungs at birth. This issue is particularly notable in babies born before 38 weeks, especially via a c-section without labour because the normal chemicals that are released during labour to tell the lungs to stop and start removing fluid from the lungs are not as strong.

More seriously, if this baby’s lungs are not fully ready, then he may experience respiratory distress and require intubation and time spent in the NICU. I suppose that doesn’t sound that scary, but my first introduction to Ava was of her full of breathing tubes while she struggled to stay alive. I can’t tell you how much of a head case I feel at the thought of meeting Nate in the same condition, especially considering lack of oxygen played a role in why Ava needed to be removed from life support.

These are all things that I have been fully aware of and concerned about for a long time now, but my OB has offered reassurance that they will be prepared for this, and together, we have come to the conclusion that the risks outweigh the concerns of another precipitous labour beginning at 38 weeks like the one I experienced with Ava, the distance we have to travel to the hospital should spontaneous labour start, the timing of the holiday season and staffing issues and of course, the unknown factor about the baby’s heart and its ability to cope with the stress of labour. Once I explained these things to the Pediatrician, her attitude seemed to take a complete 180 on the matter and she immediately shifted to the positives of an early c-section. Unfortunately, the seed of doubt had been planted. I am firmly convinced she changed her tune because she realized that she had potentially undermined the authority of my OB to make the right decisions and the tears streaming down my face were probably a clue to how upsetting her thoughts on the matter where.

The thing is, she has not revealed any new information. The only difference is in the attitude about everything. When I brought forward my concerns to my OB she had a very optimistic attitude about the outcome and my pediatrician obviously feels these issues warrant more concern and actually advised we do an amnio.

In some ways, I think the pediatrician is more balanced in her approach because she is looking at the entire process as a whole, including after the baby is born and not just the inutero health of the baby and the actually delivery.

Essentially, everyone is on the same page, so this issue is really about the perceived risk to the baby. To help wrap my head around everything I made a list of all the pros and cons of delivering this baby before 38 weeks:

-My OB will actually be delivering the baby and she knows my history intimately

-Scheduling a c-section before 38 weeks minimizes the chance that I will go into labour and this provides us with a sense of control over the birth of this baby, particularly after everything we have gone through as well as the distance we live from the hopistal

-Scheduling a c-section lets us avoid the possibility of rush hour traffic should I go into labour

-Scheduling a c-section lets us deliver this baby at one of Canada’s top hospitals
-Scheduling a c-section allows us to plan in the event of a snow storm (more control)

-Scheduling a c-section allows us to avoid the barebones skeleton Christmas staff should I go into labour and require a c-section over Christmas

-The delivery is only 2 days before the magical number of 38 weeks. Odds are that two days will not make a huge difference in lung maturity unless this baby needs 40 weeks to fully develop.

-I will not yet be 38 weeks, the apparent sweet spot for balancing lung maturity and medical intervention

-In any case, no matter what the date of the c-section, there will be concerns about lung maturity, TTN and respiratory distress.

-An Amnio could tell us if lungs are mature but if they aren’t, then the section is delayed and I could go into labour.

-A shot of steroids to mature the lungs faster is not advised after 33 weeks and the Pediatrician feels strongly against the use of them unless the benefits far outweigh the risks, particularly now that studies are indicating adverse affects of the drug on the baby’s brain.

Even thought the pro list has a few more points, I still feel torn. If I lived in my own ideal fantasy world there would be no such thing as dead babies and having to make difficult decisions. Also, in my fantasy baby bubble, since an amnio posses little risks to the baby at this stage in the pregnancy (besides triggering labour), they would admit me into the hospital and do an amnio every day until the lungs are ready. My OB would sit by my bedside and we could sip tea and eat Christmas chocolates, scalpel in hand, waiting for the signal to proceed.

Having a baby shouldn’t be this complicated, and I wish I could get off this train wreck of neuroses that I have become of over thinking and overanalyzing this situation. I wish I could just go with the flow and hope for the best, but riding on the coat tails of blind faith is not my forte.

I hate that I have to worry about these issues and I hate that ultimately I am not capable of making decisions on the birth of this baby by having faith in nature and my body to ensure all goes well. My decisions are being based on my experiences with pregnancy and childbirth and after the loss of two lives, I feel like I am forced to choose between the lesser of two evils where respiratory distress, no matter how concerning it is, sounds less permanent than death.

I need to figure out how to stop wallowing in my own pity party of self entitlement because I have been waiting for a baby for over three years now and just want this baby to be born with as little risk to him as possible.

I just want guarantees and I am frustrated as hell that no matter what road we head down, there are none.

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You are right there should be NO complications with bringing a sweet little innocent life into this world, especially to people who want them so badly!

I think sometimes Dr's like to use their power to persuade people, I think your pediatrician wasn't looking at all of the facts, she was going by the regular situation. Your situation is an exception to the rules and I think you are making the BEST decision, based on your experience and need to protect Nate! I can't wait until all this stress is behind you, my heart is heavy
just knowing you are in a situation. No one deserves to be in.

Posted by Anonymous Donna :  November 30, 2006

Your decisions have been based on the best information available for keeping Nate healthy.
I wish that you could receive guarantees too..

I can not imagine how hard it must be to try to figure out what you should do after the experiences in the past. I have been, and will continue to pray for a safe delivery of Nate, and for peace of mind for you.
Posted by Blogger Robyn :  November 30, 2006

This must be such a stressful time. I wish I had some sage advise.. but all I can give is my very best wishes for both Nate and yourself. You are in my prayers.
Posted by Anonymous Coll :  November 30, 2006


It all seems so overwhelming. On top of just HAVING a baby, which is already overwhelming, you have to deal with all of this.

We love you, and may the juju be strong with you, my friend.
Posted by Blogger Gina :  November 30, 2006

I too wish that guarantees were a possibility. Life is full of chance and risk and luck and loss and sometimes that's so frightening. I think of you and Nate daily and am praying for you all.
Posted by Anonymous Amanda :  November 30, 2006

Oh my dear Karla. I wish I could help share this burden with you. I wish there were some words I could say that would make the load of worry lighter for you. I wish, I wish.

For what it's worth, I've known quite a few babies who were born at 38 weeks and earlier, and none of them have ever had lung problems. I know that's only anecdotal evidence, but it seems to me at that stage, there's really not that great of a risk. My nephew was nearly 6 weeks early and he's one of the healthiest kids around.
Posted by Blogger Heather :  November 30, 2006

I don't know what to say except that I'm thinking about you and look forward to the day when I read your blog introducing Nate, a healthy and beautiful #10.
Posted by Blogger Linda :  November 30, 2006

Thats rough Karla, all the Doctors can do is their best, and she was right to change her tune based on the information provided. Medical advice changes based on situations, and in your the Cold C-Section makes the most sense the success rate and healthy baby rate at 38 weeks cold must be ridiculously high, and the risks outweigh the rewards. I hope we'll get to meet Nate after he's born, He'll be fine, and lucky to have a Mother that cares this much about him even before she's held him in her arms.
Posted by Blogger NegZero :  November 30, 2006

Karla, in your situation I would be doing all the thinking, re-thinking and then overthinking too. It is INCREDIBLY unfair that you arent able to relax about the end of your pregnancy. Most women never really have to think about all these things. I understand your feelings COMPLETELY. I didnt realize that steriods after 33 weeks could cause problems, because that was what I was going to suggest you ask them about.

I do think it would be the wisest choice to go ahead with the scheduled c-section. I think the risk there is less than if you were to chance going into labor on your own. Your body seems to have an intense and FAST labor and they say 2nd time around it goes faster. I also understand your anxiety about meeting Nate with all those tubes and wires. That is how I met Makily. Honestly as awful as this is to say I hate my first memory of her because it was so clouded with fear, sadness, worry etc etc etc. To this day I still get a knot in my throat thinking of it. So I understand your apprehension.
Picking the lesser of two evils ALWAYS BITES. We do it all the time in the house with our little one so I feel for you.

I pray that you are able to have a safe delivery and that he is immediately placed into your arms afterwards so you can experience his first breaths of life, no wires, no tubes, no fear....just amazing joy and love. God knows you and Mark deserve that.
Posted by Blogger Patyrish :  November 30, 2006

There never are guarantees in life. However, I guarantee that your child will never question how much he is loved.
Posted by Blogger Christi :  December 01, 2006

I think that even though you are extremely worried about this whole procedure, you are doing a fabulous job in outweighing the pros and cons. I know that you are making the best decisions for yourself, and for your child. You already are a wonderful Mother Karla. Nate is really, REALLY lucky to have a mother like you.

I can only pray that everything goes smoothly as possible for you, Mark, and that little bean of yours. I will also be praying from here on in, that your mind will be put at ease these last few days of your pregnancy, as you prepare for Nate's arrival into this big amazing world!!

lots of ((HUGS))
Posted by Blogger Melanie :  December 01, 2006

I cant even imagine what you must be going through. You and your baby will be in my thoughts an prayers. I hope everything turns out well and you have a healthy baby boy.
Posted by Anonymous Anonymous :  December 01, 2006

There is nothing more difficult than grappling, REALLY grappling, with the fact that there are no guarantees. But something to remember - there's tremendous force in also recognizing the fact that all of your doctor's power, all of the hospital's power, all of YOUR power and spirit will be directed to the end of getting as close to the guarantee that you want as possible. That's a lot of power. Hold that - and all the love and hope that you have stored up - close to your heart.

My thoughts and prayers are with you.


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