A birthday, a diagnosis, and a mother's musings on it all

In 4 short weeks, our daughter will be here. We have been scheduled for a C-section for July 7th. Our Summer Baby's birthday will be July 7, 2009 - if all goes as planned.

I am the most unlikely candidate to schedule a surgery for one of the most natural processes of life - childbirth. It's not who I am - at all. Yet I who don't even use medicine, not even a painkiller in the past 5 years (except for IV drugs for 2 days after my first C-section), have scheduled a surgery to deliver my second child.

I've made the decision with the knowledge of several things. One of these things I haven't talked about yet - our baby has what's called a Single Umbilical Artery, also called a two-vein chord. Basically, there are 2 arteries and 1 vein in the umbilical chord (one vein carrying nutrients/oxygen in, two arteries carrying waste out) and the baby's chord is missing one of the arteries that carries the waste out. This condition presents in approximately 1-2% of all births, its cause is unknown, though more common in older mothers, and it is considered a fairly common occurrence by obstetricians, but it can signal several problems. In most (about 70%) of cases, the baby is perfectly fine, the SUA being an isolated condition, which is the case with our baby. In a lesser number of cases, it can be a soft marker for other health problems, most commonly heart and kidney problems.

We've known about this since the 20th week ultrasound scan, when we were told that everything looks healthy, but that there seems to be a two-vein chord. We were then referred to a perinatologist for a Level II ultrasound to make sure they didn't miss anything and he confirmed that all the organs look healthy; the two-vein chord is just an isolated condition.

Of course, you know me, I research everything, so between the first diagnosis and the perinatologist's visit 3 days later, I became an expert on the condition and was able to have an intelligent discussion about it with him (surprising him a little, to say the least).

Since the SUA is an isolated condition, basically at this point, we just need to monitor the amniotic fluid level and the size of the baby, as one of the risk factors is IUGR (intra-uterine growth restriction) due to the single outgoing artery putting extra stress on the placenta. If the placenta is not able to supply enough nutrients/oxygen to the baby, the baby uses what is supplied for the most vital of functions (heart, brain) and slows down kidney function, i.e. not putting out the needed urine, which is what makes up most of the amniotic fluid at the end of the pregnancy. Low amniotic fluid, of course is not safe, especially when the chord only has two veins running through it (thus less Wharton's jelly surrounding it) and isn't as sturdy as a three-vein chord. So the amniotic fluid level and the size of the baby need to be monitored in late pregnancy - those are the two main concerns. If the fluid level and baby's size look good at 32 weeks, it is very unlikely to become a problem in the upcoming weeks.

We found out at the 32 week ultrasound that not only is the amniotic fluid level better than average, but that our baby is already a whopping 5 pounds! Estimated to reach 9 pounds and 4 ounces if carried to 40 weeks! I was watching her head size measurement come up on the screen (and remember, I was exactly 32 weeks along) - the head size came up measuring 35 weeks and 6 days, almost 4 weeks larger! What can I say, I have big-headed babies. From good German stock, I suppose. :)

So the good news is that my placenta is still rocking it, despite the disadvantage of the dysfunctional chord, and I'm still making just as large a baby as ever. Woo-hoo! No growth restriction!

On the other hand, I am making a very large baby here. With Caleb, we had no idea of his size, as there was no reason for any ultrasounds past the one at 20 weeks. It was the one thing I hadn't considered at the time - that the baby may be too big for me to give birth to -although I diligently studied every aspect of natural childbirth, and then some: from the most advantegous position in which to give birth (it's not flat on your back, but the squatting position, which opens up the pelvis by 1/3 more) to the various ways epidurals and other drugs can disrupt the physicological process of birth, delayed chord cutting, coached pushing vs. physiologic pushing, the precise way the uterine muscles move during labor and what wonders breathing and relaxed muscles in the rest of the body can do to facilitate its contraction almost painlessly (worked exactly like I read it), etc., etc.

Caleb was 9 pounds 2 ounces with a huge head and apparently too big for my body to pass through. My cervix stayed at 8 cm for about ten hours, then started to swell, and towards the end Caleb was not tolerating the marathon-length labor (I'm sure butting his head up against something that didn't give for 2 whole days wasn't fun) - he had to be delivered through a C-section.

I had been planning a VBAC (vaginal birth after Cesarean) throughout this pregnancy, thinking I already know what to expect in labor, it isn't bad, and worse comes to worse if my cervix stops dilating, we'll just end up with a C-section again. There's no harm in trying, the risks of uterine rupture during a VBAC are only slightly higher than they are with a C-section, but the C-section of course has its own risks, being major abdominal surgery (which trump the uterine rupture risks).

However, the SUA diagnosis has added a different twist to things, and after much research, I've come to the conclusion that it is safer for the baby to be born by C-section if she is just as large as Caleb was (we'll get the final word at 37 weeks) - considering my C-section history, narrow subpubic arch, which is strongly associated with prolonged labor and forcep or vacuum assistance at the end, coupled with the less sturdy two-vein chord, which is more easily compressed than a normal chord, especially during a lengthy labor/pushing phase. Compression of the chord during birth is very serious and it requires an emergency C-section, and even then, sometimes they cannot save the baby. Of course, it is possible to give birth to an SUA baby without any problems at all, but with everything considered in my specific case, I think the C-section is the safer option for this baby. Which means, I will never push a baby out of my body and experience the joy of natural childbirth (just the joy of post-childbirth -THE BABY) or put to practice most of the things I learned about childbirth in my first pregnancy. They do not allow VBAC after having had two C-sections. This was my one chance.

With all that said, I feel at peace with my decision. The health and safety of the baby is what's most important, not my experience.

We've believed, almost immediately after the initial shock that there could be anything wrong at all, that we had a healthy baby. Fear and worry have not crept into this pregnancy due to this diagnosis; I did not allow it. I prayed to God that first night and concluded right then and there that I was not going to worry about this situation, because worry is not from God, that I choose to have faith instead. God has blessed me with such peace during my first pregnancy and He has done the same during this second.

As I now prepare for the impending birth on July 7th, I trust that God will continue to keep me in His care - even as I put my care into frail human hands, as well.