If you are wanting an uplifting or positive post don't continue reading.
Originally, I had an appointment scheduled for my regular MFM (maternal fetal medicine) doctor on Wednesday. It was cancelled due to weather and rescheduled for today. Unfortunately, he was out of the office and so I saw someone else. I had my reservations about seeing someone different. I very much like to maintain continuity of care as much as possible and I didn't want to deal with an alarmist doctor. I made several attempts to change the appointment. But between the craziness of our house and no one answering the phone, I went against my gut and had the appointment anyway.
After the regular US the doctor and resident entered the room. I have never been in a situation where I was not first informed that a resident was present and then asked if it was ok if they sat in on the appointment. This was not the case. They never told me the resident's name. Aside from the doctor introducing himself to me, he didn't say a word to me the next several minutes...he just made small talk with the US tech and the resident. The resident asked questions about the possibility of my individual membranes rupturing. Hello, I'm in the room. Please save these questions for later, especially if I never even brought up membrane rupture. The doc proceeded to put gel on my stomach, i don't even know why because he didn't really take the time to look at anything. He just moved the damn US thing around very unintentionally, or so it seemed. I wanted to say, "My babies already had a rather lengthy ultrasound, unless what you are doing is beneficial get the damn thing off me." I didn't. I really wish that I had. I lost my voice. I knew the sizes of the babies, A: 1lb8oz, B: 1lb2oz, and C: 1lb7oz. All great weights. The fluid was normal. The bladders were normal. Everything was stable. The doctor even said everything is stable. So then why did he feel the need to say "Hopefully Baby B can hang on." Are you frickin kidding me. What during that US, especially the part when you were just screwing around, indicated anything other than healthy babies? I knew going into this appointment to have very low expectations. But I didn't actually think he would make such an unnecessary and unwarranted comment. All the joy and excitement that I had from seeing my three girls, knowing they were healthy, and growing beautifully went out the window/ Now I just wanted him out of there as quickly as possible.
I scheduled my next appointment and asked for my usual MFM. He will be out of the office all that week. Two were, available, Mr Jerk-face and a different doctor. Initially, I was thinking to stay with Jerk-face to have some consistency. Now that I've had the drive home to think about it, I don't want to see him again. I will take another doctor or try to stretch my next visit a few extra days to see my normal MFM provider.
Needless to say, I'm going to complain.
Friday, January 31, 2014
Friday, January 10, 2014
Triplet Birth Plan: Draft
Lately I have been in a "birth plan state of mind." So while my three girls were napping I decided there was no time like the present to put my thoughts on paper. I have been hesitant to write anything down for a few reasons 1) compared to my other births 20w feels so early to do a birth plan, particularly with a provider who has "proved" himself in my previous births. 2) I don't want to appear naive or even flippant to the uniqueness of my pregnancy and my birth. 3) I have only experienced "normal," low risk births and an unnecessary cesarean. So I wasn't sure I knew what was "allowed" in a triplet birth. Then I began to think about my VBACs. I did everything I could and asked all the questions I could imagine so if it came down to my birth plan taking a major detour I could feel confident that I took care of things on my end. I knew that I wouldn't have lingering feelings of doubt. So then why should this birth be any different? Why shouldn't I be able to ask for the moon and work from there?
So I drafted this birth plan in a similar way to my singleton births. Without asking for things I can't have a dialogue with my care providers. Having a dialogue with a care provider throughout the pregnancy, especially one in which things can change from visit to visit, allows the mother and provider to establish a greater degree of trust, allows the provider to better understand the desires of the mother and the mother can understand the skill set and comfort of the provider. In this type of birth, and with most other births, I believe it is important for a mother to maintain a certain degree of flexibility. But along the way it is paramount that the dialogue remain open and honest. The provider must present the facts, not over dramatizing nor down-playing them, and always discussing how they would handle situations as they arise in the birth. It is equally important for the mother to express her concerns and wishes as the pregnancy progresses as well.
So as I said, this birth plan is a draft and will likely undergo changes based on developments with the babies and conversations with the provider. I hope to be able to provide in future posts conversations that my providers and I have had about various components of the birth plan.
Birth Plan for Hannah Birchman and Triplet Birchman Girls:
So I drafted this birth plan in a similar way to my singleton births. Without asking for things I can't have a dialogue with my care providers. Having a dialogue with a care provider throughout the pregnancy, especially one in which things can change from visit to visit, allows the mother and provider to establish a greater degree of trust, allows the provider to better understand the desires of the mother and the mother can understand the skill set and comfort of the provider. In this type of birth, and with most other births, I believe it is important for a mother to maintain a certain degree of flexibility. But along the way it is paramount that the dialogue remain open and honest. The provider must present the facts, not over dramatizing nor down-playing them, and always discussing how they would handle situations as they arise in the birth. It is equally important for the mother to express her concerns and wishes as the pregnancy progresses as well.
So as I said, this birth plan is a draft and will likely undergo changes based on developments with the babies and conversations with the provider. I hope to be able to provide in future posts conversations that my providers and I have had about various components of the birth plan.
Birth Plan for Hannah Birchman and Triplet Birchman Girls:
Due to the nature of my triplet pregnancy I am aware that
there are many variables at play. I have
informed myself of the risks and benefits of a vaginal birth, breech
extraction, and cesarean (planned and emergent). I am aware that things can change quickly. Therefore, I have prepared my birth
preferences for several different birth outcomes.
I have carefully selected my health care providers and believe they will act in the best interest of myself and my babies. However, every decision regarding my care and that of my babies should not be made without my direct consent, or that of my husband if I am physically unable to consent. It is within my rights to change my decisions at any point during the birth.
I have carefully selected my health care providers and believe they will act in the best interest of myself and my babies. However, every decision regarding my care and that of my babies should not be made without my direct consent, or that of my husband if I am physically unable to consent. It is within my rights to change my decisions at any point during the birth.
During the various stages of the birth, please limit those
attending to necessary personnel only.
Vaginal Birth:
Stage One:
*Do not ask me to asses my pain.
*Use of various comfort measures: ball, stool, toilet,
shower, and freedom to move around.
*Intermittent fetal monitoring.
*Cervical checks by the OB only or upon my request.
*No stripping of the membranes without my consent.
*No breaking my bags of water without my consent.
*Please do not offer an epidural, unless I use my code
word/phrase “Give me a c-section.”
However, due to the nature of my birth…
Please allow either my husband or doula to be present if an epidural
must be administered.
*Ability to eat and drink through the course of labor.
*No Hep-lock
*No artificial augmentation of labor.
Stage Two:
*Freedom to push in any position that will allow my pelvis
to open completely. Should an epidural
be used please help me get into the most optimal position for pushing.
*Use of an ultrasound after each baby is born to determine
their positions. Should any of the
babies present breach I am comfortable with a vaginal birth.
*If Baby B or C is presenting breach but appears to be
responding positively to contractions and is progressing please allow the baby
to be birthed with little to no interventions.
*Mother-directed pushing.
No counting.
*Use of a mirror to see the birth.
*Please allow me to grab each baby as she is birthed.
*Massage of the perenium and use of lidocaine. Please do not cut an episiotomy.
*Delayed cord clamping.
Stage Three
*Provided there are not emergent situations with the babies
I would like Immediate skin to skin until it is time to birth the next
baby. Then allow my husband to hold the
baby.
*Allow my husband the opportunity to cut the cord.
*Natural birth of the placenta. No Pitocin, unless it is apparent that it is
medically necessary.
Baby Care:
*We do not want to bathe the babies and want to keep as much
of the vernix on the babies as possible.
*We do not want the Vitamin K drops, Hep B shot, or the PKU
test.
*I plan to breastfeed and so please do not give formula or
sugar water unless direct consent has been provided.
Birth Plan for a
Cesarean:
*Please do not put any IVs in my
right (dominant arm).
*Freedom to move my arms.
*Drop the curtain and have a
mirror so I am able to view the birth.
*Please be respectful that while
this may be a routine procedure it is a major procedure for me and so please be
mindful of your conversations. I would
like to be informed of what is going on during the surgery.
*Immediate skin to skin with me or
my husband. I would like to give the
babies the opportunity to nurse as soon as possible.
*I would like either my husband or
myself to remain with the babies when at all possible.
Thursday, January 2, 2014
What does it look like to prepare for the birth of triplets?
So, what does it look like to prepare for the birth of triplets? In the mere 19w I have been pregnant I have learned that I have to be very flexible. Things change from week to week, and not just size of the baby, but potentially life threatening changes. It looks like getting in the zone for a vaginal birth one day and then having to research a pregnancy reduction the next day. It is all over the map.
The latest update on my triplet pregnancy is that each baby is in its own sac, so no Mo/Mo, and we are still within the range of normal with regard to fluids to TTTS has not been diagnosed. So, I'm just a regular high risk triplet pregnancy without added risk. What a relief. But now that I am not trying to educate myself regarding Mo/Mo or TTTS I feel like I have to do something. For whatever reason I can't just BE pregnant. The fewer the complications the greater the likelihood for a vaginal birth. And so in the past few days I have allowed myself to finally read the few triplet vaginal birth stories that are out there. They are all amazing, but I am most amazed by the VBAC moms who have had a successful triplet birth, and not just VBAC, but VBA2C.
I remind myself constantly, as does my OB and my MFM, that there are so many variables in a triplet pregnancy. It would be foolish to sign-off on a vaginal birth now at 19w because things can literally change from week to week. This does not mean my care providers are not supportive of a vaginal birth, should that be the best option and my decision. In all honesty, in this pregnancy I am setting very small goals. Goals that really I have very little control over attaining, but I set them none-the-less. Every Sunday when I make it 1 more week that is cause for celebration and thankfulness. Every ultra sound, which is now happening weekly, that indicates babies are growing, bladders are functioning, amniotic fluid is within the range of normal, my cervix is still holding up(and apparently it's beautiful and boxy and indicating no cause for concern), and my 1 placenta for all 3 hasn't crapped out that is cause for celebration and thankfulness. Beyond weekly goals, my next major milestone is 24w, viability week. Ok, so those are my goals about them living one week longer.
Then other factors that I'm at increased risk for due to the multiple gestation is pre-eclampsia and gestational diabetes. At my 24w visit we will test for GD. This is earlier than if I were your average woman pregnant with a singleton. And in the past, I have declined the test and I have that choice again and the "ok" from my OB should that be the route I choose. But I don't need to have additional stress on my placenta and if there are things I can do dietary wise that I'm not already doing, sign me up.
So I suppose there are other things occupying my mind even after TTTS and Mo/Mo were not associated with this pregnancy. But thinking about all those things I listed above aren't much fun. Reading stories of vaginal triplet births and connecting with moms who have accomplished this feat or who are hoping for one is fun, encouraging, and gives me hope. But I am not naive. This pregnancy and birth is not just about thinking positive thoughts, saying affirmations, picturing my cervix opening, and hiring just the right people to attend my birth. And quite frankly that view extremely minimizes every other issue, hardship, and concern. It is about making it one more week. It's about reducing the number of days each baby will be in the NICU. It's also about figuring out how to care for my 3 children I already have at home and caring for the new little babies joining our family. It is not about how strong or determine I am. Thankfully, I have already had 2 successful VBACs so I don't doubt my body. I know that it will do what it needs to if and when it needs to. I also believe the outcome has been determined by God, I just need the wisdom and discernment to follow the plan He has set and be at peace with it.
I can't just show up and expect to have a vaginal birth with triplets. So I need to put some time and effort into finding what little data and information there is. Uterine rupture, even with two successful VBACs, is still a possibility simply because of the extra babies. But there isn't a lot of statistical data on rupture, vbac, and triplets...go figure. Each triplet pregnancy is so different, it's hard to find consistent protocols among OBs because of the great variability, so you can imagine there isn't a lot of information on the hows/whys/etc for a vaginal triplet birth. So I am doing my homework and making friends with like-minded moms who have as much similarity to my pregnancy as is possible given my birth history and current pregnancy "profile." As much as I am doing my homework on vaginal, I am also watching videos and reading about cesareans, specifically family centered ones. Like I already said, I am not naive. I know things can change on a dime. I've said it before, I am so thankful that I am under the care of two health care providers who respect and practice evidence based birth, respect the almost delicate nature of the pregnancy, want what is best for me even if it may not be what they would choose, and ultimately leave the decisions up to me. God has blessed me in so many ways in this pregnancy.
The latest update on my triplet pregnancy is that each baby is in its own sac, so no Mo/Mo, and we are still within the range of normal with regard to fluids to TTTS has not been diagnosed. So, I'm just a regular high risk triplet pregnancy without added risk. What a relief. But now that I am not trying to educate myself regarding Mo/Mo or TTTS I feel like I have to do something. For whatever reason I can't just BE pregnant. The fewer the complications the greater the likelihood for a vaginal birth. And so in the past few days I have allowed myself to finally read the few triplet vaginal birth stories that are out there. They are all amazing, but I am most amazed by the VBAC moms who have had a successful triplet birth, and not just VBAC, but VBA2C.
I remind myself constantly, as does my OB and my MFM, that there are so many variables in a triplet pregnancy. It would be foolish to sign-off on a vaginal birth now at 19w because things can literally change from week to week. This does not mean my care providers are not supportive of a vaginal birth, should that be the best option and my decision. In all honesty, in this pregnancy I am setting very small goals. Goals that really I have very little control over attaining, but I set them none-the-less. Every Sunday when I make it 1 more week that is cause for celebration and thankfulness. Every ultra sound, which is now happening weekly, that indicates babies are growing, bladders are functioning, amniotic fluid is within the range of normal, my cervix is still holding up(and apparently it's beautiful and boxy and indicating no cause for concern), and my 1 placenta for all 3 hasn't crapped out that is cause for celebration and thankfulness. Beyond weekly goals, my next major milestone is 24w, viability week. Ok, so those are my goals about them living one week longer.
Then other factors that I'm at increased risk for due to the multiple gestation is pre-eclampsia and gestational diabetes. At my 24w visit we will test for GD. This is earlier than if I were your average woman pregnant with a singleton. And in the past, I have declined the test and I have that choice again and the "ok" from my OB should that be the route I choose. But I don't need to have additional stress on my placenta and if there are things I can do dietary wise that I'm not already doing, sign me up.
So I suppose there are other things occupying my mind even after TTTS and Mo/Mo were not associated with this pregnancy. But thinking about all those things I listed above aren't much fun. Reading stories of vaginal triplet births and connecting with moms who have accomplished this feat or who are hoping for one is fun, encouraging, and gives me hope. But I am not naive. This pregnancy and birth is not just about thinking positive thoughts, saying affirmations, picturing my cervix opening, and hiring just the right people to attend my birth. And quite frankly that view extremely minimizes every other issue, hardship, and concern. It is about making it one more week. It's about reducing the number of days each baby will be in the NICU. It's also about figuring out how to care for my 3 children I already have at home and caring for the new little babies joining our family. It is not about how strong or determine I am. Thankfully, I have already had 2 successful VBACs so I don't doubt my body. I know that it will do what it needs to if and when it needs to. I also believe the outcome has been determined by God, I just need the wisdom and discernment to follow the plan He has set and be at peace with it.
I can't just show up and expect to have a vaginal birth with triplets. So I need to put some time and effort into finding what little data and information there is. Uterine rupture, even with two successful VBACs, is still a possibility simply because of the extra babies. But there isn't a lot of statistical data on rupture, vbac, and triplets...go figure. Each triplet pregnancy is so different, it's hard to find consistent protocols among OBs because of the great variability, so you can imagine there isn't a lot of information on the hows/whys/etc for a vaginal triplet birth. So I am doing my homework and making friends with like-minded moms who have as much similarity to my pregnancy as is possible given my birth history and current pregnancy "profile." As much as I am doing my homework on vaginal, I am also watching videos and reading about cesareans, specifically family centered ones. Like I already said, I am not naive. I know things can change on a dime. I've said it before, I am so thankful that I am under the care of two health care providers who respect and practice evidence based birth, respect the almost delicate nature of the pregnancy, want what is best for me even if it may not be what they would choose, and ultimately leave the decisions up to me. God has blessed me in so many ways in this pregnancy.
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