IVF on the Down Low

I’m always on a quest for some sort of information.  I always want the explanation.  There has to be a reason that things went the way that they did and it bothers me when things don’t make sense or even when people don’t make sense.  I recently started reading “The Thinking Woman’s Guide to a Better Birth”, which like most natural childbirth books explains a lot of interventions and why they occur and what the impact may be, which brought me back to Gavin’s birth and wanting to know what really happened.  A lot of people have commented when I tell his birth story seeming surprised at some of the things that happened considering I wasn’t even at the hospital until it was pushing time.  I was starting to feel like I was not quite clear on the whole story, so I decided I wanted to see the records.

Apparently I suck at obtaining medical records because I failed miserably.  I went to the hospital and requested what I thought was everything.  What I got was a stack of all of the drugs that they ordered to have on hand and lab work.  Not useful.  I went to the old OB/GYNs office and requested my full medical history.  It didn’t say anything about childbirth.  Poop.  So, I asked my midwife to tell me how the heck someone gets their hands on records related to childbirth.  Turns out, she has access to those records, she just needed my permission to look at them which I gladly gave.  She called back hours after my appointment to chat.

What she said wasn’t really what I was expecting to hear… “If you hadn’t been fully dilated, they probably would have rushed you in for an emergency c-section.” Wow.  I remember the nurses being annoying and the doctor being a royal bitch, but I don’t remember anyone being frantic.  But, the gist of it is that Gavin’s heart rate was down into the 50s and staying there sometimes for as long as 1.5 minutes and wasn’t ever rising about 90.  That’s a pretty big deal considering “normal” is something like 120-160.  They put me on IV fluids, they hooked me up to oxygen, they hooked up an internal monitor.  Now I know why.

So now my internal thoughts are along the lines of:

-Why didn’t I know this before?  The other people that were with us when Gavin was born probably knew what was going on, but Shawn and I were focused on other things and really if it was communicated we didn’t hear it.  Might have been nice if a nurse had discussed it with us after the fact or if someone had gone over it with us at the postpartum visit.  There might have been something going on that would be useful for us to know about now.

-I should have gone to the hospital earlier.  I didn’t actually intentionally go so far along.  I mean, who really wants to do transition in the car?  But labor was confusing for me.  Now I know why.  Posterior baby = back labor.  Back labor = pain that doesn’t end when the contraction ends.  That’s why I couldn’t figure out when contractions were starting and stopping and why I was having a hard time figuring out when to go to the hospital.  If I had gone to the hospital earlier or at least talked to my doula earlier maybe we could have gotten Gavin turned anterior and he might have tolerated labor better.

-How long was Gavin in distress?  I guess this is pointless to wonder considering I wasn’t monitored for any of my labor.

-If I had had a c-section would it have been “necessary”? Would I have been able to come to terms with not having my natural childbirth?

-What caused the fetal distress?  We might not ever know and it might not matter.  But, if it’s something that is an indicator of Gavin’s health or something that might recur, it would be useful to know.  I’ve done some googling (shame on me) and now I’m wondering if Gavin was an IUGR (intrauterine growth restricted) baby.  He fits a couple of the markers – <10% weight for gestational age (Gavin was <1%) and not tolerating labor very well.  If he were IUGR, he likely was the “asymmetrical” sort meaning that other measurements were normal even though his weight was low.  IUGR is often caused by some kind of placental malfunction leading to reduced blood flow and oxygen.  I have MTHFR (a clotting disorder) which could theoretically lead to this sort of problem, and could potentially make it a recurring rather than random problem.

-IUGR doesn’t quite fit though.  It’s usually caught before birth because maternal weight gain will drop off or fundal height measurements will fall behind.  Neither of these was true for me.  Usually, IUGR babies are induced early or go to automatic c-section because one of the possible consequences of IUGR is stillbirth.

-MTHFR is only something I know about randomly.  They tested me for it at my second IVF clinic because my first IVF clinic had me on massive folic acid doses “just in case”.  Second IVF clinic was going to take me off of the folic acid but wanted to make sure I didn’t need it first, and went ahead and tested me for MTHFR.  It’s never caused any issues for me.  Is this really a likely suspect?

-Oh dear.  It’s probably a good thing no one else lives in my head.

I will likely discuss this further at my next prenatal appointment.  She said to feel free to call with any questions, but I think I can wait and calling every day with questions is just going to make me crazier.  I just want to see if she has any likely suspects for what caused the distress and if it’s likely to recur.  Today she indicated that it’s unlikely to recur.  She also said it may have been because he was posterior because sometimes in that position they have pressure on the fontanelle which will cause distress.  She did also seem surprised at his low apgars (7/8) saying that indicates there was definitely something going on, so maybe when we see her in a couple of weeks she’ll have some additional thoughts.

And then once we have that conversation, as long as she feels there’s nothing to worry about for this baby, I’ll move on because dwelling on the last birth experience certainly isn’t productive in helping to prepare for this one.

We did the hospital tour tonight.  It was our third tour and we’ve stayed there twice, I just like feeling familiar with the territory.  The same things in the policy that annoyed me 2 years ago still annoy me today.  But, I’ve learned to bite my tongue.  Turns out it doesn’t matter that much what the policy is.  You just need to discuss what you want with your provider in advance, and if your provider is ok with what you want you’re good to go.  So, arguing with the tour guide is kind of pointless.  It’s not like she’s going to change the policy because you’re annoyed on a tour 🙂

I did majorly cringe when she talked about not being allowed food or drink while laboring.  She was encouraging moms to be kind and allow dads to eat even though they weren’t allowed to because that support person needs their energy.  WTF?  And mom doesn’t need their energy?  She’s the one doing all the work.  I just rolled my eyes and kept my commentary to myself, knowing that I personally will be eating while I labor whether it’s at home or in the hospital.  I had over 24 hours of back labor last time.  There is no way I would have had the energy to push if I hadn’t eaten for that entire period of time.

I find their post birth procedures to be somewhat annoying as well.  What they normally do is immediately move the baby to the warmer, do the vitamin K and eye ointment and weigh and measure the baby, give baby to the mom for 1 hour and then take baby (with dad) to the nursery while mom sits alone.  I’m going to let them do all the stuff that they want to do, but barring any medical emergency I’m going to ask them to shift things around a bit.  I don’t want the baby going to the warmer at all.  If they must do vitamin K and eye ointment in the warmer, then fine, but that can wait.  I suspect they can do those things while I hold baby skin to skin to regulate body temperature (then no warmer is needed!).  I want baby to come to me immediately for skin to skin and to attempt nursing before they do anything else.  This makes things better for me too because nursing stimulates oxytocin production which helps with the delivery of the placenta.  I’m also going to ask that all procedures that need to be done in the nursery be delayed until I can go along.  No need for us to be separated.

Just a warning.  I’m working on my birth plan.  Pretty much the same as last time. I’m feeling better about my care provider and I’m consider hacking some of it off because it’ll happen whether or not I go in fighting for it.

2 additions that I’m currently working on wording:

-The one thing I dislike about our hospital is that they insist on a mother/baby separation pretty soon after birth.  About 1 hour after birth they send the baby to the nursery for a bath and some testing.  In the past I have asked about testing in the room and they said that’s not possible.  This time I’m going at it from a different angle.  I’m just going to ask that they delay long enough that I can go along.  Problem solved.  It’s not like the world is going to end if I get to pee and shower before baby gets her first bath.

-Perineal massage.  I’m opposed.  The most recent stuff I’ve read has indicated that the aggressive massage they tend to do when baby is crowning actually causes swelling and increases the risk of tears.  Warm compress = good.  Aggressive massage = bad.

Or maybe I just won’t have a birth plan and instead I’ll yell obscenities if anyone puts their hands on my perineum.  And then when they tell Shawn that it’s time for the daddy walk to the nursery, I’ll say, no one’s going anywhere without mom.  Period.  I feel much more ready to stand up for myself.

Another warning.  I’ve been on a psycho hunt for medical records so I’ll probably rant and rave about any wrong that I feel was done to me last time if I ever get them in hand and deciphered.  I have the hospital report, but it’s not very useful as it shows all sorts of stuff that was ordered but not used (I hope) so now I’m getting the records from the old OB.  Hopefully they offer more useful info.