What to do, what to do...

So I am very excited to start my new career next month, so far my (our) plan is working as planned. We had Ava, I stayed home with her the first year, went back to school to do the CNA program, got a job. The next stage of our plan was to work for a year and then possible start trying for a third bambino. Something that was usually such an easy choice, this time is not. I am not struggling as to whether or not to have a third, that I am good with. It's everything else that is just weighing me down right now.

Issues going through my head right now:

~We don't really have room for another child in this house
~This house will not be ready to be on the market in a year
~Even if said house was on the market in a year, who knows how long it would take to sell
~Money for a new house will mostly come from the sale of this house, so yea we have to sell before we buy
~What happens if I have early complications again now that I will be working? What happens if blood pressure is an issue again? I don't want to lose this job, and I need to make sure I get enough hours in the next year to cover FMLA.
And the biggie that keeps cropping up since I had Ava
~to VBA2C or Repeat C-section

Honestly right after I had Ava, I started researching it. I didn't even get to try with her because of a push to be delivered by 41 weeks, while I could have declined the c-section they forced me to schedule, I ended up with pre-e and had to be delivered anyway. Everything leading up to that was good though. I was dilated a bit (more than I was with Logan before my water broke), I was getting into contraction patterns, they just kept stopping, I needed more time, but my body was done at 8 days past due date, and pre-e is not something you mess around with. I get it, it was necessary. My first c-section, well jury is till out on that one, we will never know if it was necessary.

So I had resolved to the fact that I would have to birth that way if we had more kids. Then a couple of weeks later the ACOG released new guidelines and research that said a VBA2C held no more risks then a VBAC. Well now since then I have been researching providers, midwives, hospitals and more research so we can give this one more try. Through this research it has become very apparent that each c-section you have puts you at much more risk for maternal death. Um no thank you.

So I have a doctors name, a hospital and a midwife practice, it will be a pain to get there, but it's the best choice and chance we have at this. I really prefer to see a midwife this time as they are more holistic in their care and take more time with you. We have decided against my better memory LOL, to try and have a natural child birth, as it is the best and safest way to VBAC. This is going to take a lot of work, classes, doula, whatever it takes. With Logan my water broke and then nothing, so I was hooked up to pitocin as soon as they got me in bed. All I know is I was 1 centimeter dilated and having back to back contractions with doubles peaks, pretty sure that is not normal for early labor. I couldn't handle it I was losing control and had to get the epidural. All the dilating I did with Logan was after the epidural and I could relax, so I don't think they are the devil as some indicate. I know it's different if you go into labor on your own, easier to handle and that's what is getting me through this idea of natural labor. I have a lot of fear to work through that's for sure.

Here is one of the articles I found:

Comparing Risks of VBAC and Repeat Cesarean: Studies and Statistics

In her book, Ina May’s Guide to Childbirth (aff), Ina May Gaskin compares the risk of vaginal birth after cesarean with repeat cesarean:

The medical evidence about VBAC is actually clearer than some recent medical and media interpretations of it would suggest. Cesarean surgery is just as risky as any other major abdominal surgery for the mother — a considerably higher risk for her than vaginal birth. With repeat cesarean she has three times the chance of dying and roughly five to ten times the risk of suffering complications. [emphasis mine]

In examining the the general risks of cesarean vs. vaginal delivery, studies have shown certain increased risks due to caesarean delivery, and other increased risks due to vaginal delivery.

General risks of cesarean delivery (those with higher risk than vaginal delivery) include:

• A threefold increase in the risk of death to the mother
• Greater risk of death to the infant, by more than double when no labor complications are present
• Increased risk of newborn respiratory problems
  
• A dramatic increase in the risk of hysterectomy
• Increased risk of infection and its complications
• Risk of dense adhesions, increasing the likelihood of organ injury in future abdominal or cesarean deliveries, and increasing the likelihood of bowel obstruction
• More intense and longer-lasting pain in the six months subsequent to birth
• Bladder injury
• Increased psychological problems for the mother, including difficulties in establishing breastfeeding, weakened mother-baby bonding, postpartum depression and even instances of PTSD
• Risk to babies in future pregnancies, including increased risk of pre-term delivery, low birth weight, brain and spinal cord injury, respiratory problems, and unexplained pre-term death in the womb
• Risks to future pregnancies due to accumulated cesarean scars, such as ectopic pregnancy, placenta previa and placental abruption

General risks of vaginal delivery (those with higher risks than cesarean delivery) include:

• Anal sphincter trauma
• Temporary urinary incontinence

Fewer studies are available in directly comparing specifically VBAC deliveries to repeat cesarean, however, studies appear to indicate:

• VBAC represents no additional risk to the infant,
• Repeat cesarean does however represent increased risk to the mother.

Although VBAC does represent increased risk of rupture of the uterine scar, again, this risk has not been shown to correlate with an increased overall risk of death compared with caesarean delivery.

Yea so there you have it. This decision should be an easy one. Especially if we do want to have a fourth. I feel like a 3rd c-section would be it, I had a hard time recovering from my second, one so I feel a third would be it for my body.

So now we have to decide when are we going to do this. In my research I read an article from Mayo Clinical about pregnancy spacing and found out that 5 or more years between births increases pre-e chances. Well I am already at increase for that since I have had PIH and pre-e in both of my live pregnancies. If we wait until we moved, we might get to that point and I don't want to do ANYTHING to increase my chances of pre-e. The treatment is really rough on me, and I am just not a present in the first two days of my kids lives because of it. Not to mention good bye VBAC.

I was starting to think we should wait two more years. I would be 32, which means if there were to be a #4 if would be a lot closer in age then we want to #3. We really don't want to be having kids much past 35 since I have so many issues already, they will just get worse as I age.

I need to get my surgical records from the hospital so I can take them to the new doctor/midwife and see what is going on and if VBAC is in the cards. I need to meet with these new care providers and make my wishes known. I have no idea how long my body is going to take to get back to normal after "the removal" it could be awhile. So if we are going to go for it in a year, I need to get started on all this. I just feel like we have to wait because if the house situation, so then I am back to the spacing problem and if we are nearing 5 years between I am putting my self more at risk for something that I am already at high risk for! So anyway, I am struggling with all this right now. We have to make some decisions and that's all there is to it. My family WILL NOT be supportive of a VBA2C, and I can only surround myself with positive as we take that journey. My husband is supportive, but I feel like sometimes he just says what I want to hear. He is however the only person that really saw what I went through after we had Logan and he was so worried after my c-section with Ava, but it was better this time. I am sure all Logan's medical issues, NICU, etc, played a big part in the hot mess I was after that birth.

I wish I could just jump into work and not worry about it until next year, but the planning and making sure I have a care provider that supports our decision, my take a year to find, or to get into if this place is super busy.

I found a lot of great blog postings from ICAN, I will have to post some. Some of the c-section ones I could have wrote myself. It' s nice to know I am not alone in the way I feel.

SO this was a long rambling post, but I couldn't sleep last night thinking about all this and needed to get it out.

I am, however, super exited to start working and I am sure my nerves in relation to that is also keeping me up at night, which gives me time to think about all this other stuff...oh well that's life!