May 28, 2004 (34 weeks 6 days) - I had another routine OB appointment yesterday, the last one in her current office.  My next visit is in 2 weeks at the practice where she is transferring.  I gained about 3 more pounds I think, but my OB told me not to worry about it, even though I'm up about 35 pounds overall so far.  She confirmed that I'd read the information about VBAC and that my plan was still to wait until at least 42 weeks before we scheduled anything, which gives me until at least July 17th to have this baby.  We now have the crib and the changing table in the nursery and the baby clothes have been washed, so all that's left right now is to buy some diapers I guess.  We also need to make a decision on how we'll be doing the carseats and get those changed soon so the kids will be able to adjust to it before the baby arrives.  Frank wants me to pack a bag soon also, but I'm not quite ready to do that yet.  I figure I have at least SIX weeks to go, perhaps more like seven.  I can't even believe it's almost June already.  Where did the time go?  Zantac has been working wonders for my heartburn for the most part, and I usually take it only once a day, before bedtime.  Other than that, I just find my stomach can't handle too much anymore and I get full pretty easily, so perhaps that will put a stop to this weight gain. 

May 12, 2004 (32 weeks 4 days) - I just had another OB appointment today.  It was pretty routine, not much to talk about really.  I received a form regarding my consent to VBAC that I need to sign and return to her, basically just stating that I know the pros and cons of the procedure and that's what I want to do.  I despise getting on the scale these days.  It appears that I am about the same weight this time that I was with my last pregnancy, and I started out weighing LESS this time around.  Frustrating, but not much I can do about that right now.  I actually have been eating better and less in the last few weeks, yet still gaining.  I guess the baby just enjoys food a lot, or at least I hope it's mostly baby.  He's quite the mover and shaker in there sometimes, and he's active quite a bit during the day and at night.  He loves to wake me up and night and cause some nice heartburn to surface.  I get the occasional cramp/contraction every now and then, but nothing that lasts, hurts too badly, or even continues more than one time.  I have one more appointment with my OB at her current location, and the next one will be with the new practice.  So far, things are just routine for the most part, though I get tired and my back hurts pretty easily these days.  I still try to stay on my feet and keep moving when I can, since I just feel like a slug when I sit around.  Frank has taken over a lot of the daily activities that I used to do for the most part.  He's great about helping out whenever he can, but it's been hard for the times he's been away.  He went away for 5 nights last month, 3 nights last week and he'll go away for 2 nights next week.  I'm sure I'll do okay though.  Perhaps I'll get the nerve to post some new belly shots sometime soon.

April 29, 2004 (30 weeks 5 days) - Just thought I'd update on my appointment yesterday and the new events that have taken place since that time.  First, I just need to say that I love my new doctor.  It is so wonderful to have a doctor that I can sit down with and openly ask questions and feel like I'm getting an honest response from her about my questions.  I discussed the fact that I was considering hiring a doula and wanted to know what she thought about the idea, and if she had any problems with it.  She was very much for it, especially in my case, and she was just as familiar with the doula that I am hiring as the doula was with her.  She said she's only had a problem with one doula in the past, and it was not the person I was considering.  Overall, she thinks it's a good idea and based on some additional information I learned while there I have decided to hire her.

The additional piece of information that enforced my decision is the fact that my OB is now moving to another practice.  The doctor who she works with currently is closing the office and going to be working directly for the hospital.  She does not want to do that, so she has joined another practice.  Since I realize this may increase my chances of having an unknown doctor as a backup, who may not be as considerate of my choices, I have decided to hire a doula, with Frank's support.  Statistics alone are enough when it comes to women who have the care of a doula make me realize that this could only be a good thing for me. 

We reviewed my hospital records with regards to my two previous c-sections.  She asked if I had any questions or opinions about them, and I did make reference to the fact that I did realize we really did get lucky with Nicolas and there's a pretty good chance he would have been a c-section anyway based on his position.  She agreed with that.  As for Noelle, it was mostly the fact that they thought she could be in danger as well, even though I still don't agree with that one.  We talked about what I would like for this birth, and things I wanted to avoid, and she strongly advised me to have a birth plan in place for her.  I think she realizes that I have a real desire to have all of my needs known and the best way to do this is to have something in place.  The fact that she encouraged a birth plan is just one more reason why I think I've made a great choice.  Most doctors would probably let you give them one, but it would most likely never be followed.  She wants to make sure mine is followed, because I did mention other concerns about my previous c-sections and things I'd like to avoid if it comes to that again.  She made sure once again that I still planned to attempt to go through with a vaginal birth, and she still has no problems with my plans at this point.

The other news from the appointment was that I did pass my glucose test.  I will see her again in 2 weeks and I guess if I have any more questions at that time I'll be sure to bring them up with her.  It's just such a different experience for me this time around, having someone I feel comfortable with from the beginning.  Frank is sad for me that we didn't find her sooner, because he can see how clearly happy I am with her and he hasn't even met her yet.

It's funny, but last night I was reviewing some material from the birth preparation class we took when I was pregnant with Nicolas.  Right in the back, it clearly talks about the benefits and it is encouraged for women with both one and two previous low-transverse c-sections.  However, that book was published in 1999 and just in the last year or two there has been a shift against VBAC again.  Still, when you review some of the studies, it shows evidence that nothing has changed in that time to cause this shift.  Clearly, the safest way to do things especially if you are considering VBAC is to NOT allow any kind of induction, and I've already mentioned that to my OB and she is in agreement with me there.

April 19, 2004 (29 weeks 2 days) -Everything is still fine, and this little guy is still very active.  I received a letter in the mail last week regarding an inquiry I'd made to my insurance company regarding coverage of my pregnancy.  I'm not surprise at all to learn that again, even though I've had 2 previous c-sections, they will only cover another c-section at 50% of the cost unless I receive a second opinion about the c-section from a provider that is not affiliated with my current OB, so it seems that even the insurance company does not feel that a c-section is always necessary, no matter how many previous c-sections you have had in the past.  I called about picking up my medical records from the hospital and they still are not ready.  I could have sworn the form said 5 to 7 business days, and we are now on day 8 and she told me to try again on Wednesday.  Fun stuff.

April 14, 2004 (28 weeks 3 days) -I guess it's time for my long and drawn-out entry about my OB appointment yesterday.  I met a new OB yesterday and have switched my care to her for the remainder of this pregnancy.  I feel it's the best decision for me, for many reasons, but the best one has to be that I actually feel comfortable talking to her about everything with regards to my care for this pregnancy.  My other OB was wonderful, but not someone who I felt comfortable having an open conversation with about my concerns.  She wasn't forthcoming with facts, but I never really asked her too much.  The fact that she never asked me about how I wanted this delivery, just told me she'd be scheduling another c-section, was something that's bothered me.  I picked up my medical records from her office and took them to this new OB yesterday and I'm very much at peace with my decision.

I don't want to get on a soapbox about my choice to not schedule an elective c-section this time.  I've done my research, I know the risks involved.  I'm perfectly comfortable knowing that there is a less than 2% chance of a rupture, and even in the event that it did happen, the chances of a death from that rupture are about .06% overall.  I know the benefits of a vaginal birth.  I'm completely comfortable with my decision.  Frank is aware of my decision as well, and though I know he has his doubts and concerns, he knows that it is my decision and he supports me.

So, I met my new doctor for the first time yesterday.  I ended up having to wait an hour to see her, as she rushed off to deliver a baby right as I arrive.  It was worth the wait though.

Anyway, we went over my history. We talked about my other 2 births and how and why they were c-sections. She didn't get into too much about why I was leaving my other OB, so for all she knows it's mostly for location reasons. She asked how I wanted this next birth to go, and I told her I did not want to schedule a c-section. She asked what my other OB had planned, and I told her she was just scheduling another c-section. She asked if she told me why, and I said no, so she then reviewed the statistics with me. I already knew them, and I let her know that. On a positive note, she did say that since I had never gone into labor, there was a high probability that I would have success with a vaginal birth if I did go into labor, since it's not like I've gone into labor and not been able to push out the other two. I'm an unknown, but she didn't seem to think that was a bad thing for me.  My chances for success are at least 76%, possibly even more than that.  Those are pretty good odds.

She told me she wouldn't induce me, since that only increases the risks of uterine rupture, and I told her I wouldn't have let her induce anyway. I've done the pitocin and cervadil route THREE times. I'm proof that induction doesn't work for everyone, something I really didn't know before I'd been through it. I was on pitocin after my water broke on it's own with Nicolas, and it did nothing. I don't see a need for doing it this time.

We talked about epidurals, and she recommended one just in case we had to do a section, since that would mean I could still be awake if we got into an emergency situation. I'm still not sure how I feel about that, since I've heard that epidurals can also stall labor or prevent you from feeling the obvious pain that could indicate uterine rupture. She said there would be signs of rupture, and I'd still feel pain in a different place even with the epidural. I'm not sure I agree with that. She's seen ruptures before, so she's familiar with them. I asked if she'd seen people have successful VBAC after 2 or more c-sections. She said she had, but it still wasn't something she'd recommend. However, she knows my feelings, she knows I've done my research, she knows I'm aware of the risks (though funny how even she didn't mention the serious risks of c-sections, which by the way are much higher to both mom and baby and more likely than uterine rupture) and she's willing to let me do things my way. I'm very happy with that.

The plan is that as soon as I reach 40 weeks we will do monitoring, like ultrasounds and non-stress tests just to make sure the baby is still doing okay. She will plan a c-section for 42 weeks if I get to that point. I'm willing to agree to that, since that means I have until July 17th to have this baby on my own.

Anyway, I was a little emotional during our talk but I felt good about it. I know that she listened to me, I feel comfortable asking her any questions, and I feel confident that when it all comes down to it it will be my decision as to how this birth progresses, for the first time.  I have nothing against those people who chose elective repeat c-sections, but for me it's just not the way I want to do things.  If I do end up with another c-section, I will be okay with that, as long as I know I truly gave it my best shot and gave this baby every possible chance to do things his way.  I wasn't traumatized by either of my other two c-sections, and there's no reason why I would worry about a 3rd one since I know I can handle it, but I just have to know it was done for the right reasons.

April 5, 2004 (27 weeks 2 days) - I'm still large and experiencing heartburn pretty much daily now.  This baby loves to get active quite often, which usually contributes to more heartburn for me.  I've had a few cases where my own heart rate also goes up, and I've had to lie down for a while due to feeling a little bit nauseated.  As for OB checkups and care, it looks like right now that is all going to be changing.  I have an appointment with a completely new OB doctor and practice on April 13th and as long as that goes well I plan to switch my care to that doctor.  I have not informed my current OB of my plans, and right now it doesn't look like I will, as I missed an appointment I had at that office on Friday April 2nd.  I had planned on it being my last appointment anyway.  I have already requested both my medical records as well as my hospital records and hopefully those will arrive this week as I'd love to review them myself.  It looks like I'll be continuing this pregnancy with a new OB doctor and delivering at a new hospital as well.  I know it's a big change and big decision, but it's something I've been pondering for a few weeks and now I've just decided that it's something that has to be done for me to be happy.  While it's true that this will be my last birth experience, and it may not go as well as I'd like it to go, but I'll never know unless I try.  If this pregnancy continues in the same way that my last two went, without any complications, I have no intention of scheduling another c-section for this birth.  A lot of people may not agree with this decision, but it really doesn't matter what anybody else thinks to me right now.  This is how I want things to be, and I've done a lot of research on this topic, so nobody is going to change my mind right now.  I know that it may not work out that way, and there could be other factors that may require me to have the surgery anyway, and I will be okay with that as long as I feel I've given this my best shot.