Friday, August 23, 2013

How I got a Bicornuate Uterus, and you can too!

Kidding. No you can't. And judging from what I've read so far you wouldn't want to have one. But as it turns out, I have one, so I'm going to talk about it a little bit.

A Bicornuate (or Heart-Shaped) Uterus is a medical abnormality present since my uterus developed before I was born. So in a sense, you could blame my mother's uterus. It was sufficiently punished when it was removed a few years ago.

.1-.5% percent of women are estimated to have a BU, though these numbers are hard to determine since many women have one without knowing.

As you can see, while a normal uterus has an upside down triangle shape and the entire organ can stretch for the baby, a BU is literally in the shape of a valentine heart, with the top dipping down and dividing the uterus into two halves, called "horns." The fertilized egg implants in one horn of the uterus and often the other side does not grow at all. My baby is in my right horn, which did explain why at first I only felt cramping/discomfort in my right side.

Since the baby only has half the room to grow, there are generally three risks involved. The more common risk is preterm labor with a weak cervix. I've read about many women who delivered too early for their babies to survive, however it doesn't happen often. It is quite common to deliver a viable premie and spend many weeks in the NICU though.

The second risk is growth restriction. My midwives were very chill about my condition, but did tell me to take extra care about my eating from now on. Up to this point I really don't know if I was always getting my extra 300 calories in, and they never said I had to. I don't feel good stuffing myself, and the past few weeks I was too sick to do that anyway. I've been bloated ever since I got pregnant, so I assumed I'd put on weight no matter what. Now they said that because my baby might have issues growing I need to make sure I eat a little more and make sure I pack in the nutrients. I ate really healthily until about ten weeks, when I started to get sick. After that anything but crackers, bread, and noodles just made me throw up, especially fruits and veggies. Midwives gave me zofran last week, and I'm finally able to eat normally and work good foods back into my diet.

The third risk, and the one I hate the most, is a C-section. Because the baby usually grows in one horn, there is not a lot of room to turn. That means that if the baby is breeched, it will most likely stay breeched. Meaning a mandatory C-section. My midwife said the only chances I have of delivering vaginally breeched are if the baby comes too quickly to do anything else, or if it became easier to do so during a later pregnancy. I so want my peaceful water birth and I can't stand to think about how my chances of a C-section have increased by a minimum of 20%. I don't want to spend my maternity leave potentially in a NICU AND having to recover from being cut open at the same time. I don't want to have to fight for my VBAC when the next child comes along.

My pregnancy was so typical until the moment they told me it never was. Previously one of my midwives had told me I was "boring" in a great way. Educated, married, planned pregnancy, steady finances, excellent health, no smoking or drinking... I did everything right and my pregnancy should go swimmingly. "Welcome to parenthood!" my other midwife teased me gently, "You think everything is perfect and then suddenly it surprises you."

"Then I turn out to have a freak uterus," I half-joked back.

"You don't have a freak uterus. Your uterus is heart-shaped because you're so nice," she said cheerily. "Many many women have completely normal births with this," she assured me later.

Truly I'm not so worried. I have more or less decided to stop researching it and stop reading message boards for women with a BU. It does horrible things to one's nerves. The women who tend to reach out online have experienced the worst of the condition, and it makes it look like a higher percentage of women lose babies than what actually do. While it's great that they've found a community and comfort, I just don't need to put that in my mind. I'll forgive myself a C-section, because I know that nothing (and no one) will make me have one unless I have no choice. My care will change slightly after 20 weeks. Every checkup will include an ultrasound to make sure the baby is growing. They'll do everything possible to get me full term. I can still have a normal, natural delivery if baby grows head down. There are many things that could go wrong, but just as many things could go right. I will choose to think about the "right" until I'm given a reason no to.

Thursday, August 22, 2013

In which I find myself for shiz up the spout.

Here are the general specs of the pea pod or otherwise-cheesy-food-comparison growing inside me.

Planned? Yes. We tried for four months, and every time the test was negative I was thoroughly baffled as to how anyone could accidentally get pregnant when we were young, healthy, and ovulating like a boss. God just has a magnificent sense of irony I guess. Also, I've decided all of the 16 and Pregnant girls get pregnant on purpose no matter what they say. Maybe not though, because according to my mom everyone under 20 has a magically fertile uterus anyway, so don't have sex, kids. You will get pregnant. And die. Not that I know anything about sex; we obviously got pregnant by dancing. We're Baptist.

When are you due? February 25th. Child, please don't come on Valentine's Day. None of us will live it down. You could even take a little longer and be your generation's first March baby! Be a trailblazer!

Who is your doctor? Doctors, BLEH. Kidding, but seriously, we are using a midwife. I've known that would be my route since around high school I think. We are so blessed that Lynchburg has a thriving midwifery practice under the umbrella of an established medical group, so fully covered by insurance with no hassle. We hit the jackpot.

A midwife? Say what? Our midwives are certified nursing midwives (CNM's), which means that first they had degrees in nursing and then got their master's in midwifery. Another option is a certified practicing midwife (CPM), which is someone who trained in midwifery only. We were more comfortable with a CNM because they are allowed to deliver at home, a birthing center, or a hospital, they can prescribe medication, and they have a wider medical background/experience because they were nurses first. Whichever midwife is on call at the time will deliver our baby, so they make sure you have an appointment with all of them at least once. I kind of don't like that, but everyone at the clinic is so great that I got over it pretty quickly. They are seriously the best.

How will you deliver? I'm at higher risk for a C-section (more on that later), but my dream of dreams is to go natural. With interventions I wouldn't have enough control of my body or enough flexibility to give birth however (and wherever) I wanted. Medication can lead to unnecessary complications as well, but my choice is much more based on wanting to give birth in whatever position is the most comfortable in the moment (which you can't do if there are needles and tubes all over you). A CNM is capable of handling a variety of last-minute emergencies (yes, including a hemorrhage), so I am not worried about the absence of a doctor. Most women have perfectly wonderful birth experiences in hospitals and with all of the most common interventions, but I would not.

I haven't decided "how" exactly I'll have the baby (i.e. in the water, on the bed, etc.), and I think I'm going to leave that up to what is best for my body in the moment. I will say that I think water births look so peaceful and that is my preference, but I don't want to get attached to an idea that might not pan out due to my medical situation.

Where will you deliver? I will deliver at the birth center attached to Virginia Baptist Hospital. I would like to have the baby at home, but my husband is wary of that, at least for this first baby. Many natural-birth advocates tend to have an all-about-mom-and-baby approach that makes dads seem a little irrelevant, and I don't agree with that. From my perspective, this birth is also my husband's. He did half the work in creating our baby, and he has a mostly-equal vote in how it's born. He is still open to being convinced, but until he has a peace of mind about birthing at home (if he ever does), I am fine meeting him halfway with a birth center for all of our babies. And after we compromised we found out that my midwives do not deliver at home anyway. I love the care I've received at our clinic so I'm good with the birth center. I just wanted to point out that we compromised BEFORE that happened, ha.

Will you find out the gender? Yes, we gotsta know.

What will you do when the baby is born? The plan is to go as natural as possible when our baby gets here. We're going to co-sleep for the first few months, using a specially designed bassinet that attaches to our bed. We'll cloth diaper, and hopefully I'll be able to breastfeed (due to a previous surgery I might not be able to). I was mostly formula-fed and I turned out fine, so I'll be zen if my crunchier leanings don't work out. But for goodness's sake, no light-up, loud, battery operated toys. Yick.

I plan on going back to work as long as we can line up childcare (it's surprisingly hard to find infant care in our town). My mom was a stay-at-home mom and I always assumed I would be too, but now that I'm pregnant I feel pretty positive that I'll keep my job. I love teaching, and I love the financial freedom we have with two incomes. My husband and I both have a little more independence when it comes to buying things for just ourselves (generally clothes for me and weird computer stuff for him, ha), and we are (hopefully!) set up to purchase a home some time next year. I want our kids to have community roots and the security of a space that is entirely theirs, and it's empowering for me to participate in providing that. I also hate doing housework, and since we both have jobs we split the chores so that's nice, ha! Eventually I want to finish my master's and then proctor online classes, which would free me up to be home. We'll see if I have the energy to do school with a four-month-old this summer though!

How is husband doing? He is very much himself: calm. He's trooped through my early pregnancy mania, watched The Business of Being Born at least three times before refusing to watch it again, comforts me when I cry during Disney movies, gets me food, and always rubs my back and holds my hair when I throw up. We both kind of want a boy, my family is pulling for a girl, but we're all pretty excited for whatever shows up in seven weeks!