A Plan

Today we had our last scheduled appointment with our local OBGYN group, two days before my due date.  We got the full workup (ultrasound, NST, exam) and discussed The Plan from here on out.

The results of the full workup are that baby is looking great, positioned in the same optimal birth position he’s been in for a few weeks now (lying with his head square on my cervix, facing my back), and my cervix is starting to change, but is not yet considered “ripe.”  (For those who like numbers: 1.5cm dilated, 40% effaced, -3 station.)  Of course, cervical info like this is nearly meaningless — it’s entirely possible that left to my own devices I’d stay at the same numbers for weeks, and it’s also entirely possible that I could go into spontaneous labor tomorrow.  But it was encouraging to hear that something is happening.

Then came the talk about The Plan.  I didn’t really know what to expect, but the doctor just came out and said, “OK, I know you have a preference for Dr. X in our practice.  She’s on call next Wednesday, when you’ll be 40w6d.  What if we start cervical ripening Tuesday night and plan to induce on Wednesday?”  I agreed, they scheduled it, and it’s on the calendar.

It all happened so fast I didn’t really feel like I could think it through in the moment, but now I have some very mixed feelings, probably because I feel like this is a problem that just has no correct answer.

It’s a little earlier than I’d wanted, but only by about two days — I’d been ready to ask for cervical ripening to start at 41w0d, followed by induction, so this is two days earlier.  Two days isn’t a lot, but given where I am in pregnancy, it could very well be the difference between spontaneous and induced labor.  Or not — the problem is, there’s just no way to know.  Since two days is unlikely to make a substantive difference, maybe it’s worth it to have the doctor we prefer… but not if induction winds up leading to an otherwise avoidable C-section (not that there’s any evidence that this would be the case — the best recent studies indicate that induction at 41w does not increase the risk of C-section even with an unripe cervix).

In my ideal world, I’d rather go into labor spontaneously.  But there’s no guarantee that that will happen, or even that it’s what’s best for my baby and me.  After all, my mom waited, wound up going past 42 weeks, needed an emergency C-section, and I almost died.  So it’s not like waiting for spontaneous labor necessarily gives me a get-out-of-jail-free card for poor labor outcomes.  Waiting until 41 weeks seems like the best compromise according to the data — so one or two days earlier is probably negligibly different.

Another thing on my mind, of course, is the anxiety.  I’ve woken up in the middle of the night three times in the last week in tears with worry about my baby.  My nightmare (literally) is that I’ll wake up one day, won’t feel him move, and we’ll go in and he’ll be dead.  I know he’s alive and healthy now, and I want him out while he’s still OK.  I’m already in the regime where stillbirth risk is rising, and even though it’s still small overall, having had a baby die inside me with no warning once means that I just don’t want to take any unnecessary risk, even a tiny one, of having it happen again.

As I’ve been thinking about it today, I realized there may be a middle ground.  I know that the risks of induction leading to C-section are higher with an unripe cervix.  Given the slight dilation I have already and the excellent positioning of the baby, I’m hoping I’ll make progress by next week, but I just don’t know at this point.  So my slightly revised plan is to ask to go in for a cervical check Monday or Tuesday before they start the cervical ripening, to find out if my cervical status has changed.  If it has, I’ll feel much better about going forward with the induction.  If it hasn’t, maybe I’ll check on the call schedule and see if one of the other doctors I’ve felt reasonably comfortable with would be on call if I waited a couple of days.  There’s one doctor I definitely don’t want, and another that I probably don’t want, but either of the other two would be fine with me.  The only problem with this plan is that I think (although I haven’t confirmed) that they will not want to induce me on the weekend, which only gives me a couple of days of wiggle room unless I wanted to wait until Monday (which I’m not sure I do, and which my husband has already said makes him a little nervous). But getting to ask the questions would be reassuring.

At least for now, I’m happy to have a date on the calendar, and to know that there is a plan that everyone is OK with that would involve me holding a baby by late next week (fun fact: if all goes according to The Plan, it’s very likely that my son would share his birthday with his father!).  I’m also happy to feel like there’s some flexibility in the plan — the doctors I talked to today emphasized that I can call and ask questions anytime in the next week, and that changes in the plan were possible.  So for the moment I’m reasonably content to sit back and wait to see what happens.  Who knows… maybe I’ll go into labor in a few days and all of this will be moot anyway!  Point is, my son will be here soon, in a matter of days, not weeks.  And when I put it that way, it’s a pretty amazing place to be.

14 thoughts on “A Plan

    1. lyra211 Post author

      Thank you! Yeah, if I could prioritize, it would be (1) safe, (2) quick, and (3) SOON! 🙂 So happy that everything is going smoothly for you!

    1. lyra211 Post author

      Ha, yes, thorough is one of my personality traits. Sometimes I take it too far. 🙂 Thanks for thinking of me, and I hope your newborn days are going well and maybe that you’re even getting some sleep by now!

  1. theskyandback

    Very exciting! I always find it’s a relief to have a plan in the books, even if that plan might change.

    Question: are you planning on not getting an epidural since you’re still on Levenox.? Obviously if you have a planned induction, you could not take the Lovenox 24 hours beforehand, but if you go into labor spontaneously and don’t have a super long labor you can’t get an epi, right? I’m a little worried about labor for myself because I 100% want an epidural. I’m switching to heparin at 36 weeks, but even that makes me nervous because Lettie was 2 weeks early and this baby could be even earlier.

    1. lyra211 Post author

      Oh, yes, the Lovenox — it’s been one of my worries all along, and in fact, that would be a silver lining of the induction plan, i.e., I’d know when to stop taking it (the day before the scheduled induction date). I’d prefer to have the option of an epidural open to me, so my MFM doctors told me that when I start feeling any contractions at all I should call them and they’d advise me about when to stop the Lovenox (alas, so far nothing more exciting than a truckload of Braxton Hicks). They thought I’d most likely have plenty of time to stop the Lovenox and still get an epidural, and I figure that the possibility of being denied an epidural is less bad than the possibility of developing another clot that might threaten the health of my baby or me (although maybe I wouldn’t think that while I was in labor!).

      Was Lettie a particularly fast labor? I guess since this is your second baby, you might not only go early again, but also even faster. Have you asked about switching to Heparin earlier? It sounds like you might have a good justification for doing that — as far as I can tell, Heparin was cheaper for my insurance, and the only reason they don’t use it throughout pregnancy is because of the twice-a-day thing and the slightly higher risk of side effects. But as I found out in this pregnancy, if you do wind up with side effects or adverse reactions you can just go back on the Lovenox and take your chances of being denied an epidural. So it might be worth talking to your doctors about switching early if it’ll make you feel better.

      1. theskyandback

        This is all good to know! I completely agree, no epidural is far better than a clot for mom or baby. But man, I sure hope I can have one. My labor with Lettie was 12 hours exactly from start to finish. This is not fast, but supposedly fast-ish for a first labor. Although it did not feel fast at the time haha. I have an OB appt today and I’m going to ask her about switching to heparin earlier.

        I hope you are able to get an epidural in your labor if that is what you end up wanting! I will keep my fingers crossed that everything goes smoothly.

  2. TryTryAgain

    Blimey, so much to think about!! Really hoping that Baby Physicist decides to make an appearance on his own and that all goes smoothly 🙂 will be thinking of you all xxx

    1. lyra211 Post author

      Thank you! It’s so nice to hear from you — I’ve been thinking about you and hoping that no news is good news! Yes, I’d be very happy if this little fellow decided to make an appearance on his own — any minute now, really! It’s funny how the longer I go, the more I feel like I’ll never go into labor, even though the exact opposite is probably more mathematically true (i.e., the longer I go, the more likely I am to go into labor soon!). Pregnancy messes with your brain in so many funny ways…

      1. TryTryAgain

        Thank you! I’m 26+6 today, so hoping to make it to tomorrow and much, much longer! 🙂

        Bless you, I can only imagine how keen you are to have him out safe and sound. I’m so excited to hear that he’s here and all is well! Crossing everything that he gets moving for you very soon! Xx

    1. lyra211 Post author

      Yes, it does help to be able to count down the days instead of feeling like I’m just going to be pregnant FOREVER! And to be able to prepare by reading up about induction and talking to friends about it. It’s kind of amazing to me how many people I know who have been induced for one reason or another. And I was musing to my husband on the way home tonight that none of them seem to have had to have C-sections — which makes me convinced that I’ll be the one! To which he replied, “Yes, because that’s exactly how statistics work…” 🙂 That’s my husband!

      1. dandisnow

        I could hear my hubby saying the same, haha! I am nervous about being induced again but hoping things will be getting ready on their own and it won’t be so lengthy as my first.

        You’re so close now – I’m excited for you. 🙂

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