Monday, October 15, 2012

Day 15: Planning for Delivery

SB awarenessWelcome to another day of my 31 Days of Spina Bifida Awareness series.  As it was interrupted by Mason’s unexpected surgeries I will simply post when I have time, and the number only corresponds to the date, it is not an accurate count of how many posts are in the series anymore.  Winking smile

One of the semi-confusing points surrounding the delivery of a baby with Spina bifida is whether a C-section is required.  There have been studies showing vaginal births do not injure the baby’s spinal cord and nerves.  I think of being squeezed repeatedly during labor then pushed out a small opening and wonder how the studies can make their conclusions. 

Especially as you cannot know what nerve damage a child has simply based on their lesion, so they’re assuming if the function is what is ‘expected’ then a vaginal birth caused no damage.   Remember the earlier post in this series explaining why a child may function at a better or worse level that their opening {regardless of delivery method}.  If they’ve had a vaginal birth you cannot say for sure that it did no damage. 

I do think a baby who has a small, low, skin covered lesion would be less likely to suffer nerve damage than one who had a larger, higher, open lesion.  There are doctors who are willing to do a vaginal birth, others who insist on a c-section, and those in between.

I’ll be the first person to say I never wanted a c-section.  After having 6 natural, vaginal births there was no way I wanted to go through a surgery for birth.  I did not want to spend weeks recovering while trying to care for this new special needs child who would be recovering from his own surgeries, as well as my other 6 little ones. 

We talked over options with our doctor.  His thoughts were that with the high and relatively large opening on Mason’s back the best option for protecting his nerve function would be a careful, slow c-section with a wider opening than usual.  I was sad but Mason’s health was the priority. 

Partway through my pregnancy Mason turned breech.  That ruled out a vaginal birth further.  It also brought in the possibility that my c-section would have to be a vertical incision so they would not be grabbing him out at his back/opening.  His position was just the way we did not want it to be right up to delivery.  A vertical incision would have impacted any future pregnancies I have, mandating a repeat c-section with no possibility of VBAC (vaginal birth after cesarean). 

A tentative delivery date was scheduled.  I had to go in for an amniocentesis that morning to check Mason’s lung maturity.  After a series of frustrations including the only machine to run the test in that hospital being broken, my sample driven to another hospital an hour away, and having to wait an hour after that for results we learned that Mason’s lungs were not mature enough for delivery.  The medical team was sent home, rescheduled for another day.  I got a steroid shot and another the next day at my local midwife’s office to help Mason’s lungs mature.  Then we came in for delivery the third day.  Finally. 

They did one last ultrasound as I was headed into surgery and Mason, while still breech, had turned enough that his back was mostly angled toward one of my hips making a safer, low horizontal incision possible.

In the end the decision to have a vaginal birth or a c-section will be impacted by many factors.   How big, how high, and how open or closed is the baby’s lesion? There can be complicating factors like extreme hydrocephalus making for a very large head that could get stuck, or a baby positioned breech.  The baby may have other medical issues combined with SB, such as heart problems.  There may be issues on the mother’s side – is she developing high blood pressure or pre-eclampsia?  Has she had several previous c-sections?  It the placenta too near the cervix?

My advice is simple – weigh your options, consider what will be best for the baby’s health and safety, and proceed with prayer.  I never wanted a c-section but I know it was the right birth in Mason’s case.   

Next time I’ll share another decision to make about delivery – where will your baby be born and why does it matter?

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