I am 36w5d as of today, and feeling every hour of it. I'm doing what I can to focus on the goal of keeping the boys inside as long as possible and ignore everything else, but whew, my body is hurting! A lot has happened since I last updated, so let me take a few steps back...
I had an OB appointment on May 5th - my first since the ultrasound on April 30th where we learned both babies were head-down. I did the NST first and the monitor picked up three good contractions. One was especially strong and caused my OB's eyebrows to shoot up when she saw it on the strip. She asked if I was having many contractions like that one and I said that I had been - some that were strong enough I couldn't think or talk through them - but they were very irregular. Still, she decided to check my cervix for progress. Alas, there was none to be found - no dilation, no effacement. I'm not sure how much that influenced the conversation that came next, but it's something I've thought about a lot since in trying to make peace with things.
My OB paged through the ultrasound report and told me the babies' sizes are great, but farther apart (and with the "wrong" baby being larger) than she'd like to see for a VBAC. Baby B's head measuring so far ahead for the second ultrasound in a row is another major concern. Based upon these things, she took the VBAC option off the table. I was crushed and asked if we could at least try it, but maybe throw in the towel earlier than we might have otherwise if it didn't seem things were going well. She said no based upon the worry that I might have no trouble delivering (smaller) Baby A, but before I was dilated enough to deliver (larger) Baby B, and that once A was out, there might not be sufficient pressure on my cervix to for me to further dilate and push B out. In this case, she'd be forced to do some kind of assisted extraction, and the risks of those procedures are too great with a uterine scar present. I asked about the known margin of error on ultrasound size estimates and she said the problem is that Baby B has measured larger for months so we have to assume that is accurate to at least some extent. With the last size differential being a full pound, she's just not comfortable "ignoring" that. The only compromise I was able to strike was holding off on scheduling a c-section. My OB said that since we know that will be the outcome, she'd prefer I not labor at all as there is no need to put any unnecessary stress on me or the babies. I asked to be allowed to go into labor on my own and she agreed as long as (1) I promise to come to the hospital ASAP once it begins - no messing around in hopes of having an "accidental" VBAC and (2) it happens by 38 weeks.
I left feeling really frustrated and upset. Even if I had the energy or desire to doctor shop at 35 1/2 weeks pregnant with twins, what are the chances I could find another OB to take me on? I felt really stupid for believing that she'd honor my request for a VBAC even though it went against the personal preference she repeatedly expressed to me. Even if she had the best of intentions of respecting my wishes (within reason), what were the chances we'd make it all the way to delivery without something coming up to spook her out of it? If it wasn't the boys' size difference, it probably would have been something else. She was never 100% on board, and I regret not seeing that for the red flag that it turned out to be. But, hindsight is 20/20. I always knew there was a chance - maybe even a likelihood - that we'd end up with a c-section. I just thought that if we got to that point, it would be our choice, after seeing for ourselves that a vaginal delivery was not progressing the way we hoped or was otherwise unmanageable. I didn't expect it to be decided for us weeks in advance, especially after our last ultrasound. Stupid, perhaps, but her decision came as quite the surprise.
Despite how upset as I was following the visit, I've mostly made peace with it now. Here's the thing: I don't have easy labors. I wanted to confirm through experience that this one would be no exception rather than just assuming that would be the case, but even without getting the opportunity to do so, I know there's at least a reasonable chance things would not have progressed smoothly or quickly. It would have been nice to see that for myself, but on the flip side, this relieves me (us) from having to make the decision in a state of exhaustion, stress, pressure and pain, and the second-guessing that surely would have followed once the fog cleared. I don't have to worry that we'll be divided - that I'll want to continue laboring and M or the doctor will want to call it, and that it'll end up being something I harbor anger or frustration over. It's cleaner in many ways, and there are pros to that. Also, I have time now to grieve the loss of the VBAC, instead of that being something I have to incorporate into those early postpartum hours and days when there will be other more important things competing for my attention. The fact that my cervix showed NO changes after lots of tough contractions was not inspiring. I know that might change very quickly once the regular contractions of actual labor start, but maybe not, too. It didn't with E. I have a stubborn cervix: Good for keeping twins inside to term; bad for getting the babies out once the time comes! On top of all of that, I'm getting more tired and sore by the day. I'm not in good shape for any type of labor right now, let alone one with the extra challenges my twin-VBAC-with-larger-Baby-B-and-marginally-supportive-OB would present. (Yes, I'm aware I'm rationalizing and all of these "arguments" are on the flimsy side, but I have no power to change the situation at this point, so what else can I do but try to make sense of it somehow?) So anyway, a c-section it will be. Having experienced one before, I am in no way looking forward to repeating the experience, but it will be quick, and surely less scary since it won't be an emergency and I won't be delirious with exhaustion, pain and infection.
I'm trying to focus on all the ways this c-section will likely be different from the last one. I'm far enough along that there is a really good chance the babies will be able to come back to our room with us. E was whisked straight to Special Care and stayed there for a full week. I won't be sick, so I should be able to see them right away and even hold and try to nurse them before too long. (Right? I actually have no idea how a "normal" c-section works. Everything about E's delivery was wrong and scary and only got worse in the days that followed.) M will be in better shape too, and we'll be able to take happy "new additions" pictures in the OR. All good things. This is going to be okay. *deep breath*
Moving on... I'm still up and around and getting out of the house every day, so the rest of last week was spent going to chiro appointments, running errands, continuing with house preparations, and waiting for babies. The most exciting thing to happen last week was that M's parents offered to help us finance the purchase of a larger, more reliable car. We already bought E a narrower convertible seat in order to make my (paid off) 11-year-old compact SUV work for 3 kids, but then a couple of weeks ago, my car started making some funny noises, not four months after we spent $1000 on a substantial repair. It was enough to scare both of us into brainstorming what to do if/when the next costly repair bill comes in on my car. We've obviously reached the point where any such investments would be part of a losing battle. We have great credit, but we're not in a position to take on a new car payment right now, certainly not the sizable payment it would take to get us into something larger and more reliable than what we already have. M decided to ask her parents to think about whether they might be willing to give us a car loan with a flexible repayment plan, once the feared repair bill comes in, most likely sometime in the next 6-12 months. Her parents surprised us by telling us to go shopping post haste and on Saturday, we bought a Honda Odyssey! It's used, but certified and it is in great condition with low miles. I've had some angst over making the move to a minivan, but I know it's the right tool for the job, and I have to admit it has some pretty swanky features. I'm definitely looking forward to the extra elbow room it will give us all.
OB appointment this Monday was uneventful. NST was long, again, but both babies looked great. Fundal height is up to 47cm. Those strong contractions I was having have all but stopped - maybe my uterus got the message it's off the hook and decided to stop practicing? My BP is still low (100/58) and there is no protein in my urine. I'm up to twice-weekly NST/OB visits now, so I go back tomorrow, and I suspect we'll schedule the c-section for 38 weeks, which will be May 25th, or whatever day closest to then she can fit me in. I'm still hoping to go into labor on my own before then, although the steep decline in contractions isn't encouraging. My chiropractor has been offering to stimulate some induction acupressure points at whatever point I decide I'm ready, so I will probably give her the green light at my appointment on Friday (37 weeks), and I'm considering paying a visit to my acupuncturist as well. I'd prefer to let things unfold even more naturally than that, but with that 38 week deadline looming closer and closer, I'm ready to get creative! I know every hour in utero counts and I really want the boys' to decide when their stay there should end. That said, I am so, soooo uncomfortable, so if they felt like coming, oh, I don't know... now, I wouldn't be terribly disappointed or anything. :-)
Just for fun (or terror), here's a picture of my belly from yesterday. This is what a 47cm uterus full of 12ish pounds of baby (maybe more?) looks like on a 5'2" frame.
Sorry for the epic post. There's just a lot going on right now and I want to capture it all before things get crazy around here, which could happen at any moment!