Interesting article - SMFM Consult--Prior non-lower segment uterine scar

This blog entry is a bit dated (2013), but it provides a nice summary of a few recent studies.  Make sure you scroll down until you get to the discussion on myomectomy (Question #2).

http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/content/tags/cesarean-delivery/smfm-consult-prior-non-lower-segment-uterine-scar?page=full

26 week baby bump

Another week has flown by.  I'm now 26 weeks pregnant.  b1 just finished prek 4 today.  b2 celebrated midsommar with his school.  It's been a great week!

Working mothers guilt

Life as a working mother of two little ones in school often leaves me feeling overwhelmed.  Juggling a full time job, cooking, cleaning, shopping, & having a life of my own, all while being present and engaged in my children's lives is not easy to do.

One of the things I've been struggling with lately, particularly now that I'm pregnant, is rationing my vacation and sick time.  B and I are already stretched pretty thin just dealing with the standard school holidays, school breaks and sick days.  Two kids in two schools with different holiday and break schedules doesn't make this any easier (a 2 week Christmas break, spring break (different weeks for both kids schools of course), winter break (at b2's school), etc).  While I love seeing my children in their end of the year celebrations, performances, and parties, I often fear that one of these events will be the proverbial straw.  Or... maybe it is just pregnancy hormones talking right now.  What do you think?

Below is our schedule for the last two weeks:

May 22 - b2 - Closed for parent teacher conference
May 25 - b1&2 - Closed for Memorial Day
May 28 - b1 - Sick
June 5 -   b1 - Sick (1/2 day)
June 10 - b2 - late night fundraising event for school
June 12 - b2 - end of year performance at 9:30am
                b1 - birthday cupcakes at school at 2:00pm
June 17 - b1 - school carnival at school, families invited (we are not attending)
June 18 - b1 - end of the year performance @11:30am.  School closing at 12:30
June 19 - b1 - school closing at 12:30
                b2 - midsommar celebration that family is invited to attend at 11:30 (not attending)

All I know is that I am soooo truly thankful to have a mother-in-law that comes and stays with us for 2-4 months a year to help with the children; a sister-in-law that helps with the children both in the U.S. and in Sweden; a mom that will fly here and work from my house so that she can help us out with school closings, school drop offs and pick ups; two local sisters who are always helping me when we need it; and a father and step mother that sometimes take the kids away on the weekends so that Benny and I can have some much needed time to ourselves.  We are a truly lucky family to have so many people that love us and our children and are here to support us!  I don't know how other families manage. I am truly grateful for how lucky we are!  It makes it easier to cope when I'm feeling like butter scraped over too much bread.

24 week baby bump - I POPPED

Here it is, it got really big really fast!

One big difference in this picture and the 23 week picture is time of day.  When I wake up in the morning, I'm significantly smaller than I am at the end of the day.  This picture is proof of this phenomenon.

More VBALM

One of the challenges in researching birth options is finding medical articles that provide unbiased research and results.  I have done a lot of digging around, and will continue to post the articles that I have found.  

Remember, just because these articles need to be paid for does NOT mean that you have to pay for them out of pocket or that you can't read them.  Simply go to your public library and request that they place an interlibrary loan request for you!  If you are really stuck, email me and I will help you get access to them.  

"Pregnancy and delivery after laparoscopic myomectomy" by Jun Kumakiri, et. al., Journal of Minimaly Invasive Gynecology, Vol. 12, Issue 3, pg 241-246 (June 2005) (Pubmed, ScienceDirect, WorldCat). 

"Prospective evaluation for the feasibility of vaginal birth after laparoscopic myomectomy" by Jun. Kumakiri, et. al., Journal of minimally invasive gynecology, Vol. 15, Issue 4, pg 420-4 (Jul-Aug 2008) (PubMed, ScienceDirect, 

"Perspectives of obstetricians on labour and delivery after abdominal or laparoscopic myomectomy" by Hélène S HS Weibel, et. al., Journal of obstetrics and gynaecology Canada, Vol. 36, Issue 2 (PubMed)

"Pregnancy Outcomes and Risk Factors for Uterine Rupture after Laparoscopic Myomectomy: A Single-center Experience and Literature Review", by Yu-Jin Koo, et. al., Journal of Minimally Invasive Gynecology (Available online May 2015) (PubMed, ScienceDirect). 

Hello Edema. Long time no see.

Temperatures are rising, and the edema has set in.  It is odd, but my left foot and ankle always swell more than my right.  I wonder if that has something to do with crossing my legs.  I've been trying to stop doing that lately, but some habits are just so hard to break!

More foot related news.  My feet have grown an entire size this pregnancy!  In March, my size 10 shoes were getting tight on me.  I bought myself two pairs of size 11 shoes so that I could be work appropriate and not wear flipflops all summer.  They were awesome!  So comfy!  For all of 4 weeks Womp womp :-(.  My size 11's are now tight and uncomfortable.  This foot growth is probably a combination of edema and possibly my arches getting lax).

On the bright side, this gives me license to get more pedicures and massages!  Score!  

Laproscopic Myomectomy

When I decided to try for a VBAC, I had to do a lot of research to prepare myself.  I wanted to make sure I understood what the risks were (both for VBAC and C-section).  This was made more difficult by my lack of surgical report, but I was able to piece together my history using my surgery video from 1997, plus talking to a doctor who was actually willing to review my video with me. This is what I learned about my history: Laproscopic Myomectomy - 1997

Intramural fibroid

4-5 cm

Left side of uterus - cornua - near tubal opening

Removal went into the wall, but did not enter the uterine cavity

Suturing done laproscopically 

C-section - 2010

• Low transverse 
• After first c-section, doctor said no visible scar at the cite of Laproscopic Myomectomy

C-section 2013

• Low transverse 

I then had to research medical statistics and findings.  My favorite databases were pubmed, ebscohost, proquest, and google scholar.  I was able to run searches in these databases using keywords like:

• Laparoscopic myomectomy 
• Uterine rupture
• Vaginal delivery 
• Vaginal birth
• VBAC
• VBA2C
• Cesarean
• C-section
• Uterine scar
• Delivery outcome

I found a lot of great articles, even some newer articles that have been wonderful for my understanding of the risks and making informed decisions.  Here are a few articles I've found:

• "Evaluation of factors contributing to uterine scar formation after laparoscopic myomectomy" by Jun Kumakiri, et. al., ACTA Obstetricia et Gynecologica Scandinavica, Vol 89, Issue 8, p 1078-1083 (Aug. 2010) (PubMed, Wiley)

• "Prospective comparison of delivery outcomes  of vaginal births after cesarean section versus  laparoscopic myomectomy" by Makino S, Tanaka, et. al., Journal of Obstetrics and Gynaecology Research, Vol 34, Issue 6, p 952-956 (Dec 2008) (PubMed, Wiley)

To read these articles, check at your local library to see if they subscribe to the articles the articles are published in.  If they do not, request through your local library's interlibrary loan!  A reference librarian will be able to help you!

VBA2C

I'm not shy about the fact that I hate that I've had c-sections.  I went into my first c-section in 2010 assuming that I didn't have a choice.  I had a laproscopic myomectomy in November 1997.  Because I hadn't requested my record or had children in the 10 years after my procedure, they were routinely discarded by the doctors office.  I did however have a VHS video of my procedure (which I converted to DVD and Youtube), but my OB/GYN wasn't interested in looking at it and we discussed nothing except for a scheduled c-section.  The second c-section was in 2013 because when I brought up the idea of a VBAC they scared me with uterine rupture horror stories and statistics that were more severe than my research indicates.

So, I went in to my c-section in June 2010 unprepared for what it would mean for taking care of my newborn, recovery, possible complications, and its impact on my future pregnancies and births.

I delivered b1 at NYU Medical Center in NYC, and overall I was happy with the level of care I received there.  My veins collapsed when a resident was putting in my IV and I passed out, so they immediately sent in their supervising doctor who quickly and easily put in my IV while also putting me at ease.  The beginning of my procedure was routine.  My epidural was started with no issues, the surgery started with the doctors, nurses, and other support staff listening to the world cup in the background (note: this is a good reason to come prepared to your birth with music or directions for what will be playing in the background while your baby is being born).  I thought the procedure went fine, but didn't understand why it was taking so long for them to bring b1 to me after she was born.  Unfortunately, during the c-section her face was cut with a scalpel, so they had to tend to that before she was brought to me.  

Luckily the laceration didn't hit anything vital on her face, this happened at NYU.  The head of plastic surgery quickly came to our recovery room, discussed our options with us, and b1 received plastic surgery on the cut within 90 minutes of being born.

Even though b1 had no difficulty nursing, it was very painful to hold her while nursing, and to find a comfortable and effective nursing position.  Then, not too long after going home my c-section incision opened up again and got infected, which required trips to NYC from NJ to get tended to. Overall, NOT FUN.  

As an active person who wants to interact with my children, the recovery process is brutal.  I don't want to be afraid of my children hurting me after giving birth.  I want to be able to play with them, and read to them, without being in horrible pain.  I don't want to be on pain medications for weeks following the birth.  I want to be able to go for walks outside if and when I want to.  I just want to be able to enjoy the days after my child's birth.  To bond, and revel in their existence without having to recover from major abdominal surgery.  

Finally, I still find it surprising by how many people that didn't recognize that a c-section is major abdominal surgery and realize how long and hard it is to be "back to normal".  

All that just to say I really hate c-sections and the recovery.  I really don't want to have another one. 

A lot of people won't understand this, and will think I'm crazy for trying to have a VBAC, but I know this is what I want.  If I need to have another c-section, so be it.  But I want to at least TRY!