February 19, 2009

We had our appointment with Dr. Gravelle this morning (the obstetrician).


We arrived a few minutes early and were disconcerted to open the door to a dark and silent office. Obviously they were not open yet. We couldn't find a light switch, so we waited in the hall, which gradually filled up with other pregnant ladies. By the time of our appointment, the office staff had arrived and turned on the lights.


It was interesting to compare the routine of the obstetrician appointment against that of the midwives. Both require you to pee in a bottle, but the midwives have a much more elaborate procedure and get you to test it yourself, while the obstetrician has a nurse to handle this for you. The nurse also does a quick history and checks blood pressure.


Dr. Gravelle was extremely nice and went through our options with us. They are pretty limited. In the case of a breech, we could try a trial of labour, but it is impossible for a transverse baby to be born shoulder first. She also said that even if the baby wasn't transverse, there would have been a good chance of ending up with a caesarean section because a uterus shaped like mine may well not be able to contract properly. Coupled with a smaller baby that might not tolerate a long labour as well, she said that a planned caesarean was not necessarily a bad idea under the circumstances. She also explained that she would strongly recommend against trying an external version to turn the baby. Even in a normally shaped uterus the success rate is less than 25%, and there are risks to both baby and mom. In my case, it's extremely likely that there is a reason that Elizabeth has settled where she is. The likelihood of a successful version is very low, and the risks quite high. She said she would definitely not risk it if it was her child. She went on to say that she is a surgeon though and very comfortable with caesareans\u2026


Although we had heard a great deal about how busy obstetricians are, and although we were expecting a short and rushed appointment as a result, Dr. Gravelle took her time explaining the whole caesarean section process and answered all of our questions. It's possible that "normal" appointments are different, but we really appreciated her thoroughness and really great bedside manner, especially since this wasn't at all the hoped for birth plan! One of the books we had ("The Birth Partner") mentioned that some obstetricians like to physically inspect the uterus by pulling it outside the abdomen, and that since the benefit was "questionable" and some women find it "uncomfortable and nauseating" that we might want to request that the surgeon not do this. It turns out that Dr. Gravelle does this, mostly because she finds it easier to suture up the uterus when she can see what she is doing. It's not strictly necessary so she did offer to suture by feel, but after her explanation it seemed to me that I'd let her do what she thinks is best.


We have two more ultrasounds scheduled just in case - Dr. Gravelle said it's always very embarrassing to pull a "breech" or "transverse" baby out by the head! Since there is a risk of a cord prolapse if I go into labour, both the midwives and Dr. Gravelle want to ensure that the caesarean happens before that. It's a delicate balance between letting the baby mature in the womb (and get a little bit bigger!) and getting her out prior to labour. Getting operating room time at such short notice is also tricky, so we're going to be taken in between emergency cases. The caesarean itself is scheduled for Saturday February the 28th, which is when I start week 39.

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