Thread: High Risk and Natural Birth

Hi everyone. I apologize I haven't been very active on this board and for how long this post will be. I just wanted to share my two cents on a situation I didn't think would happen.

At 27 weeks, I was diagnosed with cholestasis of pregnancy. It's a rare preggo-induced liver condition that makes me itch like crazy (like PUPPPS but without a rash) that is life threatening to my baby girl. Since then, I've had NST's twice a week and ultrasounds every two weeks to check for growth. She's been doing great. The plan is to have an amnio at 37 weeks to make sure her lungs are mature enough and as soon as that's determined, to be induced (likely via cervidil and pit) and deliver her. My providers consist of a CNM (who I see most often) and two OBs who were fine with me having a natural L&D pre-high risk.

I expressed my disappointment in the induction with one of the OB's in the office and she said we could always go with breaking my water first and see where that takes things (this was a few weeks ago). I'm starting to think I may not end up needing as many interventions. I've been on bed rest for a couple of weeks because of my constant BH contractions. I ended up going to L&D the other night because they were keeping a pattern and painful. My MW gave me steroids for her lungs to be safe, and I left the other morning at 1 cm dilated and 50% effaced. Now I'm on strict bed rest (just getting up to use the potty and shower). At my NST yesterday, the OB was saying after my next u/s on tuesday we'd schedule my amnio. I expressed how I was nervous about induction as I have had friends who were induced (for high risk reasons) and ended up being sent home because their bodies weren't ready. He said due to the nature of my condition, I wouldn't be sent home because once it's determined that she's healthy, she's at more risk being in utero. What impressed me was this: he said that the problem with induction is when people start thinking in time frames of "the baby will be born by x time" and that you're trying to compress what your body may be prepping to do in two or three weeks into one. So, if mum and babe are both fine, you just have to wait it out and see. I was relieved that he was taking this approach and while he said if I end up with a c/s (which they'd try to wait at least a couple of days before going down that avenue) it'd be fine, but that they don't want to do one any more then I want to have one.

So, while I may not be able to have the completely natural birth I was planning for (unless my body keeps progressing and gets me there before the amnio/induction in the days following it) I am feeling much more confident that my providers wont push things purely for their convenience. Thanks for letting me share and I hope everyone is doing well.

What are you doing up at 3am girl?

First of all I think writing out your thoughts and sharing is smart. I am glad you expressed your concerns to all involved and that their responses were well thought out and "individual", not pat answers.

I like to think that having your midwife and DH present at the time will mean that things move ahead as they have indicated and that there will be no last minute surprises or a rush leading to a section. All sounds like your "ducks are in a row" because of your preparation.

Now go back and rest.... reading lots of books?

Mia that sounds great!! The only experience I have with AROM was after Cytotec () and pitocin. It was like zero to he** in two seconds. But without the two drugs in your system, it may be a great option for you. Especially since you have been having so many contractions anyways. And you can actually go a long time with your water broken as long as you and baby are doing well... but not sure how that works with the medical condition.

It is wonderful to hear of them giving you options and not pushing an immediate c/s. Have you thought of having a doula? I wish I was there... I would SO come with you. A doula may be a great way to get the birth that you desire, as far as using comfort measures and things to avoid as many additional interventions as you can.

Whatever the case, I am sure that you will be happy with your experience. You have really put a lot of thought and research into everything, and your medical providers sound like they have your and Baby's best interests in mind.

So you are leaning more towards starting with AROM? Let us know what your plan is once you decide. I've been reading your posts, and keeping my fingers crossed for you.

I remember reading about this in my lurking on your September board. BTW, congrats on your wedding! It sounds like you've got a really good team supporting you. I haven't done all that much research into induction but I've thought that if it comes down to it I might prefer they started with AROM. Especially with the progress you've already made, I'd think your body is likely to play along and you'll be able to deliver without many more interventions. Will the cholestasis clear up quickly after delivery?

I guess that main thing I'd ask now is if they start with the AROM how long will they "let" you labor for before worrying about induction meds or a c/s? I wasn't clear on that though they may have given you an answer already.

Thanks for the well wishes all. They haven't given me a set time frame of how long they'd go after AROM to induction meds, but they seem pretty open to letting my body take it's course.

After this past week, I think they're just holding their breath expecting me to go into labor at any minute. I know of a doula who's local and supposed to be good (my BFF went to her for a prenatal massage at 37 wks) so I might look into her. If not, I honestly may talk to the nurse who's instructing my child birthing classes as she's done all natural a bunch of times and has helped a lot of women avoid c/s (breach and others). If she wasn't available for advice, she knows all the L&D staff and could definatly give me some pointers. I also have a few others friends who are nurses at the hospital I'm delivering at. While the nurses wouldn't be the same as a doula, I like that I can ask their opinions. If you were around here Ariel, I'd have you there in a heart beat.

Yes gardenbug, I've been trying to get lots of reading done. I've got a BFing book and some books I hope to finish for fun before she's here. I also am going to try to improve my novice knitting skills so I can make my little lady some hats and be able to teach her the ropes.
The cholestasis should clear up quickly after birth. The MFM specialist said it could take a few days for my bile salts to level out, but that it shouldn't be too bad. I'll be sure to KUP.

Its good that your team for birth sounds like they would like to allow you to take your time rather than rush things and push for a c/s. I was thinking the same thing as Jade with the AROM and how long they will let you birth after. I would think that would put you on the clock at any hospital but maybe they have given you more info. Sounds like your body is already getting itself prepared and getting things going when its time shouldn't be a problem. I'm glad your condition will clear up after giving birth. And congrats on your wedding!

I'm glad your caregivers all are supportive of your wishes and seem to be on board with a natural birth even with your high risk situation.

It does sound like your body is getting ready though, so maybe no induction will be necessary!

I'm sorry you are having this complication! I hope everything goes well and you get a birth as close to what you really want as possible!

I personally wouldn't start with AROM. That is your baby's protection during labor from the stress of contractions. You could start with cervidil, then pitocin and then turn it off to see if it jump started your body's natural laboring system. As soon as your bag is broke, you're on the clock and your chances for a cesarean has just gone up. GL and I hope everything turns out well.