Cesarean Scar Care Webinar

I just attended the Cesarean Scar Care Webinar with Isa Herrera via the International Cesarean Awareness Network (ICAN).  What a terrific benefit for subscribers (it was free), a great introduction to ICAN for folks who aren’t subs, and a great cost ($15) for non subscribers.

Herrera is the author of Ending Female Pain and performs physical therapy in New York City.  I was excited to attend this webinar because 5 months post cesarean, I still have a LOT of pain and tenderness, especially on the left side.  I imagine this has a lot to do with E’s position in utero.  Herrera said that an uncomfortable lie can cause more adhesions, so obviously I have a lot of work to do to break up those adhesions and get to healing!

Herrera states:

“Women coming to me are often not getting the tools and advice they need . . .” to recover from cesareans.

Sad but not surprising.

Something I previously misunderstood:  according to Herrera the abdominal muscles (the recti) are not cut during surgery.  Instead, they are pushed to the side.

Something else I didn’t know:  during a cesarean 8 layers of fascia and connective tissue are cut.  From what I previously learned, it’s the damage to the fascia and connective tissues that compromise the uterus the most.

Something of which I am skeptical:  Herrera hypothesizes that regularizing and rehabilitating the scar tissue and adhesions may reduce the risk of uterine rupture in future pregnancies and labors.  The reason that I am skeptical is that from what I know about scar formation and healing, scar tissue NEVER approximates undamaged tissue.  Scar tissue organizes differently from undamaged tissue.  On the other hand, it is possible that with Body Talk or acupuncture or other healing modalities that damaged tissue can be restored.  And it’s not like my arm splits open every time I use it, and I have a large gnarly scar on it!

Herrera talked us through a number of exercises and stretches that should help break up adhesions and encourage healing.  The ones that I plan to start using immediately are “long strokes,” “longitudinal stretches,” and kegels while drawing in my abs.  I’ve also started using my Wii Fit and have found that the exercises there have woken up my core a bit.  I am also massaging lavender oil, purchased from Young Living because of the medicinal-grade quality, into the “damaged” areas.

For more information on cesarean scar care, purchase Herrera’s book.  Also, check out the websites http://www.apta.org and http://www.pelvicrehab.com.

Stressed: Woulda Shoulda Coulda

Shoulda:  One of my strongest feelings from DD’s birth in 2004 is that I shouldn’t have gone to the hospital.  When my husband started to nag me about getting to the hospital (I was severely dehydrated, and he wanted to take me in to get that treated), I thought, “I couldn’t possibly leave my house right now.”  Somehow I did get in the car and didn’t puke or poop myself on the way to the hospital.  The minute I got there, I *needed* a wheelchair.  I was sick. 

I wasn’t treated for illness.  I was treated for childbirth.

I should have hired a doula.  I thought I was “safe” because I was being attended by a CNM.  I should have reminded her that my birth plan stated no artificial rupture of membranes.  I should have insisted on changing positions even though I was peeing out my butt.  What shouldas are ahead?

Coulda:  I could have told my DH no, I suppose.  I certainly could have told my CNM to go jump when she suggested breaking my water.  What sorts of couldas are ahead?

Woulda:  Had I a “do over,” I’d have stayed put.  Or I would have refused AROM.  I would have changed positions while laboring and for pushing.  I would not have purple pushed.  Not gonna do that again.  Thinking too much about future wouldas is overwhelming.  Let’s not go there.

Woulda shoulda coulda is that much more stressful when you aren’t given options.  I’m not supposed to give birth to twins at home.  That’s risky.  I’m supposed to want to give birth at the hospital.  That’s safe.  Yeah, hospital birth is so safe for American women and their babies that our infant mortality rate ties Poland and Slovakia.

Medical Stalker Goes Way too Far

Many people in the natural birth advocacy realm are aware of “Dr. Amy” and her polemic blog.  I was distressed to see that in addition to pillaging the homebirth and unassisted childbirth forums at Mothering on a regular basis, she is now stalking the birth trauma forum there!  If you’re interested to read her post, you’ll have to search for it yourself.  I am not going to directly link to her site.

My concerns over this behavior include:

  1. Did she get approval from these people to use her comments?  I would venture to say no.  It is one thing to directly quote from a public blog where the intent is PUBLISHING (with a link back, of course) and a whole other thing to directly quote people who are gathered together in support around a sensitive topic.  This would be more than bad netiquette.
  2. Her reason for being at the birth trauma forum – I have yet to read anything unique at her blog.  I have seen her quote and give “statistics” (laughable) based on posts at the homebirth and UC forums at Mothering and thought that was pretty low.  And now she’s raiding the birth trauma forum to gather content for her blog?
  3. Her lack of sensitivity and understanding as demonstrated by the quotes she selected for her blog
  4. The lack of privacy and sacred space that moms who are recovering from birth trauma need and deserve

I sent a private message to the birth trauma moderator.  Here’s what I sent:

“Dr. Amy” is stalking the birth trauma forum – [I removed the post link here b/c I don't want to directly drive traffic to her site.] Perhaps this should be a private forum? It’s bad enough that she posts every dramatic thing from the homebirth and UC forums on her blog, but really I think she has gone too far. I really hope that the Mothering Forum Moderators will take this concern under advisement and develop a strategy to better protect moms who need a place to commune and don’t deserve to have their stories exploited.

I hope that interested parties will voice their opinions at the Mothering Dot Commune site or to other responsible parties at Mothering.  Additionally, I hope that people will turn to more private venues such as the private forums at the International Cesarean Awareness Network website or private support lists on Google Groups or Yahoo Groups.  These women have been through so much.  They don’t deserve to have their stories exploited even though they are posting on a public forum.

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And PCOS too

Well . . .my uterus looks just fine.  Looks like I’m healed up from the surgery – the “stripe” looked just lovely.  I still have a posterior fibroid, but I don’t think that was the one the RE messed with this summer since the adenomyoma was just above the cesarean scar.

I have Polycystic Ovarian Sydrome (PCOS).  My OB just discovered it today via ultrasound – the “string of pearls” were clear as day.  I don’t know how much of an affect that has on RPL.  GETTING pregnant hasn’t been my issue, and it seems to me that most women who have PCOS and suffer from infertility are having trouble conceiving.  Maybe that’s inaccurate.

My appointment was very interesting.  My OB doesn’t believe in the luteal phase defect.  That’s not to say that he’s antagonistic – he’s more than willing to treat with HCG and progesterone injections.  What I learned today is that some reproductive endocrinologists don’t believe that the luteal phase has anything to do with conception issues.  It’s the 1st half of the cycle that governs cycle length.  Evidently, if you ovulate then you will have a sufficient luteal phase.  REs that ascribe to this philosophy are more likely to treat with ovulation triggers like clomid, especially with PCOS.

That’s about all I have to say right now.  Just wanted to give the faithful an update and those of you who struggle with faith a bit of information, hope, and comfort.  YOU ARE NOT ALONE!

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Loss Never Ending

I can’t hardly breathe tonight.

My phone rang today.  Our good friends are in need.  She’s about to have their third baby, and since baby Y-H is about a week early, my friends parents haven’t arrived yet.  Other good friends are out of town, and I feel honored that they turn to us for support during this most important time.

But now as I clean up around the house . . . and am faced with new baby coupons and childbirth books and gmail friends’ status messages updating us on pregnancies and new babies . . . I am overwhelmed by my losses.

June 4 was a lifetime ago.  Geez, no, early April, my first loss due date was a lifetime ago.  That’s right, my June baby was my “perfect timing baby.”  And the unimagineable still happened.  I lost another baby.  My baby was due around September 15.  I (should) have a 4-week-old baby, and my best friend is about to have her baby.  She found out about her baby a few days before I lost mine.  No wonder she was such a wreck when she first saw me after my loss.  She was pregnant and pukey and in agony since her dream was coming true and my dream was dashed yet again.

She’s about to have her baby.  Her third baby.  I have coupons.

RPL Update Number I Lose Count

I started writing up a big post about the more recent developments in my journey through recurrent pregnancy loss.  I still need to finish it up, but in the meantime, he’s a quick update:

  1. In August I had a hysteroscopic myomectomy done in Denver.  The idea was to hopefully remove a fibroid that was bulging into my uterus.  Instead of a fibroid, the surgeon found an adenomyoma located directly above my cesarean scar.  I have to review my records from my 1 successful pregnancy to determine whether or not the fibroid that was present during that pregnancy changed into this adenomyoma.  Otherwise, it is likely a lovely by-product of the 2004 cesarean section that was performed on me and my daughter.
  2. I have a substantial progesterone deficiency.  Progesterone levels should not drop below 8-10 in 2nd luteal phase draw, and mine dropped to 3.  I will have to have HCG shots during the luteal phase and progesterone shots during the first trimester to support the corpus luteum and developing baby.  It makes me INSANE that the last OB I asked to test my progesterone outright refused.  I lost that baby, obviously.
  3. I have to wait until November to have an ultrasound performed to let me know if my uterus and endometrium have repaired from the surgery.  Then we can talk about ttc.

That’s my nutshell.

Recurrent Pregnancy Loss Update

It’s hard to believe that it’s nearly a year since my first loss and only 4-1/2 months since my last loss.  But I am starting to put the pieces together.  Here’s the list of causes my Reproductive Endocrinologist outlined for me at my early June visit as well as my status in each of these areas.  I hope this may help others who have experienced multiple losses advocate for the help they need.

INFECTION
Yeah, it really stinks to think that I could have lost babies due to low-grade infection, but it is possible.  The RE recommends that I do a round of antibiotics during early pregnancy.

IMMUNOLOGICAL PROBLEMS
This category refers to things like clotting disorders, immuno-deficiency illnesses, and the like that can and do contribute to primary and secondary infertility.  When clear immunological problems are not identified through extensive blood testing, doctors seem to recommend taking a baby aspirin (81 mg) a day as a possible protective measure.  My bloodwork came back just fine and dandy!

STRUCTURAL PROBLEMS
Structural problems can be congenital or acquired.  An example of a congenital structural problem is a bicornuate uterus.  Some women with this uterine shape have difficulty maintaining pregnancy to term and their babies may not descend optimally (vertex, anterior-ish) into the birth canal.  I had a HSG done in late April, and my OB believed that I had a congenital uterine defect.  However, my follow-up (and second opinion) with the RE has not confirmed this to be the case.  Rather, it appears that a relatively small (1-1/2 inch or so in diameter) fibroid is distorting the left side of my uterus.  Even though it is intramural (in the muscle, not in the uterine cavity), the RE thinks it is enough of a problem to justify a laparoscopic myomectomyI am not convinced and will hold off on this invasive procedure until all other avenues have been exhausted.

HORMONES
This is where we enter a major realm of disagreement in the medical world.  Some doctors believe in progesterone deficiency and luteal phase defect; others don’t.  Some of the doctors who don’t will still agree to supplement since conventional wisdom suggests that supplementing progesterone production isn’t dangerous.  As luck would have it and non-traditional practitioners have told me time and time again, I have a progesterone deficiency.  A fairly marked deficiency, actually.  I had my progesterone levels checked twice during my last cycle – the first level was 20 (good); the second level taken only 48 hours later was 3 (NOT good).

LUCK OF THE DRAW
The fact remains that not all pregnancies are viable.  All children are a blessing, but not all babies – in utero – are meant for this world.  I do take some comfort in knowing that if any of these babies were just not going to be healthy, that they were not put on this earth.  I’ve had friends and family members choose to terminate pregnancies in the 2nd trimester, and I am thankful that I have never been given that choice.  On the other hand, knowing that my body is not producing enough progesterone to sustain pregnancy makes me sad and incredibly angry.

I am sure that the sadness is quite apparent if you’ve read anything on my blog this past year.  The sadness and loss has been overwhelming at times.  I am quite certain that my baby boy has been trying so hard this past year to come home to me, so it’s been particularly trying and emotional.

Why am I angry?  First, it is extremely frustrating to have seen three practitioners who have disparate diagnoses and protocols for dealing with repeat pregnancy loss.  Secondly, being refused services is infuriating.  Thirdly, doctors who contradict themselves and/or make stuff up make me insane.

OB 1 doesn’t (WON’T) test hormone levels during early pregnancy.  I am angry because she refused to order a simple progesterone test, and now that I know I have trouble maintaining adequate progesterone levels during the luteal phase, I resent her even more than I did before.  She has contradicted herself; she has refused services; she told me I would have to schedule a repeat cesarean for future births moments after waking up from sedation following an unwanted (but needed) D&C; she didn’t ever give good justifications for her protocols; she wanted to put me on Clomid; etc.  Mostly I am angry with HER.

OB 2 doesn’t believe in luteal phase defect but is willing to treat with progesterone supplementation.  My beef with this doctor is that he made up a term on my HSG report – partially-didelphic uterus.  It doesn’t exist.  OB 2 is great in that he’s willing to collaborate with specialists and takes the time to explain the evidence underlying various protocols.  I also appreciate that he is cautious when it comes to reproductive surgery.  He told me that I shouldn’t consider a myomectomy at this time – isn’t one uterine scar enough?

RE 1 I appreciate because he has been very thorough.  Perhaps there has been some overkill, but at this point, more information is good.  I am glad that we can (for the most part) rule out acquired or inherited thrombophilia, for instance.  I wish he hadn’t been so quick to suggest surgery for my fibroid.  I wish he hadn’t invalidated my concern for what this myomectomy would mean for my reproductive future.  Sure it may improve my fertility (possibly), but it would certainly necessitate cesarean deliveries from here on out.  I got the feeling that since my uterus is already scarred, that he assumed additional scars were negligible concerns.  He wasn’t listening.  Additionally, my last conversation with the RE’s nurse was confusing – I almost wonder if he has me confused with another patient?  Or perhaps he consulted with other doctors in his group regarding my file and has revised his protocol.  It would be nice to know for certain.

I will likely seek another opinion from a RE since I am in a big city this summer.  Recommendations for surgery really need to be followed up on with additional unrelated practitioners.  You’d get a second opinion if a doctor recommended back surgery, right?

Next up – a sonohysterogram in about a week.

RESOURCES

http://www.rialab.com/miscarriages_prevented.php

http://repro-med.net/info/cat.php

http://www.instituteofalternativemedicine.com/bioidhormone.htm

http://www.ivf.com/recurrent.html

http://www.cushings-help.com/infertility.htm [luteal phase defect section]

http://infertilityblog.blogspot.com/2007/01/so-your-uterus-is-bicornuate-check.html

http://stirrup-queens.blogspot.com/2008/01/two-part-sonohystogram.html

http://www.coe.ucsf.edu/fibroids/bg_diagnosis.html