03/06/09 OB Appointment

Twenty-five weeks and counting!  Friday was the day of my last OB appointment and ultrasound, and it turned out to be another day of affirmation and encouragement.

The morning started with my one-hour glucose tolerance test.  Judging from the way I felt during the hour I think I passed, although I won't know for sure until sometime this week.  I always somewhat dread the routine GTT, but really the worst part about it is not being allowed to drink water for an entire hour (oh, and then the part where they draw my blood.  I'm a little freaked out by needles....).

The doctor portion of my appointment turned out differently than I expected.  I was scheduled with a lady doctor whom I've never met (and who happens to have twins of her own) and was kind of excited for the chance to visit with her and to find out where she stands on the twin VBAC vs. repeat cesarean issue.  However, because she was running behind in her schedule, I ended up seeing the doctor whom we met with the day we found out we are having twins (one of the two in the practice who seems to be more supportive of my wish to VBAC).

I really enjoyed visiting with this doctor again.  Right away he brought up the topic of VBAC.  I was glad for the chance to discuss it further with him, as he seems to be a little more objective than some of the others.  He still seems to be of the opinion that my case is unique in that I've had a successful VBAC prior to this pregnancy, which I think in his mind increases the likelihood of another successful VBAC this time around.  Still, he stated the common opinion that a twin pregnancy puts more strain on a uterine scar, thereby increasing the chance of rupture.  He likened my scarred, pregnant-with-twins uterus to a big bottom in jeans with a weak seam:  Just as a big bottomed person doing squats all day long in a pair of jeans with a weak seam has an increased chance of splitting her jeans out, he said, so a bigger, more distended scarred uterus in labor for an extended period of time has an increased chance of rupturing.  I have to admit that I get a little bit skeptical when told things like this, because it seems to be in direct contradiction to the results of so many studies on VBACs which have shown similar success rates among women pregnant with singletons and women pregnant with twins.  But even in spite of the belief that a twin pregnancy increases the likelihood of uterine rupture, the doctor still conceded that he truly understands why I want a VBAC--especially since we don't have the desire to be "done" having children.

We also discussed my weight gain briefly.  I was somewhat shocked to learn that I gained ten pounds over the past four weeks but glad to know that it actually put my weight gain right on track with recommendations for twin pregnancy.  (From what I've learned, a good rule of thumb is 24 pounds by 24 weeks and 40 to 50 pounds total.)  At any rate, the doctor was pleased with my weight gain and basically told me to keep doing what I'm doing.

Next on the schedule was another 45-minute ultrasound.  Since a simple measurement of the uterus (which for me this time was 30 cm!) is not enough to monitor the growth of twins, we have an ultrasound every four weeks for this purpose.  The babies looked good.  Baby A's heart rate was 150 bpm, and she is weighing 1 lb. 5 oz.  Baby B's heart rate was 153 bpm, and she is weighing 1 lb. 7 oz.  They are still in a "T" position, although Baby B has flipped around so that her head is now where her feet were.

After our ultrasound we were privileged to meet with the perinatologist who consults with our OB practice for high risk pregnancies and who has been reading our ultrasounds.  She basically wanted to discuss with us the fact that Baby A has a two-vessel umbilical cord (one artery and one vein) instead of the normal three-vessel cord (two arteries and one vein).  Although this can often be an indication of a heart anomaly or kidney problem, scans have shown Baby A's heart to be healthy and complete and no kidney problems are apparent at this point.  (Praise God that He is hearing our prayers for the perfect and complete development of every organ!)  We also learned that babies with a two-vessel cord are often smaller at birth, but with the right nutrition, the perinatologist said, it is definitely possible for Baby A's weight to keep right up with Baby B's.

The perinatologist also opened up the topic of VBAC with me, as she was impressively up to speed with my medical records.  When she learned of my desire to VBAC, she poured forth encouraging words along the lines of "I believe you can do it!  In all my years of practicing medicine, I have seen so many woman do it.  And if you have the vision for VBAC in your heart and a supportive person by your side, you can do it!"  I was so encouraged by her positive words which filled me with even more joy and confidence than what I had before.  Those words as well as her express admission that so many doctors want what is best for them (and not necessarily what is best for the mother and baby) were like another source of affirmation to me that my desire for a VBAC is legitimate and realizable.  I praise God for using people like her to speak to me, and I pray that He will allow me to hear His voice ever so clearly in the coming weeks in regards to this matter.

I'm sure there is much more to say, but this post is getting pretty long.  Just know that I am filled with inexpressible joy and excitement as I watch the development of my babies and await their coming into this world.  May God's will be done, and may He be glorified in all of this!