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I have to confess I was genuinely shocked that I was pregnant. I know, I know. I’m an OB/GYN doctor. I’d been pregnant NINE times before. But I just didn’t think it would happen again after one cycle. Obviously, I wasn’t tracking my cycles that closely.  Something felt different with this one though.  Not physically, just…less fear, more hope.  I truly think that when the L-rd took that pain from me, it freed me up so much that I just felt more faith to trust Him.

I didn’t do my labs but I did dose way up on my progesterone, taking oral pills and vaginal suppositories.  I also started taking aspirin because of the Factor V Leiden, in addition to my mountain of other supplements.  I focused on eating well, getting sleep and not worrying every time I went to the bathroom.  I can remember only one freak-out day, when I got really anxious and starting bawling to my husband. He walked me off the ledge, as usual.  Hormonal women!

We had planned another trip in the summer to Philadelphia to see my brother and his wife.  We lived in Philly for 5 years during training so we loved going back to visit.  I calculated that I would be about 11 weeks when I would be in Philly, so I called up my mentor from residency, Lauren Plante, a maternal-fetal medicine specialist.  I’ve mentioned her before because she’s just so awesome.  She is board-certified in obstetrics, MFM, anesthesia and critical care.  She edited a textbook on Maternal Critical Care. She’s a full professor at Drexel University. And she’s had two midwife-attended homebirths. She’s basically Dr. Amy’s arch-nemesis. And if you don’t know who Dr. Amy is, consider yourself lucky.

So basically I love her.  She and I disagree on A LOT. But who cares? We have respect for each other and she has taught me more about critical thinking than anyone else in my educational career.  She is the very first person who listened to me whining about my first cesarean and said very casually, “Do you think it could have had anything to do with your induction?” That one statement literally started me on my path of modern obstetrics de-indoctrination.  Oh, did I mention she has an MPH too? From Johns Hopkins. Like, if there was a smarter person in this field, I don’t know who that would be.  So naturally, I wanted her opinion on my pregnancy.  Was she thrown by me being a 41-year-old-42-at-delivery-history-of-two-ceasareans-history-of-uterine-rupture-history-of-recurrent-miscarriage-including-one-with-severe-hemorrhage-and-hypotension-requiring-pressors-history-of-Factor V Leiden? She didn’t say, “Are you crazy?”  She said, “Mazel tov.”

Back to my fascination with numbers. I’m not going to digress into how I see all kinds of crazy number combinations on my odometer (I have a friend who sees these too, I’m not the only one!).  Anyway, numbers are very significant to me.  So when Dick told me he had seen two girls, I convinced myself that meant I was having twins. In my oh-so-logical thinking, the number of man is six, the number of perfection is seven.  Surely, G-d would not give me 6 kids because 7 is representative of Him.  I already had 5 boys so in order to make it to 7, I would have to have twins.  Yeah, I know. You may be sorry I’m letting you see how my mind works.  I fully expected to see two babies when I had my ultrasound with Lauren.  Instead, here’s what I saw:

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Don’t get me wrong. I’m was laughing and crying with relief to see my viable baby.  But I’m saying in my head, “L-rd, there’s only one. I can’t have six kids. That is not your number.” And immediately into my spirit, He spoke, “You don’t have six kids, you have ten.”  And I started crying for real!  I do have ten kids!  I have four in heaven, and I knew number one was a girl! And I knew this one was a girl!  Even though it’s too early to tell on ultrasound!  Also, remember how I told my dad at the age of 12 that I would have ten kids? Yeah, that.

Also remember how I don’t dream? Really, I don’t, or if I do, I don’t remember them.  But G-d had given me two other dreams before we got to Philly.  The first one was of my children in heaven.  All four of them were together holding hands.  As if they were waiting for the rest of their family to get there.  They were shadowy, I couldn’t see their faces, but I clearly saw them all holding hands. And it gave me such peace and relief to see them and know they were OK and that I would see them again.  The second dream was of me giving birth.  I had a vaginal birth and I gave birth to a girl.  I remember being confused and thinking, “G-d, there was only one girl.  What’s up with that?” Also, Rabbi was there.  Not like down at the bottom watching or anything creepy like that, just in the room.  So I was thinking maybe that meant she was going to be born on Shabbat or something.  Maybe it was just a sign that it was a spiritual dream and not a pizza dream. We also went to our former church in Philly where my brother and sister-in-law still attend.  The pastor’s wife who hadn’t seen me in 3 years and didn’t know I was pregnant, came up to me and immediately said, “You’re pregnant and it’s a girl.” I looked at her funny and said I know.

Lauren talked for a long time to me and Dennis about all my various issues.  It’s such a blessing to have someone just provide you with information and not try to scare you.  We talked a lot about the uterine rupture.  Although I’d had a successful VBAC after that, she let us know that there was a small chance of that happening again.  I had my operative report from that surgery. Although the surgeon told me I had a separation of my scar, she had not dictated it into the op report (CYA?) She did document a double-layer closure.  Lauren told me about the increasing literature looking at ultrasound measurement of lower uterine segment thickness as a predictor for uterine rupture. She gave me a recent meta-analysis to read and suggested I consider having it done at Washington University in St. Louis, which was one of the investigative sites.

We also discussed the importance of finding a supportive provider.  With my history, I was certainly not a birth center candidate, but I definitely knew that I needed to choose a provider carefully.  I planned on quizzing the midwives when I got back to Springfield.  Like many women who are pursuing VBAC (vaginal birth after cesarean), I normally would consider driving farther to find the right provider but with a history of a precipitous birth with my last son, I was hoping I wouldn’t have to do that.  She suggested I also talk to Jill Arnold, well-known for her work on the Unnecesarean blog and CesareanRates.com website.  I met lovely, animated, whip-smart Jill a few years ago when I was a speaker at the ICAN conference in St. Louis.  She had recently taken a job at a birth center in Arkansas and might know supportive northern Arkansas providers which wasn’t too far from Springfield if I couldn’t find anyone in town.

Sure enough, the midwives knew just the doctor they would go to, who just happened to be in the hospital system where my husband was also employed. PTL! Only problem was, she was so popular that it was nearly impossible to get an appointment.  Even though I called as soon as I got back to town, they really didn’t want to give me an appointment until I was 20 weeks! Seriously, half-way through the pregnancy? With all my “issues?” I have since learned this is standard practice with most of the OBs in my town.  I suppose they are waiting for all the miscarriages to filter out? What about women who need monitoring early in pregnancy?  Since we have lots of hormone patients at my office and the birth center, we are constantly monitoring labs as soon as we find out they are pregnant.  I have to confess I pulled the doctor card to get an earlier appointment but it still wasn’t until 15 weeks!

I instantly liked Dr. Mary Duff.  She was very laid-back and didn’t seem too worried after she read Lauren’s consult letter outlining all my “issues.” I prefer to say “issues” rather than “risk factors” with its negative connotations.  She was encouraging and supportive of my plans for another VBAC and liked the idea of the LUS ultrasound.  I was a little concerned about her partners being equally supportive but she said she would come in for me unless she just couldn’t avoid missing it.  That was actually fine with me because Cox hospital has OB hospitalists and generally they are more likely to be supportive of VBACs since they are already on L&D and don’t have other office or surgical obligations putting pressure on them.

After all that, I had a relatively uneventful pregnancy, for which I’m grateful since my friends across the street at the birth center who were also pregnant were dealing with various pregnancy complications.  My previous four boy pregnancies were complicated by gestational hypertension (my third child I also had gestational diabetes), which led to induction, which led to cesarean so I was very happy that my blood pressure (and blood sugar) behaved.  We opted not to do any genetic testing although did agree to the 20 week fetal surveillance ultrasound. I did end up monitoring my progesterone levels later (I ended up pretty much taking progesterone the whole time) as well as my vitamin levels to keep everything within optimal rather than just-barely-normal range.   The only tick was a positive Group B strep culture, which was interesting because I had been GBS negative with my others.  With this information, we began gearing up for this most precious birth.

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Stay tuned for Part 4.