I really need some advice in this situation as I feel I am getting desperate and probably not thinking straight. In the interest of getting you into my mindset, I will try to give full background info...
This is my 3rd pregnancy, 2nd child (2nd pregnancy was a miscarriage, no bleeding or anything and we waited weeks but when nothing happened I ended up having a D&C). I am currently 38 weeks. My first, DS, was born at 35/36 weeks by C-section as he was breech and no one does breech births vaginally here (the plan was to try an ECV at 37 weeks but I never made it there and none of the more natural methods worked with me + I was on bedrest). I have 'incompetent cervix' and it was diagnosed too late in the pregnancy for the cerclage so I maintained super strict bedrest, some of which was spent in the hospital, took tons of terbutaline, steroids for lung development, progesterone...etc and managed to hold out till he was born. When I went into labor, I'd experienced many contractions over the time previously, some painful feeling like real labor and some that I was almost unaware of. That particular day, I didn't feel especially pained or anything, had some contractions but they were very easy to ignore. I had a doctor's appointment and at the end, the OB thought to check me and said I was about 3 cm, did an ultrasound to see if the baby was still breech, and then sent me to the hospital (about 5 min away). Once I got there, they hooked me up to the monitors and asked if I was feeling regular contractions (I said no), and the nurse said she didn't really see any either and the doctor would be in shortly. Maybe 10 min later the nurse came back in and asked how I was feeling, about contractions again...etc. and I told her I didn't feel any differently, wasn't aware of any real contractions..., she then pointed to the monitor and said I was having a lot of them and they were quite strong and close together (it really did not hurt, all it seemed to me was that the belt would seem annoyingly tightening from time to time). The OB came in and checked me again and said I was 4-5 cm now with bulging membranes. We talked for a few minutes and after talking a bit, I felt a little gush and mentioned it to her, she noticed I was bleeding and there was a lot of liquid and told me my water had broken. She checked me again and said I was now 5-6 cm and she was going to prep the OR. C-section went fine, there were some cord issues that had prevented him from turning so I came to accept that it was very likely the ECV may not have worked anyway and that that is why he never turned with any of the other methods. Everyone who has seen my incision has told me they did an excellent job on it and it healed very nicely.
On to this pregnancy. It followed a very similar pattern except I started contracting earlier in the pregnancy (around 15 weeks, before I had completely painless cervical shortening and dilation at 20 weeks with a rapid increase in complications from there), this time I started out contracting noticeably before the shortening and dilation began and they ended up doing an 'emergent cerclage'. I had seen a midwife a few times early in the pregnancy but the complications were adding up so she advised me to see the clinic I'd been seeing (affiliated with the hospital, mix of doctors and midwives and high risk OBs) for prenatal care to manage my condition and that she would see me from time to time to keep up a rapport and if I made it to 37 weeks, she would take me on as a client then to have a HBAC as I wanted. I made it to 37 weeks after a lot of effort to sustain the pregnancy and they took the stitches out (except, the doctor who removed the stitches did say she got the knot and all but there was one tiny piece of stitch that was left in that she couldn't get out but she didn't believe it would hinder dilation at all as I was dilating perfectly roundly already and it was extremely loose as the knot was gone. She also said when she removed the cerclage my cervix quickly was dilated to a stretchy 2 cm and about 80% effaced and that the baby's head was 'pretty low'. I went home and started having some contractions, the midwife came by just to check me out and she said I was about 3 cm, still 80% effaced. She offered to stay but I did not feel it was 'the real thing' yet so I told her she could go. That night and the following morning I started having some pretty intense, regular contractions. She was supposed to come back that day anyway so I called her over and she checked again and said I was still 3 cm. She advised me to relax as I seemed to be in early/prodromal labor and it could be a while, even days or weeks before things really picked up. She also recommended that I try evening primrose oil due to the scar tissue from the cerclage (twice per day, 1 inserted directly on the cervix and 1 taken orally) After this I told myself I wouldn't call again unless my water broke or I was sure it is the real thing.
Since that time, I've had spells of regular contractions, increasing in frequency and intensity (like starting off at 7-10 min and after several hours of consistent contractions being at 3-4 min) however I did not want to call her yet (and am glad I didn't) because after many hours they would randomly taper off. I lost my mucous plug (again) and had plenty of bloody show. Now, here is the big issue for me. With all my problems and my history of preterm delivery, my husband and I felt confident that I would likely have the baby pretty soon after the stitches were removed. As that was the case, he scheduled a trip of extreme importance on July 1st - 5th. There is NO way it can be canceled. He will be on the other side of the country and he will not be able to return early even if I give birth while he is gone. We really thought it was unlikely to even be an issue. Now I have about 5 days till he leaves, less if you consider that I'd prefer not to have the baby the night before he goes and would like for him to have at least 1-2 days with our newborn before he has to leave for 5 days. My parents are also going back at the same time coincidentally, AND my doula had to withdraw herself as my doula because of a family emergency. So I am looking at a very high likelihood of birthing alone with my midwife, my grandmother MAY be able to come and that will help with moral support (though it won't make up for my husband not being there) and I won't have to ask someone to watch DS1 as she will be there BUT she does not speak English and cannot drive so in the event of an emergency or transfer I would be on my own. I've become desperate enough to break my own advice (waiting till your body is ready) and have tried pretty much every natural induction method in the book AND I even for some insane reason subjected myself to an attempt with castor oil yesterday. I know its not recommended before your EDD but I felt that since my cervix is so favorable it might work. I thought it might be as I got very regular contractions once I got over the initial effects and by bedtime was having them 2 min apart, lasting 45 sec - 1 min, and they were not letting up no matter what I did, some of them were so painful along my scar as well and I went to sleep expecting to wake up sure of being in labor, tossed and turned quite a bti due to them, but by morning I was slow and irregular again.
So here is my dilemma. It has been suggested to me (and I did scoff at it for sure so I don't know why I am even considering the idea or repeating ti) that I should just go to the hospital when the contractions get hard as they will likely keep me between that and my current dilation (I did try checking myself and believe I am about 4 cm or so) and being a VBAC. I have seen the doctors at thisplace my whole pregnancy and while I don't really like them, they 'approved' me for a TOL. I can't really imagine what they'd do with me right now since they won't induce a VBAC mom except I imagine maybe break my water or strip my membranes. Someone close to me has suggested if they do that and things get going I can always leave the hospital and go home. However, I realize that I will be starting down the slippery intervention slope, putting myself on a timer, likely ending up with a repeat c-section (this time, completely unnecessary), and losing my wishes for a natural homebirth that I've looked forward to through all the difficulties in my pregnancy. Everything is already set up, my birth kit has been bought and opened, my bed is made up, birth pool is inflated, oral vitamin k has arrived...etc. On the other hand, I worry, if I end up in labor when my husband leaves, I still have a high chance of ending up transferring (midwife is already concerned about me having a PPH due to a few risk factors + there is speculation that baby may be ROP position hence the prodromal labor) or ending up with a repeat cesarean and I can't imagine going through that alone, being in the OR alone for another section, recovering alone, having no one to watch over the baby when I can't be with him or advocate for my wishes when I am unable to...etc, or possibly ending up with PPH and having no one there for me. It almost seems tempting to take my chances at the hospital when I can guarantee everyone is here vs risk going through the same thing when I will be alone.
What would you do? Would you even consider it? Even as I write this I realize the logical answer seems glaring (to just relax and let it happen however it happens and continue on my plan for homebirth) BUT its just so hard to accept that knowing what the worst case scenario could end up being without anyone here for me.
Edited by umm.hafsah - 6/25/12 at 4:57pm