Thank you so much for the feedback. And, oh, thank you
for the support. Even processing this stuff as it comes up (I thought we were clear on no induction this week until my doctor's call Monday afternoon, and the whole growth curve thing) pulls me away from nurturing feelings of safety and security that should be important to a mammal looking to birth. I mean, I need to process it so I can make decisions and know where I stand, but the STRESS of it! Thank you for the hugs and empathy.
My feelings and thoughts have been evolving a lot on this issue in the last week.....Originally, my keenest fears or misgivings were about the possibility of acute TTTS, and that somehow going "too long" was just giving it more of a chance to happen. Although I knew it was unpredictable and all that. I also felt that probably the best insurance against it (as long as this occurred before the onset of acute TTTS, which also is impossible to predict) would be a scheduled c-section. As in, that type of elective delivery would be the best way to "protect" against the onset of acute TTTS during labor. (Better than induction, which offers the possibility of a vaginal birth, but not the same efficient "protection" that a c-section would offer against that one potentially grim mono/di complication.)
Still, since nobody seems to have any hard data on odds/statistics of acute TTTS, it seemed a huge leap (to get to the point of consenting to a scheduled c-section.) It's not what I want, it's not what I believe is best for my babies, it's not best for me. Even scared of acute TTTS, the risks of the elective surgery outweigh whatever the TTTS-related benefit may be.
But....I was sort of operating on this "eventually an elective birth will be a reality if they don't come spontaneously" agreement, but thinking it wouldn't come to that. I didn't believe that "twins come early" (even though I heard it like a zillion times, in books, from random people, from doctors) although on some level I guess I thought they'd likely come earlier
than a singleton. (I have one child, and she was born at 41 weeks. On the day, seven days past her EDD. And I was charting, and very sure of my dates as far as conception.)
Now that I've completed 38 weeks and am counting along toward 39 (this Friday I'll complete week 39), I am thinking more about that agreement that "eventually they'll have to come out." This reluctant agreement was based on their chorionicity: I was telling myself that if there were two placentas, there would be a lot more leeway. But now as I think things through, I realize that if my main reason for nervousness is the unpredictability and scariness of acute TTTS, I'm not exactly sure that I have a reason to think there's a deadline. Even with monochorionic twins.
If, like my OB, I am worried about placental function and postmaturity, babies ceasing to thrive in the uterine environment, twins being "term" earlier and therefore postmature earlier, then I have reason to think about elective delivery. But if I don't believe those assumptions, at least not with clear indications of such in my case, then exactly when is my "willing induction" date?
This is what I've been realizing....that the pressure to induce has little to do with acute TTTS (which is the main unsettling blip on MY radar, over which I assume I have no control), and most to do with the calendar, the fact that I have twins, and those older studies by Luke and by Leveno that suggested (and, effectively, established) that twins achieve pulmonary maturity earlier than singletons of the same gestational age, and may have complications of postmaturity sooner, as well. So, if I don't buy those reasons, I'm left realizing that I don't have a nice, sane compromise to show how reasonable I am.
Monochorionic or not.
Originally Posted by Novella
It troubles me that you are doing to the Evening Primrose Oil capsules when you are feeling:
How messed up does that feel?
Although we mothers cannot command labour to begin, there is no doubt that the mental and emotional state of the mother influences when labour begins. By doing something to yourself that you aren't fully onside with, you are sending your body/babies mixed signals. That doesn't sound to me like it's a good recipe for an unencumbered birth.
You are right....it is because of that evolution of thought I described above that I am conflicted, now, about urging birth on. I believed it was entirely possible that I'd go to 38 weeks or even longer, but in my heart I was hoping to reach 38 weeks and then have them come. It seemed the easiest route. Reach "term," but not go too long for the OB's comfort or approval or whatever. And they always were tracking big for gestational age, which I thought would bode well for that "plan."
Realizing that I'd reached 38 weeks with no signs of physical readiness for labor sort of blew my mind. The stoic, strong cervix that got me through the risky weeks for pre-term labor, and let me breeze right through the weeks when near-term issues could have been problematic if we'd birthed then, suddenly seemed a liability. I found myself suddenly afraid that I was carrying a couple of 40+ weekers and realized that this would put me at odds with my doctor and make things really difficult.
The evening primrose oil seems (to me) like more of an encouragement of readiness or ripening, as does sex/prostaglandin "deposits." Not that it's going to throw my body into active labor, but that it could encourage readiness, certainly over time.
I had one pelvic exam during my first pregnancy, and it was at 40w5d. My cervix was high, firm, and closed. Knowing that the next week would start with more scrutiny, NSTs and BPPs, the midwife at my appointment that day gave me some suggestions for activities and positions that might encourage better positioning of the baby (to help apply pressure to my cervix) and she mentioned EPO. I bought some and took it, and at 11 pm I passed the mucous plug and began contracting. It was a long road from there, since I was starting at 0% effaced (most of the next day was spent with contractions that thinned the cervix and I was maybe 2 cm dilated at midnight the following night.) After that long day, I did progress slowly on and I spent the next day dilating. My daughter was born at 11:12 p.m. at 41 weeks.
I know lots of people start taking EPO around 36 weeks, to help with preparing things, but I didn't want to do that because I was afraid it might do the same thing (start up my labor, even if it was long) and I didn't want to interfere with the twins' timing as early as 36 weeks! I now see that EPO isn't going to throw me into passing the plug and contracting, because I've taken it for the last few days (Friday and over the weekend, about 4 days now) and it hasn't been the same.
I feel I couldn't do castor oil at this point because of what you point out....I'm not fully onside with that action, at least not at this point.
When I bought the EPO and started taking it, I was hoping that I could encourage readiness and even encourage labor so that I'd be going naturally right around the time of the proposed induction (tomorrow) that I'd declined. I was hoping it would prepare me favorably for whatever influence the full moon might exert. I was hoping it would get me the spontaneous labor before whatever arbitrary deadline I might eventually have to agree to came along.
But then I started realizing that the only reason I was thinking that at SOME point I'd have to compromise was that I wanted to be the reasonable, compromising person....showing my doctor that even if the answer for now was no, I wasn't unreasonable and I knew that our monochorionic status meant we would have some sort of deadline. Once that premise came into question more sharply for me, I began to feel that telling my babies that it's okay to come, and casting about for ways to encourage them physically, was "messed up."
I guess that doesn't mean I think that EPO is a bad thing, because as I understand it, its "benefits" pay off whenever labor does start. So I don't feel particularly conflicted about that. Or about the sex, when we actually manage the logistics to make it work!
(We're about 2 for 4 on that one, so far.)