Birthday Fun

Phew, Kate's birthday time is over! I baked a ladybug cake for her real birthday. I was out of red food coloring paste though, so I went to the party store to get some. I looked and looked, but they didn't have anything that was 'red red', the closest they had was terracotta. The little color dot on the top was very red though, so I just hoped it would be fine. Well, it wasn't! I made the icing, and found out that terracotta meant terracotta, not red, even although the color dot looked so nicely red. Added orange, added pink, cursed a bit, and then decided that a terracotta ladybug just would have to do LOL.

The next issue was the black spots and lines. Black is always hard to make, and it kept coming out more dark grey-ish than black, so I just hoped for the best on that one too. Luckily it looked black enough in contrast with the terracotta, but it still wasn't exactly what I wanted.

Of course, where I saw all the imperfections, Kate just saw the exact cake she wanted, a ladybug!!! She was happy with the result, so maybe I should be too :-)

For her birthday party, she had asked for a castle cake. I have made those before, and let's just say, they are not my favorite! Somehow my castles always seem to be structurally challenged, in danger of toppling over if you bump into the table, or talk too loud when close to them :-) But being the nice mom I am, I just decided to try it again, and hope for the best.


Well, this time, it actually came out right! How amazing! I think it helped that I did more rigorous cutting than usual, to make the pieces really flat. So I ended up with a bit smaller cake, but much sturdier than my normal castles, so I didn't care. Kate was thrilled with her castle, and so was I. Well, mostly, I still saw some flaws, but less than usual :-) She had chosen special Powerpuff Girls and horse candles, which made the cake even more special.

Now it's all over, and I just realized that the next birthday will be the new baby! Very much looking forward to meeting him!

Spring finally seems to be here for real! This was one long winter! But on Sunday, I saw my very first robin in our neighborhood! Monday I saw so many, I kind of tripped over them :-) Then Tara wanted to come with me in the afternoon, to see them too, and guess how many we saw? Yes, zero... Well, two flying ones, but not easy to see that they were robins.

So I offered her to come on my morning walk with me, and we saw tons of them again, she counted 26... Wow! No wonder I was tripping over them :-) She might have double counted one or two, but I am sure we saw at least 20 different ones.

We have some crocuses blooming too! And yesterday, I put black plastic on some of my gardens, to get a headstart on defrosting them, so I can start putting in some plants. Can't wait to get my hands dirty!

Perfect Prenatal

Had a great prenatal yesterday. The day had a bit of a rough start, because Erik had peed his bed, and then still was half asleep, so I had to clean him up and decided to try to get him back to sleep. This all made things take a lot longer than planned, so I barely made it to the prenatal in time. Actually had two peanutbutter sandwiches in the car instead of a nice, leisurely sit-down breakfast :-)

I took the letter I am going to send to the 'She needs a c-section!' ob, so I could get her input on it. She thought it was a good letter, and hoped I could convince him. I don't even really care anymore, I am not going to have a c-section anyway, but I think it is important to present my side of the story to him and to try to convince him. Not as much for me even, but also for the moms who come after me, and might not get pushed into c-section just because of a myomectomy.

This is what I wrote to the ob

Dear xxx,

I would like to present my case in favor of a normal vaginal birth after my myomectomy, as opposed to a planned cesarean. When I was in the beginning stages of my pregnancy, I believed that there was a relatively high risk of uterine rupture because of my myomectomy.After working through a lot of medical research studies, and finding no evidence of a higher risk of uterine rupture during labor, I don't believe this anymore.

After hours of research, I have found no reports of uterine rupture during vaginal birth after myomectomy. In fact, I have found researchers who feel that scheduling a cesarean due to previous myomectomy is not justified. There are case reports of uterine rupture, but most of those were between 26 and 34 weeks of pregnancy, some even earlier. So a planned cesarean would not have prevented those ruptures. It seems that the 'high risk' period for rupture is late 2nd, early 3rd trimester, when the pressure on the uterus is high. Labor doesn't seem to be as risky.

Here is a short summary of what I have found. I am including all the abstracts of those studies in this package, so you can read more about them. I am in the process of obtaining the full text of the articles that still have question marks, so I can get the right numbers for those too.

#PG = number of pregnancies in this study
#vb = number of vaginal births
#cs = number of c-sections
#UR = number of uterine ruptures

Study	Date	#PG	#vb	#cs	#UR
Campo S, Campo V, Gambadauro P	2003	25	15	10	0
Soriano D, Dessolle L, Poncelet C, Benifla JL, Madelenat P, Darai E.	2003	52	?	?	0
Landi S, Fiaccavento A, Zaccoletti R, Barbieri F, Syed R, Minelli L.	2003	76	31	26	0
R. Seracchioli, S. Rossi, F. Govoni, E. Rossi, S. Venturoli, C. Bulletti and C. Flamigni	2000	47	13	34	0
Malzoni M, Rotond M, Perone C, Labriola D, Ammaturo F, Izzo A, Panariello S, Reich H	2003	26	9	12	0
Di Gregorio A, Maccario S, Raspollini M.	2002	105	?	?	0
Seinera P, Farina C, Todros T.	2000	65	9	45	0
Tomialowicz M, Florjanski J, Zimmer M.	2000	267	?	?	0 in myo group
Dubuisson JB, Fauconnier A, Deffarges JV, Norgaard C, Kreiker G, Chapron C.	2000	145	58	42	3, but 0 during TOL
Nezhat CH, Nezhat F, Roemisch M, Seidman DS, Tazuke SI, Nezhat CR.	1999	42	6	22	0
Darai E, Dechaud H, Benifla JL, Renolleau C, Panel P, Madelenat P.	1997	19	8	3	0
Roemisch M, Nezhat FR, Nezhat A.	1996	31	5	14	0
Dubuisson JB, Chapron C, Chavet X, Gregorakis SS.	1996	7	3	4	0
TOTALS		888	157+?	212+?	3 total, but none during TOL

As you can see, there were exactly 3 ruptures in those 888 pregnancies, and those were at 25 weeks, 32 weeks and 34 weeks of pregnancy. All cases had a favorable outcome for mom and baby. As you also can see, there were no cases of uterine rupture during labor in those studies.

I know that there aren't big studies on that, but still, I think that those studies do support that a vaginal birth after a myomectomy is a reasonable option. An interesting quote from Dubuisson, Fauconnier,et al. 2000 [1]. is "Systematic recourse to Caesarean after LM, as recommended by some authors for cases of intramural or deep subserous myoma (Friedmann et al., 1996; Stringer and Strassner, 1996; Seinera et al., 1997; Nezhat et al., 1999), does not appear justified in our opinion. In our study, a trial of labour was accepted for 72% of patients, because similarly to other teams (Daraï et al., 1997; Ribeiro et al., 1999) we made no particular recommendations concerning the type of birth after LM. A large number of these patients had intramural or deep subserous myomas. The trials of labour resulted in no complications and, in particular, no cases of uterine rupture."

Another reason that a c-section would not be optimal is that we hope to have more babies after this, and a c-section would increase the risks for future babies. Mankuta, Leshno, et al., 2003 [2], state "The risk of perinatal death associated with labor after previous cesarean section appears higher than with a repeated cesarean section. On the other hand, repeated cesarean sections are associated with increased maternal morbidity and mortality from placental pathologic conditions (previa or accreta) on subsequent pregnancies." and "The model favors a trial of labor if it has a chance of success of 50% or above and if the wish for additional pregnancies after a cesarean section is estimated at near 10% to 20% or above because the delayed risks from a repeated cesarean section are greater than its immediate benefit. The model was robust over a wide range of assumptions."

After all my research, and weighing the risks and benefits of a vaginal birth versus a planned cesarean, I have determined that vaginal birth is the less risky option for me. I hope that all this evidence will convince you that I can have a complication free, normal vaginal birth. If you have any more questions or concerns, please let me know.


Sincerely,



[1] Mankuta DD, Leshno MM, Menasche MM, Brezis MM.
Vaginal birth after cesarean section: trial of labor or repeat cesarean section? A decision analysis
Am J Obstet Gynecol. 2003 Sep;189(3):714-9.

[2] Jean-Bernard Dubuisson, Arnaud Fauconnier, Jean-Valère Deffarges, Christian Norgaard, Gustavo Kreiker and Charles Chapron
Pregnancy outcome and deliveries following laparoscopic myomectomy
Human Reproduction, Vol. 15, No. 4, 869-873, April 2000



OK, if that doesn't convince him, at least I have done my darnedest best to change his opinion. We'll see what happens.

Back to the prenatal. I had lost one pound, which is amazing, because I feel like I am eating all the time. My fundal height had increased 2.5 cm in 2 weeks though, so I am 32 cms now, right on track with how many weeks I am. Blood pressure was 104 over 60 something, urine was ok, and the baby's heart rate was 148 bpm. Baby had turned head down! Of course, he still has room and time to do somersaults, but for now he is in the right position. Well, partly, because he was posterior, but lots of time for that to change too.

So happy that this pregnancy is going so well!

Five Years Ago...

Five years ago, I FINALLY went into labor with Kate, after trying to get her out of there for at least a week. First gently, then more forcefully, ,and by the time I gave up on it, she decided that maybe she was ready to come out... Not easily though, she was one of my hardest births, I think she was posterior, even although we didn't realize it during labor.

Usually I don't bother with trying to evacuate babies who are overdue, but that time was special. Because we were supposed to fly to the Netherlands early April, to get our green cards at the American consulate over there, and the consulate was not willing to change the date of the appointment. They were willing to cancel it though... That wasn't very helpful. We badly needed the green cards, so decided to fly with a newborn (and a few older kids), it would have been nice if she had been born a bit sooner...

We flew to the Netherlands when she was 10 days old. A very stressful 10 days too. Ever tried to get a passport for a newborn within that amount of time? Two very essential things are a birth certificate and a picture with the eyes open.... With the head a certain size, and a white background. The normal passport pic places can't do babies because their heads are too small.... Imagine two people, putting a newborn baby on a white sheet on the floor, trying desperately to get her eyes open enough for the picture. We took a lot of shots like that and hoped for the best. LOL

We were able to get the passport just in time, by using all kinds of special procedures and a lot of extra money. The trip to the Netherlands was pretty stressful too, I wouldn't recommend any one to do an international trip like that when 10 days post partum! But we did end up with a green card!!! Still shudder when I think about all the stress though. Now, after five years, I can even start my naturalization process. Just waiting till next month, so I will have the money to do it :-)

Kate is having a wonderful birthday. Well, if you ignore the occasional fight with Erik, but that's something that happens all the time anyway. She got lots of presents this morning, including a gameboy color and a 'Princess Barbie', which she had requested. She did have her ballet class, we visited the thrift store (where she got a 'new' dress, t-shirt, bag, book, and swim suit), and we even went to the party story. She is thoroughly enjoying being the birthday girl.

She opted for a ladybug cake. It has been baked, but still needs to be frosted. She will have a birthday party on Saturday, but wants a castle cake for that birthday. She is in luck that I like baking cakes :-)

Spring?????

OK, I jinxed our spring by posting about it. Since then it has snowed every single day, some days just a little, but also one day with half a foot of snow! My garden is gone again, covered in snow, and I haven't seen any robins yet either! Not that I can blame them for keeping far away from here! LOL

At least it motivated me to really clean and declutter our kitchen counters. It was about time. I did it when Sander was home, so he could do his part of the scrubbing and cleaning :-) I think he was happy to go back to work today, instead of helping me doing stuff like that. I also have started a bit on the book case in the computer room, but you can't even see that anything has happened to it, it needs a lot more work.

Today we baked one of the cakes from my new Cake Bible. Tim helped me and did all the decorating. He really enjoyed doing it, and all the kids loved having a cake for dessert. Apart from Jane, who preferred a bagel :-)

I have been doing tons of research on vaginal birth after myomectomy and I am convinced that the rupture risk is actually very low. It even seems that all the ruptures I have found in the literature after myomectomy, are late 2nd, early 3rd trimester, not during labor. And where the docs want to me to have continuous EFM (Electronic Fetal Monitoring) during labor, there has been no one who has proposed to commit me to the hospital from week 28 to week 34 to have EFM during this 'higher risk for rupture' period.

Of course, the thing is that there aren't big studies out there, and most of the people in the studies end up with a c-section, but I found a few hundred vaginal births after myomectomy anyway. Still working on getting the full text of the articles I need to know exactly how many there were in the studies.

There were 3 uterine ruptures in those births, but none during trial of labor, all in that 28-34 weeks time frame. So it's not like a planned c-sec would have prevented those ruptures. And it also seems that once I make it to labor, I will be fine. that the 'high risk' part is that time frame in pregnancy when the uterus is growing really fast.

When I started out this pregnancy, I thought for sure it would be better to go to the hospital 'just in case' which such a high rupture risk (my ob quoted 8 - 10 % back then). And also the fact that my scar is at the fundus, where there are more muscles / blood, so a rupture could be more problematic.
But after doing all this research I am starting to wonder. Do I really want to go to the hospital?

Happy Birthday to Me!

It's my birthday today! So now I am even more advanced in my maternal age LOL. The kids were a lot more excited about the whole birthday than I am. Got lots of presents this morning. New binoculars, The Cake Bible, chocolate (yum!), a pocket knife, and a bunch of books (including a new Terry Pratchett one)

A good friend came over with yet another present, a nice set of note cards to write letters, which I have really been into this last year. And two other good friends called me from the Netherlands, I was amazed that they remembered that today was my birthday!

We always have the birthday person pick their cake, and Erik had told me that I had to pick a bunny cake. I still had a bunny cake pan from last year Easter, so that was an easy one to do. I know it's a bit silly to have a bunny cake for your 38yo birthday, but nobody seemed to mind LOL. I made a devil's food cake with buttercream frosting. And found out that my artistic skills in drawing the bunny contours on the cake still need a lot of improvement :-)

He also had asked for 'sticky bunbuns', so I figured I would make them too. This is his word for cinnamon buns with fondant glaze, which are indeed quite sticky :-) Tara and Jane decided that they rather had normal sandwiches though, oh well :-)

The girls made party hats for all of us, so I was stuck wearing a party hat while opening my presents :-) They had made a paper crown for when we were eating the cake.

All in all we had a great day, I spent a lot of time drooling over The Cake Bible. Tara and Tim already picked their birthday cakes, and Erik has picked at least 3 of them for his birthday... LOL.
But of course, the best birthday present of all, is our miracle baby. I am just so thrilled that things finally are working out! Couldn't have asked for anything better for my birthday!

Yet Another Prenatal

Had another prenatal today, everything is going well. I am getting 'fat' though, 160 lbs, which sounded like a lot to me till she looked up what I was with Erik at this time in pregnancy and it was 159 lbs. That's pretty close. I was spilling some sugar in my urine, but that was most likely the mango I had for lunch. Later I remember that I had trail mix too, with dried fruits and some chocolate chips, so that wouldn't have helped either.

The baby's heart beat via the fetoscope was very, very clear. Heart rate was 136 bpm. Baby's position was breech, but that's not something to worry about at this point, he is all over the place anyway. I measured 29.5 cm, which is close enough to the 30 weeks I am. Still amazed that I am the homestretch now, ¾ of the pregnancy is behind me already!

We talked more about the whole birthing issue, I have an appointment set up with the 'ob who wants a c-section' on April 12th. Will have to convince him of the error of his ways. I feel very relaxed about the whole 'high risk' birth now, or maybe I should say that I fully do not believe that this is a high risk birth, notwithstanding the myomectomy. Now I just need to convince the ob of the same... I need to get some full texts of journal articles, since pubmed charges a $30 per article fee if I want the full text. I need 3 articles, and I just am not willing to spend $90 on this, so trying to find an alternative way of getting them.

Spring is gone again, back to snow and blizzards. Actually, this morning it still felt and looked like spring, even heard my first cardinal for the year. This afternoon, we had a blizzard. Gotta love March in New England :-) Luckily there wasn't any real accumulation, but it was cold, cold, cold!

Not much exciting going on, I look at my house, think about what needs to be decluttered and then totally ignore it :-) I did buy a cute baby outfit at the thrift store this week though, I am really believing in the baby now. And a friend gave me some more cloth diapers, I just love looking at them and visualizing my new baby using them.

One really exciting thing though is that I finished my LLL leader applicant process, so I am an official leader now! Will lead my first meeting in April, not sure whether I am looking forward to it or dreading it, a bit of both I think :-)

Spring!!!

Early for New England, but spring definitely is in the air! The snow is melting, the kids have been biking, I have been walking, life is good! I even can see part of my vegetable garden again! My hands are itching to start something in it, but I think it's a tad early still :-) I did pick up gardening stuff that I ordered today though, tons of seeds, and all kinds of other goodies, like hoops and drip irrigation system. Haven't seen any robins yet though, once I see those, I will know it really is spring!

I went swimming today, after a few weeks of not getting around to it. It was fun, although I thought I would never be able to make it my normal 40 lengths. Did it anyway! I felt really good afterwards, and celebrated by having a simple lunch outside at our health foody supermarket. All by myself, well I guess not totally by myself, but with my little passenger on board :-)

Yesterday, Tara and I spent some time making baby wipes. She was so happy to help me and so proud of what we did. Just simple wipes, baby blanket with doggies print on one side, terry cloth on the other, and a dense zig zag stitch around (I wish I had a serger, but I don't) We made eight of them, they look really cute. Looking forward to using them for this precious baby.

I made cashew macaroni for a friend last week, she just had a baby and this was my turn to make her a meal. Not only did I enjoy cooking for her, but I also got to hold her tiny newborn! So small, so light, so cute!!! Made me look forward even more to holding our own baby a few months from now.

Took the kids swimming today, they had fun, but Tara had a lot of ear pain when we came home. I first thought that she had gotten some water in her ear, but then she told me that it had been hurting for a few days already, so now I am wondering whether she has an ear infection. Hope she feels better tomorrow! We also went to the playground, for the very first time this year, just ignored the ice and snow that was still on the ground there :-)

Yesterday, a good friend called me to ask whether I wanted to go to an Irish music concert with her. Of course my reply was YES!!! and so we went, just the two of us. It was fun, very good musicians and the baby really enjoyed the music too. Oh, on the way back home it was snowing, so much for spring... At least it didn't stick and today was nice anyway.