| There are three main reasons why I would prefer to have an elective caesarian, some of which are medical and some of which are not, these are listed below. |
| 1. Labour Concerns |
| I am concerned that due to the polyhydramnios, my waters breaking may be dangerous for the baby. I am concerned that it may cause problems with the umbilical cord becoming detached due to the excessive force of the waters breaking. Perhaps you could advise me on this, as the only advice I have received on this has been from people this has happened to and I obviously do not know the extent to which they suffered from polyhydramnios in comparison to myself. |
| 2. Concerns for the Health and Safety of Connor |
| My principle concern is that the labour will put undue stress on Connor. As you are aware he is likely to be a weak baby, small in size, and his ability to breath independently are unknown. While many ultrasounds have been done to try and assess Connor's health status and to date no major anomalies with his vital organs have been detected. We both understand that ultrasounds are a diagnostic tool only and may not fully reflect problems that Connor may have. I am concerned that the stress of labour, especially as this is my first child and labour may be long, may have an adverse effect on a small, immature infant with unknown problems to his heart, lungs etc. As you are also aware my main aim is not to deny these problems and their implications for Connor but to be able to spend as much time as possible with him, and to say both hello and goodbye if necessary. Consequently I would rather not subject Connor to the stress of labour if it were possible to avoid because I feel it may not allow either of us this opportunity. I wish to give him the greatest chance of success that I can. I realise that under the circumstances that your primary concern is my health and well being and I full understand the risks of a caesarean section. I am prepared to accept these risks. Dr Roberts has explained to me that in his experience the Edwards babies he had dealt with did not suffer any particular labour complications. While I would never question either his or your judgement, I also understand that the rarity of this syndrome does not allow anyone a great deal of experience with this issue. Statistically there is no data on whether a c-section vs. vaginal birth is better or not and roughly half of all babies with Trisomy 18 are born by c-section. However as you know I have spoken with many families who have had children with Trisomy 18 and am aware of many families where the mother entered labour with the baby showing no problems only to have foetal distress to occur quickly and with little warning. Frequently this resulted in the baby dying during labour. Although I realise that the medical staff will monitor me closely and are quite competent at diagnosing any distress, this is something that I strongly wish to avoid and am not convinced that labour is worth the risk for either Connor or my mental well being. I understand that due to poor muscle tone and upper body control, Edwards babies can have difficulty during labour due to an inability to �help themselves�. I mentioned this to Dr Roberts, who was unaware of any problem in this area and felt Connor�s small size may make him easier to deliver, rather than more difficult. However, as you know polyhydraminos allows Connor more room to move and will possibly allow him to "turn" into a breech or awkward position at the last moment. A large number of babies with Trisomy 18 are indeed a breech presentation. As a result this is obviously still a major concern for me as we cannot possibly know the extent of these difficulties in advance. I am also concerned that if things deteriorate quickly with the labour that there may not be time to set up an epidural and that any drugs given for pain or even a general anaesthetic for an emergency caesarian may affect Connor and his ability to cope immediately post birth. In the light of so much uncertainty about Connor�s condition, I feel I should be doing everything I can to ensure that all these potential problems are avoided. I feel an elective caesarian would minimize these risks and that is why I have mentioned it. Perhaps I am not fully informed, however I just do not feel that an extended delivery period would be in Connors best interests. |
| 3. Concerns for post delivery |
| These are the concerns I wish to raise but which are not particularly the result of medical concerns or issues. I am concerned for both the physical and emotional state I would be in myself through either a long period of labour, or a period of labour followed by emergency caesarian. There are some things I hope that you can clarify for me. I understand that providing an epidural can be satisfactorily established that I can stay awake and alert for an elective caesarian. However I understand that there is also not always enough time to establish an epidural when an emergency caesarian is required? As a result a general anaesthesia may be necessary. I also am under the impression that the period in recovery following a general anaesthetic is longer than it need be for an epidural. And that even though I will be unable to walk following an epidural that I will be alert and that there is more likelihood that I will be able to be taken to Connor or Connor to me. I am also under the impression that while delivery is very quick once the general anaesthesia is given, that any delay (e.g. if the baby is awkward to get at) can result in the baby also being effected by the anaesthesia and result in poor initial independent breathing. As you can imagine, this is a big consideration for me. I am aware that because of Connor�s condition, I may be �living on borrowed time�. There is a possibility that Connor may die shortly after birth or within 24 hours of birth. I would obviously not wish to be under any general anaesthetic in view of this. This is also one of my concerns for going through the full labour process. I am concerned that despite preparing myself mentally and physically for labour that I would not be in the mental or physical condition I would like to be in to spend time with Connor if his prognosis is extremely poor. There is also the possibility that I will need to make immediate medical decisions on his behalf during the post-birth period and I fear for my capability to do this if I have been administered painkillers, drugs or anaesthetic. This is a very large concern for me as you can imagine. I feel personally that to have gotten this far, I would be devastated to make mistakes or have regrets at the very last stage. I wish for whatever short period of time I have with my son to be remembered as happy and not to be under the influence of anything, which may affect either my state of mind or my recollection of this time. Although I realise I will have to have strong injections post operatively for pain for the caesarian section, I am also under the impression that this is not for a few hours, until the epidural has worn off. I would be grateful if you could clarify the position with regard to the medications involved (I missed the antenatal class where the pain relief was discussed.) My final concern is perhaps has the lowest priority, but it is still important to me. A planned caesarian will allow me more time to mentally prepare myself for Connor's arrival, to organise family and friends and to have some semblance of control over what is essentially an uncontrollable situation. It will allow me to prepare for a variety of situations to create memories that may need to last me a lifetime, to make this time with Connor very special. To some Connor may have "mixed up" chromosomes and be less than perfect, but he is my son, and to me he is very perfect and I love him unconditionally. As a result it is very important to me to give Connor the best possible chance for survival post-natally for however long or short that time may be. It is also very important to me that I am able to spend as much of this time as possible with Connor in a condition where I can be fully aware. |