Monday, November 14, 2011

Dr. Buchbinder visit - Still breech.

Had a visit this morning with Dr Buchbinder of Perinatology Consultations LLC in St Paul. Not someone we'd met before but very nice. He threw me off at first, a man looking identical to Ben Stiller comes walking in the room and starts giving me my enitre medical history of Herrington Rods, previous birth and miscarraige etc. He'd apparently read my entire history before meeting us. He was very sweet, very sincere, and very caring.

He did a check via ultrasound. Still no fluid, still can't see any kidneys. He did say that he may have found a bladder but isn't sure. A bladder is no good to us without kidneys anyways. He said its getting harder and harder to see because we are now in 3rd trimester with no fluid so its very hard to see the baby on the ultrasound. The pictures are coming out less clear now too.

He said Gabrielle is still breech and at this point, he's pretty sure she won't be able to flip. With no fluid there really isn't any room for her to flip over. He did say that he's delivered many breech babies without problem and that, if we chose, he would be willing to also deliver ours (since our Dr isn't really comfortable delivering a breech baby). He doesn't recommend a c-section unless thats what we chose, but he sees it as unnecessary surgery in this case.

His recommendation:
He suggested we should consider inducing sooner rather than later and delivering a smaller breech  baby. There is still a lot of risk in delivering a breech baby, but the smaller the better. He wasn't pushing us to induce, but suggested that it may be the better option since she is breech. Being breech she could get stuck. Her body could come out and her head could get stuck which would cause a medical emergency, possible surgery, and could cause them to take extreme measures to get her out. Although he did seem semi confident that it wouldn't be too much of an issue if she's smaller. But that puts us back at deciding on a date to deliver. He was very sincere about making sure we didn't view it as a date to terminate, but a date to deliver and hopefully meet our little girl. Although it feels like a termination date...

He said we could try a version, to flip the baby manually, but that with no fluid its not likely to work. Although I heard its quite painful, I might have to at least let them try. We'll see what Dr Landers says about it.

He also suggested that we should consider delivering at St Johns instead of Woodwinds because St Johns has staff specifically for this type of situation, staff who deals with premature births and babies who may not make it. They also have a NICU incase something changes when she is born and the diagnosis was wrong. He said its fairly obvious what the diagnosis is, but they are only doctors not God.

I did learn something new however, he said that it is possible the kidneys had originally formed but did so incorrectly and ended up shriveling up and being disfunctional. I didn't know that. I thought it was simply that they didn't form at all. He recommended getting an autopsy (which we already planned to do) to confirm this. Not that it would necessarily change anything, but that it would give us answers.

He set me up with an anestesiologist to disguss medicine options for me. I want to find out what I can have that won't cause any sort of amnesia effect, but also if I have a c-section, do I have any options other than a spinal (which I can't have) and general anestesia.

Common Questions I've gotten:
There are 2 questions I seem to get quite frequently, and I finally remembered to get the official medical explanation for them today.

1) Where did the fluid go? At 15 weeks, we had a normal amount of fluid, at 20 weeks we had none. Where did all the fluid go? Well, Dr Buchbinder said that the baby probably swallowed it and breathed it for a short time and when it didn't go anywhere (no kidney's to go to) it essentially got absorbed by my body and the babies. Without kidneys the baby wasn't producing its own fluid (via urine) and so no fluid re-entered my uterus

2) How does a baby live in there with no fluid?  Dr Buchbinder said that the only thing the baby needs at this point to live is oxygen. Its getting its oxygen from me through the umbilical cord. Its not breathing in the fluid and so its lungs aren't developing which means it won't be able to breath upon birth - causing the condition to be fatal.

The hardest part:
The toughest part of all of this is the unknown. They can't tell us if the baby might flip, they can't tell us if the baby will make it another day without pinching off the umbilical cord causing it to die in utero, they can't tell us if the baby will make it through labor and delivery, they can't tell us how much time the baby has if it isn't still born. We have no idea what to plan for, how to prepare and what to do.

We basically have 2 options at this point. We induce soon and deliver a breech baby, which poses much risk and grusome possibilities. OR we plan for a c-section and I give up any time I might have with the baby if she comes out alive, since it takes time to wake up from general anestesia and time is what we don't have.  He said we could just keep doing what we are doing and make the decision at birth, but the baby would be bigger causing more risk for breech delivery, and a possible need for a c-section...

Neither of our options seem ideal, I woudn't chose either if I could. I wish I had someone to just say "your life is at risk, we're taking the baby out now!" so I wouldn't have any choices anymore. I feel like I can't continue making these choices, but have to. I don't know what to do, if baby was head down we could deliver as normal, but she's breech. Why not though right? That seems to be our luck. Everything I've wished for in this situation, hasn't worked out in our favor.

Thank you for the love and support. It means so much to us to have so many people following our story, reading about Gabrielle and sending us love and well wishes.


  1. Thinking of you and your sweet baby as you continue to prepare for her arrival. My Potter's baby Wyatt was transverse in utero and was not able to turn because of lack of fluid. I delivered him via c-section with a spinal (so sorry that's not an option for you) at 37 1/2 weeks and he was 6lb 8oz at that gestation and quite chubby too. We opted not to try to turn him. He was born alive and lived about 3 hours. Our baby Eli was born at 36w6d also by c-section because of prior births though he was breech I believe and pretty far down in my pelvis. He weighed just over 5lb and was also born alive but lived only about an hour. (I don't believe either of our boys were able to turn in the 3rd trimester but anything is possible, like you said, doctors don't have all the answers). There is no good choice in this situation.

    Can you have epidurals instead of a spinal? I've seen that's sometimes an option in c-sections. Though I had spinals I never was given medication that affected my memory or awareness and was fully present for the births of our sons. I can tell you this, meet with whatever doctors you need to and put in writing what is most important to you and distribute it as necessary. In our experience, medical professionals are very willing to make your child's birth and life as much of what you want as they can, especially when you make your wishes known ahead of time. If you have a scheduled delivery you can meet with the anesthesiologist who is scheduled that day ahead of time as well and discuss any wants/concerns.

    Take care.

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