PT for the Home Stretch

My PT gave me a few exercises for the last six weeks - all designed to help strengthen the pelvic floor and the bit of the core I have left, haha!  Kegels (three kinds), as well as standing pelvic tilts and hip slides.  Also little hip figure 8's.  Those standing ones are difficult because I place my hands on my hips to ensure I have the right posture, but I really don't have hips anymore to hold on to!

C-Section

Met with my PT today. She said the clinical studies available to her indicated there was not a greater risk with delivery one way or the other, but the consensus among the other PTs she spoke with (including two PTs who are experts in women's health) was that they recommended a c-section. The combination of my fused SI joint, PS pain and history of large babies made them all wary. Soooo, I'm not saying anything else to my OB and will just go with what we decided at our last appt: c-section at 39 weeks. That means 6 weeks from now------YIKES!!!!!

39 weeks

I finally met with my OB this morning, after sending her this letter.  Her response was that she disagreed with my assessment.  Even considering my lax ligament history, she insisted my risk for pubic symphysis (PS) diastasis (severe joint separation) was extremely low. 

However, she agreed to perform a c-section anyway, as long as I understood the risks.  At least half the risks have to do with future pregnancies, but since we decided long ago that this was our last child, that took away half the concern right there.  However, she said even if I have a c-section, that's still no guarantee of avoiding PS diastasis, since plenty of people get it without having babies.  I assured her that I understood there were no guarantees, understood the increased risk of bleeding, pain from scarring (inside and out), a longer recovery and possible injury to the bladder.  But I still want a c-section.  The idea of passing a large child through an opening where one of three joints is fused, and another of the three joints is already painful, well, that's enough to seal the deal for me.  I am the 1 in a million already, and I intend to do everything to avoid going down that road again.

I told her that while she had me open, she might as well tie my tubes.  She said she couldn't do that because I'm delivering at a Catholic hospital (which I think I knew but had forgotten).  I assured her that was no problem -- I would never ask, and certainly not insist, that anyone or any group violate their religious beliefs for the sake of my own convenience.  So we'll be discussing other options --  a tubal ligation at a later date, or (ahem) a snip for the hubs.  Either way, Sarah Elizabeth will complete our family, and I'm super excited to meet her, on or near April 2 (at 39 weeks).

30 Weeks

Aches and Pains

I've been dealing with piriformis pain again, having been inconsistent with my PT on my own.  I've requested a new PT referral because I will need to modify the exercises, not only because of my growing belly, but also because my pubic symphysis pain makes some of the exercises impossible.  I am not doing anything that exacerbates the PS problems, because I'm getting nervous about post-partum recovery in that area.

Dear Doctor...

Sorry for the letter, but I can explain myself more clearly in writing and I couldn’t wait three more weeks to discuss this with you.  When you told me that the pubic symphysis ligaments are some of the strongest in the body, that really made me think.  Because the SI ligaments are also some of the strongest in the body, and mine failed me last pregnancy.  My SI Joint Dysfunction was not due to a fall, a car accident or any kind of trauma – it was just relaxin.   Pregnancy hormones alone ruined my SI ligaments, I ended up with a hypermobile joint and excruciating pain for 3.5 years, visits to 20 specialists, fights and appeals with insurance, and ultimately ended up having a violent, brutal surgery with a year-long recovery.  And I am still not up to par.  So, unfortunately, the fact that the PS is supposed to be so strong didn’t assuage my fears.  In the general population, I’m sure that’s true.  But I’m already a part of the 0.001% of the population who needed SI fusion due to my tendency towards excessive ligament laxity.  And that’s something 2 orthos and a physical therapist have told me as well.

I’m just not willing to risk being a statistic again.  I spent 4+ years disabled and incapacitated.  Because of this, I would like to discuss scheduling a c-section.  In fact, I am concerned about diastasis from simply carrying a baby, let alone delivering one, considering my ligament history.  It’s possible I’m just being paranoid, and I realize there are risks with a c-section as well, but it’s the only decision I’ve entertained so far that doesn’t leave me anxious at this point.

I realize you don’t know me, and so have no reason to trust my judgment, but please know that I am not someone who believes everything she reads online.  I know my own body very well after what I’ve been through.  That being said, of course I have no medical degree.  Just feel like I could have one, having gone to hell and back once already.

I hand selected you as my doctor because your reputation in the community is one of being able to effectively and calmly handle high-stress/high-risk situations.  I have already found that to be true, from the way you cared for me during my appendectomy.   I didn’t want you to take this letter as a question of your judgment, but just as a clarification because I feel I may have not fully explained my laxity/ligament history.

Sent this letter today.  I'll let you know how she responds.

Birthing a Baby

My OB and I discussed my pubic symphysis (PS) issues yesterday, and she seems quite convinced that regardless of my right-sided iFuse, I will NOT tear my PS ligaments during delivery, and that even diastasis would be extremely unlikely. She is willing to explore any birthing position I want, including side-lying (her suggestion, and one I've read about on PS sites as a good one) and even on all fours. PS sites suggest all fours is the safest for the PS, but my OB said there are other risks with all fours, like tearing your urethra or even clitoris (!), which, let's be honest ladies is a horrific prospect, lol!

I was very glad to hear that she is willing to explore alternative positions, even though she doesn't place any stock in the idea that I have an increased risk of permanent damage. I tried explaining to her how many of my SI friends have had permanent or long-lasting problems with their PS, but she dismissed that... So, I am both relieved at her willingness to explore what I want, and nervous that she seems so nonchalant about the possibility of real PS damage. She was adamant "fusion or no fusion, your risk is extremely small," she said.  She said it's because the PS ligaments are some of the strongest in the body. Of course, SI ligaments are also supposed to be some of the strongest in the body, right?  And mine failed me last pregnancy resulting in a violent and brutal surgery.