There Always Seems to be Something

I didn't sleep very well during the night before our anatomy scan. Perhaps it was because the cats were chasing each other about, or perhaps it was because it dawned on me that this pregnancy was progressing too easily. After all the challenges to become and stay pregnant, I seem to be managing it well. I made it through the first trimester without any bleeding scares or vomiting episodes. "Are you tired?" I often get asked by my colleagues who are in the know. No, my energy level is great. My appetite is normal, I'm eating healthily, and my weight gain is right where I want to be. I credit much of this to the fact that I've still been exercising. I placed my hands over my bump as I tried to fall asleep. Savour this. I reminded myself. It can still be all taken away from you...

The ultrasound technician began our scan by measuring my cervix. Hmm, my placenta looks awfully close to it...I observed. Once she completed the anatomy scan and offered the reassuring words that baby Jate was growing appropriately and no major structural issues were noted, I started mentally composing the text update to my colleagues: baby looks great, but placenta is low-lying. A low lying placenta isn't a big deal. It indicates that the placental edge is close, but not covering the cervical opening. The protocol is to repeat a scan in about 8 weeks to ensure that the os is still unobstructed. Then the tech took another look at my placenta. "Actually, I think it may be covering the cervix." she announced. "So is this a marginal placenta or partial previa?" I asked. "We'll see what the doctor says when he takes a look." she replied, which I know is code for 'yes, it is, but I'm going to let him be the one to tell you...'

The perinatologist arrived a few minutes later, which was just long enough for Husband and I to exhale a sigh of relief and bask in the triumph of Jate's normal anatomy survey. He shook my hand as we acknowledged the long time mutual name recognition, but this was our first time meeting in person. He started scanning my placenta and turned on the colour flow doppler to get a better appreciation of the vessels. "It's a complete placenta previa isn't it" I asked while simultaneously learning the answer. "Yes, it is." he replied. In the situation of a complete previa, the entire placenta is covering the cervical opening. It's a common finding at this gestational age, and in 90% of cases, the placenta will migrate away from the cervix as the lower uterine segment develops. However, for the 10% of patients whose previas persist, it puts her at a bleeding risk and necessitates an earlier Caesarean delivery. In fortunately rare situations, the placenta can invade the myometrium, creating the obstetrical nightmare known as a placenta accreta.

We'll repeat a scan in six weeks to re-assess the placenta location. As we made our follow up appointment and left the office, I think some mothering instincts started to develop. I wasn't phased at all by the issue with my placenta. I was just so delighted that all was well with Jate. We weren't coming back for a follow up scan because they saw fluid around the kidneys, or something questionable in the brain. We weren't being referred for a fetal echocardiogram due to a hypoplastic left ventricle. The rest was just details. Prior to infertility and pregnancy loss, I would have been devastated by the prospect of needing a Caesarean. Now I really don't care. Actually, avoiding the pain and anguish of labour, getting to have my stomach muscles re-approximated, and as I recently had my first leak with a sneeze, a C/section is sounding better and better by the day! I've long abandoned the dream of having the fucking textbook perfect vaginal delivery that Myrtle had. That is just not my reality. I've accepted that I have no control over my delivery process, and besides, pregnancy is not a competitive sport. However, I can control the fact that I've gained much less weight than Myrtle.

"Wow. Nothing seems to be easy for you." Two friends made this comment to us, but I wasn't quite comfortable with it. Things could be much worse. Yet, as Husband went home to google 'placenta previa' and I reluctantly acknowledged the risks involved, we came together to address the fact that things can become much worse. The details surrounding my placenta location are not insignificant. Best case scenario: the placenta migrates far enough from my cervix and I am able to proceed with an induction at 38 weeks. Worse case scenario: the placenta previa persists and I'll have a scheduled Caesarean at 36 weeks. Worser case scenario: the previa becomes an accreta, and I'll have to be delivered at 34 weeks with a hysterectomy. Worst case scenario: a major bleeding episode occurs and an emergent delivery will hopefully be performed in time.

What makes this situation so difficult to process is that there is such a wide range of possible outcomes, from everything will be fine to complete catastrophe. We both have been acknowledging that we're not usually on the favourable side of statistics. This six week wait is harder than any previous two week wait. I was proud of myself as I didn't inspect the TP during my first trimester. I figured that if I were to start bleeding, I would wait until it was obvious. Now, I'm meticulously examining every time. Just as when we were going through infertility treatments, our lives feel on hold again. My parents keep asking when we want them to come out after Jate's arrival, as they are keen to book their flights, but we really have no answer for them. We have a trip to Florida in April that may need to be cancelled. Our approach is to take things day by day. Pre-eclampsia now feels like it could be the least of our worries. After waiting so long to become pregnant, and knowing that this will be my only pregnancy, it makes me sad to think that it may be cut short.

Cue a bit of whining from my inner petulant child. Seriously, Universe. Was it too much to ask for a normal anatomy survey and no other complicating factors? Apparently. There always seems to be something.