Sunday 22 February 2015

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.

16 comments:

  1. aww man! I hope when you go back in 6 weeks that stupid placenta will have relocated as far away from the cervix as possible! You just never know what will happen whether you know about it or not. We didn't find out until after our picture perfect home birth that I had valementus cord insertion despite an US at 22 weeks AND 30 weeks! That could have had a horrible ending and had I known in advance I might have ended up with a c-section but instead I had this perfect birth experience. I can't tell you how glad I am that I didn't know until after my baby was in my arms!!! Crossing my fingers for you!

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  2. While I'm soooop happy for you that your baby is healthy, I'm sorry about the placenta previa. I will be praying that it migrates on its own and that baby Jate will get to stay put for as long as possible!! XO

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  3. Yay for good anatomy scan! I can TOTALLY RELATE about the "whatever attitude" about vaginal delivery. Once you go through infertility and the ringer, some things don't matter (aka in my case even carrying my kid). I know it can be hard on moms that never dealt with the pain of "will I EVER have my own child?" torture but it was SO Hard for me when mom's would complain about not having milk/low milk supply-I was like BUT YOU HAVE A BABY!! Anyways, I hope the 6 weeks goes fast, it sounds like the odds are really good to not have a bad casenario.

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  4. Aw, so sorry that stress has come back into the pregnancy. I will hope for the best case scenario, but even if it is not ideal I am confident you and your care team will take good care of baby (and you). You have a great attitude!

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  5. Shit! I really hope it migrates. That's so strange. Placenta previa is uncommon with IVF because embryo placement.

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  6. Always something. Doesn't that seem to be our motto? But I'm so happy to hear about the great anatomy scan and I'm praying that the placenta will relocate on it's own. Great job on the slow and steady weight gain and taking care of yourself. You are doing everything right, everything you can to provide the best environment for your baby. Hang in there and keep us posted.

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  7. Like you said, take it day by day. At the end of the day it is out of your control so try your hardest not to stress more than you have to about it. All you can do is educate yourself (which you have done) to be prepared (as much as possible) for any of the outcomes. In the meantime, i'm sending lots of prayers your way that the placenta migrates and you have a great pregnancy!

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  8. There always does seem to be something, but I'm glad your baby is healthy. Hopefully you find yourself on the right side of statistics this time and everything works out perfectly!

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  9. Yay for a healthy baby! I hope that 6 weeks from now you will be breathing easy and the placenta will have moved on its own. Come on placenta!!

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  10. Phew. I'm glad Jate is looking healthy all over (and I was a little disturbed by the actually-yes-English-speaking patient from your previous post). Sorry about the placenta previa scare. It's probably true, there's always something. I (well, progesterone) managed to convince by cervix to stay long and closed, and then I slithered towards preeclampsia. Hoping that you'll also manage to slither by the worse-case-scenarios and deliver Jate at full term without major concerns for either of you. (Also, I didn't know they could diagnose placenta accreta on ultrasound...)

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  11. It always pisses me off when those of us who already fall on the wrong side of the statistics fertility-wise end up also having problems during pregnancy. There's a much better chance than not that this won't continue to be an issue for you, but it really sucks that you have to worry about it at all.

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  12. So glad to hear Jate is healthy! What a piss off about the placenta previa though, hopefully your next check up reveals good news!

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  13. I've been crappy at keeping up with blogs the past week… glad I went back and caught this. I'm so glad that everything is looking good with Jate! Desperately hoping that no news is good news for the next six weeks and that everything will be fine by the next appointment.

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  14. I'm so so happy that Baby Jate is healthy! That's a major relief and something to certainly be thrilled about. I'm so sorry about the placenta previa. I was a big risk for placenta accreta even before our one and only transfer, so I know what all that means. I certainly will be sending every good thought in the universe your way that it and any other worse case, is avoidable.

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  15. Oh dear. Well, this time the odds seem to be in your favor. I hope it moves on it's own and everything looks great at your next scan.
    I have to admit that the fact that my one and only pregnancy was cut so abruptly short still pisses me off a little. It just seems so unfair. However, I have finally stopped regretting the c-section and it's all because of my stomach muscles being put so nicely back where they should be. I expected my whole abdominal area to be a nightmare after a twin pregnancy and it really isn't (maybe the early delivery helped that as well). So, I say yay for c-sections!

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  16. Omg. I can't stand it when I type out this long comment on my phone and it disappears! Anyway, short version: I'm so glad Baby Jate is doing well. Hopefully in 6 weeks you will have the best case scenario and that placenta will have behaved and moved. If not and you have to deliver early, you might miss a few extra weeks of pregnancy, but you'll still have that precious baby! We won't even talk about the worst case scenario. That's not an option!

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