Saturday, July 18, 2015

A scare

Pregnancy after a preemie is a different experience, especially when we're just not really sure why Chase was early in the first place, it just kind of happened. As much as I love the idea of a natural home birth, our gut instincts told us it wasn't the right path this time, either, and I have been under the care of a competent OB since my first trimester, and a few high risk fetal specialists for equally long. My prenatal appointments are frequent, mostly impersonal, and not enjoyable like they were with my midwife the first time around. But, I still feel like it's what needs to be done to get Max here as safely as possible so it's what we do.
Part of my specialist care has been having cervical length checked every other week. Let me tell you what a boatload of fun THAT process is. The appointments are the same every time. Go in. Pee in a cup. Strip from the waist down, including every last shred of dignity that I have, and hop on the table, feet in the stirrups where I proceed to have an awkward small talk chat with a nurse I've probably never met before about if we know gender or have started thinking about names yet as she probes my crotch. BOATLOADS of fun, guys. Boatloads. Then I get a lovely, burning shot of progesterone in my hip, wait for the actual doctor to come in and tell me everything looks fine. Then I get dressed and go home, to repeat the process in a week or two.
Except this week was a little different. I knew looking at the screen something was off. I've had enough of these checks by now I'm halfway decent at knowing what I'm looking at and it's not all just a mass of black and gray on the screen anymore. I knew my cervix looked way, way off. And when the nurse went silent it was confirmed. This wasn't going to be like every appointment the weeks before. She proceeded to do a couple of checks and measurements on Max- something we don't always do at these appointments- and assured me HE looked great, and the doctor would be in to talk about me.
I like my doctor. He's quiet, humble, kind, and listens to my concerns. He seems to be pretty understanding of the anxieties I (and Jon, too!) has surrounding all of this based on our experience with Chase. He isn't pushy and actually talks to us like we are educated human beings, which is honestly more than I can say about a lot of the specialists we have dealt with.
He pulled out the images from the ultrasound and started going on about dilation and "funneling" and using words like cerclage, preterm labor, viability,  and miscarriage. His deep concern was obvious and I was nervous. I kept asking what all of this mean for Max, and he explained that a cerclage (stitching the cervix closed) may help keep him in longer- at least until viability- but that if I was in preterm labor or contracting that it would be too dangerous to do, and we would lose him. He explained my cervix was funneling, which means in side side was opening but the end closest to the outside of my body was closed- for now- and we needed to know how gradual this was happening.
There I was, alone, (Jon usually goes to be supportive but we decided together that he wouldn't this time because it was juuuuuuuuust like all the other appointments nothing ever happens at and he was better off staying home so Chase could get a much needed nap.) It was about 4:30 on Friday afternoon and my doctor said it couldn't wait until Monday, and he wanted me to leave there and go straight to Provo for the night, to be monitored for 12 hours and make sure it was safe to have a cerclage done first thing in the morning. If I contracted even somewhat regularly they would not be able to perform the procedure.
Not one, two or three but FOUR cervical exams later, another ultrasound, two hours of monitoring, and a team of five doctors later we came to a few very interesting conclusions.
First, we all know what the initial ultrasound showed and there's no mistaking it. But when I had another just a few short hours later, while it was not perfectly normal there was NO funneling to be seen. It is short, it is softer than it should be, and I am slightly dilated. None of these are good things, but none of them are as dire and scary as what the image that sat before us, showing extreme funneling was showing. The specialist herself even said it was one of the "probably the scariest 20 week cervixes she's seen, and she sees a lot of cervixes." We watched, for 5 minutes. Nothing changed. Medically, it makes no sense. She explained how angles, pressure, etc. can change or skew measurements and images slightly, but was baffled, ABSOLUTELY baffled at the difference. Baffled enough to have several other doctors brought in on the case. (yayyyyyy more exams!)
The cerclage is less effective the later it is performed and they stop performing them near 24 weeks. I comes with a lot of risks, and is done as an absolute last resort.
This entire team of doctors, and myself and Jon, decided that because we have things to worry about but the situation has shifted to not AS intense as before, to not have the cerclage done just yet. I am on very, very strict bed rest this weekend and will go back first thing Monday morning again. ANY changes in an unfavorable direction and we will be performing the procedure immediately, and hospital bed rest may be a reality until viability. That is to be determined then.
They recommended we stay the weekend but said it wasn't unreasonable to go home with the commitment to honor the bed rest bit. It's not that we don't take it seriously, we do, but I much preferred to be at home with Chase for now. Expecially as the liklihood of another go in NICU seems to grow day by day, I want to soak my little buddy up as much as I can now.

I am immensely thankful for the medical interventions that help keep these babies baking. I've had a few well-meaning comments about how glad people are we aren't attempting "the whole home birth thing" again, and I do want to make a few things clear:
I am NOT planning a home birth this time for one very simple reason: I'm not a good candidate. I still aaaaaaaaaaabsolutely believe it is a WONDERFUL, dare I say superior, option for low-risk, healthy women without a history of these complications. For reasons I may never know or understand, my body doesn't do this gracefully. But I know this is the EXCEPTION, not the RULE and that birth is USUALLY beautiful, safe, and not complicated. Things can change, and when I went into labor early with Chase, I was not filling up the bath tub and starting the hypnobabies tracks while Jon lit candles and started the tea. No, we went to the hospital. Where early labor belongs. I have so much gratitude for the knowledge of all of the doctors who are on our team. I also have so much respect for the reproductive process, and what it means to me. I'm thankful for the knowledge *I* have so I can make choices for myself and Max with confidence, and not be blindly following doctor's advice.
So we press on. 21 weeks tomorrow. I think I will get to know Netflix a bit better. 

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