Thursday, June 14, 2012

Gratitude, Part 3

May the blessings of heaven rain down on the effeminate man at the perinatologist's office who expedited my paperwork and got me an appointment for Friday afternoon. We'd only have to wait 48 hours between appointments to hear more news.

Thursday morning, things felt different. Mike had held me the night before while I tried to turn off my brain and get some sleep. He had given me a blessing. We talked as much as we were ready to talk. When I woke up the next day, I felt peace. Still a little unsettled, but with a new perspective.

The overwhelming emotion I felt was gratitude. I had endured horrible morning sickness from week 5 to week 18, and suddenly I was so grateful that I had had the opportunity to experience morning sickness at all. If I could only be pregnant once, at least I would have the full experience. Mike and I had to try for several months to get pregnant. Though I was scared of what might happen with my placenta, I was thankful we even got pregnant at all.

I was thankful we moved to San Antonio. When we moved here, we felt like we should live in an apartment complex that wasn't very convenient to Mike's school. Though we're farther away from his campus, we're just a few minutes from the South Texas Medical Center, an enormous resource of experts and specialists. We live near people who can help us. We live near state-of-the-art facilities. We have insurance to cover it all. We are surrounded by people who can get us out of the worst case scenario. We are so lucky.

I was grateful we switched from our Elmer Fuddian OB to the midwife practice. Our midwife delivered this news in the kindest, most compassionate way. Any lesser bedside manner would have devastated me. I'm grateful we had a thorough ultrasound tech. She caught a potential problem. Maybe a different tech wouldn't have caught it.

I still had moments of intense fear. Thursday night, I started to panic again. I knelt by our bed and started to pray but broke down, sobbing. Mike came in. "I can't do this," I told him. "It's the waiting that's getting to me."

We crawled in bed and Mike held me and comforted me as best he could. He was worried too, but so grateful that I was healthy. It was the closest I had ever felt to my husband.

Friday morning, we were both on pins and needles. I felt too tired to think or talk about all the what-ifs anymore.

Finally, it was time to speak to the specialist. It is very difficult to give a urine sample when you're nervous, for the record. After a mountain of paperwork, a woman led me and Mike to an ultrasound room. We waited for about 20 minutes for the tech to come in. She asked what brought us in today as she flipped through my paperwork.

I explained the preliminary placenta accreta diagnosis.

"How many previous C-sections have you had?" she asked.

"None," I said. "This is my first pregnancy."

She frowned and squinted at my charts, muttering to herself.

"Well, let's start with baby. Do you know what you're having yet?"

The tech had fun determining our baby's gender. (This is a recurring characteristic among ultrasound techs, in my experience. And our little guy is an obliging exhibitionist.) She took us through all his anatomy again, showing us how perfect he was. 65th percentile for size. Slightly above average! Just what we want in our children.

"Okay. Let's look at the placenta now." The tech began to dig around in a long examination of my placenta. We watched her measure the circumference of each of the larger black spots on the screen. She scanned every last inch of the border of the placenta. The exam was so rigorous. It was actually painful after a while.

"Well, this is not placenta accreta," the tech said.

My first thought was HALLELUJAH! I was so relieved. No hysterectomy looming over us, none of the horrible possibilities we had imagined over the past two days. I squeezed the daylights out of Mike's hand.

I was surprised the tech said anything at all; I thought that would be the doctor's job. But hey, good news is good news, right?

"However, I've been scanning for 20 years, and I've never seen anything like this."

Well, great.

Our perinatologist eventually came to our room after conferring somewhere else with the ultrasound tech. The doctor, a stunningly beautiful woman of Haitian heritage, smiled at us as she picked up the ultrasound wand and started to look at my placenta. She explained to us that the dark spots, a common appearance of placenta accreta, were actually blood clots. She showed us the imaging of the endometrium. It was unbroken throughout the edge of the placenta. So no bonding between the placenta and the uterus.

But I did--and still do--have blood clots in my placenta. "We don't see intervillous thrombi very often. At all. I don't think I've seen it since I've been here." A recurring theme.

"We don't really know much about them," the doctor continued. "We don't know how they form, or why. There's no clear complication of thrombi, either. That is, we can't really predict if they will hurt you or the baby."

As best as she could tell, the blood clots are my own blood, not the baby's. Because the placenta is so critical to the baby's growth, the doctor said we couldn't do any sort of direct testing on it right now, especially while it was doing its job so well.

The doctor told us to return every four weeks for monitoring. If the baby's growth seemed to flag, i.e. if the placenta stopped doing its job, I would deliver at 35 weeks after a treatment of steroids to build up the baby's lungs. Barring any growth issues, we could expect to try for a normal, vaginal birth. Since our midwife group shares an office with its associate ob/gyn group, I'll be monitored by a ob/gyn specialist, in case things do go south during delivery and some sort of drastic intervention were required.

People, today marks 30 weeks. Baby is big and healthy and active. Every time I visit the perinatologist, the doctor and ultrasound tech shake their heads as they measure the blood clots. We know those clots very well by now. No one knows why they're there, but we know they never change size, which means no blood is leaking anywhere.

I wonder if I needed a little scare to fully appreciate the miracle happening in my body right now. If I needed a reminder to be grateful.

We're still not in the clear yet. Until the baby is in our arms and the placenta detaches properly, we can't be 100% sure that everything is alright. And until the placenta is tested after delivery, we won't know if I have a clotting problem (though all blood test results to date have been completely normal) or some other bizarre disorder that gives me a funky placenta.

What I am sure of is the great gift that it is to conceive and have all the million and one tiny factors come together for a healthy baby. I am so grateful for God's plan for me, even if it had included (or may yet include) a great devastation. I'm excited to meet our son. I'm grateful for blood clots. I'm so overwhelmed with gratitude for my sweet, affectionate, supportive, gentle husband. He has been a wonderful help during this roller coaster of a pregnancy.

I'm just grateful.

Tuesday, June 12, 2012

Gratitude, Part 2

By the time we got to the car, I started to lose it.

I gave the keys to Mike (I usually drive us around) and called up my mom. We had been texting all morning with family, taking final guesses on the baby's gender. She was anxious to hear our news.

We started to leave the parking lot, because we have to pay $1 per half hour after the first 30 minutes of each visit. And somehow, even in a moment of emotional crisis, it was important to me to leave the lot so we didn't run up a "big" charge. Strange, I know.

Anyway, I told my mom we had good news and bad news. Why people choose to start off major announcements in a way that invites panic, I do not know. Why I chose to phrase things that way, I do not know, either.

I could keep my voice steady, even cheery, while I told my mom she was going to have a grandson. There were congratulations and expressions of excitement, I'm sure. I explained the complications, too, still fresh on my mind. We sobbed together. Never had 1,600 miles felt so far away as it did at that moment. I asked my mom to tell my dad. For some reason I couldn't bear the idea of breaking down over the phone with him on the other end.

When I finished, Mike called his mom and relayed the same news. Maybe my mother-in-law is made of tougher stuff, but she took it all quite calmly and said everything would be alright.

We didn't know what to do with ourselves. We went to a random Mexican supermarket down the street and wandered the aisles, holding hands, tears rolling down my cheeks. Neither of us was ready to vocalize the thoughts in our heads. I can't speak for Mike, but I was grieving for our unborn children. For the first time in my life, I felt angry about adoption, upset that I might not be able to have more biological children. I wondered what would happen if they removed my uterus. Would I have the proper hormone levels to breastfeed? Would I experience changes similar to menopause? Would I have problems being intimate? Would I resent our son for what might happen to my body?

I did have words of comfort for Mike. Somehow, though I was absolutely terrified, I kept saying things like, "Maybe we'll be lucky, and they'll be able to remove the placenta surgically after delivery." It had been explained to us that I'd have to have a C-section, and then my placenta would be examined immediately after. That way, the doctors could observe me right away and make their decision--hysterectomy or no--without delay. "Women have C-sections all the time," I kept telling Mike. "The baby and I are going to make it through, and that's all that matters."

But it wasn't all that mattered, not to me. Right after confronting my fear, I was filled with tremendous self-loathing. I was angry that my body didn't function properly. I felt betrayed by the fallibility of the organs that so shaped my identity as a woman. I was broken. Out of order.

I went through a short phase of regret. Maybe, just this one time, my body couldn't form a placenta properly. Maybe this pregnancy was the only one that would have this problem, and because of our chosen timing, we had negated the possibility of other children. I wished several times, but for only a split second each time, that I weren't pregnant.

That night, things looked ugly. For the record, Google is a pregnant woman's worst enemy. Searching placenta accreta opened my mind to a whole world of horror stories. Most women had to have hysterectomies as a result of their attached placentas. I couldn't find any testimonials of women my age. I really couldn't find anything but scary statistics and scarier reports of disappointment and heartache.

I was told to give the perinatologist's office 24 hours to process the midwives' request to take me on as a patient. Those hours were grueling. Mike and I slept poorly that night.

Monday, June 11, 2012

Gratitude, Part 1

On Wednesday, March 21, 2012, ultrasound imaging showed us that we were expecting a little boy.

On Wednesday, March 21, 2012, ultrasound imaging also hinted that this would be our only biological child.

Note: There is a happy ending to this story.

Our anatomy scan, performed a day before our 18-week mark, showed that our offspring was indeed male. We gloried over the four chambers of his heart and watched them beat in perfect symphony. We marveled over tiny bones, a round little belly, a huge noggin, a small upturned nose.

A boy! As the oldest of five girls, the novelty of a boy in the family rang through me. Mike squeezed my hand excitedly as the ultrasound tech explained all we were viewing.

I felt awash in the glow of motherhood. I had felt a few small movements before, but now I was finally looking at my child.

The ultrasound tech continued her exam, explaining she would next check out the placenta. Mike asked her what the big holes were on the screen. Everything looked like Swiss cheese. The tech muttered something, though in my euphoria I didn't recognize what she said. Honestly, I wasn't listening; why should I care about a placenta when there are small pictures of my baby's profile to obsess about?

Mike persisted a little, but the tech, in a totally professional manner, declined to say much more. About half our exam focused on the placenta. The tech saved many images of it, at least as many as of our baby. Eventually the scan ended. I wiped the gel off my belly and we headed back to the midwives' office to go over the results.

One of our midwives met with us in a small room. The walls were covered with pictures of babies, fruits of the delivery efforts of the office team. I beamed at Mike. We were having a boy! It was like finding out we were pregnant all over again. After months of morning sickness, I felt rejuvenated by the news.

The midwife held up several images of the baby, confirming everything we already knew: he was healthy and strong, a good size for his age.

"We're thrilled!" I told her.

She then held up a sheet or two of images of the placenta. "A normal placenta will look smooth and uniform. Do you see these dark holes?"

We nodded our heads. "I wondered about that," Mike said. "Why does the placenta look like that?"

The midwife asked if I'd ever had uteran surgery of any type before. When I said I hadn't, she shook her head and explained the symptoms of an uncommon condition called placenta accreta. It occurs when there is a lack of endometrium in part of the uterus, so the placenta bonds to the uteran wall instead. Endometrium fails to form over scar lines, hence the question about surgery. Older women who have had multiple C-sections are at greatest risk, since they often carry thick scar tissue. Combined with a low-lying placenta, these women sometimes develop placenta accreta. The consequence of placenta accreta is surgery of some form. The best case scenario is that the placenta is only barely attached to the uterus, requiring a minimum of cutting to release it. The worst case scenario is that the placenta is firmly attached to the uterus, necessitating a complete hysterectomy. An untreated placenta accreta that won't detach from the uterus can hemorrhage until the mother dies. Hysterectomies, though extreme, are often recommended since they are the best way to guarantee the mother's survival.

Apparently, the dark spots in my placenta indicated connections between the placenta and the uteran wall. Even though this was my first pregnancy. Even though I had no known scarring. Even though my placenta was high up on the right side of my uterus.

"You both need to prepare for the possibility that this will be your last pregnancy."

Mike remained silent. I tapped the counter with my finger. "But the baby is fine, right?" I asked. "Is he at risk because of this?"

"The baby is totally fine," the midwife said. "There's no reason why he won't be completely healthy. This condition isn't hurting him."

"Well, that's good, we just want a healthy baby," I said.

We sat in silence for a moment. Then the midwife addressed Mike. "Are you alright? You seem more shaken up about this than your wife."

"It's just a lot to take in." I could see that Mike was upset, but I was still so excited that we were having a boy and that he was going to be healthy.

The midwife referred us to a perinatologist, to see if I did in fact have placenta accreta and how to proceed. The rest of our conversation as a blur. We left the office, three precious ultrasound images in hand, and walked out to our car.

I don't know if the magnitude of what happened hit me in the elevator or somewhere on the blacktop outside, but I had to hand off our little pictures to Mike because I suddenly felt so ill. So completely gripped with the reality of being a hysterectomy patient at 25 years old.

Saturday, June 2, 2012

Dear Baby, June 2, 2012

Dear Baby,
  It's been awhile since Mom or I have written (let's face it. I've not written yet, although you have been on my mind). A lot of things have happened since Mom's last post, so I'll bring you up to speed.
  You have been kicking Mom in the ribs everyday for the last three weeks. You've become so strong that I can feel you. Earlier this week, I woke up early for work. I placed my hand on Mom's belly, and you kicked. I pressed down, and you responded to the pressure. We played like that for several minutes, and I felt closer to you than before. I kept thinking of Billy Madison, when Adam Sandler says, "He's going to be a soccer player." Maybe you will be, but for now, take it easy on Mom. You're kicking/punching her ribs with such force, that you might break a rib.
  You are quickly growing. The doctors thought Mom had a problem with her placenta, which means she visits a specialist every four weeks. They were wrong, but the plus is we get to see you. Last visit, the ultrasound tech and Mom saw you suckling. You are currently two gestational weeks ahead of schedule. So, you can either be a big baby, or you're coming early. Either way, come safe. You have one more trimester to fatten up.
  Child, you are also taking over apartment space. Since we last wrote, Mom found a nice stroller/car seat combo. When she picked me up from work, there they were: the car seat fastened in the back, and the stroller in the trunk. It was a new experience taking out the seat. It was a brief preview to upcoming events. This is the rest of my life, I thought, struggling to get the stroller out, while balancing the car seat. The only things missing was a diaper bag loaded with stuff, and you. I'm not complaining. It's just new.
  Coupled with these is a mini-crib your mom and I built. The crib was part of Mom's Mother Day/Birthday extravaganza, but we waited until after Uncle Dan and Aunt Fleming's wedding to build it. It is now placed next to our bed, on Mom's side. It is another reminder that you are coming. It's almost a sad confession that it takes furniture and accessories to remind me, but in my defense, I don't live with you inside me 24/7. At one time, I thought of you abstractly, but each day you become more and more real to me. I love talking to you. When Mom and I found your name, I whispered it to you, and you responded. I hope you like your name as much as we do. We love you very much. Keep growing, and we'll see you in a few weeks.

Love,
  Dad