Results of the Follow Up Ultrasound

Oof. It’s been a really tough week. I might write a second post. I’m so sad. I mean, I’m okay. I have lots to be thankful for, but I feel like it’s acceptable for me to mourn the childbirth experience I always dreamed of whilst simultaneously counting my blessings.

Follow Up Ultrasound

The follow up ultrasound (abdominal and trans-vaginal) showed that the placenta still posterior (at the back of my uterus) and it totally covers my cervix, and in fact extends 5 cms (2″) beyond it. Then come the blood vessels which connect the succenturiate lobe (which is anterior, or at the front of my uterus), then the lobe itself. It was a lot bigger than I expected it to be, from what I could see it’s half the size of the main placenta, not a little extra piece at all! So here’s what we’re looking at:

Baby V is Doing Just Fine

According to the measurements, Baby V is an estimated 1lb 10oz / 751g. Her femur (thigh bone) is 4.3cms / 2″ long, and her humerus (upper arm bone) are almost as long. She has a fat little belly for her age too, which kinda made me swoon. All her measurements are right on track, and she is measuring two days ahead (which isn’t really significant at this stage, but I still like it). Her head is about the size of this apple :) The sonographer also looked at her brain and heart, but didn’t take any cute pictures for us. We just have one, but it’s hard to make out as Baby is folded in half, like in a yoga position. I was disappointed not to see her face.

Complete Placenta Previa

The official diagnosis is Complete Placenta Previa, and it is “highly unlikely” that it will move out of the way before Baby V is ready to be born. PP puts me at a higher risk for pre-term labour and bleeding. If I bleed and it’s bright red, I must go straight to Labor & Delivery, whereupon I will be admitted to hospital for 48-72 hours. If this happens three times, then I will be admitted until it’s time for Baby to be born. Otherwise, I can do gentle swimming, but must take it easy going up and down stairs, and not lift more than 20lbs. And, yes, I’m still on pelvic rest… And yeah… caesarean.

Some Good News

The good news is that the reach of the placenta over the cervix puts a reasonably healthy distance of 5 cms between my cervix and the blood vessels. Vasa previa would be a really terrifying diagnosis — because if the blood vessel ruptures, mama can haemorrhage and / or baby could bleed to death — and even if nothing happened, such babies are delivered around 34 weeks. I was relieved to  hear that vasa previa in our case is now “unlikely.” We’re not out of the woods, but I can relax just a smidgen about that.

 Aaaand… Some Not-So-Good News

At the anatomy scan, which diagnosed the placenta previa and succenturiate lobe, the doctor who reviewed my ultrasound kind of screwed up. She should have told me that my Inhibin levels are a little on the high side. She also should have put this in my chart. It was only because the attending perinatologist yesterday asked me why I was back so early: he wouldn’t have expected to see me again until 28 weeks, so the fact that I was 24 weeks was a red flag to him.

He asked if everything came back normal with my AFP results (the second trimester blood test). There were five terrifying minutes whilst he searched my medical records. After reviewing my records, he explained that my Inhibin levels were a little high, and this puts me at a higher risk for pre-eclampsia, preterm labour, and the baby’s growth could be restricted, and that’s why I had been asked to come back sooner than 28 weeks.

DH got very angry and protective. I could tell he was fucking furious, but I was so proud of how he kept it together. The perinatologist completely agreed with him that we should have been told, and that this information should have been in my records. He even went and got a business card for the person DH should complain to.

Meanwhile, I got quietly upset. I was still reeling from the news that this placenta is not going to budge and I will need a caesarean. It wasn’t a shock to hear it, but it was still upsetting. I was trying to focus on the good news about the waning risk of vasa previa and that Baby is active and healthy. I’ve been dealing with a lot of anxiety since my anatomy scan. Most of the time I can deal with it but something as simple as a song from last year can set me off.

In the moment when the doctor was explaining the consequences of high Inhibin markers, my ears began to ring and I felt myself withdraw. So I closed my eyes and focused on my breathing so I could better take in the information.

I heard:

Growth Restriction — not a concern because the averages of her measurements show she’s two days ahead.
Pre-term Labour — well, I’m already at risk for that because of the placenta previa, so the Inhibin doesn’t change that.
Pre-eclampsia — at a higher risk, just how much can be determined by an ultrasound on my uterine arteries.

So I ended up having a second abdominal ultrasound. Uterine blood flow is good, so my risk of pre-eclampsia isn’t much higher than normal. Plus, I said brightly, I always have really good blood pressure, so maybe I’ll be okay. The perinatologist acknowledged that was a good sign, and added that my Inhibin levels are probably due to a hormonally leaky placenta.

Why Having a Caesarean is So Upsetting to Me

I am staring a c-section squarely in the face, and I don’t like it one bit.

With everything else I’ve had to deal with, was it really too much to ask for a vaginal childbirth?

Guess so. I should know better by now than to have even reasonable expectations. But I’ll deal with it. If I can deal with a miscarriage and infertility, I can deal with this.

My fears partly stem from the fact that my mother elected to have a caesarean to deliver my sister, who is 14 years younger than me. Well, the surgeon cut my sister’s head and she required a stitch in her scalp; I saw my mother gnashing her teeth in pain; and she really couldn’t do much for the first 10 days. I wasn’t getting up in the night to feed my sister, but I was definitely helping out a lot — I even showed my step-dad how to change a girl’s diaper because he didn’t realise that you need to wipe front-to-back with a girl! (It was slightly awkward for my teenage self to have to explain WHY to him, haha!)

Because it would be too risky to allow me to go full-term with Baby V, she will be delivered between 36-37 weeks. So she will be a October baby, not a mid- to late-November baby. I’m hoping I can compromise with delivering her at 38 weeks, or around Hallowe’en. I want to minimise the possibility of her spending time in the NICU…

I’m disappointed DH probably won’t be able to cut the cord.

I’m disappointed we won’t be able to film the birth.

I’m worried that Baby will need immediate medical attention, meaning we won’t get skin-to-skin contact immediately after the birth.

I’m not happy about the idea of my pain medication leaching into breast milk.

I’m also not happy about the recovery time. I’ve had surgery before, the first two weeks are fucking awful and it takes a full six weeks before you feel like yourself again.

I know the important thing is that Baby V arrive safely. From here on in, my focus will be on how to make a caesarean as positive an experience as possible. I’ve bought a couple of books on the subject, and one lovely lady on Twitter sent me her c-section birth plan. And, by coincidence, my friend just delivered her baby by c-section this week, and my OB, Dr. D, was the surgeon! I’m also thinking about reaching out on Facebook, even though that would basically be akin to a pregnancy announcement.

I’ve started gathering information and am feeling better about the prospect of major abdominal surgery to deliver my baby.

If any of you had a positive c-section experience, I’d love to hear more. If you had a c-section that wasn’t positive, I’d also like to hear about how you would have done it differently (but please keep any horror stories to yourself). Please tell me about it either in the comments below. Thanks!