Friday, August 15, 2014

Previa Update

In preparation for our appointment with the Maternal-Fetal Specialist, I scoured the internet to come up with a list of questions for the doctor. Here's what I found:

-Is the previa centralized over the cervix?
-Is the previa anterior (on the front of the uterus) or posterior (at the back)?
-How far away from or over the os is the previa (the os is the opening to the cervix)
-How many cm from the os does the placenta need to be for a vaginal delivery?
-How likely is it that the placenta will move?
-What are the activity restrictions?
-How much weight can be lifted?
-How much housework can be done? Walking?
-Is the cervical length greater than 30 mm (my research told me that chances of hemorrhaging and emergency c-section increases when cervical length is less than 30mm)

As usual, the tech wouldn't give us too much information but when I asked if she could at least tell us if the previa was centralized over the uterus,  she said "It looks like it moved". Really?!? Awesome!  She didn't tell us how far it had moved but we were super-excited to hear that it had already started movin' on up.  I put a  "No!" next to my first question.  We asked her how long the cervix was and she told us 34mm.  Awesome!  I wrote that next to my last question.   We got to spend a lot of time just watching Baby O wiggle away while she took some measurements and then waited for the doctor to come in.

When the doctor arrived, he began asking questions about Ellen's age and the age of the egg (I was 40 at the time of retrieval) and then said that normally when a mother is 40 he likes to see her weekly during the third trimester.  Although Ellen isn't 40 yet (she'll be 37 in October) he said he would like to err on the side of caution and treat her as if.  That's my kind of doctor! Initially,  he said he would plan on seeing us again in 4 weeks.  As he kept looking, he mentioned that Baby O is measuring a bit small (in the sixth percentile) so he wanted to just keep an eye on him.  He said he would follow his progress and if still appeared small towards the end of the pregnancy, we would just take him a week or two early. This seemed counter-intuitive to me at first as it seems like he should cook as long as he can if he is small, but it appears that if a baby is no longer growing and getting the nourishment he needs inside the uterus, it makes more sense to take him earlier where he can be nourished outside.   After looking at our tiny Baby O, he decided he wanted to see us a week earlier and said we should come back in three weeks.

He continued the ultrasound without any mention of the placenta and I finally asked, "What about the previa?".   To our shock and amazement,  he said "Previa's gone".  What?!?  Gone, gone??? Yes. GONE.  He said if anything it was low-lying. We couldn't believe it.  When the tech said it had moved, I thought she meant maybe it had started moving out of the way and was beginning to move in the right direction. But to hear the doctor say it was gone?!? I was floored.  We asked if this is typical to see complete placenta previa resolve in two and a half weeks.  He told us he hadn't done the first ultrasound so couldn't verify it was complete, but that while previa does move, it is rare to see it move so quickly. BABY O IS SUCH A GOOD LISTENER!!!!

While we are super-relieved, we aren't able to exhale just yet.  As the doctor continued with his ultrasound he noticed an abnormality near Ellen's cervix.   He said there appeared to be a "v" shape near the cervix.  Ellen asked if this was funneling and the doctor said he didn't think so.  (meanwhile, I'm wondering what funneling is!). The doctor said he didn't think the "v" was coming from the cervix, but if it was it could be indicative of the cervix prematurely opening (hence the funnel shape).  He mentioned that it was too late to do a stich, but that it could be treated with progesterone.  He also used the term "incompetent cervix".  While I wasn't familiar with the term funneling, I had heard of the term incompetent cervix (it certainly sounds ominous!) and was aware of the term "stitch".  A stitch refers  to a cervical cerclage, which is basically a suture to sew the cervix shut to prevent premature labor. My research later told me that this is usually done during weeks 12-14 of a pregnancy- so at nearly 23 weeks we were definitely too late.  This of course, was all only hypothetical.  The doctor really didn't seem to think that we needed to be concerned, but because he is my new favorite doctor, he decided to move up our follow-up visit.  Now, instead of the four weeks he originally stated, and then the three weeks, he decided it was best to see us in two weeks. This is fine by me!

I'm going to treat the next two weeks differently than I did the last two and choose to not stress about this.  The doctor didn't really seem overly-concerned, the cervix is still nice and long, and he is on top of things.  The good news is- its an excuse for us to get another peek at Baby O.   Hopefully next time we see him he'll be growing bigger and that "v" will be gone just like the previa is!

Baby O- 22w5d

Friday, August 8, 2014

Movin' On Up - Ellen's take on the previa

Let me start by reiterating that I have been so fortunate to have 4 healthy, full term, textbook pregnancies and deliveries.  So #5 should be a cake walk, right?   Right!  My medical history is part of the reason Jason and Kerri chose me and trust me to safely nurture baby O for 9+ months.  I wasn't expecting the doctor to say I had placenta previa.  As Kerri stated, the doctor was a little nonchalant about it.  Which frankly pissed me off afterward, but thinking back, I think she also didn't want to cause undue alarm and worry.  Either way, I wish we had had a few more minutes then to process the news and get some more info before we left.  It's no secret that Kerri and I are a little obsessive with googling and researching everything we can along this journey, so the previa has gotten more than its fair share of googling.  Kerri and I are much on the same page with our feelings on this.  I can say ditto to many of the things she is feeling.

ANGER - I'm not so angry at the doctor now as I was initially.  I am, however, angry with my body.  I've done this drill before.  My body knows what to do and how to carry and deliver a baby.  It's pretty awesome at it, actually, which is partly why I'm doing this to begin with.  So I'm angry with my body for causing this fluke thing and not doing what it's supposed to. 

SCARED - To say I'm scared would be an understatement.  I'm scared of hemorrhaging, I'm scared of delivering early, I'm scared of bed rest, and I'm mostly scared of letting down Kerri & Jason.  The placenta previa has been consuming me.  It's all I can think about, which I know isn't healthy or logical.  I didn't do anything to cause it.  Nor can I fix it.  All the worry and fear in the world isn't going to change it.  It's likely going to fix itself. So why can't I make myself stop??

GUILT - You betcha!  Guilty that after all Kerri and Jason have been through, now this.  In the second trimester, which is supposed to be the easy one!  They have entrusted me to carry and nurture their baby, and my body has caused this worry and fear for them.  And guilty that impending bed rest could cost them more money.  Sure when we signed the contract we all knew it was a possibility, but one we never hoped to face. 

SAD - Yep.  Like I said.  Sad that this should be the worry free part of the pregnancy.  Kerri and Jason should be registering and preparing for baby O's arrival, not worried about me, or the well being of little O. 

We have an appointment with the perinatologist next week, so hoping to be able to report that all this stress and worry was for naught and that bitchy placenta has indeed, moved on up!  I don't care if it's the east or west side, so long it migrates up from the south.  ;)

Thursday, August 7, 2014

Move Bitch- Get Out The Way!

This homage to Ludacris  is now our morning mantra.  By Bitch we mean Placenta.  That Placenta best get out the way of the cervix or there are going to be a lot of unhappy people.  As I mentioned in my last post, we did a bit of googling and questioning on surro boards about placenta previa which raised our concerns.  Most people mentioned the need for bed rest, or at the least, pelvic rest (meaning no intercourse).   We read a lot about the risk of spotting and in worst case scenarios, hemorrhaging which leads to early delivery (like 30 weeks!).  Thankfully, Ellen is as proactive as I am when it comes to medical issues so she took it upon herself to email the nurse of her regular doctor to ask more questions.   We did not like what we learned.  The nurse told Ellen that the doctor that we saw should have advised her to go on pelvic rest.  She said it wasn't mandatory but it was strongly recommended.  She also said that the doctor saying that in 90% of cases the placenta moves was very optimistic for placenta previa at 20 weeks.  UGH.

It's been a see-saw of emotions for all of us since we got that news. We went from thinking- "minor complication, it will probably resolve itself, no big deal" to- "this could be serious, it could mean bedrest, hemorrhaging (please no more hemorrhaging!) and even a premature baby".  Personally, I have a ton of different emotions going on:

ANGER-I'm angry at that doctor for letting us think that everything was fine, for not giving us correct information and for minimizing things. And I'm angry that things are not fine.  Really?!? Haven't we been through enough? Can't we just have a normal pregnancy?  I mean, clearly it's not a normal pregnancy- but does it have to be even less normal now?  Enough already!

SCARED- I'm scared to death that something is going to happen to this baby.  I'm scared that he will come early- maybe too early to make it or so early that he ends up having lots of problems.  I'm scared that if he might need more care than the NICU at Piedmont Henry County Hospital can offer him.  At night, I lie awake worrying about things like should he be delivered at Northside where they have a Level 4 NICU and specialize in taking care of micro-preemies???  And then I worry that we can't even do that now even if we wanted to since we have submitted our PBO (pre-birth order) that says he will be delivered at Piedmont.  And really, is delivering at Northside even realistic? Northside is really far from Ellen (I mapped the distance- its 45 miles away as opposed to 7.7 miles away). Obviously that doesn't make any sense in an emergent situation.  I'm scared for Ellen too- scared that she will have an emergent situation such as a hemorrhage- which I don't wish on anyone.

GUILT- I feel guilty about Ellen having to go on pelvic rest. This is not what she (or Chris) signed up for.  I know many pregnant women aren't interested in intercourse as they start to grow bigger- but she's still pretty small and I'd rather it be her choice, not the doctor's choice.  I feel guilty about the likelihood of her having  a C-section. Ellen has only had all natural deliveries.  Like, not even an epidural.  I'm pretty sure she's never had a surgery in her life. I feel bad that she may have to have a surgery now because she is carrying our baby. I feel guilty about the possibility of her having to go on bed rest. Ellen has a full-time job. She's a mom- and not just a "let the kids watch TV while she sits around eating bon-bons" kind of mom.  She very involved with her three kids and they are very active- they're at the ball field almost every day during season.  I feel guilty about the possibility of taking her away from all those things to lay in bed. Because of our baby. And I feel guilty that Ellen has to worry about these things too. 

SAD  I'm sad that all of these feelings are getting in the way of us enjoying what should be a really happy time for us.  A good friend of mine offered to help me register this weekend. She has  6 1/2 year old triplets who are at the grandparents this weekend so she has a rare window of free time to help me with this.  I was all excited about going, but then the fear crept in.  Is it too soon?  Should we wait to see what happens with the previa? What if I jinx things?  I ultimately decided to take a rain check on registering. I want to enjoy that process whole-heartedly and I know with all these other emotions happening I can't really do that just yet. Sigh.

ANXIOUS ABOUT THE COSTS-  I can't deny that this has been a concern for me as well. Pregnancy complications come with additional costs to Intended Parents. We are responsible for Ellen's lost wages incurred during bed rest, as well as childcare and housekeeping needs.  We will be responsible for additional reimbursement should she need a C-section.   At the end of the day, Ellen's health and the health of the baby are most important and you can't but a price tag on that.  And yet, there still is one in surrogacy. I'm hopeful we will avoid all of these things but they still remain a concern. 

SCARED- Did I mention that I'm scared? Mostly I'm scared of not knowing what to expect. When the doctor gave us the diagnosis, I barely knew what the term meant, never mind knowing what kind of questions to ask. Are we worrying for nothing? Should we be worrying more? If the chances of it moving aren't 90% then what are they?  Not knowing sucks.

So, what do I do with all of these emotions?  Well, for starters I decided I needed to understand more about placenta previa and its implications. And while Doctor Google can be both a valuable resource and a curse, I decided it would probably be best to seek the expertise of an actual doctor.  I asked Ellen if going to a specialist would make her feel better or worse and she agreed it would help to get more information.  A couple of my friends recommended some Maternal-Fetal Specialists in Atlanta, but Ellen was concerned about the distance and additional time off of work (since she may need that time for bedrest/c-section) so we decided to start out at the local Maternal-Fetal Specialist that her OB recommends and seek a second opinion if we felt it was necessary.  It took us about a week to get that appointment scheduled but I can already feel myself exhaling a bit knowing we will get some answers soon.  Doctor Google has helped give me a list of questions to ask from sites like  Placenta Previa:Stuff I Learned Staying Up All Night .  I cracked up at 4am when I read that subtitle- good to know I wasn't the only one researching at all hours due to this diagnosis!   I'm looking forward to getting some of my questions answered next week. In the mean time, I'll keep singing Luda's anthem! I might need to add a little Tom Petty in there too...

Friday, August 1, 2014

Whoa-oh we're halfway there....

So I know its been a while since I've posted. I've been slacking a bit, but we've also been pretty busy.  Right after my last post we went on our Baby-Moon!  For those of you unfamiliar with this term, this is a vacation that you take with your spouse before the baby arrives- sort of like the last hurrah before life forever changes.  Jason and I went to Costa Rica and had a blast!  Unlike most women on baby-moons, I got to enjoy adult beverages- one of the perks to having a surrogate. I also got to do a lot of adventurous things that most expectant mothers can't do.  We went white-water rafting, repelled down a 165 foot waterfall, went surfing and horseback riding.  I even started drinking coffee for the first time! (I figured now is as good a time as any to to introduce that magic elixir to help me get through the sleep deprivation that comes with motherhood.)

Normally after a trip like that, there is a sense of sadness that comes from getting back to reality.  And yet for us, we were excited because we had our 20 week ultrasound the following week.  We hadn't gotten a peek at Baby O since our 13 week ultrasound so we were really excited to see him.  We did get a chance to hear his heartbeat at week 16 but almost had a heart attack of our own in the process.  Since  the appointment was really just for bloodwork, we didn't attend in person but did have her Facetime us in when it was time to listen to the heartbeat.  Unlike previous appointments when the ultrasound tech is able to visualize the heart on the screen, this time the doctor was using a doppler on Ellen's abdomen to locate the heartbeat.  We made our introductions on the iphone screen and excitedly waited to hear that magical sound.  And waited. And waited.  We started out all smiles, but after about a minute (which felt like hours) our smiles quickly faded.  Why is it taking so long? Please tell me it's still there.  Wait- did I just hear it, but now its gone?  Please tell me its not an intermittent heartbeat again.  We asked the doctor if it was normal to have trouble finding it and she assured us that it was- the fetus is still tiny at this point and it's hard to locate without the benefit of visual help. Finally after what felt like eons- we heard that beautiful thump, thump thumping.   I felt an enormous sense of relief.  Jason? Well, these pictures will give you an idea of how Jason felt.

This, my friends, is what PTSD looks like.  Jason texted me hours after our the appointment and said "I'm not gonna lie. I'm still rattled from this morning".  That's what four plus years of disappointment does to a person. Even though we ultimately got good news, those long moments of waiting-of not knowing what was going on- of thinking the worst because that's what we've grown so accustomed to-- are hard to shake.
We were hoping our 20 week appointment would go better than the last little scare and for the most part, it did.  Chris joined us for this appointment too which was a pleasant surprise.  Immediately, we saw Baby O wiggling away.  He even waved to us! On impulse I started waving back until Chris reminded me that he was not actually up on the ultrasound monitor and instead in Ellen's belly. Oh yeah. Whoops.  Here's what Baby O looked like at his 20 week ultrasound.

Bottoms up picture- proof that he's a boy!

As I said, for the most part the appointment went well.  We were all smiles when we met with the doctor (who we are pretty sure just finished her residency in 2012). She told us everything looks great with Baby O.  He is measuring on time and appears to be developing appropriately.  She ended by telling us there was a small concern- Ellen apparently has placenta previa.  No big deal she told us.  It just means her placenta in blocking the cervix.  90% of the time the placenta moves, she assured us. If not, Ellen will just need a C-section.  No big deal, she said.

This is the four of us after the appointment.  We were smiling then, but that was before Dr. Google and FB informed us that placenta previa may not be as innocuous as that Doogie Howser doctor led us to believe.   More about that in a future post....until then,  we are excited that we are half-way there, but as the song goes...we're still Livin' on a Prayer.