Same old story – it’s just unexplained

PC Diary @38Weeks 0 Days

The unknown doctor came in, shook our hands and looked at us in turn, he looked concerned.  But after a strange pregnant pause he managed to get the words out….”Everything looks good with the flow to and from the placenta”. Phew…a sigh of relief! From the look on his face, we both thought he was going to say something bad.  Another awkward pregnant pause and he said to us “We don’t know why your baby is measuring small.” (This doctor had very a very strange and awkward bedside manner)

Chris and I had bets on how this appointment with the Maternal Fetal Medicine (MFM) specialist would go.  We both bet it would be ‘unexplained’, because that just seems to be the way the cookie crumbles with us.  Unexplained infertility has done that to us, it has better prepared us for accepting the unknown.  By the way the unknown SUCKS.  But nevertheless, we seem to be able to handle it a lot better now.  We think that the doctor was expecting us to give him a hard time about not knowing why Rocky is measuring small.  But instead we just said, OK so there is nothing obviously seriously wrong? Although, she was even further behind than our past growth scan in the 3rd percentile (She was in the 5th percentile the week before), but these measurements have error inaccuracies, especially at this late stage of the pregnancy. There was no denying the fact that she is still very small and behind.

The doctor recommended that she be delivered in my 38th week so we can get her out of me and feed her up.  Later that day I went back to my OBGYN for another non-stress test and an ultrasound to check on my amniotic fluid levels.  All was looking good.

It was an emotional roller coaster day of nerves and relief.  We don’t know exactly how healthy Rocky will be when she arrives into the world and what the impact of the growth restriction has been on her, if any.  Perhaps my anemia was the culprit, perhaps it has been my bowel problems not getting the right nutrition to her or perhaps she is just a naturally skinny thing.  We don’t know, but that’s OK, because we are going to meet her very soon and hold her in our arms.

At my next appointment with my Obstetrician we talked about the induction process.  We had been penciled in to arrive at the hospital on the evening of the 20th December to have my cervix ‘ripened’ overnight.  Rocky is currently head down and engaged at Stage 0 right now, and I am still 1cm dilated and 50% effaced, which is a good thing and may mean I don’t need to have my cervix ripened.  If that is the case, then I may be asked to come into the hospital in the morning of the 21st December and they will put straight onto the drug Pitocin (it mimics oxytocin, the hormone which causes contractions).  The doctor warned us how long this process can take 12-24 hrs, and there is no way of knowing how my body will respond.  Sometimes a small baby can be a good thing and time can go quicker and I may have an easier time pushing her out!  Or sometimes not….  they will keep a close monitor on Rocky because sometimes growth restricted babies struggle to keep their heart rate up during contractions.  If Rocky’s heart rate decelerates then there is a very good chance I would end up having a cesarean section.  But the great news is, there is no reason for me to not have a vaginal birth.

My birth plan is that I wish to avoid pain medication at all costs.  However, I am now being induced using Pitocin and this can cause contractions to be a lot stronger and successive far quicker than a natural labor would be.  This means that there is a higher chance of this being painful!  My current feelings are that I will try my dammed hardest to not ask for the pain meds – in whatever form.  Chris is well versed in my desire, and my doula will be there to help me get through it too.  Although I want a vaginal birth, I have spent some time thinking about how to cope with an unexpected c-section.  I am now feeling ready for that moment because I know Rocky’s health is the most important thing to think about.  Luckily I will be on one of my favourite obstetrician’s service that day and I feel like I can trust her.

All this being said, the past week has been strange.  I had some plans for my maternity leave…I was excited to be taking some time to myself and thought 4 weeks before Rocky’s arrival I would have some time to do these things – Christmas dinners with friends and colleagues, executive development program study, knitting, Christmas card writing, email sorting, Christmas shopping, housework, blogging and more.  But with being on ‘rest’, many doctors appointments and not knowing what is going on has actually been exhausting and I have done very little on this list.  Even the things that don’t require me to leave the house for I haven’t been able to focus on, I have just been lethargic and brainless.  It doesn’t help that I am not even sleeping well and having lots of pregnancy related nightmares.  I might be physically well rested, but my brain sure isn’t.

Finally, just one more thing.  Now when people say to me, oh you look so good for 37/38 weeks pregnant…I actually feel bad inside.  I now know that my bump is small and I have put on little weight to the detriment of Rocky.  Until I meet her and hold her safely in my arms, that guilt is not going to stop, no matter how much people will tell me it’s not my fault.

But guys….I am almost at the end of all this…I am on the brink of exploding with happiness about that!

From a High to a Low: Fetal growth restriction

My obstetric appointment didn’t go quite as exactly as hoped for.  The doctor measured the fundal height and asked me if I had an ultrasound yet, I said no.  So she said well you are going to have one today, you are measuring a small.  Since I entered the third trimester I have had comments about my small bump, but the doctors say that because I am tall and have a long torso Rocky has more room upwards which is why I don’t go outwards.  But then there is my weight issue, I have only put on 1lb in the past 8 weeks.

The doctor did a pelvic exam and Rocky’s head is very low down (yeh my poor bladder knows this well!), she had troubles getting to my cervix – ouchie that hurt a lot!  I am 1cm dilated (how much the cervix is open, from 0-10cm) and 50% effaced (how much the cervix is thinned and shortened that means the cervix can dilate more ready for labour, from 0-100%.).  Well that doesn’t mean much at 36 weeks and is perfectly fine.

I had more blood drawn and we headed in for our ultrasound.  Really at this point in the pregnancy it is very difficult to tell body part from body part.  These technicians are very skilled!  She pointed out a head of hair….really it looked like white mess and I couldn’t tell there was even a head!  As she measured Rocky’s tummy, the size was measuring 29 weeks and 30 weeks…she took the measurement several times, and everytime is showed between 29-30 weeks, way behind.  But when she measured her thigh bone it measured spot on 36 weeks.  Rocky’s head is way down in my pelvis so she had a hard time getting a measurement, but when she did it measured 36 weeks.  With all these measurements, this meant that Rocky is weighing in at 4lbs 10oz – just under the 5th percentile for 36 weeks. Anything less than the 10th percentile is considered as growth restricted.  Her tummy size is in the less than 1 percentile. That is scary.  The technician confirmed that yes she was weighing in small, so went to give the results to the doctor.

We were then sent to have non-stress test.  I had heard about these, where you wear two monitors, one that measures contraction strength, the other the baby’s heartbeat.  You sit in a chair, relax and press a buzzer every time you feel the baby move.  This monitoring goes on for at least 20 minutes depending on how active the baby is, assessing baby’s reactivity and changes in heartbeat.  Rocky performed well!

After the non-stress test the doctor came back and explained her thinking.  Rocky has asymmetrical intrauterine growth restriction (IUGR).  Asymmetrical means that her head and length is normal, but not the stomach.  In more than 70% of cases, this indicates a likely problem with the flow to and from the placenta and baby not getting enough oxygen or nutrients.  Rocky diverts the energy for growing the brain and bones, meaning that the liver and fat build up doesn’t happen, which is why her tummy is so skinny. This form of intrauterine growth restriction usually occurs in the third trimester. (The other form of growth restriction is symmetric where the baby is small all over).  There are other causes of this type of restriction, but most of those we can rule out.  So we need to rule out the placenta problem and I have to go to Maternal Fetal Medicine specialist to have a special ultrasound to look at the flow to and from the placenta using a doppler.  The catch is I have to wait for an appointment.  The doctor said that I will be induced in either week 38 or 39 because the baby will do better outside my body.  But if I have placenta problems she will want to induce me ASAP.

I am now on twice weekly appointments including a non stress test twice a week and an ultrasound to keep an eye on Rocky…particularly as the amniotic fluid might reduce over the coming weeks they want to monitor that and ensure that Rocky isn’t struggling getting the oxygen she needs.

I am also on ‘rest’ not bed rest exactly, but just resting and preserving all energy for Rocky.  So I would have been signed off work if I wasn’t on maternity leave already.

There is no medical intervention that will stop this from happening, all that can be done is that we are both monitored closely and assess the right time to deliver Rocky.

What does this all mean for my labour, delivery and Rocky’s health?  We don’t know.  We know that there is an increased risk of her having problems during labour, I am more likely to need a cesarean section, there is an increased risk of still birth and perinatal mortality, she is also likely to have a number of health problems after being born in both the short and long term, or she may just be perfectly fine…but life is like a box of chocolates and you don’t know what you are going to get.

I have to remember and keep telling myself that there is nothing I did to cause this and that Rocky needs us to be strong and positive to help her make it into this world safely.

Now I just wait for my appointment with the specialist.  Until we know the placenta issue, we are helpless and not knowing is quite frankly scary 😦