Wednesday, April 6, 2011

The Parallel Paradox: My Experience With Placenta Previa, Part 1


"At this point we're calling it a complete previa."

The perinatologist stated this so casually, so technically, so matter-of-factly. A complete placenta previa, detected during the Level II ultrasound I had agreed to do at 18 weeks, as what I thought of as a fair compromise to all the other prenatal testing options offered (and encouraged, frankly) by the CNM practice I had been seeing in tandem with my home birth CPM. The quad screen produced too many false positives, the CVS seemed way too invasive and risky. But hey, I had thought about doing a basic anatomy scan at around 20 weeks anyway, so why not do a sonogram that would be a little more thorough? Including a consultation with a perinatologist to boot? What could be the harm?

Backing up for a moment: Unless you're brand-new to this blog, you already know the happy outcome of my pregnancy: I had an uncomplicated home water birth with a healthy baby girl. What I've never talked about here is the story of the pregnancy itself, including, yes, a placenta previa that cast a shadow over the whole experience, threatening to change my plans for not only a home birth, but any hope of a vaginal birth at all.

Periodically, I see moms posting about their own previa diagnoses, on message boards and Facebook and the like, and my heart goes out to them - I know just how uncertain and anxious and helpless the feeling can be. I always swore that I would someday write out my own story in order to offer up a positive spin on the whole angsty saga. Only 3 years later, I'm finally getting around to it.

The story has more to it than just the painstakingly slow migration of my placenta, however; the experience of getting what's commonly referred to as "parallel care" from a conventional medical practice has lessons - and pitfalls, in my case - of its own. It's hard to separate one aspect of the pregnancy from the other, I've found each time I begin to approach it, so I tell the two tales together.

So before we get back to the perinatologist delivering the bad news to me, a bit on how I, a mom who was planning on homebirth from day one, had even gotten there in the first place.

When I decided on my home birth midwife, Nancy, a wonderful CPM with a very experienced apprentice, I had no intention of getting any extra prenatal care. But in order to get my blood workup done, Nancy recommended I go to a practice in the area that was relatively friendly to the idea of home birth. Emphasis on the relatively; they did not formally offer parallel care, but knew that some of their patients would occasionally be doing this anyway, and so had a waiver on hand releasing them of responsibility. Fair enough - but I didn't go into their practice even expecting to go that far. The plan was just to get the blood work and be done.

But when I made the appointment, the receptionist asked if I wanted the CNM rotation or the OB rotation. I thought it was nice that they offered a choice, and asked for the CNMs, of course. When I arrived, it turned out that I had been scheduled for a full initial prenatal appointment, not just the tests. "Well, why not go ahead and get checked out?" I thought.

"What could be the harm?"

Well.

In that first appointment, the CNM I happened to get was the youngest in the practice, and in my experience, the most conservative. She looked over my history, and with great concern, noted that I had needed a cone biopsy on my cervix due to moderate dysplasia, a full 15 years prior (with no abnormal pap smears since). This was something I had discussed with Nancy and Gengi already, who thought there was a small the scar tissue might be an issue when it came time to dilate, but otherwise saw no need for additional concern. They had worked with plenty of other moms with similar procedures in their pasts and had no issues during pregnancy or in labor.

This CNM, however, saw only the worst case scenario, recommending that I have my cervix checked for "incompetency" every two weeks, until I reached 20 weeks, and if it should show signs of prematurely dilating, they would put a cerclage in place, essentially stitching it closed until late pregnancy. The fear was put in me. My body was flawed, my baby at risk. How could I say no, and risk a miscarriage? Never mind that this was at an extreme additional expense: I should also note that this was all going to be out of pocket, since try as we did to get me health insurance, not one company would take me once I was already knocked up, since pregnancy was a pre-existing condition. We were already planning on paying Nancy her fee out of pocket, but hoped to at least get something for any additional care that was needed. To no avail.

In that same initial visit, the alarm was raised about my dates. Despite knowing exactly when I had conceived, I was "measuring large" for what was supposed to be a 12 week pregnancy, and I was more or less ordered to get a dating ultrasound, even though I had been hoping to get only one anatomy scan at around 20 weeks - again, just to be on the "safe side". I tried to reason my way out of this early ultrasound, hoping that we could just wait until 20 weeks and get a date estimate then, but apparently the sonogram's dating accuracy declines as time goes by, and she insisted that without accurate dates, they couldn't properly continue my care.

I reluctantly agreed to return in 2 weeks for this, along with my next cervical examination, and with some additional strong words encouraging me to decide on a variety of prenatal testing options, we finished the visit. I walked out feeling shaken and manipulated. Not because she meant me any harm - on the contrary, she was just recommending what, according to her training, was the safest course of action. She was only doing her job. But my feelings about my pregnancy were permanently changed, my belief in my body was shaken, and I found myself unable to stand up for what I believed and wanted.

To be continued.

7 comments:

  1. You can't stop there.... lol! Looking forward to the next part.

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  2. OHhhh! Can't wait to hear "the rest of the story". :)

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  3. Medical professionals do not treat individuals, they treat conditions..in this case, pregnancy. It's so unsettling.

    At first I was very focused on these unnecassary interventions during birth, then I releazed that these interventions don't start when you are 38 weeks or so pregnant - they start on your first prenantal appointment!

    Something will eventually change, slowly - but change will happen : ) It already has .....

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  4. And here we'll sit, waiting on the precipice of "what happened next?!?" Hurry with part 2!

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  5. Wow... So weird that I happened to read this right after getting home from my weekly visit with the CNM at the Birth Center we're attending. My "problem" is not placenta previa, but a higher-than-they-would-like BMI which has led to weekly bio-physical ultrasounds. Naturally, my unborn daughter passes each one with flying colors, but as you have shared perfectly and I couldn't agree with more, it has also changed my feelings about my pregnancy. Where I thought I'd feel empowered has, in fact, left me feeling disempowered. The thing that really chaps my hide is how I ALLOW it to disempower me. Anyway, can't wait for part tow, either! ~ Rania

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  6. Rala (hey!) I can so relate. I ALLOWED myself to be disempowered too. Got my groove back eventually, but it was a looong strange trip. On which, part 2 hopefully later today!

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