Monday, April 18, 2011

The Parallel Paradox Part 3 - Dealing with Placenta Previa

Continued from parts one and two.

After getting off the phone, and calming down, I drove directly to my local natural parenting store, where I'd been going for cloth diapers, slings, and a home birth support group. Surely their abundant bookshelves would offer up some helpful and reassuring information, somewhere in all the books I'd been devouring for their information on natural/home birth and holistic pregnancy.

On the contrary. I looked in index after index after index. And each book in turn referred me to a page that mentioned the several universally-agreed-upon contraindications for a vaginal birth. I might as well be walking around with a pre-prolapsed cord. Some mentioned that placentas can migrate late in pregnancy, but offered no further information. All the crunchalicious books I had found so empowering were now shutting a door in my face, or so it felt.

One of the employees that I had become friendly with came over to offer some help, and I told her what was up. "I guess I'm just feeling pretty powerless right now," I said, fighting tears but still self-conscious that maybe I was blowing the whole thing out of proportion. She reiterated what the perinatologist had said about the likelihood of migration, and though she didn't know anyone who'd dealt with this personally, she had known of some women on a message board who had. I decided to check in on the message boards when I got home.

Before I logged on, though, I decided to browse through my own shelves and see if I found anything new. All of my own books produced the same result as the books at the store - "Previa, placenta, 176, contraindication to vaginal delivery"; "Placental abnormalities, 242, previa"; "Placenta previa, 52, reasons for cesarean"; "Previa, placenta, 67, abandon all hope" - except for one. One very unexpected resource.

When she got the news of her impending grandmahood, my birthmom ran right out and picked up what seemed to be THE book, the bible, even, for pregnant women, and was recommended as such by the bookstore employees: "What to Expect When You're Expecting". Now, as you'll gather from that snarky link of mine there, this is a book that, generally speaking, is not held in the highest regard by many naturally-minded people. Those on the spectrum of crunch tend to see it as very conventional, quite pro-intervention, and unnecessarily anxiety-provoking. Yet this book was the one place that went beyond listing placenta previa as a flashing red light, offered me some more information, and even managed to be reassuring.

It explained that previas are present at only 1 in every 200 births, that "A low-lying placenta is fairly common but as pregnancy progresses, the placenta usually moves upward and away from the cervix." It went on to say that nothing (nothing!) needed to be done about it - no mention of pelvic rest or limiting activity. "You don't even have to give your low-lying placenta a second thought." I wondered if I should have the authors call [insert Connecticut OB/CNM collaborative practice name here].

The book then mentioned a few risk factors for placenta previa, including smoking and previous uterine surgery. Though I had already quit, I did smoke for 15 years, and 'uterine surgery' does include D&C, which, as the perinatologist had so sensitively clarified in categorizing its non-spontaneous nature, was also true in my case. Enter guilt: because of mistakes and poor choices past, my baby was now at risk. Add that to my custom blend of fear and helplessness.

Yet despite feeling this guilt, I felt a little better about my odds, and a little more armed with information. I had a longer talk with Nancy, my midwife, about things I might be able to do for myself under the circumstances. "The worst part is that there's nothing that I can do about it!" I cried. "Oh, but there is," she said. No, she didn't know of any acupuncture or homeopathic treatments, as I had been wondering, but talked about visualization as a powerful tool, and explained how placentas tend to be attached to parts of the uterus with good, iron-rich blood supplies. I devised a regiment where I would take Floradix*, a natural and non-constipating liquid iron supplement, every day, and every night I would utilize my massage skills and use upward strokes on my belly to help me visualize my placenta migrating upwards. (This is not a medical treatment or even an official massage technique, simply a tactile aid to my own visualization and positive-thinking process.)

As the week wore on, I talked with others who offered comfort and support, and also valued the use of visualization. One of my wise massage therapy co-workers and mentors was especially adept at 'manifestation', and helped me fine-tune what I was going for. One important point was to work on visualizing and verbalizing things in the positive - in her view, the Universe doesn't respond to our negations of things in our statements, but to the things themselves. I know, I know, can I vague that up a little more? For example: in a birth plan, rather than asking for "no episiotomy", you would ask for and envision "an intact perineum." So, in my case, rather than asking for and focusing on "no placenta previa", I worked on manifesting "a clear and open cervix".

Does this all sound awfully "woo" to you? I know. It kind of is. I'm actually really not much of a woo person in general, but this was all I had. It helped me to think I was doing something for myself, being active in the process, and taking back some power in some small way, rather than sitting around feeling passive, powerless, and sorry for myself, victimized by a cruel combination of questionable past choices and lousy luck.

All this was prior to my next cervical check with the CNM practice. I had one more to go before they would give me the no-cerclage-necessary all-clear, and the perinatologist had sent them his recommendation to do all subsequent internal exams via transvaginal ultrasound. So I returned to the CNMs about a week after the Level II ultrasound that diagnosed the previa, a week that had started out as an emotional Space Mountain, but during which I had gradually found my way to feeling more stable and optimistic, however hesitantly. Assuming my cervix was still closed, I was planning on discontinuing the parallel care, but was a little uncertain now that my placenta had thrown a wild card into the mix.

I started with a trip to the ultrasound technician's room, where she confirmed the same placenta location, and also noted that my cervix was still long and closed - no sign of 'incompetency'. I then went into an exam room to wait for whoever the rotation assigned to me that day, feeling a little wary but fairly resolved, based on everything I had learned.

The CNM that entered the room was the one I had come to think of as Ms. Worst Case Scenario, the youngest one in the practice and also, in my experience, the most conservative. It had been she who raised the alarm about my cervix to begin with, and had exerted a substantial amount of pressure regarding prenatal testing. Now, she looked over my revised chart with its fresh new scarlet P, and reviewed all the precautions I needed to take, including pelvic rest and no strenuous exercise. I agreed to all of the precautions, and then started to explain what I was doing on my end, with visualization and positive thinking.

She cut me off with a shrug, saying, and I swear I quote this word for word, even after all this time, "Well, either it's going to move or it's not, and no amount of thinking you do is going to change that."

Long pause.

You know, you don't have to believe in what I was talking about. I had my own doubts. But my GOD, it was obvious that the whole placenta situation was really , really upsetting to me, and even more obvious that this was something that was helping me to feel better about it. Would it have &@#$!ing killed her to at least pretend to be - well, not supportive, because that was clearly beyond her, but to simply remain neutral? Sure, YOU might not think it would help, but there's also no way it would hurt, so what the hell was the problem? Even a noncommittal nod, a "Mmm-hmm . . ." and a change of subject would have been preferable to just dismissing me outright.

I shouldn't have let it affect me, but I was already on shaky ground. I tried to remind myself that, AGAIN, this was just the world that she came from, and she wished me no ill will; on the contrary, she was giving me the care that she believed in, and was trying to do what was best according to her belief system. A placenta previa WAS something to take seriously (none of my posts are intended to suggest that it isn't.). And again, in contrast with other major pregnancy complications, fetal OR maternal, things certainly could have been worse. I knew better. Already, I knew better, yet her words took the wind right out of my fragile fledgling sails.

Slowly, I was realizing how I had been swept along in a cascade of interventions, prenatally. Hospital tickets aren't only issued for the grand finale-ride of labor.

We went on to have a bit of an argument about whether or not it was okay for me to fly home for Christmas. I had mentioned my plans to visit family in Colorado, and she grimaced as though I was suggesting I take up jousting. Asking her to explain her concerns, as every book and website I visited stated that travel was fine at this point (it might be unpleasant when feeling nauseous in the 1st trimester, and that in the third, the concern was that IF one should happen to go into premature labor, one would be away from appropriate care - not that it caused premature labor), that 2nd trimester was the safest time of all. Did my previa make some kind of difference?

She said her concern was the possibility that an abrupt change in pressure, should there be an incident, could cause my water to break. I was learning to speak up, however hesitantly, and have fewer l'esprit d'escalier moments five minutes after leaving the office where I thought of all the things I wished I could have said in the moment, and I pointed out that this unlikely scenario could happen to ANY pregnant woman. So was she really suggesting that no pregnant woman should ever board a plane, period? She waffled a little, but essentially said yes. There was a risk, and if that risk came true, how would you live with yourself?

This is pretty much where I realized that East was East, West was West, and never the 'twain shall meet. I was trying to reconcile two very, very different worlds, and had fallen into a strange kind of mostly self-created trap as a result. The fact that I had been needing to decompress after every CNM visit had already demonstrated that there was a fundamental dissonance in mindsets. However unintentionally, I had bought the hospital ticket. I went into the situation thinking that parallel care would be "the best of both worlds", but it became ever clearer that it was not nearly as simple as that. The kind of care given (and sought) in pregnancy IS, in part, a manifestation of various sets of beliefs. I don't think it's remotely as black & white - or as polarizing - as "Trust Birth" vs. "Fear Birth", but there IS a spectrum between those two poles, and these particular CNMs** and I were clearly many, many miles apart.

I left that visit with a stamp of approval regarding my cervical competency, informed them that as a result of said competency, I was not planning to continue parallel care in general, but did need to return for a follow-up ultrasound at 28 weeks. The odds were totally with me. One more spin on the hospital ride, I hoped and prayed and visualized - to see if it had migrated.

Here I break with what would make the most sense in serial narrative form, and post a spoiler:

It hadn't.

*Note: I'm a fan of Floradix, but word to the wise, plan to have something in hand to 'chase' it with immediately. Great product, revolting taste. I always followed with orange juice.

**It bears reiterating that I am not at all trying to slam CNMs in general - this is, again, just my own experience.


  1. Good grief woman but you can spin a tale and leave a Doula hanging!

  2. I'm so sorry! If I told it all at once it would be ridiculously long, though! All the powers that be say you should try to keep posts under 1500, and I'm already over the limit! :O)

  3. It really is remarkable how AWFUL these "medical-model" prenatal visits can make you feel. Scared, unsure, ready to scream "YES, PLEASE" at almost every suggestion. It really is a truly amazing psychological process. When you are a person who has been in both models of care, the differences are so striking as to be not even addressing the same someone who had almost every high-risk red sticker firmly pasted to my charts during my OB/CNM care, I can relate. Those very same pregnancies resulted in smooth, gentle, intervention-free homebirths. It is disheartening to see the typical outcome when the care is continued in that model for a healthy pregnancy. I love Ina May's new book in which she suggests that ALL hospital/OB/maternity staff be certified doula's BEFORE they enter into their formal education.

  4. Personally I thought Floradix wasn't bad. I never chased it... Well anyways, I had obcencely low levels of iron and it I couldn't raise them my midwives couldn't legally deliver me. I took iron in pills and floradix and barely got my irons levels up in time. That stuff is amazing. I'd keep it on hand but it's not cheap and has such a short shelf life.

  5. Justine, exactly! So you can see what a - well, pardon the French, but there's only one term I can think of for this - mindfuck it was to experience both within the same pregnancy!

    Lisa, a chacun son gout! (Speaking of French.) :O) Glad some people like it/don't mind it. I'm just saying, BE PREPARED just in case it makes you want to hurl, like it did my first time. I swear the secret ingredient is squirrel blood. I feel like I heard that somewhere . . .

  6. With my, ahem, sensitive palate and aversion to awful tastes, there's absolutely no way I could swallow Floradix. Which is too bad, as I have ridiculously difficult to treat anemia.

    You're kiiiiiiiiiiiiilling me with the cliffhangers! Part 4 is the last, right??

  7. I had a rotating OB practice for my first 7 1/2 months, and then switched to a CNM just 5 weeks before giving birth (give or take some time). It was a world of difference, but my CNM was wonderful. I know other people who have had csections pushed on them by CNMs.

  8. That is exactly what I did! I read over all my natural pregnancy books, went to my natural parenting sites etc. and they ALL scared me. None of them offered anything reassuring at all..only "this is an emergency and you should seek help immediately." Or something like that.
    It was very discouraging when I was so used to finding alternative info at the drop of a hat. Can't wait to read the next part!

  9. Have you written a part 4 to this story? I am so intrigued about the whole thing.

  10. PaceFamilyGirl, I am ALMOST done with part 4! It's just been a particularly crazy few weeks, including relaunching my other blog (a food one), along with school and work and such. I know, excuses excuses, but I plan to post the last part this week!