Sunday, April 10, 2011

The Parallel Paradox Part 2 - Diagnosis of Placenta Previa

And so the stage was set.

Despite not having any health insurance, and despite my own reservations, I agreed to the CNMs' recommendation, returning to their practice to have my cervix checked every 2 weeks. As frustrating as this was, I only planned to continue this parallel care until week 20, when they had decreed we could stop the cervical checks. Once I got the all-clear, I was done with them, and would continue my care with Nancy and Gengi alone.

So began a pattern where after each visit to the CNMs, I would visit my CPMs to decompress from the experience (or make a lengthy phone call, if we had no appointment that week). Nancy and Gengi, who I thought of as my 'real' midwives - not because CNMs (a.k.a. nurse midwives) are not legitimate, but because I had started out with no intention of getting any care from them; I had just stumbled into it - did an admirable job of talking me down after each CNM experience.

Fortunately, as those who get CPM care know, these visits were always at least an hour long, sometimes more. The old joke is that with an OB you wait for an hour and see them for 5 minutes, and with a CPM you wait 5 minutes and see them for an hour. (In my experience, which is only my experience, with these particular CNMs, you'd get about 15 minutes rather than the OB's 5.) With Nancy and Gengi, sometimes the first half an hour or more would have to be devoted to therapeutically working through the damage from the last CNM visit. It mostly had to do with my potentially-incompetent cervix, but there were plenty of other opportunities to instill other doubts and insecurities, too. You've gained HOW much weight already? Aren't you getting any prenatal testing done? And what about those suspicious dates?

At week 14, I stayed after my cervical check to get a dating ultrasound, in order to clear up the discrepancy between my conception date and the extra centimeter or so my belly was measuring. I had only planned to get one anatomy scan at around week 20, but hey, what's one more compromise? I got my first glimpse of the precious, and determined that the dates were possibly a week off, though it was impossible to tell for sure (but hey, what's an extra cost for no reason at all?). I also was told that my amniotic fluid might be a little bit high (but hey, you PROBABLY don't need to worry about it yet).

And then, literally as I was on my way out, the technician seemed to make a last-minute decision to share one more piece of information with me, something she had been hesitating about.

"Just so you know, right now it looks like your placenta is lying a little low." I must have looked alarmed, because she immediately added, "Most of the time it'll resolve by the end of your pregnancy. It's pretty common for it to be low this early.'

I left the office feeling uneasy, but decided to take her word for it and investigated no further at the time, focusing on the pictures of my sweet wiggly little being, the fetus we came to know as Samily - Sam if it was a boy, Lily if it turned out to be a girl.

More cervical exams with the CNMs, more ranting and railing therapy sessions with my midwives.

Eventually, week 18 arrived, time for the Level II ultrasound I had agreed to as my one concession to prenatal testing. For this, I went to the UCONN Health Center, where the most advanced technology and high-risk specialists were located. Somehow, walking in, I still looked forward to it, being as interested in all things pregnancy and birth as I was. Surely it would be objectively fascinating as well as personally moving to get such an in-depth look at my future baby. First, a friendly technician set me up, spreading the gel and connecting the computer screen to a larger screen where the images were projected on a huge wall in front of me.

There she was (though they complied in keeping the gender a secret), my gorgeous baby. I was captivated, glued to the screen as the technician took measurements and pointed out various parts. There may have been a point where she furrowed her brow and looked worried about something, but I'd be lying if I said I remembered or even noticed at the time - I was too enchanted by the black & white silent movie of my dream come true, shifting and squirming and already looking cuter than any ultrasound I'd ever seen - my motherly bias was already in evidence.

Then the perinatologist entered the room, a bearded and professionally aloof man in a long lab coat. After briefly greeting me, he turned to my chart, reviewing a few things like my age and how many weeks I was. Then he asked about number of pregnancies, seeing that his was not actually my first, and asked, about abortion, "Okay, was this a spontaneous abortion?"

Excuse me while I digress here for a minute. Not only was that completely unnecessarily awkward and uncomfortable, I am fully aware that the medical term for a miscarriage is "spontanous abortion". Is there ANY woman, ANYWHERE who would actually refer to her own miscarriage as a "spontaneous abortion"? For crying out loud. I realize that one's history is important, but there has to be a better way to clarify. Anyway, already off on the wrong foot, I begrudgingly confirmed that no, it was not.

After going over Samily's measurements, which all appeared to be perfectly normal, he moved on to the placenta. Which brings us back to where I opened.

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

After a nanosecond of shock, I burst into tears. I could already see myself on the operating table, right then and there. My hopes of a home birth or even a natural hospital birth, dashed. My body, a betrayal. The doctor, to his credit, tried to reassure me. He explained that, as the technician had mentioned, the odds were in my favor that the placenta would migrate upward as my uterus grew, and that most previas diagnosed this early would 'resolve' by the end of the pregnancy.

There are varying degrees of placenta previas. There are complete previas, which refers to when the entire cervix is completely covered; then partial ones, where only part of the cervix is overlapped; and also marginal ones, where the edge of the placenta just barely borders the cervix but is still close enough to be a concern. My own, to be more specific, though it was complete, was not centered over the os (the 'mouth' of the cervix), as depicted here:

Rather, mine was positioned so the lowermost edge of the placenta lay over the cervix. A bit more like this:

He then used the analogy of drawing a dot close to the opening of a balloon before it's blown up all the way; the dot won't actually relocate, but it will appear to move upward as the balloon grows. This was likely to happen with me - likely, but not guaranteed. I nodded through my tears as he explained that a follow-up ultrasound would be scheduled for about 28 weeks, and this meant that I was on pelvic rest until it was determined that the placenta had cleared out of the way. No sexual activity of any kind at all, especially anything that could cause orgasm, and nothing in the vagina, period. For the next 10 weeks, I was also to avoid any exercise more strenuous than gentle yoga.

Oh, and (double-checking my charts) due to the need to continue checking my cervix for at least one more appointment, the exams would need to be done via transvaginal ultrasound, rather than fingers. Yes, that's right, I was on order to have nothing in my vagina, nothing, not even the gloved fingers of a conventional medical professional . . . unless it was a big expensive medical dildo-like medical instrument. THAT was fine. I agreed, of course, and tried my best to hold it together until I left the office.

As soon as I hit the elevator, I finally let myself sob and sob. The doors opened on a group of young doctors, and I quickly walked by their sympathetic looks, feeling ashamed. Even then, I had perspective. I knew that this medical center had seen more than its share of sobbing pregnant women, and the reason for that sobbing was often much more serious than my own. I knew that this very moment there were women receiving far worse news than I, news of terrible congenital defects or other heartbreaking outcomes. I knew that given the opportunity, plenty of women would trade places with me in a heartbeat. A mere c-section compared with one of the "incompatible with life" triosomy abnormalities, just for one example? No question.

But being aware of this, and trying to count my blessings, didn't quell my sorrow or my fear in that moment. I called the father from my car, followed by my midwife (my 'real' midwife), both of whom did their very best to reassure me. A for effort.

Part 3 coming soon.


  1. I'm going through this very thing *right* now in my pregnancy. I wasn't told to be on complete rest, or even to abstain from sex (is it really a problem?!?)... I just hate having to gestate and be nervous at the same time. High risk imaging coming up in a week and a half... :-/

  2. I'll try my best to complete the trilogy/quadrangle before then, Candice!

  3. You know what I'm going to say Anne, right?

    Can't believe I almost went to bed without seeing this, me who has been hanging out for it "forever" :dramatic:

  4. I find this so weird. Maybe I didn't read the post carefully enough. I'm super tired (and sick), that is more than possible.

    I live in Canada and had the care of a midwife as well. At my ultrasound they said that it looked like the placenta was covering *some* (not all!) of my cervix. They said, maybe a c-section, maybe not. Asked me to come back for an ultrasound many weeks later. My midwife barely raised an eyebrow. This also happened to at least 8 other women I know off the top of my head. None of us had c-sections. NONE of us were told to take any precautions in any way at all!

    NOW. I am NOT saying that what you were told was wrong or advising you to do ANYTHING outside of your medical advice. I am just curious about the difference in treatment. Again, maybe I didn't read it thoroughly enough, so if my questions/curiosity is irrelevant then just ignore...

    I understand your worry and potential heart break. I hope for you that things will shift and all will be well. I think you are wise to count your blessings and hold on to them :) Good luck.

  5. Thanks, Momsicle! This is probably clearer in the first post than I made it here in part two, but it IS all 3 years in the past and (SPOILER ALERT) it did eventually migrate, thought not until very late in the game. I went on to have a home birth with no complications.

    I'll be getting into how I think it all could have been handled better (including by me) in the next post or two. It sounds like the way your midwives dealt with it is a huge improvement. If being Canadian is a factor, then go Canada! :O)

    I hope that clears up your curiosity, somewhat at least! Parts 3 and 4 on the way soon. Ish.

  6. Thank you for posting this!!!!!! I was just diagnosed with a posterior complete placenta previa a few days ago (13 weeks). I have been freaking out by what I've been reading...and I too am a home birth midwife mama. So this is all very overwhelming to me. I go back in 2.5 weeks for another scan to get a little more detail on the exact location etc. I can't wait to read your next posts!