Please come home safely – and soon – Spirit Baby

I have been holding off in writing this post for the past week or so because it touches on a topic that sparks deep, unforgiving and breath-stealing fear. 

At my OB appointment last week I thanked my lucky stars for not having a brain or heart aneurysm (at least none of which I’m presently aware) because I was confident either or both would have burst. I have been unable to write about what happened because I’ve been scared to death, not sleeping and very emotional. Admittedly, the lack of sleep from the bruised ribs and last week’s anxiety surge coupled with this evil, unrelenting nausea are not helping me be less emotional or more rational. I am trying to do my best (which for the past 5 days has been not all that well). So it goes.

At last week’s appointment I had asked my OB about what would happen with scheduling and whether he recommended sticking with a caesarean rather than being induced if labour didn’t happen early on its own, assuming my placenta has moved the requisite 6 mm by this Wednesday (at 35 weeks) from where it was on April 29th (at 32 weeks).  If that happens he said it removes the need for a caesarean at or before 37 weeks to avoid me going into labour and facing the risks associated with that (bleeding to death being the worst case scenario, an emergency hysterectomy being another serious risk).

Last week, my OB said that if I get off of the placenta previa watch and only have my crappy placenta (which has been flagged as being at risk of early deterioration and placenta accrete which could also lead to emergency surgery include hysterectomy but apparently that’s all speculative whereas the previa has been concrete) to worry about, he wouldn’t schedule me to deliver until 39 weeks because (a) he’d get in trouble scheduling a section any earlier if there wasn’t a serious risk like previa driving it; (b) studies show babies benefit from staying in until 39 weeks; and (c) that said, studies also show an increased risk of stillbirth in otherwise healthy women over age 38-40 (that ship sailed some time ago!). 

I was so upset, I just shut down.  There is no way I trust this placenta to function properly to 39 weeks.  In the moment last week however I could not express my anxieties. I was struck dumb. Literally.

Some of those anxieties stem from knowing my Mom lost her baby from her second term pregnancy when the doctors would not listen to her saying she felt something was wrong and wanted to be induced – and so I left the office, called the LP and sobbed so hard I had to go for a long walk before I could return to work (which was pointless since I did not billable work after that morning appointment anyway). Suffice to say I was a hot mess. 

If I’ve harboured one unrepentant fear during this pregnancy above all others it is the fear of losing this child. Once we cleared the first and early second trimesters it became a raging nightmarish fear of stillbirth. This fear is potent. It is so profound and deeply seated I cannot tell if it’s driven by intuition (whether a premonition-type thing or otherwise) or merely an overwhelming anxiety.  I suspect it is as deeply rooted as it is in part because of my mother’s experience having punctuated my own childhood and having evoked fear throughout my adulthood since I began trying to have children of my own.

What I can say with certainty about my fear of losing this baby – my dear Azulito/a – at this late stage is that nobody, not even my OB or my other caregivers, are saying it’s irrational or unreasonable or not founded in the reality that we all know that my placenta is troubled, that my immune issues elevate the risk of something going seriously wrong at this late stage, and that a family history of this happening is not something to brush away like a family history (maternal) of male pattern baldness (not to say that hair loss in men is inconsequential but it’s not the life or death of your child). 

Nobody has tried to tell me that there’s nothing to worry about. Because that would be a lie. My worries are legitimate. The risk is real. And none of that helps assuage my fear or my wish to end this pregnancy sooner rather than later if it means I get to hold a living baby at the end of this journey and not mourn the loss of one whose life expired before the generally applicable expiry date.
Another thing I can tell you about this fear is that it’s a powerful motivator. I would climb mountains, wrestle wild beasts and tear out the eyes and heart of anyone who stood in the way of my goal to deliver this child before it’s too late – whatever too late might be. I have never been more of a mama bear than I have been in my non-sobbing moments during the past week. I would move mountains if I had to. Those of you who’ve been ‘here’ or somewhere like it know what I mean. And I know you’d do the same. I *know* you would.

 I would also consume supplements and drink horrible-tasting and devastating side effect-inducing cocktails to bring on a natural labour. On that note, I’ve been lining up the ducks for that eventuality should it become necessary. Whatever it takes.

 For now, however, at least until early Wednesday morning this week, I am still considered to be diagnosed with Placenta Previa. I cannot say I want my placenta not to have moved – I don’t really want a caesarean to be honest and most of you will recall I never did. The LP still wishes I’d forego the risks and just choose that path regardless. My OB is letting me decide if the previa diagnosis disappears this Wednesday (so is the LP though he knows I know what he would prefer).

 This morning, my OB relented on the 39 weeks requirement and said we can talk about inducing earlier if the previa is determined this week to have resolved itself. I asked if he’d agree to 38 weeks and he said possibly and agreed we could talk about it next week (Wednesday) if the previa is resolved. He also gave me another requisition for blood work to test my bile acids (more fasting – awesome!) in case there is any chance of me developing Cholestasis again (there is a 50-70% risk of reoccurrence). If I do, that would involve an earlier induction or caesarean too. Why? Because the big risk with Cholestasis is stillbirth.

(I know, right?)

I said I was not wishing to be diagnosed with that again even if it meant an earlier scheduled delivery. Thanks but no thanks!

I really like my OB but this roller coaster is no fun. I want someone to hit the emergency stop button so I can get off. I’ve had enough. 

As matters stand, I might be delivery via c-section on June 9th. I might be ingesting stuff that in the course of making me sick I hope brings on labour and a vaginal delivery. Or I might be getting medically induced or going through a scheduled caesarean sometime in the week of June 15th. The LP is in trial every day from next week until the end of June and two days this week. The timing could not be more perfect. So it goes.

It is time, Azulito/a. Please come home safely.  And soon.

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56 thoughts on “Please come home safely – and soon – Spirit Baby

  1. I can totally pick up on your fear. And my dear friend, you have every right to be fearful. I think Wednesday will give you a better idea of your options, but I do wish your OB would LISTEN NOW instead of increasing your anxiety. I’ll be sending lots of positive vibes to you that baby will arrive safely… and early.

    • The weird thing is, my OB is very aware of and verbally acknowledges my fears. He conveys a great deal of sympathy and has said to the LP today that even without an indication that would require surgery for example he would agree to do it on our case. I know saying “let’s talk about this again next week” is his way of saying he does not want me worrying unnecessarily because the whole dialogue may be moot if my placenta ha not moved at least 2 cm from the OS. He even said he does not want to tempt fate by even discussing worst case scenarios though he genuinely appreciates our concerns and my anxiety. His ability to calm and reassure us is a huge part of why we like him (the other being that as the head of obstetrics and high risk here and an expert used extensively in medical malpractice cases he is knowledgable and careful) and would normally go a long way with us toward alleviating our (especially my) stress. And I do feel better after today’s appointment than I did last week. But not knowing and not having a firm commitment scare the crap out of me and no statistics or assurances are going to change that now. That part just sucks. Thank you so much for getting it and “hearing” me.

        • Of course. It’s the unknown and the fear that those we need (and can’t simply work around) will fail us when we need them most that fuels such anxiety. Ugh. I wish this were simpler. Or over already.

  2. Nothing about this pregnancy has been easy- why should the ending right? All jokes aside, it sounds like you’re caught in a situation where all options kind of suck, and so your focus is then on maximizing the chances of your take-home baby. I hope that Wednesday brings news that you can work with, and that your OB works with you to find a comfortable solution. I hate how anxious and scared you are, and I feel it through your writing. I know that nothing will alleviate it other than having that baby breathing in your arms, but hopefully finding a plan that sits well with you helps too.

    • Thank you. I don’t think I’ve ever understood the word unfathomable as intimately as I do these days. I cannot imagine going on living if we lose this child now. I can’t even think about it.

      • Don’t think about it. Don’t give energy to the negative outcomes. Do what you can to focus and visualize things working out. I know it’s so hard because sometimes our intelligence makes us focus on the stats and the scary possibilities,

        • Yes. That’s always been a good practice for me, to visualize the outcome I want. The trouble right now is that the fear has shaken me to the core and I can’t even get to a place of sufficient calm to meditate or visualize and “buy in”. I will never say I hope the previa persists or I get a crappy bile acids blood test result this week because both spell risk but honestly because they’d mean baby would be here in 2 weeks I would take either one over this dreadful uncertainty and endless anxiety. Thank you for all of your support and kind words.

        • Thanks. Poor baby and poor MT. I made both stop while I lay down at the park in very prickly grass yesterday to poke and prod my belly because I had not felt movement in a while. I’m sure that isn’t what you had in mind but this is the manifestation of my worry. And my love for this little one. I cannot lose this love now.

        • We have all been alongside you since your beginning with this little one. Your love for Azulito/a is vast and deep. You have a world of followers sending good intentions. We’re all rooting for you and baby.

          As for kicks, I’m in the unfortunate position of having an anterior placenta, so Dumplin’s once obvious kicks (at about 14 weeks) are less obvious now (at almost 18 weeks). It’s driving me nuts!

      • … But do what you can to stay sane and take care of yourself. Fight for what you want on Wednesday, and believe that things are more likely to work out favourably than you think.

  3. I believe most fears are not grounded in reality, but rather our minds playing out the worst case scenario. That said, your fears right now, they are real and are deeply grounded in your reality. Your history, your mother’s history, your current immune reactions, these are very real high risk scenarios. You have every single right to be fearful and to fight for whatever you need right now. Like Lindsey above, I wish your OB would listen to you now, but I have faith in you. Keep fighting momma bear, you’ve got this!
    Sending you so much love and dreaming of the day that your little Azulito/a arrives safely.

    • Thank you. I don’t think he isn’t listening so much as wanting me to calm down by not going to bad places in my mind if it all at be for nought. Usually his advice in that respect is helpful so maybe he’s as lost as I am to reconcile this. He did expressly say he would be willing to induce before 39 weeks today. That’s not commitment enough to help me feel confident but it’s better than where I was a week ago so I took it. I suppose there is something to be said for not tempting fate too. 😉

  4. I am joining this too late in the process to be worthy to comment, but I must say one thing: you are an awesome mother. Truly you are. A fierce lover of your children. And because children know everything before they forget, your children know this too.

  5. *Hugs*! Are you having NST’s? I was having bi-weekly NST’s and if I showed the slightest amount of distress they’d threaten to keep me in the hospital. It took very little for my BP to spike past the acceptable range (hint hint) and if I had wanted to deliver early I know that would’ve been my golden ticket. XOXO

    • I have notoriously low BP (90/60) and even under all of this stress the highest it has gone is 110-112/80. And that’s on prednisone which raises it. 😦 If you have tips I’m all ears. I’ve been having BPP ultrasounds instead of NSTs but my plan is to burst into tears on Wednesday and spill my guts about my anxieties (perhaps inadvertently reminding her that we are both litigators) to the MFM (Perinatologist) and asking for more monitoring of baby if I won’t be delivering on June 9th. Funny you say this given that my OB was also looking for a good reason to keep the date and even thought said I haven’t been super itchy this time he’s sending me for the cholestasis tests too. If I knew how to increasezm

  6. Omg poor you.. I can’t even imagine what your going through. You have every right to question the doctors we have to be our own doctors so your doing the right thing. I wish you strength during this last stretch.. Wishing you a safe delivery. Hope that wed appointment is a good one!!

  7. Sending you a big virtual hug. I have no words of wisdom and I know nothing I say will ease your fears. Sending so many wishes for you and Azulito/a to make it through this final stretch and come out of it happy and healthy. xxx.

  8. I simply have nothing I can add that I feel,is going to be beneficial at all, so I will simply tell you I am saying some prayers for you and little A, and that I fervently hope with everything crossed that however this all plays out (vaginal birth or csection, earlier or 38/39 weeks, whatever) that when it is all said and done your holding A and looking into each other’s eyes and everything else is a non-issue. Because that’s what matters, that s/he arrives safely, regardless of avenue of arrival. All best, darl. All best. Xoxo

  9. I have no words except know that I empathize with your feelings in the deepest way possible. I feel so invested in your having your spirit baby safely in your arms sooner rather than later (in the context of 37wks vs 39wks). Huge hugs.

  10. I am attending yoga shortly and my intention for my practice tonight will be to wish you and your family an abundance of good health, peace, and love in your journey ahead.

  11. I am so, so very sorry for all that you are going through including the fear and anxiety. ❤ I wish I could say something that would make everything better. You and Azulito/a will continue to be in my thoughts and i am sending so many positive, healthy thoughts your way! Much love to you!

  12. Hoping all will be well! I am so behind in my reading, I didn’t know you were pregnant! Anyway, I had placenta previa and surprise placenta accreta and villitis. I went from wanting a midwife-led birth to a planned caesarean. I was devastated to think I’d had something else snatched away from me. But, honestly, it was okay. The first two days were rough, but I was amazed by how quickly I recovered. When you’ve fought for so long to have your baby, when you’ve given up the genetic connection and your wishes for the birth of your child, YOU CAN DO ANYTHING. Promise. Happy to chat further, feel free to email! L xo

    • Thank you so much for this reassurance. You are so right about the ability to do anything after the journey we’ve had to get to this point. Were your caregivers able to manage your accreta and villitis without hysterectomy? I don’t recall your mentioning that but I can’t remember my middle name lately so that means nothing. ;-(
      I’m okay with the surgery if need be, I’m way more scared of losing this baby due to my crappy placenta by pushing its limits. Thank you again for sharing. I may yet email you depending on how my u/s goes tomorrow. I’ve been flagged at risk for accreta because of the poor vascularization of the placenta, multiple large placental lakes (vascular lacunae) and elevated maternal serum alpha-fetoprotein (MSaFP) but so far it hasn’t been confirmed (or refuted) through my many prior ultrasounds with the MFM clinic.

      • I did not have a hysterectomy. It was a rough surgery because of the surprises. In your case they suspect / know ahead of time and be prepared. Ask your OB what their protocol is with accreta. The risk of haemmorrhage is high so some OBs perform a hysterectomy rather than trying to detach the placenta. Then again, my OB said there are a number of measures that can be taken before a hysterectomy is performed.

        I also had high MSaFP — high Inhibin, anyway — which put baby at risk of IUGR. She came out at a healthy 7 lbs 11 oz at 37 weeks. Obviously everyone’s situation is different but just be you’ve had bad news doesn’t mean doom.

        And, honestly, as long as your baby arrives and is healthy, everything else is negotiable.

        I’ll be thinking of you tomorrow!

        • Thank you so much for sharing. The protocol with my OB is to attempt removal of the placenta unless accreta or percreta has been confirmed prior. I’m not generally a doomsayer but I’ve been warned of the risk of stillborth and iugr and preeclampsia since before I got a BFP and am averse to avoidable accordingly. Until the past week or so I was holding my fear in check and maintaining a healthy optimism. Feeling unheard about my deepest fear last week threw me in a tailspin. I really appreciate you sharing your experience. Thanks again.

        • I see — and because they can’t confirm either way, you don’t know what will happen on the day, and that alone is enough to stress anyone out without the added worries about placental function, stillbirth, etc. Ugh. Big hugs xo

  13. My heart hurt for you reading this. I really hope you get some news on Wednesday that you get the answer you want and need. Don’t be afraid to push and be your (and baby’s) advocate. In the meantime, I’ll be thinking of you. I have faith in you, and in your baby, and am sending you both love.

  14. I am in intercessory prayer that come tomorrow, the doctors will be able to tell you something positive. I, like LP, think you should do the c-section and do what is safest. You have LP, MT, and Azzie here and they need you. Do not do anything that will risk your life. You have worked too hard, worried too long and fought to get to this moment !

    As for your fears, it breaks my heart that you have such anxiety over this and it is truly understandable given all that you have been through. Praying that tomorrow brings you some good news and that you can move the date up a little so that you have one less thing to worry about. I can not wait for this little one to get here and all the stress and all the worry to be over and you will look at him or her and feel such relief and joy !

    xoxoxoxo

    • Thank you so much for your prayers abs compassion. I am really torn about delivery if it comes down to me choosing but right now I’m hoping I don’t have to choose because that would mean much of this anxiety could be put to bed for the moment.

      • Just go with the c-section and leave the rest to God. For me, I will NEVER opt to push a baby out LOL. That is “labor”… I will take the easier way out and let them cut me and then get a tummy tuck lol. I have to keep the hoo-haa nice and tight ! 🙂

  15. You are all in my thoughts. If only every baby could have such a devoted mama bear. I hope tomorrow’s appointment will bring you a plan you feel comfortable with. I wish we could all take just a bit of this worry off of your shoulders for you.

    • Thank you Molly. You’re no stranger to stress lately yourself. It would be nice to have a Hollywood pregnancy where nothing goes wrong, we all look glamorous and get lots of rest and freedom from any serious worry. Wouldn’t it?

  16. Very very sorry to hear about your situation. I am hoping that your provider allows you to deliver before 39 weeks based on a shared plan that you create together. That being said I would like to make a few somewhat controversial comments from the standpoint of a family doctor/OB researcher/husband/parent/person. I will add that my background includes connections with several USA stillbirth organizations (ASAP/Star Legacy) and I have been sensitized to the devastating impact of the “outcome” called term stillbirth. I would add that I would be happy to provide citations from the medical literature that support the followoing comments (e-mail: jnicholson@hmc.psu.edu).
    1) The first comment is that one of the three major medical ethical principles we learn about in medical school is “Autonomy”. “Autonomy” captures the idea that patients should have the right to request or refuse reasonable medical treatments. Is your request for an induction of C/S prior to 39 w 0d reasonable? Sure sounds like it to me – and many others on this comment page. However, the principle of “Autonomy” often conflicts with – and is truncated by – the principle of “Beneficence”. “Beneficence” involves that obligation that providers have to treat their patients in the best possible way. The best way possible is usually determined by high quality research. The 39-week Rule was developed/enforced by multiple professional organizations because of the belief that its use provides better outcomes than not using the 39-week Rule (i.e., allowing “non-medically indicated” delivery prior to 39 weeks 0 days of gestation). However – and here comes the controversy – the research that supports the current 39-week Rule is not of high quality, and there is an increasing amount of higher quality research that is showing that planned delivery earlier – rather than later – within the term period of pregnancy (defined as 37 – 41 weeks of gestation) actually provides better outcomes (lower C/S rates, lower NICU admission rates, lower term stillbirth rates). In other words, there is NOT a solid evidence base of high-quality research that supports for either the imposition of the 39-week Rule in particular OR the growing restrictions on the use of “non-medically indicated” term induction in general. In fact, the 39-week Rule is actually in conflict with an increasing amount of high-quality published research. All in all, there is not a solid base of high quality evidence that justifies the unilaterally application of the principle of “Beneficence” at the expense of “Autonomy.” Accordingly, the principle of “Autonomy” should carry much greater weight than it currently does. Yet – as you are experiencing – the 39-week Rule continues to be used to effectively block patient Autonomy (even, shall I say, “distressed” patient requests for Autonomy). I do not think this situation – as it currently exists – should be tolerated. Yet many many women are currently feeling helpless with reference the timing of their childbirth
    2) The second comment is that it is well known that the cumulative risk of term stillbirth increases with increasing gestational age. That means that the further a woman goes through the term period of pregnancy, the more likely it is that her baby will die in utero prior to delivery. Many people do not know that term stillbirth is a relatively common “outcome” – it occurs in more than 1 out of every 1000 USA term pregnancies. “We” – speaking as a provider – generally do not warn women about the increasing risk of this outcome as they pass through the term period because “we” – speaking for the profession – do not think there is much that can be done to lower that risk……..”so why worry the pregnant woman who already has so so much to worry about……….” However, something can be done…….term pregnancies can be delivered somewhat earlier rather than somewhat later. What IS the optimal time for delivery for any given pregnancy? That is unmeasurable at this point in time (we do not have algorithms that can give us individualized answers to the question “What is the optimal timing of your delivery”). However, the optimal timing for delivery is certainly NOT captured by the 39-week Rule. Yet the Rule is being applied in a strict manner to the general population. Recent publications have concluded that the more regular use of “non-medically indicated” labor induction – including “non-medically indicated” labor induction in the early-term portion of pregnancy (the 37th and 38th weeks) – significantly lowers the risk/rate of term stillbirth without increasing the risk/rate of other major birth adverse birth outcomes. There is growing concern that the 39-week Rule, by forcing many women to gestate longer and until at least 39 weeks 0 days of gestation, is increasing the rate of term stillbirth in the USA. So is your concern about your baby reasonable? Absolutely! Is your baby at higher risk of stillbirth than a “normal” pregnancy? Certainly! Would term delivery prior to 39 weeks 0 days lower the risk of term stillbirth? Yes! The delivery of you baby in the 37th or 38th week of gestation probably increases your baby’s risk of needing NICU care for a day or so, and probably increases your baby’s risk of other more serious problems (expectant management can also lead to serious problems), but a birth plan involving an early-term delivery would clearly lower the risk of stillbirth. Do you feel capable of weighing the risk of multiple potential outcomes, filtering those risks through your own personal situation, incorporating your provider’s recommendations and coming up with a birth plan? Is so, what would your birth plan look like?
    3) The third comment is that the 39-week Rule is very well established and will be in place until it is challenged by the people who are – or have been – most affected by it (i.e., pregnant women, or women who have suffered adverse outcomes because of delay in the timing of delivery). From a strictly scientific standpoint, the evidence that supports the Rule is not of high quality. From a medical standpoint, the process by which the Rule became a strict national policy was flawed. Beliefs became agendas became recommendations because enforced policy. It is unusual that a clinical guideline (the 39-week Rule) was developed and enforced without the support of even a single randomized clinical trial. The Rule needs to be challenged. The autonomy of pregnant women should carry much more weight than it currently does.

    Finally, I truly hope that you and your baby do well in the weeks/years/decades to come. But I also hope that something is done in the near future that will challenge the 39 week Rule and that changes will occur that will provide pregnant women and fetuses/babies with better outcomes than they currently have. One of those changes hopefully will be that greater weight will be placed on the preferences that women have concerning the timing of their childbirth.

    • First, I am deeply indebted to you for the time and consideration as well as the helpful information and perspective you have shared.

      As it turns out the placenta hasn’t moved (found out this morning) so surgery is not optional and delivery is scheduled at 36w 0d. I’m both relieved and disappointed if that makes any sense. My partner is simply relieved. I have a background in medical malpractice defence (my OB was my former firm’s favourite expert on “bad baby cases” – always hated that term). I consider myself capable of making informed choices and considering risks and recognizing liabilities and were it not for today’s ultrasound results and the MFM telling me no chance of delayed or vaginal delivery this morning, I would be asking you if you’d mind sending citations so I could make my case with my OB. Though I don’t need that now personally I would very much be interested in sharing more of what you’ve written here and creating a post about stillbirth risk, autonomy and beneficence in the future. Would you mind if I called upon you in that regard? A friend a couple of years younger than me but still AMA lost her baby at 39 weeks last year and I think about her trusting her doctors to her detriment often. To be fair, I do trust my doctor – or I wouldn’t be with him – and he was willing to discuss and noted the Autonomy principle with my partner and I earlier this week (knowing we are both litigators and assuming my partner did medical defence work too, which he never has). I don’t blog to have a million followers but many of my blogging friends have factors that may increase their risk of stillbirth as well. I would like to share more information if you would be interested in working with me to do that (meaning sharing your citations and any other resources to which you can refer me). My blog email is spirit.baby.please.come.home@gmail.com. I’d be happy to include links to organizations in which you or others you support are involved as well.

      Finally, assuming you actually carry a Y-chromosome, you ought to win a prize for being the only male person to have ever commented on my blog! Thank you again – truly – for sharing what you have.

  17. Oh friend, that seems like a lot of fear infused into a time that should be filled with waiting and getting ready for Azulito/a’s arrival. I’m glad that you are voicing your concerns so adamantly to your OB. I hope everything turns out well. Ive been thinking about you….sending love your way…also, the only thing that has been proven to bring on labor is nipple stimulation…you may wanna get on that!

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