Leave it to me...

[bronwynrh]

to have a middle-of-the-road diagnosis. No interventions inside, just talk about what my future may look like :)

I had a trans-v ultrasound today and it was immediately obvious, even to me, that we're looking at marginal placenta previa. That means the placenta is cozied right up the edge of the cervix, but isn't covering it. The technician said it was the clearest case she'd ever seen. Yes, thank you. Leave it to me to be a textbook case.

My OB said that he was no longer in a position to strong-arm me into a c-section (his words), and that I was ok to try a normal birth if I wanted to. He acknowledged that I'm educated enough to understand and accept the greater risk of hemorrhage that comes with marginal previa. He said that many women, knowing the risk, would want to schedule a c-section anyway, but he understands that I'm not like that, and he's ok with it. Yay for a doc who understands and acknowledges my over-educated self!

So I'm *sort of* back in a position of control. Acknowledging the greater risk (and assuming the placenta doesn't move farther away) I told my doctor that, instead of laboring at home as long as I could, I will come in soon after labor begins. That way, if I do begin to hemorrhage, I'll already be where I need to be for it to be managed safely. The hospital is half an hour away from home, and I'm not in the mood to bleed out in the car or while waiting for ambulance O_o

Let's see, what else? Baby measured 5 lbs, which is a couple of weeks ahead of my 31w6d timeline. 91st percentile! I find this amusing, as my son's head was only at the 5th percentile when he was born. Yes indeed, every pregnancy - and every baby! - is different.

Baby is also breech. There's still plenty of time to move, but I'll be paying close attention and looking for advice on how to encourage Baby to Do The Right Thing :) Otherwise, if the baby remains breech, I'm looking an external cephalic version and, of course, the possibility of a c-section.

Oy.

I've scheduled an appointment with one of the hospital anaesthesiologists, to discuss a proper plan in the event I am required to have the c-section. Anesthesias and I don't get along very well, so this is my opportunity to lay it all out for them. If I'm lucky, I'll get one who sees it as a challenge that they want to rise to, and not just a pain in the ass (my OB's words).

I've also got to check/confirm hospital policies (I have two options) regarding where the baby goes after a c-section. One hospital apparently whisks baby off to the nursery while mom is in recovery, while the other lets baby stay with mom. Needless to say, that's an important distinction for me.

So. I think that's it. I go back in two weeks, then another u/s two weeks after that to see if the placenta has moved any more.

x-posted a bit, too. My apologies to those of you seeing this more than once.

Comments

[travellight.livejournal.com]

First it's high school on a different continent from your parents. Then it's a doctorate in something involving material that can't be seen with the naked eye. Now this. Always got to do something different from everybody else, don't you?

It's a good thing you're a tough cookie.

[bramey.livejournal.com]

With some things, I just can't do average, I guess :)

My coworker was telling me yesterday that she'd been thinking about me over the weekend, thinking about how strong I am.

*blink*
*blink*

I don't feel strong, most of the time, but I guess I must be stronger than I think.

[travellight.livejournal.com]

I haven't noted you being average at anything.

You're going to be fine, whatever it takes, you know. Because you're just going to. What else is there to do?

[bramey.livejournal.com]

This is true. The kid's coming outta me, one way or t'other.

[adaon.livejournal.com]

I have no idea what any of that meant, except "At some point, Bronwyn is having a baby."

Speaking of which... when is your due date?

And yes, girl, you are stronger than most. I think I am too. It's simply who we are.

[bramey.livejournal.com]

Well, I do a lot of crying and making-the-husband-miserable, so that makes me feel the very opposite of strong, but I suppose those are my coping mechanisms.

[bramey.livejournal.com]

Oh... October 15 is the official due date. But that really only means, "somewhere in the 4 weeks around this date."

[adaon.livejournal.com]

My mother said I was four weeks overdue - so, she carried me for around 10 months. She was not a happy lady.

[bramey.livejournal.com]

If you think about how it's presented, people often say "9 months" but it's also counted by weeks - 40. So for those who shorthand a month into 4 weeks, that sounds an awful lot like 10 months!

These days, most OBs won't let a woman go beyond 42 weeks. They're so concerned about liability, they stick very closely to their risk assessments and err on the side of too-cautious. Hence the high rate of c-sections these days.

That said, I'm sure your poor mother was miserable. Near the end, carrying this watermelon around becomes quite the uncomfortable burden!

[journalismgirl.livejournal.com]

On the upside, being a textbook case means that they know what to do if there's a problem.

How long will the placenta continue to move. Is this something where you could go into labor, and they could check, and you could make a decision accordingly? (I know about public health policies and childbirth, but outside of my own uterus, my knowledge is fairly limited.)

Baby's a good size!

[bramey.livejournal.com]

I think they can check right up to the end, although growth slows substantially in the last couple of weeks. From what I'm reading, the marginal placement makes it more risky than normal, but less risky than the complete coverage, wherein mom doesn't stand a chance.

Looks like it's going to be a combination of placental and fetal placement that's going to determine whether or not I bleed... what stinks is that I can't find any definitive data regarding risk assessments in the marginal case.

Well, I haven't found it using lay searches. I'm off to search the NCBI.

[journalismgirl.livejournal.com]

When you say fetal placement, does that mean that Baby's being breech plays a role?

I'll see what I can find, too. The lay literature is pretty crappy.

[bramey.livejournal.com]

They lay literature is, indeed, crappy and it's definitely geared toward c-sections. I need more hard data, less lay-interpretation.

From what I can tell so far, breech or anterior presentation may affect the amount of bleeding. I think what they're getting at is that if the baby's head is placed in such a way that it tamps off the site of bleeding, then bleeding will (at least temporarily) stop.

I've not had any bleeding, so I guess for now it's all wait and see and hope. I'll accept the c-section if it's necessary, but I want to exhaust all other avenues first.

[kendokamel.livejournal.com]

Well, you're just about the strongest person I know!

*hugs*

[bramey.livejournal.com]

Heh. Thank you.

If everyone says it, it must be true, right?

[tonya.livejournal.com]

I'll add "Move Bronwyn's placenta out of the way!" to my prayer list. :)

[bramey.livejournal.com]

Thank you!

[sayga.livejournal.com]

I'm glad it is at least not previa. Between the placenta's position and being footling breech, this baby seems to be begging for a csection. Ugh. I hope everything straigtens out. Have you checked out spinningbabies.com? Make sure you're not sitting way deep in the sofa and slouching. If possible, lean forward whenever you're sitting, and don't put your knees higher than your hips (unless you're squatting or something). I did lots of all fours rocking too, to hopefully open up the area to make room for the baby to flip if she wanted.

[bramey.livejournal.com]

Thank you for reminding me about spinningbabies... i haven't checked them out this pregnancy and had forgotten.

how'd you know I was slouching? *looks around, paranoid*

;)

[sayga.livejournal.com]

how'd you know I was slouching? *looks around, paranoid*

Because it's THE most comfortable position to sit in while pregnant!! (and while not too)

[bramey.livejournal.com]

Gah! The site isn't working.
I'll keep checking back, maybe they'll get it back up and running...

[(Anonymous)]

I agree about spinningbabies.com. It sounds like you certainly know your stuff - everything I was going to mention you've already thought of, so I'll just tell you that you're obviously in a good place to make the right decision for you right now. :)

Leah
http://lakelinesthoughts.com/

[bramey.livejournal.com]

Hi, Leah! Thank you for the vote of confidence!

[curlicue.livejournal.com]

It seems people with diagnoses of ANY kind go either of two ways:
They do all the research or
They listen to their doctors and report anecdotally.

Unfortunately, the latter are the websites you seem to be finding. Keep googling, and I hope you find a lot of facts so you can make decisions in an informed manner.

My friend was awake for her csection. She said watching the OB deliver her baby looked like a guy rummaging aorund in a duffle bag for his keys! And they handed her her daughter while they finished her up. (the anesthesiologist did one of those spine thingies, if you'll pardon the technical jargon.) She said it was very satisfactory solution to her myriad high risk stuff going on. So if it goes that direction, see if you can be awake!