Friday, May 4, 2012

Sad and scary

I know this isn't news to a lot of people, but recently another blogger who had lost her first child due to spina bifida recently lost her rainbow baby at 36 weeks due to a uterine rupture (she had a vertical incision with her first baby.) A beautiful, healthy, nearly full term baby girl. Fortunately, there aren't that many people who lose babies in two separate incidents for two different reasons. But it does happen. And it is so incredibly sad and tragic and not.freaking.fair.

This is why I felt like I was holding my breath every second I was pregnant with Lucas, and him being safely born alive was the biggest relief I felt in my life. (Until I think some of the postpartum hormones hit me pretty hard and I still then managed to convince myself he still was going to die at any second. I seriously TRIED NOT TO SLEEP for like the first 3 days he was here because I was terrified I would wake up and he would be gone.)  It's easy to tell someone "you don't have to worry about that", but so hard to really believe yourself. There are a number of people on the pre-eclampsia foundation forums who have a horrible first pregnancy, a normal second pregnancy, and then an even worst than the first pregnancy for their third. Of course there are also people who have a normal second pregnancy AND ALSO a normal third pregnancy. I wish I knew in advance which group I would be in.

I was talking to our infant loss group leader a couple days ago and asking her how often she has the same people back twice, and how often for unrelated reasons (aside from miscarriages). She said she has NEVER, in 20+ years working at a major L&D hospital with the highest level NICU in our area, had someone come back for a different reason. She also said she's only had a small handful of people with more than one later loss, and those are always known and related issues like incompetent cervix and pre-eclampsia. (Yes, she did give pre-eclampsia as an example. I'm glad I didn't ask her this when I was pregnant with Lucas! Not that I didn't very well know what was at stake, but I tried to focus on the people who had horrible first pregnancies and healthy second pregnancies.)

There is also that scary risk of uterine rupture now in my mind. Don't get me wrong, my OB made me very well aware of the risk (more than once) before she agreed to do a classical c-section to deliver Olivia. And they pounded it into my head, ad nauseum, while I was recovering in the hospital that week. "You have had a vertical incision on your uterus, which now gives you a 1 in 10 chance of uterine rupture if you go into labor. You will always have to have c-sections before you can go into labor." But I did a lot of research about it on my own and decided the risk of that was miniscule compared to my risks of pre-eclampsia and everything. Some research even suggests that even with a vertical incision, the risk of uterine rupture is around 1%. So I pretty much dismissed it, I had bigger things to worry about.  But this was why we did the amnio at 36 weeks and 1 day, it came back good, my water broke at around 1 am and I *went into labor* as we were driving to the hospital. They were originally going to make us wait until 7am to deliver him because I had eaten at 10 pm. When they saw my contractions on the monitors, they called my doctor and started prepping me to deliver. He was born at 4:54 am at 36 weeks and 2 days gestation. That other mother, her uterus ruptured, in the evening when she was 36 weeks and 2 days pregnant. They were going to deliver in 5 days.

We have a huge quandary for "next time". My high risk doctor told me when I was in the hospital with Lucas, that she had never had that happen before. (Someone go into labor after the amnio.) So...she's not too keen on trying an amnio at 36 weeks again and risk putting me in labor. The point of doing the amnio was to make sure his lungs were mature enough for delivery, but if they hadn't been, we still would have ended up delivering last time anyway, what with my water breaking and all. If we hold out to 37 weeks, we won't do an amnio at all. I had thought I wanted to skip the amnio and just deliver at 37 weeks. I wonder if Luke wouldn't have had jaundice if we waited an extra week, or if he would have been better at nursing from the start, etc. But those things are petty compared to the risk of my uterus rupturing and the baby dying. That being said, my OB got a good look at my scar for herself when she was cutting out Lucas, and she said it looked FANTASTIC, labor and all. So good that she wouldn't have known it was there if she hadn't done it herself. She was really really happy with how it had healed. Still, all of a sudden, a risk I had more or less dismissed before seems pretty darn real now. Good thing we have plenty of time to think about it more and decide later.

Toddlers are stressful! Luke has learned to climb and he especially enjoys climbing on our couch and hanging off the arms. He has not figured out that everything has an edge and if you get too close to it, you fall. This morning he fell off our couch and smacked his forehead HARD right above his eye on our coffee table. I am just finishing my A&P class which does not help that I immediately thought "OH NO! His frontal lobe! His memory!" My first instinct was to pick him up, bring him to the ER, and make sure he was not brain damaged. But we just got a $250 bill from his last ER visit, and I used to work with toddlers and saw them fall and get hurt ALL THE TIME and they were fine. I think it's different when it's your kid, especially after you've had a baby die, and especially the first few times they bump their head hard. Hello! Developing brain in there! Can we not bang it around so much? I put some ice on it (which Luke preferred to try to eat), and made waffles (the already frozen kind), and as he ate breakfast it became pretty clear that he was just fine. Eating normally, when I asked how old he was, he grinned and pointed his one finger at me (Phew! his memory is not destroyed!) Even so, I called the pediatrician and asked the nurse under what circumstances to bring him in. (FYI, he starts acting unusual, he stops doing something he normally does-like can't walk, he has trouble waking up). It looks like he is just fine, except he is now sporting a pretty ugly bruise on his forehead. At least he didn't do this last week before his pictures or birthday party. I guess I am going to have to get used to injuries like this. I am also seriously considering putting our coffee table in the basement or getting rid of it altogether. It's not like we can really put much on it these days, anyway.


Brooke said...

I know that this loss really struck a chord for you, given the similar risk that you have for this pregnancy. I hope that the success of your pregnancy with Lucas helps give you some confidence, even though I KNOW you can't be sure which group you'll fall into. I'm glad your MFM (our MFM) is keeping such a close eye on you.

And, yes, toddlers are resilient, but I think the bruised head would freak me out too!

Tiffany said...

it is so unfair. i can imagine that hearing the news hit very close to home for you. i think all of us that have lost children felt our hearts break for her and her hubby because we all worry about having to face that pain again.

SG said...

Oh, it is so scary - I've been wondering about my own c-section scar. It's hard not to right now.

And I'm going to admit - I'm a little afraid I'll follow your lead with the not sleeping after baby is born thing. I will try hard to take your advice that it's NOT the way to go, though...

Sorry to hear about Lucas bumping his head :(

MissingMolly said...

I am so, so sad for her. Unbelievably heartbreaking.

I think doctors should admit anyone who has an amnio who also has a vertical incision. This is a big concern of mine as well, and unlike you, my doctors did not pound it into my head about the risk because they never even told me. They took me into an emergency c-section, not discussing with me what type of incision they would need to make, and then didn't tell me afterwards, either. I only found out after my new doctor reviewed my records, which I believe was negligent of my previous OB. But then, that was her middle name.

I also think it's negligent and careless of physicians to send someone home after an amnio with that kind of history since having an amnio, especially that far along in a pregnancy, can stimulate labor.

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