Friday, March 18, 2011

A night of doubts and omens

The night before the delivery, I still was in two minds to wait till at least Thursday (38 weeks complete). We were packing, getting organized. My sis was staying with us, managing home for me. My in-laws were coming on 21st (as per original date). All seemed organized. I wasn't so much convinced as resigned. My doc had done an external check and said the head seemed to be in down position, she didn't feel a transverse position, though hadn't dropped so position changes wee possible. I was toying with the idea of waiting. Letting the position correct, baby drop, maybe go for natural delivery. I was mentally prepared for 21st..not tomorrow! I wasn't ready. What if I didn't lactate. What if baby hadn't crossed 2.5kgs? What if loops were back? So many questions...so much indecision.

And then all of a sudden, I leaked milk. It was totally unexpected and shocking. Whoa....! It seemed like a sign. I took it as a sign. I still couldn't believe that I had managed it so far, and my survivor baby had held on despite all the things that had kept going wrong. It seemed destined in a way. I stopped thinking and just let it be.

Reaching fetal viability

From my last pregnancy I knew that 28 weeks was the first milestone, while 32 weeks was the absolute minimum. I stayed in bed and counted the days off. When I reached 28 weeks, I felt some confidence, but didn't let myself hope too much. At 30 weeks, my doc sent a fellow practitioner to check my progress externally. She was fine with me, but wanted me to take steroid shots to accelerate fetal lung development in case of pre-term labor. I had been feeling the baby move for a while and she told me to start keeping count. I started an excel sheet!

I asked my doc if I should get an ultrasound done, since I had no check up after week 18 and till the doc visited me at home at week 30, but she said she didn't want me moving before week 34, at which point, she would be fine even if she had to deliver then. Week 32 brought another home visit and all seemed fine. At week 34, we finally went for an ultrasound. At this point, it had been almost 4 months since we had any internal check done and we had NO idea what was going on inside, apart from the two home doc visits who just checked my belly externally for baby size and position.

At the ultrasound, it was amazing. We saw a 3-D ultrasound. We saw our baby....really developing. Everything looked great, till the sonologist hit us with a whammy....the umbilical cord was wrapped around the baby's neck...twice. It was a possible danger scenario, not so much of choking as the loops constricting nutrient supply to the baby and creating problems. Again, it was a case where the loops usually resolved themselves (though not two loops usually) and babies born with loops did survive. (My mom told us, she herself had been born with loops around her neck.) However, it was a complication, and my doc asked me to track fetal movements closely and keep check. Also, the baby was growing on track, except for her abdominal cavity which was 2 weeks behind. What more..seriously >.< We went home to wait it out. My doc had lifted my bed rest restriction, but I still followed it to some degree...what was a few weeks more anyway.

At 35-36 weeks, we had our next ultrasound. Amazingly, our baby had taken off both loops! Even our sonologist was amazed. At this point, finally I let myself start believing that this time..it might actually happen!! Unfortunately, the baby had turned and was now transverse, a position that again usually resolved itself, but in delivery, was impossible without caesarian. The doc told me to remember the head was near my right flank, not that I realized the significance of that comment at that time. We went home. It was Durga Puja. We spent it at home, only going for Navami morning puja, on the completion of my 37 weeks on Asthami Friday. The next day was Dussehra, at home, and then we had an appointment on Monday evening.

My doc was now keen to plan a C-section with the completion on 37 weeks (which completed on Friday)...the lower limit for a full term baby. I was still toying with the idea of a normal delivery though after my doc heard that the baby was transverse, that went out of the window. Transverse babies do resolve and my baby hadn't dropped yet, but with my history, my doc wasn't taking chances post 37 weeks. The baby had been 2.4kg in the 36 week ultrasound. 2.5kg is the lower limit for a normal weight range baby. We were sure baby would have crossed that.

I was tracking fetal movements on my excel sheet and it seemed to me there was a little drop in them, though still above the standard 10 kicks count. We fixed Thursday the 21st for the C-section. Booked the room, OT everything. On Monday 18th, when I went to meet my doc, I mentioned the change in fetal movement pattern. She was immediately disturbed. She sent me up for a monitoring test. The test showed within range, but when we spoke to her, she told me she wanted to deliver the next day, as soon as we got a slot in the OT. She told me the baby was probably over 2.5kg, we had made 37 weeks, at this point, it was absolutely fine to deliver. And while it was of benefit to keep the baby in as long as possible to pack on more weight, she would rather not take a risk with a precious pregnancy, with my history, and with my feeling of changed fetal movement pattern, however vague and unsubstantiated. In her terms, maternal instinct took precedence, even if I wasn't wholly sure. If I felt enough to raise the issue, it was enough. She wanted me to get admitted immediately for delivery next morning. I asked her if it was an emergency or could I go home and get admitted in the morning. She was ok with that next morning admission and we went back home.

Things start to go wrong...

I had slight bleeding the day of my appointment with my possible prospective ob-gyn. But I figured I was meeting her anyway...will get it checked too. It happened last time as well and had cleared up on its own. I had spoken to both my fertility specialist and her on phone and sorted out roles. They would do the cerclage together and then she would take over if I wanted to change my current gynae and stay on with the same hospital.

On my way to the hospital (barely a 10 min drive) I felt a gush of blood and got terrified! I told my new doc and she asked me to get an ultrasound done immediately. The ultrasound showed a large retro-placental clot and a low lying placenta. She advised me not to take chances and admitted me immediately to get the bleeding under control. With an openly bleeding unresolved clot , it was not safe to do a cerclage at this time. I had come to the hospital alone, without anything or anyone, just for a consultation and I found myself admitted! Worse, hubby was out of town, in fact had just left that morning. He had planned the business trip because after we met our specialist and she was agreeable, everything had seemed ok, and he wanted to free up the next week for my possible cerclage surgery. I called my mom, luckily she lived only an hour away or so and got my admission and home front organized. I was kept on complete bed-rest for a week or so to see if the bleeding would subside and we could do the cerclage. However, the bleeding didn't stop. The clot was still there and fairly big, but now, my placenta was coming very low, almost half placenta previa. A symptom of this condition IS bleeding and the method to control it...you guessed it cerclage! But with the clot still unresolved, the cerclage could not be done. There was nothing we could do but wait for the clot to resolve. And as long as the placenta was low, I would continue to bleed. Placenta does travel upwards in most cases and resolves itself by the end of the second trimester, but for the time being all we could do is wait and watch. Would anything ever go right!

After a week or so in the hospital, and seeing that the clot was slowly resolving itself, I spoke to my doc about going home. We would anyway have to wait for 4-5 weeks or so for the clot to completely resolve. I would have to be on strict bedrest...but then I had got used to that. The bleeding continued throughout, attributed to the low placenta now. Luckily through all this, my baby remained fine. It was already week 14. It seemed like I was destined for late emergency cerclages. I closed things with my original gynae since considering my case, I wanted to stay with the hospital close by.

At week 17, I went for another ultrasound, after spending the month on strict strict bedrest. The clot had resolved a lot, but the placenta was still low and bleeding. Plus there was a very slight but definite opening of the cervix. At this point my new doc suggested going for the cerclage which would manage both the bleeding and the opening. But my fertility specialist was out of the country! We spoke to her, decided not to wait, and went ahead with my new doc.

The cerclage went in and I was discharged in my 18th week, after my level II scan. Miraculously, the baby was still doing fine, everything with the fetus was on track. Now I only had to hold everything together.

My new doc put me on strict bed-rest, arranged for someone to come give me my progesterone shots at home and told me she was confident of me and just to stay positive, in bed, keep my digestion smooth and take things easy.

A change of doctors

At 13 weeks, we were in two minds about getting a cerclage. It hadn't helped the first time. It had led to infection and tears. This was a natural conception. If this could happen on its own, maybe it was best not to interfere. On the other hand, history of cervical incompetence has a very high probability of recurring. In fact it is the standard reasons to do cerclages! And the first time, it had been a twin pregnancy, the cervix had already started opening, and the cerclage was put in as an emergency procedure. This time we had time on our side and it was a single baby.

The other thing making us uncomfortable was my gynae herself. Though very experienced, we had only had failures with her in 4 years. Her cerclage had been unsuccessful. She lived and operated far away from our home, and during the miscarriage emergency, we had realized the need of having medical help close by. But I was uncomfortable changing her. She was vastly experience, knew my entire history and literally knew me inside out. It wasn't her fault I was turning out to be such a stubborn patient. On the other hand, in her own words...sometimes the relationship just doesn't click. And this wasn't clicking. Things like her extreme conservative approach and focus on negatives was becoming grating with each successive failure.

We went to her for my 13 week check up, actually meeting her for the first time in my pregnancy. She examined me but was iffy about the efficacy of a cerclage. It must be put of course according to her, but there was no guarantee it would hold. NOT the thing you want to hear after a failed cerclage and loss of 2 babies. She indicated extensive tearing on one side, and was not confident of having enough place to take a stitch on that side. But when we asked her if she would recommend we shouldn't go for it, she said it was chancy. The cervix may not open, but if it did, it would be emergency cerclage again. And 13 weeks is best time for a cerclage. Post that it takes time to settle, and it might be the same story all over again. She told us to think over it, and also the decision of to stay at her hospital or go to one closer to home (where we had had to go during my miscarriage emergency).

We came away feeling troubled. I felt like she had literally left me dangling off a cliff in a damned if I do, damned if I don't position. The thing that hurt me most (and pissed both of us off) was her attitude of not taking any responsibility for the cerclage. It was like I'll do it, but its your luck. I don't guarantee anything. Now I know any surgical intervention has failure rates. But to so totally distance oneself from the result really got to both of us.

We decided to take the advice of my IVF specialist, who consulted at the hospital where I had gone during my miscarriage and had taken an interest in monitoring me then, even though she doesn't practice obstetrics anymore. She actually was my gynae's reference for fertility treatments, and would manage conception to first trimester, post which you would go back to your regular gynae. I was so demoralised by my current gynae's frankly morose predictions that I needed a balancing view. I had found this specialist very technically skilled and hoped for at least a more objective if not positive view.

I made an appointment with her. She was happy to see me pregnant, attributing it to my weight loss (which she had suggested in her very consultation with me). She was confident a cerclage could be placed and was adamant in her advice that I must get one done. She did operate at my preferred hospital and was willing to do the procedure. However, neither of us wanted to slight my regular gynae and she could not help me with obstetrics and pregnancy management for the rest of my term as she no longer practiced it. At this point, I remembered another doctor, who consulted at this hospital, who had in fact done my D&C after my miscarriage. She was younger than my current gynae, but I had found her extremely nice and positive during my stay at the hospital. I decided to consult with her for taking me on as a patient post cerclage and fixed up a meeting on the next day.

The greatest shock of my life

After all the downs and even more downs of 2009, by end of Jan 2010, I just wanted to put the past behind me and get back a hold on my life. We decided to stop trying and started making plans of what to do next. Hubby quit his job and we started looking at jobs abroad, and experience we had always wanted, but didn't want to act upon given all the medical problems I was going through. However, once we decided to take a break, we were free to look at that option.

February is lovely weather in Delhi, spring flower shows and melas. And we made the most of catching as many of them as we could, almost like a mini vacation.

I had started my cycle, post miscarriage, end of Jan. When I missed the next one, I didn't really bother. After all, I had never been regular anyway, and the thought of me conceiving, without any external help, in just one cycle, after 4 years of failed medical interventions...was laughably remote. Around second week of March, my hubby suggested I should try a home test. Anyway, there were still a couple of kits left over, may as well finish them off. It barely mattered..may as well finish off a kit..or thats what I thought.

To my utter disbelief, the result was positive! No intervention, no medicines, heck barely a couple of instances on our part even! I tried the second kit...same result! Called my gynae...already 8 weeks in, she sent me for an ultrasound....and what do you know...I WAS pregnant!! It was unbelievable!!

Went back home in utter disbelief. Gynae put me on medicines specially progesterone support (ugh injections!..since my parallel blood test report had shown low prog levels) and told me to take it easy and meet her after 13 weeks were up. At 13 weeks, given my cervical history, we had to make a decision on whether to go for cerclage or not.

So till then I just took it easy and lived in utter disbelief.

Thursday, January 21, 2010

Update

So I had my last visit with the surgeon on Jan 16. He said I was all fine, scars healing nicely and ready to move on! Whoopie! Of course, that didn't mean I have license to eat, eat and eat...just that there were no more real restrictions, and with some circumspect eating, I should be fine!

I felt like a racehorse let out of the box! Immediately, I wanted to eat everything! Suddenly my appetite is back too. I feel hungry almost all the time! So far I've tried mexican (chicken tortillas, nachos without cheese), chinese (dimsums, soups and chicken in oyster sauce), buttered garlic bread (2 at a time), chicken teriyaki half-sub sandwich, mayo scraped off chicken burger, assorted snacks like khatta meetha, chana dal, small samosas, boiled corn, chocolate, small cup of milk (double toned), standard indian fare - normal tadka dal, aloo-gajar subzi, etc. So far so good! No stomach aches or anything. If I overeat, I feel a bit sick...not achy sick but more gassy/acidity sick (but not enough to warrant an antaacid)..and of course gas remains a problem. Otherwise it seems ok. Makes me feel very optimistic. Maybe its all really going to be fine!

Now I need to keep a control over how much I eat. I tend to feel hungry all the time. So far I had avoided snacking, but off late I think I'm overly snacking. Small meals many times a day has kinda translated to many snacks, and lunch/dinner are not always as small as they used to be (3 rotis instead of 2, 8 dimsums instead of 2 or 4, etc. etc.) I'm giving myself a couple of weeks to get the freedom eating out of my system. I lost a lot a weight last year, so I plan to keep weighing myself to keep a note of my eating. And though I am going a bit easy on myself this week, I think I should get back to slowly introducing restrictions back...on portions and on snacks.

But I really think this may work!

On the gynae front, my lochia stopped a couple of weeks back. I've been on the watchout for it restarting, but so far so good. 6 weeks are over since the surgeries/delivery and I'm in the safe zone. Not sure how my usually irregular periods will work out. Not really looking at conception this year, so I'm more relaxed about that. I guess I'll give it a month or so before going back to the gynae for a general check up and PCO status. Otherwise, I've kind of pushed this part to the back burner for now.

Monday, January 4, 2010

Getting out of the house

On 2nd Jan, my bandages came off. Doc said I was doing fine, reduced my medicines and told me to come back after 2 weeks. With the bandages off, I felt a lot better. The cuts had scabbed over, but the doc said part of the scab was actually the glue used to seal the skin shut. The area around the cuts was dry and I was asked to apply any moisturiser (or preferably coconut oil) to the area. It itched like hell!

I was so happy to get them out, I went shopping! Earlier I was in two minds about shopping immediately after getting the bandages out. I wanted to buy jeans/pants and the 3 of the 4 cuts where in the waistband area. But apart from the itchiness, they weren't really hurting, and some retail therapy would be wonderful...so I went for it.

This was also my first foray into eating out. I went for plain grilled chicken for lunch, and the chicken teriyaki 6-inch sub for evening snack. Did I mention we shopped for 6 hours! The best part was trying on clothes, realising I'd dropped a couple of sizes. Sadly I didn't get a good pair of jeans (low waisted ones don't suit me), but I did get a lovely pair of dark blue cords and a comfy but chic pair of sweatpants. Got a full sleeved T-shirt as well. Tried tons and tons of clothes but that's all I bought. And a few books...about 7 actually. :D

Came back home exhausted. Changed and rubbed baby oil onto my cuts. While rubbing, part of one scab fell off. That immediately got me obsessively trying to remove the bigger scabs by careful levering and generous application of oil. Its amazing how obsessive scab removing can be! As long as I did it carefully, it didn't hurt...and the relief when I got the scabs out of the two big ones was amazing! I wasn't sure if it was just the healing process, or that the scabs had been pulling the skin, but as soon as they were out, the worst of the stinging while bending was over!! Hallelujah...I'm on my way to wellness at last!!