Week 29 jitters

Not going to lie, it’s been a completely draining week.  Ever since I woke up this past Saturday, I’ve had this sense of dread and pending doom that has colored every action, reaction and thought I’ve made, considered and opted out of pursuing.  Some might say it’s the looming holidays, others might call it a particularly moody mood swing, but I know exactly what it is:  anniversaryitus.

For better or for worse, I remember dates and details of events well after the normal person and long after I necessarily should.  Sometimes those dates wind up surfacing some sweet memory like November 8 as the anniversary of when HB proposed, October 27 as the date of my first (only?) marathon, or March 17 as the anniversary of GW and GV’s baptisms… but other times, they take me back to some of the most miserable moments frozen in time and carved into my memory that I want to ignore. December 21 is the day my father gruffly told me my Grandmother died and I, being entirely too young to understand, found blame for her death in myself and the clothes I'd selected to wear that day. October 21 is the day Mandy Morrison died after falling from her window on the fourth floor of the girl’s dormitory to which I was a Resident Advisor.   April 4 was the first day of HB’s last deployment to Iraq, a day I feared would be our last.  And, pregnancy wise, week 29 was the week that all went wrong with GV’s pregnancy when out of the blue I went down with a partial placental abruption.   I know, date wise, that the actual event happened September 25, but that week in the hospital forever changed my view of women’s bodies and the terrifyingly beautiful risks we take when we carry a baby.

The feeling I so vividly remember of my pregnancy with GV before the abruption happened was not one of concern or even of real acknowledgement of my "condition," but rather of simple normalcy.  I’m not trying to suggest that I feel “normal” while pregnant because, really, what woman in her right mind could feel normal while pregnant? But what I mean is that I had no reason to think of myself in any different terms than the way I consider myself while not pregnant – athletic, capable and independent... simply me.  Translating that into my actions, I didn't think I needed to sit down on the metro (what risk of falling?), have help while carrying groceries (I'm pregnant, not weak!), get a hand up after sitting on the floor (I wouldn't have sat here if I couldn't get up), or stop moving furniture (it's called nesting).  But when my hand was covered with gushing dark, thick blood and the thought of losing the baby entered my brain, all of my preconceived notions about myself and my pregnant body went out the window.  I wasn't weaker, but I was different.  I was more fragile and more vulnerable to the everyday slip ups that I would have kept rolling with were it not for the tiny life dependent on me not slipping, not lifting, not eating x, y and z, not sleeping on my back or right side, not exercising with my heart rate above 140 beats per minute, not ... snuffing out its existence through my actions before even having a chance to live.

In some ways I look back on my time before that terrible week with envy - the ignorance of fear was so wonderful and, to be cliché, thoroughly blissful.  But now that the USS Unaware has sailed and I'm fully onboard the USS Worrywart, I can't escape the vast, rocky landscape of ebbing what-ifs.  On one hand, I can find some degree of comfort in the fact that my awareness of pregnancy as something delicate leads me to choose actions or inactions that prioritize the baby's safety before my own that I might have missed otherwise.  Conversely, the opposite of ignorance is hyper vigilance and, let's face it, 180 degrees from dysfunctional is still dysfunctional.  Should I be as scared of GW hugging me with his unbridled enthusiasm as I am?  Maybe.  Should I opt out of walking our 118 lb mastiff for fear of her pulling? Perhaps.  Should the fact that I'm in week 29 this go around mean history is bound to repeat itself? Not at all.

At the end of the day, I guess the superstitious side of my young-self that found blame for my Grandmother's death (at age 91) in my closet persists to one degree or another despite my internal reprimands for logic and reason.  I know I am at an increased risk for repeat placental abruptions because of my previous abruption history and because of my elevated amniotic fluid levels, but neither of these complications guarantees another abruption or a particular pregnancy outcome.  Whether I have an abruption now, in three weeks or down the line with a future pregnancy, I can't do anything more than I already am and my suffering from anniversaryitus does nothing but raise my blood pressure - which charmingly further elevates my risk for adverse complications.  The only cure I see to this ailment is safe arrival at week 30 this Saturday... at which point, I realize, nothing will be different except an arbitrary number that, for whatever reason, I fear. 

Week 31 Perinatal Appointment

Well, I had my first perinatal appointment this morning since returning home from the hospital just over a week ago.  And while I'd love to say that the doctors announced that I'm perfectly healthy and ready to go back to pregnant life per-normal, they, unfortunately, did not. 

It was an odd appointment - not like any of the others that I've had before.  Instead of getting another sonogram and then seeing one of the doctor in one of their cushy offices, we were taken into an exam room (I'd almost forgot what those look like) and asked how I was feeling rather than told what has new.  I explained to the doctor that I am continuing to get contractions, that they're worse and more frequent when I stand, that Baby's been moving about less than before and that I've generally been feeling like absolute blah.  Listening with an increasingly concerned face (never what you want to see), the doctor stepped out of the exam room and asked the sonographer to do the previously unplanned sonogram. And off to get sonogram #12 we went... 

Checking only the crucial bits and not doing a full examination of the baby, the sonographer admitted she was sad to see me on a week where she otherwise wouldn't have.  Reassuring me that she's there whenever I need her to be (and decreased fetal movement is a good reason to need her), she checked to see if I was effaced from the contractions (which I am not, thank God), she checked the amniotic fluid level (down from 28 to 17, so back to normal ranges) and she checked the injured portion of the placenta.  She showed us where the blood clot has formed under the membrane next to the placenta edge AND she found the source of the bleed... an undeniable partial placenta abruption.

At the hospital we'd been told they couldn't identify anything except a "dark portion" of the placenta edge where blood flow was no longer occurring (the clotted area) and that the hemorrhaging must have been from an injury to that edge.  Today, however, the sonogram clearly showed another dark spot a little ways in from the known clot that medically confirms a degree of detachment and bleeding between the placenta and the uterine wall.   While there is a bit of comfort provided by the fact that we have an answer for what exactly happened, it's definitely a more concerning complication than an abstract injury to the edge of the placenta because once you've had an abruption, they're more likely to occur again.  So that continues to be scary. 

Here's a visual for a couple of the complications with the placenta that
I have had with this pregnancy. The partial previa has fortunately cleared
itself up, but the abruption will stay "as is" due to my gestational age
(assuming it's not further injured that is).

The last thing that the sonographer checked was Baby's biophysical profile - which I am pleased to report Baby scored a perfect 8 out of 8 on.  Seeing as she only got a 6 out of 8 at the hospital on Sept 29 due to her limited practice of breathing, this was a comfort to learn because it means her lungs are continuing to mature for delivery.  Which, by the way, she apparently has decided to get ready for by flipping over (yay! vaginal delivery is a serious possibility!) and no longer firmly planting her head under my rib cage.  From what the sonographer could tell, it's this new position that Baby is in that is causing the decrease in the fetal movement I feel because she's not only behind the anterior placenta, she's also facing backward.  So any movements she makes either need to be quite large or lateral to translate into more perceptible kicks... though I must say her hiccups are far more obvious now than ever!

Reviewing all of this, the doctor was glad to see that Baby is still the resilient little toughie that she's been and that the contractions haven't been causing distress to her or further damage to the placenta.  She instructed me to continue to stay on modified bed rest and to call them immediately if the contractions increase to four or more an hour that last over a minute.  But seeing as I'm "only" (ha, that word is used oh so loosely) getting them every 15 minutes for 30 seconds when I stand or sit up, that's "just" (again, ha) a sign of significant uterine irritability caused by the abruption.  Because blood remains behind the placenta and in the clot, she said to expect the contractions to continue... lovely.    Beyond that, the doctor requested that I start weekly appointments the week after next and she expressed hope that I'll only need to do weekly non-stress tests rather than biweekly or more.  We'll see how that goes.

All in all, I guess you could say that it was an uneventful appointment in that we didn't learn of some new complication or problem we need to address. Baby and I are looking stable on bed rest and there is still a fair shot that I could make it into November before she is born.   I guess my bond with the couch will continue to grow and my slower weight gain will sustain (still five pounds down from before the hospital) - for better or for worse. I'll keep you posted.