The Ultrasound

October 19, 2010 J, Alanna and I went in for my second level ultrasound appointment early in the morning.  We'd kept Alanna out of school that morning to come with us because we wanted to see her baby brother together as a family.  She had not been at the first ultrasound where they diagnosed the Placenta Previa and the elective ultrasound we'd done to determine gender was truly just a quick peek where we really didn't get to see him moving about.

We arrived and entered the ultrasound room as planned.  The technician found baby Archer and began doing measurements and pointing out things to Alanna, Here's his foot, do you see his heart beating?, etc.  She confirmed that indeed baby Archer was a boy and then moved on to double checking the placement of the placenta to see if it had moved at all.  She hesitated.

I caught the hesitation.  She recovered nicely, but she hesitated.  She continued on to tell me that the placenta had not moved, but that she wanted to check a few other things and then bring the doctor in to take a look.  I knew.  I knew something was very, very wrong.  But I also knew that we'd just seen our little boy moving about and all of the measurements were fine.  Two hands, two feet, a heart beating, normal average measurements standard routine ultrasound.

When the doctor came in he reviewed her findings and they talked a bit in hushed tones using the super secret medical language that they think those who are not in the medical field won't catch.  I suppose in a lot of ways they were being kind and not trying to worry Alanna.  I have enough medicolegal terminology in my dictionary from way back college courses that I caught the gist.  There were baby blood vessels where they shouldn't be, outside the umbilical cord.

The doctor, who I'll never forget because he was wearing a bowtie, gave me a grave look like I was going to blow up at any moment and there'd be shrapnel all over the examination room.  He explained that they'd found something they needed to look at more closely, but that he wanted a second opinion because it is extremely difficult to diagnose.  He reassured us that I was fine to go home, but asked if I needed to go back in to work or could be home for the remainder of the day.  I said it would be fine to swing by work on my way home and grab a few things then work remote.  He said that they'd be giving us a call after he was able to get the second opinion.

I don't know why I left thinking that it really was ok and that I'd probably just need a C-Section as part of our birth plan in several months.  For whatever reason the request to go home rather than work really didn't strike me as a red flag.  Perhaps I simply thought that they certainly wouldn't let me go home if I really was the time bomb that his original facial expression had indicated.

So we stopped by work, I let my team know I'd be at home and sent J to take Alanna to school.

The nurse called me about an hour after we'd left the office.
Nurse:  "We need you to come back in."
Me: "Ok.  When would you like me there?  My husband has taken my daughter to school, but should be back shortly."
Nurse: "As soon as you can would be good."
Me: "Back up to the clinic?"
Nurse: "No.  We actually need you to go down to the hospital.  Bring an overnight bag."
Me: PAUSE.  "Ok."

I hung up and went to pack literally an overnight bag.  Enough for one night.  Again, I don't know why I thought that was sensical.  I suppose I figured that whatever tests they needed to do were just to figure things out and may take 24 hours.  I waited for J to come back home and we headed downtown.

They admitted me and took me to a room.  The attending explained that they'd do additional testing in a week (A WEEK!!) and that I'd need to be on hospital bed rest until that time.  That they had identified what they believed to be Vasa Previa and would confirm the following Monday.

At this point in time no one really, truly told me what Vasa Previa was other than very high level.  It's like they knew how serious it was, but were trying to protect me and not tell me.

So believing that I'd likely be going home in a week, I called work and asked if I could work remote for the week.  I sent J home to get some more things and the laptop and settled in to my 7 day countdown.

In my head there was a slim chance that I had this Vasa Previa thing.  I had this huge window visualized and the window was wide open.  I just had to make it through a week, then back to normal until Little A was due.

Every nurse who came in, every doctor I spoke with (and there were a LOT) over the course of the next 7 days shut that window just a tiny bit.

The nurse who finally made it crystal clear to me that I was not going home was the one who came in and pointed at a large painting on the wall and said, "You know, sweetie, when you start getting Christmas cards you can cover up that painting with them.  None of us are overly fond of it and it'd be a fun way to decorate.  You can also bring in a little rug or a lamp if you'd like to make it more homey."

It was OCTOBER.  I wasn't due until mid-January.  I was only going to be there a WEEK.  Christmas cards??? Lamp and Rug???  I looked her in the eye and asked, "I'm not going home, am I?"

"No."  I thank her for her honesty.  She was truly the only one who didn't tiptoe around things with me.  She told it to me straight.  She explained the actual picture of what was going to happen.

Because my doctor wasn't on rounds until 4 days after I'd been admitted, every other doctor hadn't wanted to step on his toes and told me the bare minimum.  It was like trying to Google with the wrong phrase.  You'd get close to the real answer you were looking for, but just not quite get the full picture.

Hospital Life up next and the verdict after the follow-up ultrasound in the hospital with the specialists.

Vasa Previa

**Reader be warned.  For those who stumble, trip or otherwise inadvertently google their way onto this blog, the posts on this topic will be brutally honest and probably a bit graphic.  This post is in NO WAY meant to give medical advice nor am I a medical professional.  Any medical details are my recollection and understanding only.**

I truly still don't really know where to start with this story, but as per Zazzy's suggestion I'm just going to start typing and see where things go.  I did make one modification to her suggestion and am accompanying this post with a glass of wine.

Vasa Previa.  Don't google this unless you're ready for some graphic results.  The most helpful medical definition of Vasa Previa in my opinion is the one from the International Vasa Previa Foundation's website: "Vasa previa is a rarely (1:2500) reported condition in which fetal blood vessel(s) from the placenta or umbilical cord crosses the entrance to the birth canal, beneath the baby. The condition has a high fetal mortality rate (50-95%). This can be attributed to rapid fetal exsanguination resulting from the vessels tearing when the cervix dilates, membranes rupture or if the vessels become pinched off as they are compressed between the baby and the walls of the birth canal."

In short and in not nearly as pretty terms, this means that when a woman is pregnant there is a slim possibility that some of the baby's blood vessels could get in the way of the exit door and if there is enough pressure on those vessels and they burst (as would happen in a normal birth), the baby has an incredibly high likelihood of bleeding to death.  The way it was described to me when I was diagnosed and finally got someone to tell it to me straight was that I was essentially a ticking time bomb and a proximity risk.  If I was too far away from a hospital when (and it was not a matter of "if", but of "when") the blood vessels ruptured, there would be absolutely no time to save the baby.  As it was also defined by the nurses, the window of time before the baby "bleeds out" is incredibly small, hence the high mortality rate.

This definition is far more harsh than ANY I ever gave any of my friends or family when my diagnosis was provided to me.  Of course they could have googled it and I'm sure many did, but I don't know that I ever let on how slim a chance it was that my son was going to survive.  Perhaps it was my own coping mechanism for dealing with things.  Every time a nurse entered the room, the first question she would ask me is, "Have you had any bleeding, any at all?"  Multiple times a day people would inquire as to the state of blood in my underwear.  Of course the thoughts crossing my mind were about how would I know if I was bleeding?  There have certainly been times in my life where I haven't known that my period has started until that moment of going to the restroom and "Ta Da!"  With the super slim window of saving a child from bleeding to death, how was I going to make it to telling a nurse that there was a problem in time?  That thought lived in my mind daily.  That thought drove me to accept that the truth was I wouldn't be bringing my child home, so I probably shouldn't get my hopes up.

But I'm way ahead of myself.
"What was I thinking??!"  I was 36 years old, had a beautiful, happy 8 year old daughter and was pretty comfortable in my life.  Apparently when a biological clock decides to tick, it does so loudly and then stops abruptly after it gets its way which leads to a clarity of thought otherwise known as a major wake up call.  When I found out I was pregnant with my second child, the clock stopped.  HELLO!   All of sudden all of those things that I'd conveniently forgotten about came rushing back.  Daycare, diapers, teething, sleepless nights, boogers, tantrums, baby food, breast feeding, and on and on.

Once I got my head around having a second child we were fairly happy with the idea.  We'd convinced big sister that it was going to be neat to have a baby brother and had even gone and done one of those early ultrasounds where you find out the gender before the actual medical ultrasound is scheduled to do so.

Before we even got pregnant I had sought out the OB/GYN I had when Alanna was born.  It was almost a deal breaker for me to have another child without having him as my doctor.  When I look back that was probably the moment we saved baby Archer's life, even before he was conceived.

Doctor V. is a cautious man and tells it like it is.  I'm not sure if this is how he is with all of his patients or if I've just gotten through to him that I'm a "cut to the chase" kind of girl.  With Alanna there was an issue found in utero that resulted in several second level ultrasounds and an MRI prior to her birth.

When I came to him after becoming pregnant with baby Archer, he suggested that if I'd like to have a second level ultrasound out of the gate because of my prior history as well as my age (haha) that he would most certainly approve it.  I said yes.  Alanna's condition really wasn't hereditary and frankly I wasn't worried, but when they offer you an upgrade just like moving up one class of vehicles when renting a car you take it.  After all it was an opportunity to find out more information about the baby with a better quality picture and it wasn't any extra work on my part; I was going to have an ultrasound regardless.

At my initial ultrasound appointment, they identified that I had Placenta Previa which is where the placenta is in the wrong spot either by a little or a lot.  At the time it wasn't a big deal.  Worst case scenario it would result in a C-Section if the placenta didn't pull up and out of the way of the cervix.  Best case as the uterus expanded and grew, the placenta would move similar to being stuck on the edge of a balloon on the inside and birth would be normal delivery.  They advised to not worry and come back in 6 weeks to see where it was at that point.

This seems like a good stopping point for the evening.  Then I can pick up with the diagnosis ultrasound visit and resulting hospitalization and birth of baby Archer.