Thursday, October 24, 2013

Life is Sacred

You probably all already know about this case that I have entirely missed until last week.  I has been haunting me all along since I read it.  This woman shows up at 17 weeks of pregnancy with back pain and fully dilated.  She does not progress on to delivery, but instead stays that way for days, with the uterus exposed to vaginal bacteria, and nobody does ANYTHING about it despite her ASKING them to.  The baby is doomed to certain death but they are continuing to monitor the baby's heart beat and wait, and wait, until she dies of sepsis.

That's kind of the picture I have in my head.  I have a suspicion that cervical incompetence was actually her problem, I mean it sounds so much like it from where I am sitting.  And I know one can die from incompetent cervix, because were I left without any medical intervention, I probably would have died as well.

Contrast this with my situation:  as soon as the cervix was noted to be dilated, the OB tried a cerclage, but told me it probably won't work, and that the biggest risk is that of infection.  I was on two IV antibiotics in doses high enough to kill a horse, and monitored for fever or white cell count increase.  The moment I decided that it was not worth it anymore (because I was in labour), the cerclage was removed, despite the baby being alive at that time.  That is because, guess what, it was not going to work anyway, and I was in danger of shredding my cervix with labour+cerclage.  And we were all (me, MrH, my OB, my GP) very, very worried about infection.  Labour = infection, often, often, often.
Then, at 9 cm, I started bleeding very heavily, and the baby had to be manually removed.  Then I had a retained placenta that needed oxytocin and manual removal in the OR.  I needed so many things because a uterus at 20 weeks (or 17 weeks) does not behave very smartly and cannot contract always effectively, which is why the retained fetus or placenta can happen.

I got so much care that I would not have survived without!  And I am so thankful to have been in the right place, at the right time (haha, in a small Northern town in Canada, with one old OB a GP anesthetist.  Better care than University Hospitals in Ireland).  Women who are pregnant need a lot of medical attention when things don't go according to the usual nature's ways.  Or wait, dying is one of nature's ways too... Anyway, if the doctors at the University Hospital in Ireland did not feel able to deal with this case because of ethical issues involved, why did they not simply transfer her to England?  That happens all the time, we from Canada transfer to the US if there is greater expertise or if all the NICU beds in the province are full, etc.  Why would this not be possible elsewhere?  I am so baffled at this case, and so sad and angry about it, probably because I identify with it too much.

Wanna know what we would have done in my hospital?  Have a talk with the mom about the zero survival chances of the baby.  Given the parents a moment to make up their mind.  And then, when they are ready, break the waters, and help the delivery along with some misoprostol or oxytocin, including operative extraction if needed.  Is this not kind?  Is this not right?  How would the outcome been any different?  Mom walks out of hospital alone anyway.  But at least she walks out...  Because we all know that LIFE IS SACRED.

Monday, October 21, 2013

dragging on

What's new over here? Well, I thought I had it bad when I was just sick from the pregnancy, but now, to improve things, I also got a cold and a sinus infection.  My right maxillary sinus feels like it wants to explode through my teeth.  I have decided to hold of on antibiotics for a few days and see if I beat it without, since in pregnancy one can only take crappy antibiotics anyway, which are unlikely to work and will give me a yeast infection.

Emma is doing very well but watching way too much Dora and Caillou.  I just cannot entertain her anymore in the evenings, and so I let her loose on my ipod.  Guilty as charged...

Two days ago, feeling like I should do something for this poor child, I decided that I am going to the swimming pool, sinus exploding or not.  I was pretty sick, but dragged my butt over there, and was a good sport mostly sitting on the side of the hot tub, while she was playing with plastic boats in the warm water (our hot tub is actually a warm tub).  When I got up to hopefully go home, thinking that I deserved a medal for showing up, the lifeguard lady came to me and said "I hope you don't mind my saying this, but your butt is showing through the bathing suit".  Apparently the fibers had stretched more than I noticed and the suit had become transparent.  I threw it in the garbage right away, but...

Was that ever an embarrassing moment, in particular in this small town where everybody by now probably knows that my ass was on show.  I have decided, in mature fashion, to realize with my adult mind that having a stretched out bathing suit is not a character flaw, and that given how sick I am lately, this is the least of my worries, along with other appearance-related issues.  But in this society, appearance is more important than being a good, moral person, and so it does matter.  

Emma wants to go "wimming" all the time, so I will have to show my face there again.  Not looking forward to it...even though I have another bathing suit that is hopefully in a bit better shape.

Tuesday, October 15, 2013

vomit comfortably?

I am vomiting a lot more often now, and it is soooo painful, especially when I don't have any food in my stomach and all that comes up is pure acid.  I am still taking the zofran, but it is not working as well anymore.  At 9 weeks, I guess the nausea and vomiting are hitting their peak, hopefully before they start to subside...

One of my colleagues did some acupuncture on me, but the pain from the needles created more nausea, and I ended up puking just as I was taking Emma out of the car when I got home.  She started crying and saying "mommy hickup".  She gets freaked out by my being sick all the time...

Here are some websites that I am researching lately...haha.  In case someone else is struggling with it.

Saturday, October 12, 2013

Prenatal diagnostics

I went for two appointments this week, as I was in Vancouver.  First, I saw my OB, who advised me to get myself down here from 20 weeks onwards and to stay in the city until at least one month after delivery.  The second appointment, I got an ultrasound at the IVF clinic, and the baby measures 9 weeks (should be 8w5d) and there was a very small subchorionic hemorrhage that had caused the bleeding, nothing worrisome.  In fact, the bleeding has stopped about one week ago, and I am ecstatic about that.

The thing that we discussed at this appointment was the prenatal diagnostics options.  With Emma I did blood work and a NT scan.  With this one, I have the option of NIPT testing, namely one called VERIFY, which takes fetal blood cells from my own blood and looks for chromosomal abnormalities in terms of trisomy 13, 18 and 21. It works just like an amnio, but it is much safer, since there is no belly poke, it is done by taking my blood. (As an aside, I am hoping that they will tell me the sex of the baby too...).  The test is done at 10 weeks, and the results come at 12 weeks, which for me is very beneficial, because terminating a pregnancy later than 12 weeks with a cerclage in place is almost impossible.  I think even 12 weeks is a bit late to be done through a regular d/c procedure, rather than a hysterotomy.

(Cause guess what, I will be 35 when I have this baby.  I have reached Advanced Maternal Age).

In any case, I am not going to worry about it, all I want to know now is that the baby is healthy and whether I am having to buy a pink or a blue pair of shoes.

Tuesday, October 8, 2013

8w1d heard the heartbeat

It is possible to hear the heartbeat this early!  I heard it, and MrH has too.  It just takes a very long time of playing with the doppler, and the sound is very...tiny.

Tomorrow I am flying to Vancouver, which will involve two separate flights.  I have the feeling I should take a couple of puke bags with me on the plane.  This take off and landing business is not the best for me right now.

I don't have any other updates.  I am still spotting.  This is taking so long to stop... perhaps at least in Vancouver they will be able to see where I am bleeding from.  At least it is nice to know that I can now hear the baby, so I don't have to sneak into the ultrasound room every time I bleed.

Saturday, October 5, 2013

almost 8 weeks

I am going to be 8 weeks in two more days.  I am very nauseous today and, despite using ondansetron (which I am rationing a bit, taking only 4 mg at a time, and only if I am working or very sick) I have started vomiting.

For some reason, I am not as gracious this time with the nausea and vomiting as I was with Emma's pregnancy.  I had so much more patience back then!  I felt like my body was hers to use, and that was that.  This time, I am waiting impatiently for the nausea weeks to subside, so that I can be a good mother to Emma again.  As it is, being in bed makes for a cuddly momma, but hardly for any learning or outdoors activities, and in my head, that is what makes me a good mother, giving her opportunities to learn and live a healthy life.  Is being next to me in bed while I am two shades of green healthy? Is listening to me puke scarring for her?

I think essentially that is what is at the root of the impatience and lack of acceptance for this pregnancy's  nausea.  I am just starting to figure out how I can be a good mother to two babies.  I guess the road is long and complex ahead of me.

PS.  I deleted the prior post with the picture of food, as it was making me sick. Don't ask.

Tuesday, October 1, 2013

little smurf

I saw the little smurf today on the ultrasound.  As of Monday morning, I woke up with almost no nausea at all, I mean I get the barfys if I smell stuff or drink too fast, but gone was the ever present nausea that was making me lay on my side constantly.  I am up and about, and cooked some elk steak and green beans today, and am even going to BAKE something, a sweet bread with yeast and honey/walnuts on the surface.  I will post pictures...mmm...

Relief aside, I was very worried that babyB has died and that is why I am feeling so much better.  To be honest, there is not an hour that goes by in the day where I do not worry about the baby having died,  but over the past two days I started worrying about how I am going to miscarry with the cerclage in place and with my colourful history of bleeding to near death twice before, and no OB on a radius of 500 km, no operating room, etc.  You know, the usual stuff that remote rural crazy pregnant people should worry about.  Oh, that and the fact that there are only four units of blood here in town.  Total.  If I start to bleed, that is NOT going to cut it, man!

So, after playing my exsanguination fantasies in my head for a while, I went to use the ultrasound machine in the hospital.  I was not able to see anything on it last week, so I did not have much hope,  but this week the little smurf was a lot bigger, and there was an obvious heartbeat, and that is all I cared to see.  In my limited non existent ultrasound experience, I could not see a subchorionic hemorrhage this week either, so what the heck, I have no explanation for my weird bleeding.  I guess it is just one of those things...

Even at 7 weeks I have a belly!