The messy-but-hopeful update

Okay, friends. I have some news and a big, long, messy update. I will give it to you in the order I have been learning it. Please bear with me. I know it will be more detailed information that some of you really want, but I also know that some of you like to know the nitty gritty.

Last Monday (12/12) I had my routine weekly ultrasound with the perinatologist I'm seeing. He is sort of annoyingly close-mouthed, and unless I know exactly the right questions to ask him to get information, he doesn't tell me much and I just receive the details of his report from my regular OB when I see her and we discuss what it means. Last week I didn't see her until Thursday, so until then I knew only what I'd found out at the ultrasound - the baby was now head-down, I'm being monitored more often, and I had the updated info from the discussion I had initiated about my expected timeline.

So Thursday (12/15) my doctor came to see me and informed me that according to the latest ultrasound report, the vasa previa that I was diagnosed with when I came in here no longer appears to be vasa previa at all. I was startled, and asked what exactly that means. From what I understand, I still have the placenta previa (edge of the placenta is covering my cervix) and the marginal cord insertion (the umbilical cord is inserted along the edge of the placenta instead of into the middle as is usual). But four weeks ago, the perinatologist seemed quite sure that the blood vessels attaching the cord to the placenta were exposed and vulnerable, unprotected by the cord. At the ultrasound last week he got a more comprehensive look and (although he didn't mention it to me...grrr) he reported that he believes those vessels are actually encased within the cord after all - NOT dangerously exposed.

That's good news. It certainly does a lot to relieve my feeling that I have a ticking time bomb in my womb, and that my baby could bleed to death at any moment. While the placenta previa and the location of the cord insertion are not ideal, they are not nearly the risk factors that the vasa previa would be, and I'm glad about that.

Also, more good news is that I got sick this weekend with some sort of a stomach bug, and had awful contractions every 2-4 minutes for an entire 24 hour period Saturday afternoon to Sunday afternoon. It was a pretty miserable weekend between the stomach pain, the vomiting, the IV drip, the omnipresent monitors strapped to my belly, the side effects of the medications they were giving me, and the fact that I wasn't allowed out of bed during most of that time. Okay, obviously none of that sounds like good news, but the good news is the fact that while all that stuff was going on, I had no bleeding at all. Knowing that I contracted and vomited and was generally miserable for a couple of days, and yet had no bleeding and absolutely no signs of fetal distress makes me feel much less fragile.

And for a final piece of good news (since I'm on a roll now), I had my latest ultrasound yesterday afternoon (12/19), spoke at length with my doctor about it today, and got some more encouragement. The latest word as of yesterday is that the previa has been downgraded from a complete previa (the placenta entirely blocking the cervix) to a partial previa (the placenta is partially covering the cervix). In and of itself, this does not really change anything, since the plan for delivery is the same either way. But it could possibly indicate that in spite of the placenta being firmly fixed over my cervix since we first discovered it ten weeks ago, a shift is finally occurring, much later than anyone anticipated.

What this actually MEANS for me is not clear yet. If the placenta and cord insertion point are blocking my cervix when it's time for the baby to be born, the course of treatment is to avoid labor and have a cesarean to deliver the baby. But if there is any possibility of the placenta moving out of the way of my cervix over the next few weeks, I'm not about to let people cut on me anytime soon. Ha. The wonderful thing about my doctors is that they are not particularly eager to do an unnecessary cesarean (part of the reason I chose this practice to begin with). When discussing the situation today, my doctor said that we are NOT going to schedule an amniocentesis at this point, and we're going to wait to make any decisions until we have another ultrasound next week and see if the placenta has moved any more. Given that I'm apparently not dealing with a vasa previa and that I have a partial rather than a complete placenta previa, there is not nearly the urgent need to rush the delivery that we expected four weeks ago when I checked into the hospital.

If the placenta appears to be moving, even slowly, it may be possible to simply check week by week as long as there are no danger signs, and give it as long as possible to get out of the way. If it never does, and I end up with a c-section anyway, at least I'll know that the baby got to spend as long in the womb as possible and that we didn't rush into anything. Oh, but wouldn't it be wonderful if my previa goes from partial to marginal, and then to nonexistent? It's possible, folks. I am prepared to do whatever is the best thing for my baby, but I would so love to have the opportunity to at least attempt a vaginal delivery if possible - and I will be thrilled with any type of delivery around full-term rather than between 34-36 weeks.

Of course, since my doctor was giving me all this encouraging news, I immediately asked if I can go home. She's not comfortable with that because of the incidents I've already had, and the fact that we've only had a single ultrasound indicating that the previa has shifted somewhat. But she didn't rule out maybe going home if the previa looks to be still improving next week.

I don't know what's going to happen, but here is what I'd LIKE to see happen. Ideally, the previa will resolve, the placenta will end up the required amount of space from my cervix to allow me to remain pregnant until this girl decides on her own that she's ready to be born, and I'll be able to give birth on my body's timetable with no complications. And since God already knows that's what I want, I don't think it hurts to ask him for it. If you're a praying person, you can ask him for it, too. If it's not what ends up happening, I'm okay with it - after four weeks here, I have accepted that things have not gone the way I expected or intended during this pregnancy, and things are not likely to go the way I wanted for the delivery, either. But it is okay to hope, and okay to be optimistic (my doctor is being decidedly less optimistic than I am and does not want me to get my hopes up - but she's not the one stuck in the hospital with too much time to think, so I am not taking her wishes into account on this issue).

And considering that I am officially 34 weeks tomorrow, and we were afraid when I arrived in the hospital that we'd be dealing with a possible birth right now in this time frame, every single day and week from this point on is good news, and better than the worst-case scenario I've been envisioning.

Are you confused? Did I explain well enough? I know this is a lot of information. I have been working on digesting it for a while, and I think I've got a handle on it, but I've no idea if I have adequately conveyed the details.

I guess the bottom line is that things are looking much less scary than when I came in here, and I'm hoping that they improve enough to allow me to go home and be pregnant for five or six more weeks, and maybe even have the type of delivery I've been hoping for from the beginning. I would appreciate it so much if you pray for me, and help me ask for that. And if the answer is no and I end up staying here in the hospital and having a c-section, it's okay - at least we asked. :)