14w3d, reality check

 

So I can comfortably say I’m in my second trimester and I’m feeling a little freaked out because with the twins, next week is just when everything went to hell and it took 5 days to finally deliver. 

 Over the weekend, husb and I had a discussion about what our plan of action is and we finally decided to get the stitch sooner than later and do the shots.  So we called the peri and they said we need a referral again to do it so we called Dr. M.  It turns out that according to Dr. T’s recommendation, our care would have to be transferred to UCSD( 30 miles away) until I’m 28 weeks, then I can go back to Dr. M.  What the hell!!! I just built rapport with Dr. M and now we gotta switch it up with the peri people.  Shit, there’s goes my confidence!  That had me a little frazzled on Monday and of course I had to work.  I spent a large part of my night doing research on MDconsult and I realized that doctors are sadistic and cruel.  They want ladies to go through multiple 2nd-trimester losses before they think a cerclage is needed.  Or get in trouble before a cerclage is needed which in turn will end up as a loss.  Docs really don’t care about you as a pregnant patient until you’re in your 3rd-trimester.  I guess they figure whatever happens between conception and 24 weeks is a toss up, so good luck and we’ll see you later.  

Back to my research of medical journals: “Patient’s with a prior 2nd-trimester loss were 10.8 times more likely to have a recurrent 2nd-trimester loss or spontaneous preterm birth, compared to those with prior full-term delivery.”  OUCH!!  Then in the conclusion of a study regarding 2nd-tri losses it stated “if in fact 2nd-tri loss and early preterm labor occur by similar biological mechanism, women with 2nd-tri loss would be candidates for therapy that reduces subsequent preterm birth such as p17 and not for cervical cerclage”.

Still confused. I feel like I’d be taking a big chance either way.  I have prayed and prayed and prayed over this decision.  My mother-in-law called me yesterday to check on me and said everyone was praying for me.  God has watched over this baby despite all the bleeding and spotting. 

My mom talked to one of her ob-gyn friends (Dr. Lo), it turns out it was the same doc that saw me when I was first admitted to the 1st  hospital.  She did a pelvic exam and saw the sac bulging in my cooch. My vaginal cultures were negative so what’s all this infection talk?  I bet by the time I went to the second hospital, I was head down and stuff probably started sliding back north and the contents of my uterus wasn’t as heavy so it didn’t look as bad when that peri saw me.  Dr. Lo said “GET THE CERCLAGE” since she has seen cases where it happens again. Even Dr. M said do both.  And the old peri said get a cerclage for the next pregnancy before I was discharged.  So I should feel good, right?

I’m still scared of the surgery.  Just because it’s surgery.  I want this baby so much and it took sooo long to make this baby, all the shots and meds and waiting, I will do anything to boost it’s chances of growing up. I wanted to have a “normal pregnancy” but I have to let that dream and my ego go. Plus getting shots in my ass every week sounds like so much fun! I needed help getting pregnant and I need help staying pregnant.  That’s my reality.

I better hurry up and get my hair braided before the referral goes through. I might be in the hospital for a looong time.

Live and learn, Peri visit

Referral finally went through so, first peri visit on 3/27/09.  Husb and I drove like 30 miles to a teaching hospital (UCSD)  that had perinatal and genetic services. So we talked to Dr. T.  (new chick) and discussed my pregnancy history, but first, she did a quick viability u/s.  Lil’ bit is growing fine and looks more like a baby with the skeleton glowing and squirming around in there.  My husb. calls the baby “gummy bear” so he was so excited to see his gummy bear moving on the screen.  Fiesty one…think it’s a girl.  We’ve seen baby 5 times now with a great heartbeat.  At 6 w, 8w, 9w (ER), 10w, and now @ 11w2d.  So begins the talk about my history.  I had to relive the last moments with my twins. Very painful, but necessary.  According to Dr. T. my case is not clear-cut.  I could have IC or PTL or infections that started the whole process (raging UTI at the time).  In other words, she can’t really tell so I had to get my hospital record with the pathology report for her to continue to piece the picture together.  Same shit they told me when I lost the twins.  Docs don’t really know what happened.

Apparently, with “true IC” a person may have discharge, leak or break their bag of water and the cervix is already dilated so delivery happens fairly quickly.  In my case, I leaked, broke my bag, then had contractions in the ER, but I had to be induced to go into full blown labor and that happened like 5 days later since I was like 1-2 cm dilated. Plus because it was twins, it’s even trickier because of the weight of two babies, two sacs.  But I remember feeling like there was something in my cooch the night before my water broke but I wasn’t sure.  So I’m thinking IC because baby A’s sac was bulging.  Either way, we have choices and she is not jumping on the cerclage bandwagon yet due to it’s risks, especially if it’s not really necessary.  Go figure.

1. Take progesterone shots to prevent PTL that could lead to IC.

2. Get a cerclage and take progesterone to cover for IC and PTL

3. Do nothing, watch and wait, get  my cervix checked every 2 weeks and pray it doesn’t shorten or else an emergent cerclage  is needed.

In the meantime, start getting my cervix checked for length and vaginal cultures for any infections.

Hmmmmmm.  The risks of the cerclage: rupture my membranes, screw up my cervix (even more than Dr. L’s dumb ass already did with the LEEPs), infection, andor fetal demise due to early labor.  My husb made a good point that the risks of doing it are the same as the risks of not doing it.  We’ve been through the scenario before and would like to PREVENT it. Watching and waiting freaks me out because I had seen Dr. L. less than a week before my water broke.   In the two weeks that I’m waiting for another check up, I could dilate. Dr. T. said think about it, she’ll send recommendations to Dr. M. (we see her on 4/6) and to call the office if we have more questions or make up our mind.  I want to do everything to save this baby, especially since we couldn’t save baby B last time. 

We went the hospital that I delivered the twins at and got my chart.  I should’ve done that a loooong time ago, but I just didn’t have the strength.  I also realized that stupid Dr. L. should’ve gotten my pathology report and let me know what it said, but he never did.  What the hell!  Thank goodness, I am persistent and we have a new OB.  So I read the report and learned some things.

• Baby A was a boy.  So his name should be Angelus, not Angeline.  Sorry baby.  We couldn’t tell because his skin and body parts were macerated.   So we had two boys.  If they were alive, their names would’ve been totally different. Angelus’s placenta was infected and even his umbilical cord was infected.  My poor suffering son. I almost cried reading the report.  But we had to know.
• Augustin was not infected.  Could we save him, maybe.  But the risk of the infection spreading was too high.  I always miss you both.

So the choice is ours again.  I think we’ll take door # 2 .