Placenta Previa & Incompetent Cervix


I’m so very sorry for not updating the blog.  But things have moved quickly this week and have been very chaotic around here.  Friday we went to the obstetrician (Dr. O) and ya’all know about that already.

Monday we had another appointment with Dr. O and we requested a referral to a University hospital here.   He not only gave us the referral, he said he was glad to do it, his only goal was healthy mama and healthy baby and he hoped they could do it.  He had them call IMMEDIATELY down there.  My appointment was at 1:00. By 4:00 that day, the phone consult had been done, the records had been faxed, and the appointment for an indepth ultrasound and a physician consult with the perinatologists had been scheduled… For THURSDAY!  We were thrilled.

I should go into more detail about Dr.  O.  For one, the man has zero ego.  When he says he only wants a healthy mama and a healthy baby, it’s true.  He cares very much about his patients.  I’ve heard from the grandmother of a baby born still through no fault of anyone and  I hear he cried with Mom and Dad after the delivery.  He is deeply invested in his patients and I can’t tell you how incredibly blessed we feel to have him as our obstetrician.  That said, a doctor is as good as his staff.  And honestly?  I can’t tell you how much I look forward to going into that office.  Every single person from receptionist, to the person who takes my blood, to the nurses and ultrasound tech are about the most cheerful, encouraging, lovely people I’ve ever had the joy to be around and I’m glad to be going back to a place that very OBVIOUSLY loves children.  They constantly ask about mine and we enjoy taking them in on occasion and getting them ooh’ed and aah’ed over.  What an amazing blessing.

Thursday was the consult.  With a LOT of people, sigh.  First we did a very (VERY) thorough ultrasound.  After all we had denied all of the prenatal testing and you’d not want to go to extraordinary lengths to keep a pregnancy of a less than perfect child, right?  Oh my.  I think I answered that one with grace, I think.  I explained to the doctor that knowing ahead of time that there was something wrong with the child and doing less than we would for a “perfect” baby and not try to keep the pregnancy would entail a very serious ethical dilemma for us and that we would do exactly the same for a less than “perfect” baby as we would for a so called perfect baby.  And he dropped it thankfully.  I don’t say this to say he’s a bad man.  Actually we QUITE liked this Dr. Y.  I feel a bit sorry for him.  I suppose seeing high risk patients with babies with serious issues probably does jade one quite a bit, don’t you suppose?  We had two ultrasound techs and two perinatologists consult on that.  Then we were sent over to the OB clinic for an internal exam, a history work-up of past pregnancies, and a consult.  Had the exam and was found to be a “good two” whatever that means…  I HAD been 4.1 on the previous Friday, so that was a little concerning but not surprising.   They wanted to fit my cerclage into the schedule by the following Wednesday but couldn’t do it with the two particular doctors they wanted to do it, and they didn’t feel it would be prudent to wait longer than that at this point as we would be past the 17 week mark….  So they fit me in on Friday,  the NEXT day.  LOL, it was such a relief but oh my what CHAOS.

Oh, and did I mention I developed some kind of infection/bite on my leg on Wednesday?  It showed up on Tuesday and we drew a marker circle around it.  It was hot and inflamed and obviously growing.  By Wednesday it was really unpleasant, having grown a full inch all the way around.  DH was concerned and so off to the doctor I went.  I’ll say nothing nice about the doctor, so I’ll just say nothing at all.  Suffice to say that was a clinic visit utterly wasted.  Do you ever feel you should get to deny a payment to the medical field if they don’t actually DO something?  Kind of like any other profession where they sit and hmmmm at something but don’t actually touch the car or whatever they’re supposed to fix?  Sigh.

At the appointments on Thursday and again on Friday they were quite interested in my infection.  It was general consensus among the doctors down there that it was cellulitis, a fairly non threatening infection of normal bacteria like staph or strep that would normally live on the skin.   At this point (Thursday afternoon) it was over the circumference of a softball.  I was on antibiotics at this point and they decided to do the surgery anyway, but gave me more antibiotics injected.  I can honestly say today it looks MUCH better.

Onto Friday.  We showed up at the hospital at noon.   The procedure began around 3:30.  It’s normally a 20 minute surgery.  It took a little longer due to a small issue with scar tissue from past cerclages.  They were able to deal with it beautifully though and instead of placing the normal 1-2 purse string stitches, they placed FOUR.  That made me smile a little.  I guess we can safely say we got our money’s worth?  There were three doctors, including the department head,  doing the surgery as apparently they found this pretty fascinating.  The popular discussion of the day seemed to be wondering how much scar tissue I’d have in there with this many cerclages.   We were later told by her that she’s glad they scheduled it for Friday and not the following week as I was very soft and already dilating.  Thank God.

Thanks to ansthesia and some nice drugs that helped me to not vomit violently 😉 it was by far the most pleasant cerclage experience I’ve ever had.  I can’t begin to express how grateful I am to God for what He has done.  Oh, and that pesky previa?  Yeah, it’s gone.  Not marginal, not low lying, but a very nice, healthy placenta exactly where it should be.  No signs of accreta, and no abruption.  I can’t begin to explain the miracle that has been done here.  I guess if you read the past excerpts you’ll begin to understand where I was, almost hopeless, to where we are now.

Oh, and they think she’s a girl.  Did I mention that?!  How blessed are we?

I looked at our two year old today and wondered if there was anything more beautiful than a child.  I think not.  Mamas, do you know how blessed you are?  You were CHOSEN.  Yes, YOU!  You were CHOSEN by God Himself with the remarkable task of being entrusted with His beloved children for their training, protection, and love.  What a shocking and mind boggling task.  Without dependence on Him I wonder how we should succeed at all???  And be so grateful.  You should SEE my house right now.  It is an absolute disaster.  Pictures would only begin to describe the smell of the dishes that have sat for about four days now.  It is more than a little chaotic and exhausting.  And we have my sister’s shower tomorrow to celebrate her daughter whom we will welcome to this family sometime in the next four weeks.   What a perfect end to an exhausting week – the celebration of a new life!

Don’t begrudge your tasks.  Don’t belittle your role.  You were chosen.  Your ministry personally given and assigned by God Himself.  What a beautiful thing to be given such an important, vital, life altering ministry.   And to something to precious to God as a child?!?!?!  Truly, mother, He must love you and think highly of your ability….  And remember not all children are given biologically.  Mother, if you haven’t children biologically please think not that I don’t include you.  He shall and perhaps has also laid out your ministry….  God bless each and every one of you in this amazing blessing we’ve been given.  Please be grateful each and every mess, er, I mean DAY, that we even have the chance to be a mom……  We are so blessed.

We had our own miracle here yesterday.

I’ve been having a lot of pressure and contractions, and finally a lot of crampiness yesterday and finally went in for an ultrasound….. To find that my cervix is STILL 4.1. It’s slightly shorter than it was but not by a lot which was a big surprise and great news. But that wasn’t good enough. The complete previa has moved and it’s now only marginal previa.

So let me explain HOW big of a deal it is. Because it seems like every pregnant woman I know is climbing out of the woodwork to let me it’s no big deal, their previa moved too, lol.

It’s a VERY big deal.

Miraculously so.

And this is why: A pretty good number of women get previa. It’s not uncommon at all. I’ve had it three times now. The first time was marginal. The second was low lying. This one was complete. Most women will have marginal (on the edge or lip of the cervix) or low lying (very close to the cervix.) A few women will have complete previa where it covers the complete cervix. And fewer still will have complete previa where it’s fully centered over the cervix. The last category has the smallest chance of it moving. Now. Let’s say you have ten women with previa in a room. Out of those ten women, NINE of them will have their previa move. This is why there are pregnant women relating their stories saying, “Well, I had previa and it moved.” That tenth one is usually someone with a complete previa. But that’s not all. Previa generally moves in the late second trimester, or early, or mid third trimester. It’s almost always moved by 34-35 weeks. As the uterus grows much larger and stretches, the placenta takes a natural trip along the wall and further and further away from the placenta. And in the worst case scenario, and they still have the placenta at delivery? Well, you do a c-section and it’s done.

In OUR scenario, we didn’t have ’til 34 weeks. Our obstetrician wouldn’t take the risk of a hemorrhage and place the cerclage we need in place for our incompetent cervix. We NEEDED that placenta out of there no later than 20 weeks. Sooner (like NOW) would have been better. But because the uterus is relatively small at this stage and not growing rapidly, it doesn’t tend to move yet. At 12 weeks I had a complete, fully centered, placenta previa. And I had been told no stitch. With all the contractions lately and the amount of pressure, we felt like the baby had been given a death sentence.

More than that, we were worried about me as well. An incompetent cervix dilates to a very large degree (6-8 in my case) pretty much totally painlessly and without any warning. In our last two deliveries I dilated to 8 without any unusually strong contractions. The fear here is that when my cervix starts to dilate, we’d start to hemorrhage. It was, honestly, a pretty frightening proposition.

IT MOVED.

I no longer have complete previa. I only barely have marginal previa. My dr. still will not do the cerclage. However, he will refer me to a perinatologist in a larger university hospital so it can be done. I get the referral on Monday.

My God? He’s a BIG God. He didn’t do a little miracle. This one was one of those monster miracles… The REALLY big kind. If this placenta had moved at 26 weeks… 28 weeks… 34 weeks… Well, it wouldn’t have been that unusual. But to move in THREE weeks. THREE WEEKS!!! And do you know how far along I am? 15 weeks 4 days. That’s it. We’re not talking about a stretching uterus. We’re talking about the placenta – as one friend put it – growing legs, pickin’ up, and relocating. 🙂 LOL

And I’d like to say I withstood this with grace and I can’t. I can say some days I was strong through Him. And some days I was very, very weak, especially thinking about Hannah’s death, which was pretty ugly. Everyone, please, say a thank you to God today in your prayers for me. It looks like in December/January I might just have a baby to hold.

First, thank you all so very much for your prayers.  I am so sure they have helped and ARE helping.

Now a praise.

Where I was sure there were NO options, there has opened a window for a couple.  My current OB has said he will not give progesterone until Week 22.   It’s been very stressful here lately and I’ve not been sleeping well as contractions began Tuesday early AM (around 3:00) and they’ve just been consistent for the last couple days.  It has been exhausting, not because they’re painful or even uncomfortable, but being 15w 4 d pregnant and having contractions and a cervix that dilates painlessly?  You feel like a walking time bomb.

So I called for the progesterone injections to start.  And that was when I found out that my OB won’t start them until week 22.  I found an ACOG (American College of Obstetrics & Gynecology) Opinion (#419 if you’re looking) that shows a study that has had significant impact on preterm labor using progesterone beginning in weeks 16-20.  It IS experimental.  We’re requesting a referrral to a further away university hospital where they do perform experimental work.

Moreover, last night I “happened” upon a study that has nothing to do with incompetent cervixes.  It had to do with previa.  It appears in 1993, and again about 10 years later, they did studies trying to find out if by placing a lower McDonald’s stitch ( a type of cerclage) in the cervix if they could better the rates of infant mortality and mother’s health in at risk previa patients.

The conclusion was that there was no effect.  But did you catch the important part?   They were placing cerclages in previa patients!  Moreover I then “happened” across to an Incompetent Cervix support forum – NEVER knew it existed!!!  And there was a post on there (a few actually in the Search engine) talking about previa and IC.   Several women had had a cerclage placed WITH partial or low lying previa and at least one had had it placed successfully with total previa.

Today I’m calling the OB and requesting an appointment.  I’ll need a referral to the university hospital.  I’ve already put in my request for a specific doctor specializing in preterm delivery and placenta issues.  I’m praying for a couple things – that doors would be opened, that I have the grace to pull through this.

I’m not going to kid you.  I’ve had a rough couple days and I started bawling on my poor husband’s shoulder yesterday before work in the morning… I just really don’t know that  I can hold a baby while she dies again….  Nothing about it was fast, or painless, or peaceful.  It was tragic & awful and I just don’t want to lose this little one.

So I’m asking for continued prayers please.  I firmly (FIRMLY) believe the Lord is active in even the smallest aspects of our lives, every single day.  There is not anything He does not know, including this little one He has so generously loaned us.  I pray His will be done in our lives and that His peace and grace shine through no matter the outcome.

I popped over to read a blog a friend had sent me.  The woman, also a Christian, and a mother of 13 children, had a little boy 8 months ago and experienced problems with complete (total or full) placenta previa.

While much of our situations is different with my preterm labor/incompetent cervix,  I did find her blog encouraging.  I did notice that she categorized her placenta previa posts under a separate category for ease of finding.  So, I’m creating another category and hopefully some day this drama will encourage someone else.  We’ll see. 😉

Placenta previa occurs in approximately 1 out of 200 women or 0.5% of the time.  9/10 cases diagnosed in the early second trimester will resolve themselves spontaneously.  Unfortunately those are almost always marginal, partial, or low lying previas.  It is rare that complete previa spontaneously resolves.  Approximately 40-50% of women with previa at the time of delivery will need blood transfusions.

9-10% of patients with placenta previa will develop a condition called Placenta Accreta.  It’s important that if you’ve been diagnosed with placenta previa that your obstetrician be watching for this.  It is VITAL that you watch for it.  While it is not common in people without previa, if you are reading this blog because you have previa, are a mother to many, have had previous c-sections, you have significant risk factors.  From what I can find the hysterectomy rates for patients with accreta is running at 66-71% and this is to prevent hemorrhage of the mother.  The transfusion rate is approximately 90% and the death rate for patients with placenta accreta is 7% or approximately 1 in 14-15 women.  It’s not pleasant, but part of the reason accreta is so incredibly serious is that it is often NOT diagnosed.  When the mother delivers the baby it is THEN that accreta is discovered and it’s often a nasty shock.  Accreta can be partially diagnosed through the use of color mapping and ultrasound, but knowing the risk factors, it should certainly be something to be wary of.   In over 50% of the cases accreta is NOT diagnosed until after delivery.  If  accreta is properly diagnosed there are preparations that can be made.  Not all accreta cases are previa and so some are delivered vaginally.   Obviously it would be better if these were delivered via c-section.  Imagine that, me advocating a cesearean.  I’m waiting for a pig to fly over my head.

And so we shall see………

Next doctor appointment – August 3rd.  They will most likely check cervical length and placental position again then.  We’ll be just over 16 weeks.  I get the feeling this fall is going to be very, very long.

Some things you take for granted.

You take the sun rising each morning for granted.

You take creamer being in the fridge for your coffee every morning for granted.

Clean socks… No one knows how they get there, but they aren’t appreciated.

Babies.  We get pregnant, we make it to the second trimester and we take healthy babies for granted.
I haven’t had that luxury since Hannah’s death.  I’ve always walked on tiptoe until about week 14-16 when they place in that beautiful purse string stitch, the cerclage, around my cervix.   We tell the kids they “lock” the door of the uterus.  They stitch it up tight so it can support the weight of the baby.

I had a doctor’s appointment this past Monday.  It was a wonderful thing.  I was seeing a doctor I really adored and I love his staff!  As a bonus, we got our first ultrasound and what did we see?  A perfectly healthy baby.  Really it couldn’t get much better.  Sounds lovely doesn’t it?

And it was!  All of her little arms and legs and parts were there.  Unfortunately the placenta isn’t cooperating with our game plan.  We’ve had previa before – marginal previa.  Where just a naughty little lip of the placenta hung over the edge of the cervix.  And really?  Worse case scenario?  The absolute WORST thing that could happen?  I’d have to have a cesearean section a few weeks early.  Would I love it?  No.  But, ah well, a healthy baby is the goal and a healthy baby is worth the price paid in a pound of flesh. 😉

I didn’t realize I was at such high risk – several risk factors.

~Previous previa – twice
~Previous D & C  – to remove retained placenta after Ana’s birth
~Grand Multi-Para – lots of babies
~Previous C-Section
~Advanced Maternal Age (have to love that at 32, lol.)

Previa usually moves!  As a matter of fact, out of all the people who are determined to have some type of previa, only 10%, a teeny tiny 10%, still have it by the time they need to worry in the late third trimester.  And here we sit… Our little ticking time bomb.  Because we can’t wait for the third trimester. Oh no.  That cerclage was supposed to be placed in July.  And it won’t be.  And if the previa doesn’t move in August, it won’t be placed then.  And we have the unfortunate coincidence of having total (a.k.a. complete) previa.  It’s the least likely to move.  If it hasn’t moved by the beginning of September we’ve effectively closed our little window of opportunity to put in the “magic” stitch……

So what does it all mean?

I wish I knew.

I was one of those mamas who took a healthy baby for granted.  I mean sure, I had to jump through hoops, but a healthy baby?  After the surgery, everything has gone fine in the past.  And, after all, there is that *unmentionable* thing to be mentioned….  I lost one baby.  When Hannah was born at 26 weeks, she lived 12 days.  Who has TWO children die?  Who?  No one.  Right?  Not in this day and age……..  So that was, albeit not politically correct, it was my reasoning.   I had given up one child and why would God ever allow me to lose two?

And so here we sit.

I wish that was all.  We have the added complication that if the cerclage isn’t in place, my preterm labor is severe.  I dilate painlessly.  I am one of those incredibly blessed women who do not know they are in labor.  Think I’m kidding?  Abigail and Sarah.  They’re my examples.  With both Abigail and Sarah, I went into a doctor’s appointment and found out I was, respectively, 6.5 cm and 6 cm. dilated.  Contractions?  Nope, nothing out of the ordinary.  As a matter of fact with Abigail, strong, labor like contractions did not start until I was at eight, and then we broke my water.  She was born about 15 minutes later.  Lucky me!  I love this part of labor, lol.  But.  Not. In. This. Case.

In this case painless dilation is a serious threat.  The biggest risk about going into labor with total previa is the risk to Mom and Baby.  If you’re dilating without warning, the little vessels inside the placenta begin to break.  Pretty soon you start to bleed.  Baby can die with no warning and Mama can begin to hemorrhage, sometimes dangerously so.

Many doctors head this off by doing an early c-section.  What does one do when one goes into labor at 20 weeks?  What about 24 weeks?  28?  What about when you’re choosing, by delivery, to end the baby’s life?  Or at the very least make life awfully hard?

I’m wondering in the next months what decisions we’re going to be asked to make?  Are we going to be asked to terminate?  The answer would be decidedly no.  Am I going to end up hospitalized again, like with Hannah?  What does a mother of seven living, homeschooling children do when she’s hospitalized for weeks?  Are we going to be asked to choose the life of the mother over the life of the baby… Effectively that’s what IS going to happen if we start going into labor at 24 weeks or earlier.

I wonder these questions.  I wonder more morbid ones as well.  Did you know you can bury two children in the same plot at the cemetary?  Why would you?  I know this.   I hemorrhaged badly after Hannah was born.  I still remember the very LITERAL sound of splashing blood.  Memories like that haunt you sometimes…..  There are darker questions you wonder… Do you have enough life insurance?  Have you taken enough pictures?  If the worst happened, which children would have memories of their mama?  It’s late… The mind wanders.

Most of all I wonder why God would put me in this position.  I’ll not shy away from the fact that I’m praying for His protection.  For mine and the baby’s well-being to be sure, but for more than that… For His protection from being faced with ALL of it.  I’m praying for the placenta to be moved, and this burden to be lifted, these choices to be removed.

And sometimes God says, “Yes, I’ll take this cup from you.”

And sometimes?  Well, sometimes He says no.

I do entirely trust that His will can and should be done.  I acknowledge that His will is far better than mine.  I live to serve and wonder how I’ll be used in this instance…….  I pray for His eyes to see.  And I remember the story in the Bible with the father and He is asking the Lord to heal his child.  And the Lord asked, “Do you believe?”  And the father answers, “I beleive Lord, take away my unbelief.”  And I pray that He’ll remove doubt and unfaithfulness from my heart.

Part of me rests easy.  The better part of me is patiently trusting, waiting to see and hear and experience both what is and what will be.

The other?  Ah well, she is researching previa trying to find the exact statistics of total previa moving by exactly 20 weeks.  I know her.  She’s the same one that could quote the statistics for a 26 week old premature little girl surviving.

I’ve said over and over and over again, statistics aren’t relevant.  Even if the statistics are 98% to 2%, if you’re meant to be in that 2%, it is as it will be.  And no amount of worry will change that.

All prayers are appreciated.