The Current Normal

“Give me silence, water, hope
Give me struggle, iron, volcanoes.” ― Pablo Neruda

My pregnancies with Theo and Quentin were the definition of normal, save for the c-sections at the end. Morning sickness. Aches. Weight gain. I ate what I was supposed to eat and took walks for exercise. I grumbled about my discomfort. All normal, boring prenatal appointments.

I had a small breath of relief after my 24-week appointment with Maternal Fetal Medicine. For a minute, the pregnancy felt “normal” even though I had just left the office of a highly-specialized doctor. I came home, felt movement, and talked to Ger about the baby’s name. I asked him if he felt better after the appointment and he said “a little.” I felt the same… just “a little.”

It has been better as I feel regular movement now, but there are still evenings when I find myself gasping for breath. My mind becomes filled with horrible thoughts of a sudden stop of a heartbeat. Of not feeling movement and being scared, of using my heart rate monitor and being terrified, and then racing to the hospital to confirm my biggest fear – that the baby was gone. I still don’t know. I still cannot be fully reassured. I tried to tell myself that this pregnancy is like my first two, not the last two, but I don’t know that.

The autopsies showed Fetal thrombotic vasculopathy: clotting, on the fetal side. Of unknown cause. Ger and I were tested for blood clotting disorders; I’ve been put on blood thinners – though that shouldn’t matter since the clotting was not maternal – but nothing definitive. There is so little information about FTV: it is not well understood. Articles are scholarly and dense, and an online forum with posts from other moms are scary, talking of late-term losses. But on lists of issues, I’m being watched for. Growth restriction. Blood flow. Fetal cardiac problems. Fetal movement and heart rate starting with my non-stress tests.

Finally I read something that calmed me a bit. Interuterine demise before delivery of at least 3 days can cause FTV on the placenta, due to decreased blood flow. My OBGYN had said that to me after Nelle’s autopsy came back: the clotting could have occurred Post-Demise. We have no way of knowing what day they were gone. I clung to that idea for a moment; that the FTV was a result, not a cause. Anything to calm my nerves for a minute. Telling myself over and over that I have had two healthy children with no complications.

I had my 28-week appointment with MFM today and woke up around 2:00 a.m. with a sharp pain in my side.  I felt movement, so I decided not to panic.  When it hadn’t subsided by the time morning rolled around, I was certain that I would leave immediately and go to the hospital before heading to MFM.  But, I calmed myself enough to do kick counts.  Got to 10 within the normal timeframe, took a breath, and knew that I could wait for my 9:00 appointment.  By the time a few more hours had passed, the pain was completely gone.

I brought up how much the FTV scares me.  I asked about the chances of something (a blood clot) happening suddenly.  He acknowledged that is a concern, but said that he would expect to see issues like growth restriction that would be an indicator that something is wrong, and so far we haven’t seen that.  Every growth measurement has been perfect.  Nelle had the growth restriction, but Iris did not – so this was only partly comforting.  I asked about decreased fetal movement, as I had read about this in some medical articles as well, and he said yes, this could also be an indication.  I have a good baseline for myself with kick counts every day, so he said any variation we could look into.  He asked if I would prefer to come back in three weeks instead of four, and I agreed that it would make me feel better.  He also told me that we could start non-stress tests at 30 weeks instead of 32 if needed.

I then talked to him about my c-section date.  I am scheduled at 39 weeks, 2 days.  I let him know that I went into labor with Theo 6 days before my due date and Quentin 9 days before my due date – so I have never made it to 39 weeks, 2 days before.  I told him that date is giving me a significant amount of anxiety.  Between the two live births and my high risk status, he said that he would recommend the c-section at 38 weeks instead of 39.  He will put that in his notes to my regular OBGYN, and then my regular OB will need to put in the order for the change.  That appointment isn’t for another two weeks, but I feel better about 38 versus 39 weeks.  That means fewer than 10 weeks to go.

Though these appointments have been a normal part of the pregnancy, and will be occurring with increased frequency, I still found myself with my heart racing during the minutes between when the ultrasound tech left and when the doctor came in.  The tech had been typing into the computer and I thought “what did she see? what is she not telling me?”  Even though I had watched every measurement flash across the screen and now have become so familiar with the images that I could tell when she was measuring head, belly, bones.  She tried to get an image of the face, but Baby Three kept putting up hands and wiggling around in protest.

Countdown has been reduced by seven days.