Saturday, August 27, 2011

Seeking acceptance

Last week was my first week back in the office (well, partial week, since I only made it Tuesday through Thursday, and Wednesday was the only 8 hour day), and it was pretty ok. I did find the distraction of tasks and co-workers helpful, and really felt the love and support of my co-workers, too, which was nice. I felt anxious about the end of the week, though, since the previous two weeks showed us that, subconsciously, Thursday, Friday and Saturday hold very painful memories that leak out when we least expected them. In anticipation of that, and the fact that I had my postnatal/post-op appointment on Friday, I took the day off.
I did find myself a little weepy on Thursday, and moreso on Friday morning. The appointment, though, was really good. I saw the same doctor who was on-call the night my water broke, the one who ordered the final ultrasound and vaginal swab to confirm amniotic fluid was present (in my vagina, not where it was supposed to be, around Baby A), the same one who admitted me to the Family Birth Center, and who rushed me back for the D&C when the placentas failed to deliver.

She was as wonderful yesterday as she was that horrible night, so very compassionate, searching my eyes for my feelings and so willing to answer every question I could muster through my tears. She helped me find some peace with what happened, based on the answers she gave:

The placentas, both of them, looked very, very normal. There were no signs of clots due to underlying issues with Baby A's placenta; we may never know why it was so fragile.

She didn't take the time to examine the babies closely after delivery because she was more concerned with my health, the amount of blood I was losing and the fact the placentas wouldn't budge. She can't say whether Baby A had a shorter than normal umbilical cord and whether that could have caused the abruptions.

When she examined me in the ER, and based on the ultrasound, my cervix was already changing due to early labor. Hastening delivery only sped up what nature had already started. (This is why expectant management was never discussed as an option for wasn't possible.)

My blood work that night showed slightly elevated white blood cell count, not high enough to say for sure that I had an infection, although it's likely. (My count was 14,200; normal for a pregnant woman is 11,000-13,000).

She confirmed I have four polyps on the outside of my cervix, but agrees that those should not have caused the outcome we had. Blood is an irritant and likely weakened the amniotic sac...but that blood would have had to have been from inside the cervix or the uterus, not on the outside of the cervix. She didn't feel any polyps when she scraped the inside of my uterus during the D&C, but didn't look for a polyp inside the cervical canal. She thinks having Dr. M. do the hysteroscopy in the next month to look for one is a good idea. She said my cervix STILL shows signs of inflammation (stop the insanity!!), so has put me on an antibiotic to try and remedy that. This could also make those four polyps disappear.

As Paul pointed out, one of the biggest things she did is restore a little of our faith in Group Health, our HMO. Both of us were so disheartened with the apparent lack of serious care I received in the three weeks I was with them, but Dr. A. is so *fantastic*...we both really, really liked her in the ER (odd in the face of disaster we'd love the doctor, huh?), and my experience yesterday only strengthens that. However...we know that Dr. M. would have continued to see me, a high risk twin pregnancy, every two weeks throughout the second trimester, then moving to weekly later in the third. Group Health appears to only see even high risk twin pregnancies on a monthly basis until moving to weekly later on...that's a problem. In a perfect world, we'd keep Dr. M. as our fertility specialist and Dr. A. as my OB, but only under the conditions that we'd be seen more frequently and only by her...options we likely don't have through the HMO-controlled process for monitoring OB patients. (I sent Dr. A. a private message last night asking about this through my secure Group Health account. Hopefully she'll respond, but I acknowledged that my question may put her in a difficult position so I understand if she doesn't.)

All these things together help us understand that what happened was a very unfortunate chain of events that led to an inevitable tragic outcome. The babies were just not ours to keep. We have definite worries of recurrence of placental abruptions in future pregnancies and with what happened, I'm even more high risk than I already was. We want to be sure that whoever we choose as an OB, whether Dr. M. or Dr. A., manages my prenatal care very closely and conservatively to help us have the best possible outcome. We do both have faith we'll be pregnant again's just the positive outcome that is harder to believe in.

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