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| My Personality and Medical History |
The exam went well. The baby is doing fine it seems. Heart rate normal. Uterine growth on target. I still haven't gained any weight but I was referred to a nutritionist. I was also told I have to drink more water, eat more fiber and I was asked if I needed relationship counceling.
*blank stare follwed by dramatic pause and quiet chuckle*
I'm still on pelvic rest. But the good news is that my activity restriction was greatly reduced. I questioned this and the contrasting advice from the previous doctor but I was told the prior restrictions were in place until the full report was done in light of my other factors. [Insert "everybody is different" pre-rehersed lecture.]
So here is "The List" with the "so far" answers I was given:
What type of placenta previa do I have? Is it complete, marginal or partial?
Complete. No measurements were indicated on the report. However, her suggestions would be the same regardless if it was marginal or not. No sex, nothing in there, no orgasm, no stimulating contractions or bloodflow to the area and nothing irritating it. I was instructed to refuse, beligerantly if needed, anything that could penetrate or arouse me; not even to let ER doctors do a pelvic exam.
My thoughts that I kept to myself: #FML
How many CM wide is my cervix? How many CM of placenta are overlapping my cervix? Is the placenta centralized over the cervix? Is the placenta anterior or posterior? Is it leaning to one side? If so, which side? Is the placental cord single, double or presenting any abnormalities? Are there any signs of other complications such as placenta accreta, increta, percreta, vasa previa or placenta abruption? Can I have a MRI to rule out additional complications? Can I be referred to a high risk clinic or have a perinatal specialist involved in my care?
No measurements were indicated on the report. She is scheduling a follow up ultrasound for 26-28 weeks, at which point if it has not resolved, there measurements will be taken and I'll be referred to the high risk clinic in Boston for routine ultrasounds and to be involved in my care. At this point she wants to see if it resolves or improves before putting me through the efforts of extra bi-monthly appointments, walking, stress etc. As for accreta, the placenta not improving at all by 26-28 will indicate if it's deeply embedded. As for vasa, it's not a major issue if the placenta moves.
My thoughts that I kept to myself: She's right that extra appointments would be stressful and burdensome, considering I have a toddler in tow AND that it was my toddler's meltdown in radiology that prevented the measurements from being taken in the first place; cutting my appointment short and getting only the basics done. Still, it could be she just doesn't want to complicate matters for herself. She's so nice and easy going, I really can't tell her motives. (But I like that about her.)
What are the chances at present that this can resolve on its own?
At present, there is an 75% chance it will resolve itself. However, if it hasn't improved some by my next ultrasound, then the chances drop drastically.
How many CM away from the cervix must the placenta be in order to be cleared for vaginal delivery?
Her: "Off... like, way off." Me: "How much is way off?" Her: "OFF off [insert *the look*]"
Is the fetus having any growth abnormalities, deformities or anomalies?
None indicated on any ultrasound report and everything seems normal and going great otherwise.
Do I have gestational diabetes or preeclampsia? If so, how does it affect my care and are there any special precautions?
Am I at risk for blood clots or thromboembolism? If so, how is this managed?
I need a blood glucose test. Needed my HIV test (mandatory for each pregnancy). Blood pressure normal. Not at abnormal risk for blood clots at this time. Walking or moving around greatly reduce the risk of clotting.
What follow-up care will I need for the rest of my pregnancy?
I'll have a routine follow up monthly plus required tests until my next ultrasound, which will determine my care after that point. Previa is common when diagnosed before 20 weeks and in the absence of pain or bleeding, there isn't much more that can be done other than wait.
Can I be monitored monthly by ultrasound for placental localization changes?
Since ultrasounds done on previa patients are transvaginal, considering my history, she doesn't even want to risk doing an ultrasound. She doesn't want anything in there or anyone pressing on my belly - period, until the baby has good chances outside the womb.
My thoughts that I kept to myself: Although it would be nice if I could know as soon as possible if I can resume normal activities, her suggestion seems most logical actually. Something around 90% of babies born after 28 weeks do okay.
What exactly are my activity restrictions right now? What is the most weight I can lift? How much housework can I do? How much walking can I do? What kind of exercise can I do? What kind of travel can I do? Car? Boat? Plane?
- Pelvic Rest no sex, etc.
- No high impact exercise causing vigirous breathing or activities that could result in falling. no sex, etc. lol
- Don't fall. Don't bang myself into anything. no sex, etc. lol
- I can lift my toddler, just not walk around carrying him or anything. Putting him in and out of playpen, high chair, car seat, on/off slide at park etc. is okay. If he's kicking, or wiggling too much, don't do it. Don't want him kicking my belly. Okay, so this was a big improvement for me because my youngest son needs help getting in and out of things and my doctor knows my muscle tone can lift him with one arm, no strain, no problem. So I was really sad about not being allowed to do those things the past couple weeks. And I'm happy she didn't see a problem with this. No piggy backs though =(
- I can lift whatever my arm/back/chest muscles can tolerate without needing core muscles. Again, this was a big improvement for me; as I didn't want to do ALL my shopping online.
- No abrupt bending or reaching, hoola-hoops, volly ball, sports. Awe, no hoola hoop?Aweeeeeeeeee =(
- Light housework.
- Light cooking.
- Don't travel, stay close to hospital.
- Mild exercise. Walking casually with breaks and listen to my body. Prenatal yoga is okay, so I'm gathering she's leaning toward this "impact scale." She did say mild hiking was okay, just don't push it or fall. I'm guessing that swimming is okay as long as I'm not bleeding.
- Overall, "take it easy." Overall, taking it easy is not easy for me. I am very active. So even taking it easy is torture. But not as much torture as total bedrest. So I'll take it.
I still need to gain 8-15 lbs.
Notes: So far I've flucturated around my pre-pregnancy weight. In the first trimester I lost around 10lbs. And I've gained and lost. This appointment, I lost a half pound from my previous appointment. She's referring me to a nutritionist. :-/
What do I do in the event of a yeast infection? What do I do in the event of constipation? What can I do to prevent constipation?
She's calling in a prescription with refills of yeast infection cream and fiber suppliments at my phrarmacy. However, she recommends preventing this in the first place with diet. Her personal suggestions are eating bran and psyllium every day, apple cider, yogurt, kefer, water, etc.
How should I respond to BH contractions?
Prevent them by staying hydrated and not staying in one position too long, longer than an hour or so.
Personal Theory: Almost everything I read about experience with bleeds starting while laying down or dehydrated. I'm wondering if the uterus takes advantage of "downtime" by practicing it's contractions when the body is most still, such as during sleep or while immoble. Now I'm contemplating how many women notice BH contractions or start bleeds during regular casual activity. Hmmm. I also know that the baby itself can compress a previa, so standing or sitting can sometimes act as "applying pressure to a wound." Although I've read contradicting views that the weight of the baby also puts pressure on the placenta, which could aggrivate it. Now I'm actually interested in knowing which is most detrimental.
What symptoms should I look out for? Fever? Shortness of breath? How should I respond to pain or cramping but no blood? How should I respond to bleeding? When should I go to the ER? How should I respond to mucus discharge or signs of cervical shedding?
If anything abnormal occurs, come in. If I'm not bleeding and can't come in, at least call. If I bleed, come in A.S.A.P. by ambulance if needed. Whatever happens, do not let ER doctors put anything in there or do an exam unless it's life threatening. Have them call an High Risk OB immediately. Tell them I have a previa and do not touch me.
I'm getting the idea that my doctor does not trust doctors at all, or anyone for that matter. Her whole demeanor throughout the appointment seemed as if she really wanted to emphasize that I should be not be letting anyone touch my "privacy" or my belly. He facial expressions were such that if it were legal to suggest, she would have probaby recommended I carry pepper spray. Haha. :-x
If the placenta doesn't clear, does the hospital give steroid shots for fetal lung development? If so, at how many weeks? If the placenta doesn't clear, will I need to take tocolytics? If the placenta doesn't clear, does the hospital conduct amniocentesis for fetal lung monitoring? If so, at how many weeks? If the placenta doesn't clear but there are no other complications, when will a c-section be scheduled? Are placenta previa c-sections conducted under general or spinal anesthesia? If placenta is anterior and a c-section is required, will the surgeon do a vertical incision or cut through the placenta? Can I store my own blood in case of the need for a transfusion? If so, how can I arrange that?
What procedures and policies do I need to know about regarding a c-section? What procedures and policies do I need to know about regarding the NICU?
Right now, my doctor's thoughts are a c-section is off her radar. While this pregnancy may require a c-section, may be further complicated and may not improve; she doesn't even want to think in that direction yet and suggests I don't either. She did say that if the condition persists and a c-section is needed, as long as it's not an emergency delievery, she will probably have me transferred to deliever in Boston (which could happen anyway); because they have a bigger blood bank.
My doctor is such a hippie. Granted, my kid's doctors are also hippies and I think I pick them for that reason. Despite my questions going unanswered (which is mildly peeving); she really wants me to visualize and focus on having a natural vaginal delivery. Perhaps she's right in this regard. I certainly put stock in the power of visualization and faith.
If I start to bleed heavily and am waiting for an ambulance, is there anything I can do to prevent massive blood loss or decrease bleeding? What bed rest policies are in place? (For instance, if I bleed once will I be put on bed rest? If I bleed more than once, will I be hospitalized?) Are there any special foods or drugs that are usually safe during pregnancy that I should avoid specifically? Could anything bring on contractions or increase likelihood or severity of bleeding? Can I donate my afterbirth to research? If so, how can I arrange that? What local and hospital resources do I have at my disposal? How can I get the rest of my questions answered, if they were not answered?
I can't believe I forgot to ask these questions. =( I will ask next time I talk to a doctor. In the meantime, I'll research some of this later.
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