Another Bleed, Another Hospitalization, But I’m at 36½ Weeks

A week and a half ago, on St. Patrick’s Day morning, my placenta started bleeding again. I was stunned, for it had been nine weeks, to the day, since my beginning of prior bleeding episode. At 34½ weeks of pregnancy, I’d gotten comfortable, thinking I’d become the best-case scenario of a high-risk pregnancy patient with placenta previa, and I’d just deliver my baby boy via C-section when my doctors determined he was mature enough to do so, for it wasn’t safe to go into labor—or deliver vaginally—with the placenta covering my cervix.

Then a trip to the bathroom.

Bright-red blood soaking my incontinence pad and underwear.

Fear.

I called my high-risk pregnancy practice, The Center for Maternal and Fetal Health, and spoke with a nurse, who told me to immediately go to the office, rather than Labor and Delivery, because the doctors were still holding office hours. My friend Yana drove me, took my 5-year-old son home for a playdate with her son, then took both of them to afternoon preschool.

At my doctors’ office, I was quickly ushered in and waited for only a few minutes before being seen by Dr. D, the doctor I’d seen in Labor and Delivery for my bleed in mid-January, at 25½ weeks of pregnancy. She asked if I minded pulling down my pants, so she could see the extent of the bleeding. Upon viewing the blood, she said, “If you keep bleeding, we’ll just do your C-section today.”

I told her I was relieved, that the bleeding, resulting from my placenta partially tearing away from my uterus, makes me nervous because I have a sorority sister from college who lost her baby at 41 weeks—while on a fetal monitor, in the hospital, the night before she was being induced—due to placenta abruptio, a condition in which the placenta completely separates from the uterus.

“She lost her baby in two minutes, in the hospital, on a fetal monitor,” I said. “So if know that if I started bleeding severely, I could call 911, and I’d still never get here in time.”

“Placenta previa is different from placenta abruptio,” she said. “With placenta previa, YOU die.”

Subtle, huh?

My practice is connected to the hospital, so Dr. D had Kathy, one of the nurses, wheel me down to Labor and Delivery, where I was checked in, put into a room at the end of the hall, and given a hospital gown.

My nose started bleeding profusely. Sometimes it will bleed when I blow my nose, which is a common pregnancy side effect, but I’d never had an actual nose bleed in my life. I had an overly dramatic thought that I was bleeding from every orifice, which wasn’t true, but I was feeling panicky without my husband, who was on his way from his office downtown.

Alone in Labor and Delivery, I felt intense sadness, and it took all of my strength, physical and mental, not to cry. I was worried about having my baby at 34½ weeks, when he’d likely land in the Neonatal Intensive Care Unit (NICU) because of respiratory and/or eating difficulties. Then again, my 5-year-old was born on his due date, but spent his first five days in NICU because he was born in acute respiratory distress after aspirating meconium, his first bowel movement in utero, during delivery. After he was able to breathe on his own, he refused to eat, which the NICU nurses said was likely because his throat was sore due to his initial intubation. So even at full-term, babies can end up in NICU, but I recognized that, at 34½ weeks, my baby would have a guaranteed stay.

After I’d changed into the gown, nurses took my vital signs, positioned the two monitors on my stomach to evaluate my baby’s heart rate and any uterine contractions, and inserted an IV line.

Next, a resident entered and said she needed to conduct a vaginal exam to determine if my cervix was dilated. It was just a basic exam, with a speculum inserted into the vagina, so the resident could see—with a light strapped across her forehead, as if she were a miner—my cervix. However, it was one of the most painful medical procedures of my life: I was tense; my feet weren’t in stirrups, but straining to stay at the edge of the bed, and after nine weeks of bed rest, I had little muscle tone; and the exam was long, because the resident couldn’t see my cervix because of the amount of blood in my vaginal canal. She kept removing the blood with swabs, then trying again.

I have a high pain threshold, but I was so uncomfortable that I was whimpering, so I was relieved my husband wasn’t there to bear witness. It would have increased his stress levels.

The exam revealed that my cervix wasn’t dilated, although I wasn’t sure why that mattered, since I was having a C-section. But I didn’t question any of the bustling staff members. They seemed very sure of every stage of their evaluations of me and my baby.

Next up was a meeting with a member of the anesthesia staff, then an abdominal ultrasound, during which Dr. M, the head of my high-risk practice who was on-call in Labor and Delivery, changed course. He said that it looked like the placenta was no longer covering the cervix, but right next to it, making a vaginal delivery possible. To get better ultrasound images, he sent me back upstairs to the practice’s office, telling the technician that he wanted to personally see the images, so, when she was ready, to page him.

My husband met me in the hallway as I was being transported by wheelchair to the office. Once again, my name was quickly called, after which my husband and I were led into an ultrasound room, where both abdominal and trans-vaginal ultrasounds were performed. Our baby, breech during my previous ultrasound, was head-down, and Dr. M pushed his head up and away from my cervix to get a clearer view. But clear wasn’t possible.

Dr. M said that he thought that the cervix was free of the placenta that had been covering it since my week 13 ultrasound, more than 21 weeks of my pregnancy. He showed us what he thought was the harder edge of the placenta, as compared to what he thought what was on top of my cervix—a blood clot. He asked the ultrasound technician to run a blood-flow analysis, which made him more confident, because blood would flow through the placenta only, not through a clot. All of the images consisted of shades of gray, and Dr. M admitted he couldn’t be 100-percent sure of his readings.

He then recommended that we first try a vaginal delivery because he believes that, as the baby descends into the vaginal canal, he’ll push the placenta farther up inside the uterus, enabling him to be delivered safely—before the placenta. He assured us that, in case of any complications, he’d immediately perform a C-section.

He explained that he was considering the best interests of both me and the baby, and a vaginal delivery is preferable for me because of less recovery time, and delaying delivery is preferable for the baby because, even at 36 weeks, just a week and a half away, he’d likely be able to come home with us, rather than spend time in NICU due to breathing or eating problems.

I asked, “You really think it’s safe to try a vaginal delivery, even though I’ve had two placental bleeds?”

“Yes.”

But then he added that he wanted to consider my emotional state, that he’d heard that I had a friend who’d lost her baby via placental abruption, but that placental abruption is extraordinarily rare, as in 1 in 1,000 pregnancies, and that what happened to my friend is yet another 1 in 1,000 placental abruptions. He outlined the signs of placental abruption and said that I’d likely be at the hospital, diagnosed and having a C-section before either my baby or I were at risk.

He said we could evaluate the situation and decide when to induce, based on how I’m feeling emotionally.

“I just want to do what’s best for the baby,” I said.

And what was best for the baby was to stay put, rather than attempt a vaginal delivery on St. Patty’s Day.

So I was wheeled back down to Labor and Delivery for observation—for another five hours before I was released—during which I wasn’t permitted to eat or drink, just in case of increased bleeding necessitating delivery. I’d woken up at 5 a.m. to eat some Frosted Mini-Wheats and hadn’t been hungry again before my bleed started, so I went almost 13 hours without food or drink.

So I lay there in Labor and Delivery with fetal monitors strapped across my stomach, starving, emotional, and having to disconnect the monitors and wheel my IV into the bathroom every 10 minutes because the IV fluids were making me pee. And my husband sat there with his laptop on his lap, accessing the hospital’s wireless Internet so he could work. And we were both reeling, because we’d been worried about my bleeding, we’d been told we were having our baby via C-section because of the bleed, and we weren’t sure waiting and trying a vaginal delivery was the right call. Because, at the time, we never could have known.

But Dr. M was right, and we were right to listen to him.

When I was released, Mr. M put me back on complete bed rest until last Friday, the day I hit 36 weeks, his goal. In the past week and a half, I haven’t had another fresh bleed, although old, brown blood is still coming, 12 days later. But old blood is nothing to worry about.

I am now at 36½ weeks of pregnancy, and, on Friday, I will be full-term, for full-term is defined as 37 to 42 weeks. At this stage, our little man will likely accompany me home from the hospital.

And last, during my 36-week appointment on Friday, it was crystal-clear, via ultrasound, that the placenta has moved even farther away from my cervix.

I NO LONGER HAVE PLACENTA PREVIA.

So the plan is that, if I bleed again, for my placenta is still low-lying, and low-lying placentas are more unstable, I’ll be induced, and my doctors will try a vaginal delivery since there is now no reason for it to be dangerous.

If I don’t bleed, my doctors will continue to evaluate the results of my weekly exams, in which I have ultrasounds to check on placental position and amniotic fluid levels, plus non-stress tests to evaluate the baby’s heart rate and whether I’m having contractions. If any problems are revealed, I’ll be induced. If all’s well, they’ll likely let me continue until I go into labor.

This weekend I told my husband that, if I don’t have another bleed, I’ll probably not go into labor until close to the baby’s due date, April 23, since my 5-year-old son was born on his.

“You have a history of one,” he replied. “I don’t think it’s a good idea to rely on that.”

Yes, I have a history of just one, but having a biological child is a miracle that many DES Daughters don’t have the opportunity to experience. And because I was able to carry my 5-year-old son to his due date, although I was dilated starting at 27 weeks, and because he stretched out my DES (diethlystilbestrol)-induced T-shaped uterus while he was in utero, I felt confident that, if I could get pregnant, I could carry another child to term.

This time around, I admit that I’ve alternated between feeling blessed and cursed, because, rather than have premature dilation and labor as I did with my son, my cervix is long and closed—even at 36 weeks—but instead I lost one of my twins, and I’ve suffered from placenta previa.

But I don’t have placenta previa any more, and it’s rare for it to rectify itself in the third trimester. And if I can make it until Friday, I’m at term. Just four more days, and I’m at term.

  1. marciaellis
    March 29th, 2010 at 19:57
    Reply | Quote | #1

    Hang in there, Mary Katherine!! So excited for you that your placenta previa has recified itself….my Caroline was born at 36 weeks and was 5 lbs 15 ozs! Healthy as a horse! Make sure if you decide to go vaginal that they get your epidural on board first, our DES exposed cervixes dilate very quickly(mine 15 minutes after my doctor induced me by breaking my water). He wanted to induce me in case that would happen! Just a word of advice from your fellow DES exposed friend….by the time the epidural kicked in, she was already out! I’m praying for you…can’t wait to hear the happy news:)

    Marcia from Cincinnati

  2. mk
    March 30th, 2010 at 10:12
    Reply | Quote | #2

    Hi, Marcia:

    My docs think my baby boy is huge already. My 5-year-old son was 9 pounds, 7 ounces on his due date, and we’re only 3 1/2 weeks away from this little guy’s due date, so the head of my practice said he could be close to 9 pounds now.

    Thanks for the advice about epidural timing. It took three epidurals before I had pain relief the first time around, and I don’t want to repeat that experience!

    MK

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