Chapter 206: Previa
May 8th marked yet another doctor's appointment. They had been once a month, but this was the first of the every two weeks appointments, and it, like a few of the others, began with an ultrasound.
Jimmy had asked Tim about that. Best he remembers seven month ultrasound isn't standard operating procedure.
So Tim told him what Dr. Draz had told them back at the 20 week ultrasound, Abby's placenta was a bit low, and they just wanted to check on it.
Jimmy's staring at him, confused and amazed, and finally asks, "Why haven't you been freaking out for the last ten weeks?"
That draws Tim up short. "Should I have been? Doc said something like one in three women have that issue at twenty weeks, but they check again later, and it's like one in two hundred by the 30th week. Uterus grows, shifts its shape and it pulls up and everything is fine."
Jimmy's nodding at that, because, yeah, that's technically true. "Okay."
"She didn't act like it was any sort of a big deal at all. Pretty much said it was normal, or at least really common. She was way more concerned about the Nuchal Fold test and making sure Abby's blood pressure and sugar levels stayed normal. Hell, I haven't thought about it since then."
"It's probably not a big deal." But Jimmy's not exactly sounding confident on that.
"Okay, you're starting to freak me out."
Jimmy rolls his eyes. "Yeah, well, I'm a little sensitive on things like this."
"So, is this you being overprotective or was she feeding us happy bullshit because there's nothing we could do about it?"
"Overprotective. She's right, placenta previa is really common mid-pregnancy and almost non-existent by the time you get to full term. They'll check today and see where everything is?"
So, sitting in the ultrasounds lab, Tim's feeling a bit more nervous than he'd like to be. He really didn't like the look on Jimmy's face when he mentioned the placenta was low. Yeah, Jimmy's sensitive to things like this, but…"
The tech came in and began the ultrasound. And 4d images of Kelly more or less shut down his ability to worry. Overwhelming awe: that face, those tiny fingers curled into her mouth, they could even see her lips sucking gently on the forefinger.
They were both floating on that image when the tech said, "I'd like to get some more images of the placenta. I can get better quality from a transvaginal scan."
And cute and love and drifting along on clouds of happy baby joy came crashing to a halt.
"Why do you need a better image?" Abby asked.
"It's still low, and we need to know exactly where it is."
They won't let you use your smartphone in the doc's office. This is deeply annoying to both Tim and Abby right this second. They're sitting in an exam room, with nothing but fear to keep them company.
The Ultrasound Tech, Julie, wouldn't tell them anything beyond, 'low.' What does low mean? 'Talk to the doc.' Is this a big problem? 'Dr. Draz'll read the scans and let you know what's going on.' Can you at least tell me my wife and baby aren't in danger of dying in the next five minutes? 'No one's dying today.'
Abby's dressed again, and sitting on the examination table. She's so nervous she isn't moving. He's pacing.
There's a computer on the desk in the office. It's for the doc to use. Not him. Right now, he doesn't care about that, at all.
In less than a minute he's into it, and searching the internet for whatever the hell a low placenta is and what it means. He's trying to remember, Jimmy called it something, but he's so scared it's slipping his mind.
So he googles low placenta and finds reams of information on placenta previa. He's reading to Abby about how it means the placenta is over the cervix and as the cervix gets softer and opens it can tear the placenta and hemorrhaging can occur.
To say they are both less than thirty seconds away from hysterical fear when Dr. Draz walked in would be a very accurate description.
She saw both of them, hovering next to the computer, skin white, faces tight, Abby clutching onto Tim's hand as they were reading, took a deep breath, reached over, turned off the computer and said, "It's not that bad. Sit down, take a few deep breaths, and start to calm down. Abby's not going to be bleeding to death in the grocery store."
She gave them a minute to sit down, both of them on the exam table, Tim has his arm around her shoulders, and she's snuggled into him, gripping his knee.
"Okay, let's start at the beginning. Obviously you both know about worst case placenta previa now. That's not you. Right now, your placenta is at 2.5 centimeters away from the cervix. Anything lower than two centimeters and we get nervous. Basically as the cervix thins and softens the placenta can rip and result in bleeding.
"First and foremost, right now we're at watch and wait. Hopefully, as your uterus continues to grow, the placenta will end up further away from the cervix and this won't be a problem.
"But even if it stays where it is, this isn't something to panic about. We know it's an issue. We're going to keep monitoring it. The biggest thing we're going to be dealing with is how fast your body changes in relation to how fast Kelly grows. If your body stays at full thickness and no dilation, up to 37 weeks, then this will be very easy. We'll schedule the c-section, and one morning come the middle of June you'll come to the hospital and a few hours later, you'll be holding Kelly.
"If your cervix starts to ripen and dilate before that, we'll start something called pelvic rest, no internal exams, no sex, you take it easy. It's not exactly bed rest, but if you don't have to get up to do it, you don't go do it. Pretty much, no jostling the uterus. Thirty-six weeks is officially full term, but we like to see babies get to thirty-seven weeks, the outcomes are a bit better, and their lungs are usually in better shape.
"If you start bleeding before that, we'll use medication to try and make the bleeding stop. If that works, then you go on bed rest." She checked their information. "You live close enough to the hospital that you'd probably be able to go home for that. Bed rest means exactly that, you lay in bed and catch up on your TV and reading. The only thing you get up for is to go pee. You'll stay on bed rest until Kelly hits thirty-seven weeks."
"What if the bleeding doesn't stop?" Tim asked.
"Emergency c-section. The placenta has a lot of blood flow, but it's not an artery. You're not going to bleed out in five minutes if it ruptures, no matter what those morons on the internet say. Sure, now is a bad time to decide to go on a cross country trip. Right now you don't want to be more than twenty minutes from a hospital. But everyone in this practice can get a baby out in less than seven minutes if need be, so no one is going to bleed to death.
"The biggest thing to keep in mind right now is that if you start bleeding, get to the hospital right away."
Tim and Abby are a little calmer with that, but a little calmer and calm aren't precisely the same thing.
Abby pulled it together enough to ask, "What do we do to avoid bleeding? I mean, do I need to start pelvic rest now, or…"
Dr. Draz shook her head. "No. You don't need pelvic rest now. I'm not saying you want to start running marathons or anything. Take it easy. If it weighs more than fifteen pounds, have someone else pick it up. But that's fairly standard seven months pregnant advice, anyway. Right now, while your cervix is full thickness and shut, everything is perfectly fine. Given where your placenta is, the most likely story is that it'll continue to scoot out of the way as your body changes, and by the time Kelly's ready to come out it'll be far enough out of the way to not be a problem. In most cases like this, if we were back in the pre-ultrasound days, we'd have never known there was an issue."
"What does 'most' mean?" Tim asked.
"In my experience, about seven out of ten. I'm thinking we'll keep an eye on it, see how and if it moves, and by the beginning of June we'll make a decision as to whether you want to try and deliver vaginally or if you'd rather schedule a c-section. It's entirely likely that by the time you're at term that it'll be a good three inches away from your cervix and this won't be an issue at all."
"Is there anything I can do to try and… encourage it to scoot up? Stretching or anything? Hang from my knees, inversion table, anything?" Abby asked.
"Is sex okay?" Tim asked.
"Right now, yes."
"I mean, we have a whole lot of it."
"Good for you. Yes, it's okay. Obviously, don't do anything that hurts, but I'd assume you already know that."
Tim's nodding. "It's really okay?"
Dr. Draz sighed, she's seen this before, knows it's a normal, scared male response, knows that this is basically the only part of this issue that he can control, but well, her sympathy for it is somewhat limited.
"Is your penis a foot long?"
"No." He's looking at her like she's completely insane and says, "Orgasmic contractions are kind of like labor contractions, right?"
Her respect for Tim jumped up about ten notches. Poking the placenta and breaking it is the usual guy fear. He's the first guy she's seen who's put together the idea that orgasmic contractions might move the uterus in a bad way. She smiled gently.
"It's really okay. For right now, and likely the next month, everything is going to keep being exactly the same as it was before. We're just watching more carefully. As the cervix starts to ripen, and we've got a better idea of what is going on, we'll be able to plan from there.
"I'm thinking we'll keep with the every two weeks appointments, but once you start having any contractions at all, we'll move to once a week. You will, eventually, start to have little contractions. They call them Braxton-Hicks, but really, they're all the same thing. It's just your body getting ready to get the baby out. You don't need to sprint to the hospital as soon as you feel them, but once you do, it's time to give me a call and schedule an appointment for the next day. So, we all okay with this plan?"
Tim and Abby nodded absently. That was a ton of information, and no, they weren't really ready, or okay. They just weren't in a blind panic anymore, and while that's better than being terrified of breathing wrong for fear of bleeding to death on the way home, neither of them were particularly happy or calm on the ride home.