And so it begins...
On Friday I went along for my 16 Week growth scan (due to holidays I was actually 17w2d gestation). I was super excited to see our little puggle again and possibly have the gender written down for a later reveal. I dropped James off at Grandma's, drank a litre of fluid and hobbled in with my legs half crossed feeling as though I might wet myself at any minute!
The scan started off beautifully, with our active little babe putting on a bouncy show once again! The measurements were a little small (about a week behind on average), but not too concerning. The amazing sonographer then asked me to look away while she checked between the legs and wrote down the gender. I then finally got to empty my bladder and prepare for the internal to check my cervical length. The doctor always comes in for this part, and it was lovely when a familiar face popped his head around the corner and said 'I know you!' - he was part of the MFM team at the Women's and Children's Hospital (WCH) and knew Jimmy's story (it was the talk of the nursery when he was born). We went over my history once again and it was so reassuring to have someone there who understood our complications.
They measured my cervix and I could immediately see it was a concern. Dr M summed it up with 'it's definitely short for this gestation with beaking and sludge present'. He checked a few more times before he explained that he didn't think I needed to rush to hospital but he would speak to Dr Yoong immediately and that I should prepare for either progesterone or an urgent stitch. He then spent the next 15 minutes with me re-checking measurements, dopplers and the placenta. He explained I also have marginal cord insertion, which is when the umbilical cord attaches to the side of the placenta rather than the middle, causing reduced blood flow. Dr M said they don't usually see the effects of it this early, but it could explain why bubs was already measuring a bit small. This all matches up with the previous low Papp-a level indicating a small baby and possible placenta complications. Thankfully we are already doing everything required to keep an eye on this such as frequent growth scans. Dr M was exactly what I needed at that time...a knowledgeable doctor who took our situation very seriously and was extra cautious. I left that appointment feeling so grateful that we have an amazing team, not only of doctors but even the best sonographers in Adelaide.
I awaited the call from Dr Yoong which came that afternoon. It's scary how quickly everything can change in one single moment. We had the car packed ready to head away to Normaville for the weekend, but he wanted to do a cervical stitch that night and told me to fast for surgery. I knew it didn’t sound like sunshine and rainbows in the room earlier, but I didn’t expect this. Panic set in for me when he said 'the aim now is to get you to 24 weeks, and you need to stop work immediately.' He was concerned that I was only 17 weeks and believed it would be better to act now that wait until it was too late, especially considering my history. We decided to have the procedure privately with Dr Yoong, I hung up the phone and the tears started flowing. I was in shock. I had finally wrapped my head around the low Papp-a, finally felt confident about NAIT and the transfusions, and now I had an incompetent cervix. Something they were always going to monitor ‘just in case’, but something I never thought would be an issue. I rang Scott and told him the news, and he left work to come home.
And then shit hit the fan. We were on the way to the hospital when we got a phone call that we weren't covered privately for pregnancy. Funnily enough, I knew this…but in the stress of the moment it didn't even click that this was a pregnancy procedure. I'd had three previous surgeries privately, but these were gynae related! We had chosen pregnancy cover for a private obstetrician in a public hospital as this is what we needed - we were always going to deliver at WCH where a NICU was present.
So we turned around and drove home feeling deflated and even more confused. What now? We felt like we were risking everything. I felt embarrassed. I felt terrified. I felt angry. Such a huge mixture of emotions. A massive meltdown later, Dr Yoong called back and explained that we were safe to wait until Monday to see Dr W at WCH MFM and in the meantime we would start progesterone pessaries and I would stop work. He didn't recommend bed rest at this stage but 8 long hours on my feet in ED wasn't safe. I felt more reassured at this moment knowing we had a plan in place, but I admit that I was still extremely uneasy. I wanted action immediately – I’m impatient and I didn’t want to risk anything. Every time I moved I felt pressure on my pelvis. I was taking small steps so nothing would ‘fall out’. It might sound silly but all of a sudden everything was heightened. Scott and I decided that night that we would advocate and fight for this baby – we have prayed so hard for this little miracle and as much as we trust the medical professionals caring for us, we would not hesitate to trust our own instincts and push for what we think is best. We then decided that the next best thing for us to do at this stage was to take our minds off it as best as possible in the coming days, so the next morning we headed away to Normanville as planned to relax with family.
This morning we packed up and went straight from Normanville to our appointment with Dr W at the Women’s & Children’s Hospital. We didn’t really know what to expect but we kept an open mind knowing that every doctor is different. Dr W reviewed the information from the scan - on Friday my cervix was measuring 22mm, with ‘normal’ being 35-50mm. He explained that they start to become concerned when the cervix shortens below 25mm but at this stage his treatment usually consists of progesterone and close monitoring. Given our history he understood our concerns, and he decided to do a quick scan and have a look himself. After we said hello to our little puggle who was bouncing about happily, he measured my cervix which was now only 18mm…there was suddenly no question that I would be getting an emergency cervical stitch and within minutes it was booked for tomorrow (Tuesday) morning. I felt both relieved and petrified. I knew that the stitch would give this pregnancy the best chance, but I was also fully aware how delicate this situation was. Dr W explained that the biggest risk with inserting the stitch was pregnancy loss (1 in 200), but at this stage the risk was greater if we didn’t go ahead. This made me feel physically sick. I am only 17 weeks pregnant…if anything happens now there is no hope. I understand that there are still no guarantees if we make it to 24 weeks, but there will at least be hope.
Tomorrow morning I will present bright and early to WCH for surgery at 8.30am. I will be staying overnight for antibiotics with a follow up scan the next day. While I’m there, the doctors will organise the IVIG treatments which will begin in two weeks. I will also be having weekly scans from now, which will be coordinated on the same day as the infusions. Dr W agreed that bed rest isn’t necessary, but I should finish work and limit my activity as much as possible (although he was realistic that this would be difficult with a toddler!) While we expected this pregnancy to be difficult, we thought we were aware of and managing the main concerns…it’s as though I had a false sense of security and am being punished for it. This has certainly been an unexpected slap in the face, but right now we are hanging onto all the positives we can - that this stitch will work and we have the best team in Adelaide providing the very best care. Today as we were leaving Dr W said ‘you are doing a great job Amy, the baby is healthy and well’, and this touched something deep in my core. I have so much guilt and feel so much responsibility for the difficult journey my family are experiencing, but these kind words made me feel enough, even if just for a split second. Time to practice what I preach and trust the process, one day at a time…