This is what the doppler image of a cord scan during a biophysical profile looks like. They measure the cord in various places to get a reading which comes from the peaks and valleys of the imaging at the bottom, indicating the flow of oxygen and blood through the arteries within the umbilical cord.
My last post talked about cord accidents in general, the research behind them, identifying different types, how this impacted us and how women who have had a cord accident are at an increased risk of having another cord-related incident.
Entering this pregnancy, I knew there was that risk because what I read about them last year. My doctor knows those risks and that is why we have had this increased monitoring and why I am and always will be classified as a high risk pregnancy. I didn't want to believe it could actually happen again but of course it has been a fear which has driven some anxiety lately because of the point of this pregnancy that we have reached - nearing the 32/33 week mark when we lost Hudson. I haven't really been sleeping well, I have been a lot more emotional than usual, and have been feeling rather on edge. We went to our 31 week appointment on September 1 and were confronted with news that made us stare our fears in the face.
At our 31 week sonogram last Thursday, Hadley presented with high blood pressure flow in three places of her umbilical cord. The ultrasound tech checked a few different spots and the levels didn't sit right with her. It was enough of a jump in her scores from previous weeks to warrant concern. We were none the wiser walking out of the ultrasound room and went about our merry way to wait for my doctor. When our doctor came in, she was in good spirits and started by saying that Hadley looks beautiful but that something new has come up and she didn't want us to panic, that we are catching it early and there are things we can do. She started to explain that the blood pressure in her umbilical cord was elevated which can be problematic and we are going to take every precaution there is given our past with Hudson's cord accident. She let us know that best case scenario is that it could go back to normal on its own and it could just be situational. That it could mean bed rest. That it could be the beginning of a developing problem and could mean I'm admitted to the hospital to be monitored more closely. It could mean we deliver that day if needed.
Try hearing that last one and not panicking. Suddenly my baby's life felt like a waiting game and I was back in a position of fear in that doctor's office. I didn't know how much of her approach was in efforts to keep me calm and what I wasn't being told. I didn't know the extent of how serious it was or what it could become. I didn't know what this would mean for Hadley in this very moment and each one after for the next 6 weeks.
I sat there partially processing and the other part stunned, my husband immediately taking on his calm role of support. I blurted out that I felt hiccups yesterday and had a melt down the night about it because what hiccups could mean if they occur too often. Now, I had only felt them one time, but my mind went to the scary place. I felt hiccups with Hudson at this exact time in my pregnancy. I only felt them three times with him over the course of two weeks, which is in no way excessive, but it still haunts me. The fact that I felt his in the two weeks leading up to his passing and now I was feeling hers at that same week mark and there seemed to be some kind of cord related issue again pushed me over the edge. She told me that we are going to get through this, we are being proactive and her nurse was in the process of calling another fetal high risk specialist for a second evaluation. That was our next step and we will determine from there, that we have a plan.
As they worked to get in touch with them and send over my medical records, we were told to go downstairs to the hospital cafeteria and eat, to try to relax and if we don't hear from them, call in an hour. Riddle me this - how could I possibly eat or relax!? My stomach was in knots, I felt sick and the last scenario she mentioned was going through my mind what if we have to deliver today at 31 weeks? We waited nearly two hours before getting the call to head over to the hospital's Fetal Care Center. I was going crazy thinking what if something happens to her in this time, doing kick counts and recording her movements in my phone to monitor her activity. I have to tell you how amazing my husband is in tough situations. He kept us calm, at as much peace as possible, and distracted as best as he could. He knows how to handle my reactive nature and he is the eternal optimist.
The other doctor we saw was phenomenal with us and very compassionate regarding our previous cord accident loss. Before he started, he laid it out there for us though. He said that he will not take any chances and that if she so much as looked at him wrong on the ultrasound, he would admit us or send us over there to deliver via emergency c-section. By the time I got into see him, it was nearly 3 hours after the initial scan. He looked at the cord in depth in several spots and in two of them, the levels had stabilized to normal realm of comfort. In one area, the numbers were still slightly elevated and a little further apart, but not to the point where they felt we needed to monitor her in the hospital or the need to deliver her immediately.
Want to know something interesting he told us? After we talked about Hudson, he said there are more babies that die before birth in the state of Texas than women who die of breast cancer each year. It is a harrowing fact and one we should pay more attention to. That was eye opening for me but it reinstated his passion for what he does and made me feel in very good hands.
He spent a lot of time evaluating various aspects of her development that could indicate any kind of cord restriction issue, like fluid build up in the brain and heart chambers. Both were completely clear and functioning beautifully. Her heart rate was at a strong 151, and she is growing like a weed. He even took the time to point out a fat roll, so sister is getting what she needs, which is a wonderful sign so far. At the conclusion of the scan, he explained to us what the imaging of the cord blood pressure readings meant. To be honest, I can't fully remember all the different medical terms and explanation of what was happening. I was clinging to every word but not completely processing it because I was waiting for bad news. Essentially, what I was able to gather from the little of the conversation that I retained, is that the cord will go through times where it will constrict and get tighter which will drive up the blood pressure in the arteries through it. This can happen due to maternal anxiety, stress, lack of sleep. Even though my blood pressure is not elevated, he said I need to rest because it effects hers. He and my doctor decided that I am to be on bed rest until my next appointment the following Tuesday when we will go back and do another BPP and most importantly, check that cord flow. At that time, we will look at our course of action for keeping her safe and healthy for the next 6 weeks or until we deliver, whichever comes first. With elevated blood pressure flow in the cord, the risk it can pose is not a sudden thing, it is gradual so they were comfortable with me being home over the long weekend and checking again in a few days.
We were told to be prepared that we may not make it to 37 weeks, but there's nothing saying that we won't. I have a perpetual need to understand and be prepared for things that can come my way. Some may call that being a planner. Guilty. We went into that appointment ready to tell our doctor that we had decided on the date we wanted to induce, ha! Throughout the weekend, I had to fight my need to know everything and start googling so that I don't drive my anxiety up more. I started to look it up on my phone in the hospital as we waited, then read a few sentences in an expecting mom's forum and decided not to read anymore. I needed to just listen to what my doctors say and go to their nurse with questions. I practiced some extreme self control for my nature.
So over the last five days, I've rested. I've finished Parenthood, started Narcos season 2 and spent a lot of time browsing online Labor Day sales to get post-partum recovery items ready. I sat in the glider supervising as Max finished some things in her nursery, like chandelier installation. We are trying to finish things in case her arrival comes sooner than planned. That initial 24 hours was not easy, I was a headcase. I had a hard time sleeping because of all the what ifs swimming in my head, however, it tapered off. Throughout those five days, her movement was great, I checked her heart rate daily and it was strong and consistent with the numbers we've been seeing.
We went back to the doctor today. Hadley started moving around this morning at 5 am so I had immediate comfort starting the day. Our sonogram today revealed that her levels are looking good and are in the range we want them to be in. Bed rest did it's job and we want it to stay this way. We will go in twice a week from here til delivery day, and more if needed. By slowing down with my schedule, restricting physical activity and cutting back my work hours, they feel like this should help contain her umbilical cord blood pressure to safe levels and keep her out of additional risk.
Thursday marks 32 weeks, the beginning of a time frame that I have been anxious about because the very end of that week became the end of our pregnancy last time. Our prayer request first and foremost is for Hadley to remain safe and healthy and for my anxiety to decrease to help with that. My doctor said that if we have to deliver her at anytime, she will be a NICU baby but a NICU baby is a living baby and we will be in excellent hands at our hospital to see her through to coming home. Of course, all we want is a living baby and we will do whatever it takes for that to happen. As her parents, we also want an as-healthy-as-possible baby second to that. We would like to be able to keep her cooking as long as we can and to get to that goal mark of 37 weeks, however, if inside the womb becomes more risky than being on the outside, we are becoming prepared for that.
We have confidence in our medical team. We believe them when they say we will get her here safe and sound. Even with that, it's still hard. It's hard for me when I feel like my body is somehow responsible and I want to understand why the umbilical cord is now an issue in both of my pregnancies and what that can mean in the future. That's really difficult to deal with and I've caught myself dwelling on it and making my head spin, but it's not something we can get caught up in, especially right now. Staying calm has never been more important.
We are thankful for the good news received today giving us some much needed relief. We are thankful to have a wonderful team of medical professionals who have the attitude that there is no such thing as too careful as we go forward. We are thankful for our network of those holding our hands through this. Thank you for following us on this road and supporting us in thought, prayer and action!