Sunday, December 16, 2012

Notes from the NICU: Future Babies

In a comment on an earlier post, Money Beagle asked, 
...Through all the posts I've wondered if they have indicated what caused you to go into labor so early and if there was any reason that the methods they tried to hold you off did not take. Also just wondering how this affects any potential future pregnancies...
Which I guess I should have clarified! I mentioned it only briefly right after Baby M was born, and not as part of this series.

I didn't go into labor, exactly. No one knows why I was having such frequent contractions so early in the pregnancy, but as they were painless and not effective, they alone would probably not have caused her early birth. I had a placental abruption, which is when the placenta detaches from the wall of the uterus. It occurs in 1% of pregnancies and is life-threatening to both baby and mother. In my case, the detachment was happening slowly, so they were able to keep me pregnant for a few more crucial days.

The irritation of bleeding in a pregnant uterus can cause labor to start (the causes of labor are actually not entirely understood!). The drugs I was given kept me from going into labor, so they definitely worked. But once an abruption starts, it's only a matter of time before it becomes severe enough to endanger the baby and/or start labor that cannot be stopped no matter what. The abruption reduced oxygen to Baby M, which put her in distress. (I learned a lot of this after everything was over. I'm glad I wasn't told from the beginning: Hey, you're going to be on bedrest till you have the baby! Which we hope happens sixteen weeks from now!)

It's not known what causes abruptions. Cocaine use is frequently correlated, but that wasn't true in my case. I didn't fall, I wasn't hit in the abdomen. There is no history of it in my family. It's just one of those things that happens to people. Unfortunately, because it has happened to me once, there is a higher risk that it could happen again.

I have some other things against me in the reproductive arena: I have poly-cystic ovarian syndrome, which makes getting pregnant difficult, and can have increased risks of multiples/pre term birth if fertility drugs are used. I have a bicornuate uterus, which frequently is associated with pre-term birth (I was actually expecting to give birth around 35 weeks, but not 25!), but is not associated with an increased risk of abruptions. Having one pre-term birth correlates highly with having a second for reasons that are not entirely understood. And having a c-section so early in the pregnancy increases my risk for a uterine rupture.

All of that has not necessarily put me off having a second child. All of the risks above, even the associated ones, are relatively small. I asked my doctor point-blank if she would recommend that I avoid future pregnancies, and she said no. So I have the official medical greenlight to try again, with a few caveats.

If I get pregnant again, I can expect to be placed on bedrest from the beginning. I would be monitored closely by a perinatologist as well as my OB/GYN. I would be kept pregnant for as long as possible but likely would not be allowed to go full term. I would have another c-section, unless, in my doctor's words, I "showed up to the emergency room so far into labor that the baby came before we finished signing the paperwork." I would be terrified for every minute of the pregnancy, and if we did wind up in NICU again, I would be dealing with the stress and trauma that I now know very well along with a child who also needs attention. In addition, I am fully aware of how smooth a path we have taken compared to some, and I'm not sure I like the chances of the road being that easy a second time (for example: boys struggle far, far more than girls do. That's an 50% increased chance of major issues right there!).

There is also a pretty big chance that I'd get pregnant easily, have a completely uneventful road and give birth to a totally healthy, basically full-term baby with no complications. We just don't know. At best, I think I would only try for one more pregnancy. I am 31, and it would take me a few years to be emotionally ready for this - and guess what, pregnancy over 35 is correlated with pre-term birth!

I've had to come to terms with having a pregnancy and birth end not the way I wanted them to. I've had to come to terms with never getting to have the type of birth experience I wanted. I am still coming to terms with not birthing the number of children I wanted (three or four) and possibly raising an only child, something I was kind of set against (no offense to only children or one-kid families; I have lots of siblings and they are a huge part of who I am. That's just what I know and what I wanted for my own kids.) Peanut and I have talked about adoption but right now it's not something we envision for ourselves.

So, in short, I don't know whether I'm done having kids. It might be irresponsible of me to even consider it. It might not be a big deal. At any rate, I have no business making decisions of that magnitude right now, so it's something that we are putting off for a couple of years.


  1. Thanks for taking the time to answer my questions. I think you have a lot to think about now and you're doing a great job. If the time is right for you to have another down the line, you'll know :)


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