Wednesday, May 17, 2017

Velamentous Cord Insertion (VCI)


This pregnancy has been night and day different from my previous two. While I feel each one was unique in it's own way, for the most part the girls' pregnancies had more than a handful of similarities. This time around is another thing. From the intense and unrelenting exhaustion, completely different "morning" sickness symptoms (this time around turned out to be less sea sick feeling/dizziness and more crampy upset stomach) and with a lower laying babe, alllll the bladder issues (hello, midnight bathroom visits x10) that I NEVER experienced with the girls because they pretty much lived under my ribs- ouch! Another difference with this one has been the 24/7 worrying. With Maisie's pregnancy I was young and naive, so I went with the flow. With Ellie's I had enough mothering experience to be confident in my body and skills that I have learned on the way. But this one? He's kept us on our toes.

At our first prenatal appointment when I thought I was 8 weeks along, but really turned out to be 9 weeks, we learned I had a subchorionic hematoma (the accumulation of blood within the folds of the chorion (the outer membrane, next to the placenta) or between the uterus and the placenta itself). It wasn't anything I was too worried about, but it was something I found myself thinking about often enough. Most women who have a subchorionic hematomas go on to have healthy pregnancies, but my brain would wonder about potential risks mostly the increased chance of miscarriage. But as my baby continued to grow and with every check up I was more reassured and began to forget all about it. With a quick ultrasound at 17 weeks they confirmed that it resolved on its own and was no longer visible. Sweet relief. I found myself enjoying the pregnancy more. My anxiety nearly died, other than freaking out about having a boy (ahh!). Ok, its all downhill from here, everything is fine. 

A few weeks later at my 21 week anatomy scan (we had already found out baby was a boy at the 17 week scan)  I went to this appointment without Austin. Normally Austin doesn't miss a single appointment, but he had had his gallbladder surgery that morning and was pretty down for the count. I reassured him "Everything is ok, they are just looking at everything and we already know the gender soooo no big deal. I'll facetime you ok?" I ended up taking Maisie because she was pretty excited to see her little brother. I thought the ultrasound was going great, but I could tell she was checking something, checking and rechecking on my lower left side. She would switch from 2d to 3d to the blood flow monitor over and over. She finished up the ultrasound and then said "First, baby looks great!" uhhhh what's second?? "I see an abnormality with the cord and placenta." She seemed pretty lax and unworried so I asked what the problem was. She said "I'm having a hard time being 100% sure, but either the cord attached marginally (the very outer side) to the placenta or it didn't attach to the placenta at all". Now I don't know why, maybe it was her calm demeanor or the fact that I had been up since 5 am and at the hospital for Austin's surgery allllll day long or that Maisie was sitting right there, but I wasn't bothered by the information. I figured with how calm she was being that if it were  something to worry about she would have told me? I don't know. I do remember her saying that with this sort of cord abnormality, it puts the baby at a slight increased risk for a cord accident and stillbirth. Also I just assumed that I must have had the marginal insertion because how relaxed the appointment was. I went home and explained to a very groggy and drugged up husband what I was told. Even explaining it to him I could see the worry in his eyes and confused as to what this meant as far as the rest of pregnancy. I tried telling him "she told me not to lose sleep over it, so I don't think it's a big deal".

As the days passed, I started to worry more and in that worry I turned to the internet. I know, I know, but I honestly wasn't looking for horror stories. I just wanted the facts behind the abnormality. Everything thing I read mostly discussed Marginal Cord Insertion and pretty much said while they will monitor the pregnancy more, mostly making sure that the cord was suppling enough nutrients and that the baby was growing according to schedule, it wasn't anything to be too concerned over or anything too uncommon. As I was reading through the articles I kept coming across info for Velamentous cord insertion or VCI and how it's a much different beast than Marginal cord insertion (my description, not the articles hah). I felt reassured that I MUST have the marginal version because based on everything about VCI I had read, it was contrary to the way the ultrasound specialist had acted. Another day passed and I became sick with worry what if it is the velamentous one? So I called my midwife hoping to get an appointment, but she was already over booked for the day and there wasn't a chance to sneak myself in (of course it was a Friday so I would have to wait until the next week). So then over the phone to the nurse I explained my uneasiness about the results of my ultrasound, she forwarded the call to the radiologist and that lady said in exact words "I don't know why the ultrasound tech said she couldn't tell if it was attached or not, but I can confirm that it is NOT attached and IS Velamentous." Over the phone I began to sob. All of the what ifs and anxiety I had been feeling the days prior all came flooding back hundredfold. All the things I had read about ruptured or pinched unprotected cord (aka the means the baby gets nutrients and more importantly oxygen), restricted growth of the baby, stillbirth, cord accidents, retained placenta, more likely to hemorrhage during birth... yadda yadda yadda. I was freaking out. Austin came home from work to a wife in fetal position on the couch full on melting down about how our baby boy is going to die and I can't stop it. He was able to pull me out of my spiral of doom pretty quickly (he's good at that) but he allowed me to vent and express all the fears of hopefully less likely and very undesired results.

We left on vacation to Arizona before I could meet with my midwife and speak with her about what this diagnosis means as far as birthing options, monitoring and tests. I tried to just enjoy our vacation without worrying too much, but it was exhausting not knowing more about this potential serious and scary abnormality. I took solace that so far baby boy had been growing right on track or even a smidge bigger than gestational age. So while the cord/arteries/veins was not desirable with location and lack of cord protection, baby boy was growing and was healthy.

Finally, after a few weeks we were able to get into our appointment with the midwife. Some ball was dropped on the ultrasound techs side because when I started to sob to the midwife about how anxious and worried I have been she looked confused. "What's wrong? What did the ultrasound show?" they didn't inform her, so it was news to her. She immediately pulled up the ultrasound and started looking over it. She was mad because had she known, she would have called me to talk about it and try to explain things. We talked about what the rest of this pregnancy would look like. She said the main concern is growth restriction on the baby and a potential early delivery based on his ability to thrive from the cord. Her other worry was a retained placenta after birth. Since the cord is not attached to the placenta theres nothing to help pull it out, which means manual extraction, a possible D&C and potential hemorrhaging requiring a blood transfusion. She made me feel much better as she described exactly what she would do if any of those scenarios happened. Austin and I left the appointment feeling much better. After we discussed it with family and friends everyone said "maybe get a second opinion?" so after the recommendation of Austin's boss, we made an appointment with a high risk OB. We wanted to consult him and see what he would do differently, if anything than the midwife could/would do. He explained that he has had a handful of VCI cases, not tons because of how uncommon it is, but he's had enough experience to know exactly what could happen. He explained that he would do much more extensive monitoring of baby's growth, cord location, fluid levels and starting at 34 weeks twice weekly non-stress tests along with ultrasounds every 2 weeks. This was very different than what the midwife wanted to do. Which I guess is the beauty of a midwife- they are hands on, less intervention, less stress. But Austin and I both felt that in this case more monitoring would make us feel better. Plus with this sort of cord abnormality it puts me WAY more likely to need a c-section. This OB could do it on the spot without any backup calls, where as the midwife would have to exchange me over, which is precious time we can't have wasted. Our OB explained that once my water breaks that's when its imperative to monitor the baby constantly. He explained that without the cushion of the water for the exposed vessels it's a matter of how long the baby can hold his breath if they become pinched or compressed against his shoulder etc. We knew right then, we needed an OB and it broke my heart because I LOVE my midwife. If it were any other birth, she's exactly who I would want, but with the so many unknowns and potential risks we need to be where they can be addressed the quickest and unfortunately that's not with her. Also, we needed to switch from our hospital to one with a NICU and trauma unit just in case. So right now the plan is to be induced at 39 weeks if no other complications come up before that point.

So in about 7 weeks we will have our baby boy! I wish I could fast forward to the day after he's born just so the worryingr and stress can be over and hopefully an uneventful birth without complications will be behind us. All I want is safety for the baby and myself, its so nerve wracking not knowing what's going to happen, but I guess that's the case for all births. I hate the lack of control I feel at all times, but I have to be reassured that we are being as diligent and proactive as possible and that's all we can do at this point. I'm so happy we have made it to 32.2 weeks without any scares and that so far everything is on track and going well. I am so thankful for modern medicine and that we were able to catch this and be aware of its presence and be ready for any and all complications that could arise.

Let's do this baby boy! Not much longer now. :)


1 comment:

  1. I commented on FB before I read here. Way to go! You listened to your mommy instinct. You made the switch that you know you and your baby need. Midwives are awesome (we both know that) :) but they are here to serve the moms and babies with routine pregnancies. Hopefully I said that as carefully as I intended. It can be disappointing when a person has done all they can to have a healthy pregnancy and things pop up any way. Good job again on doing what you needed to do. Love you!

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