And Then the Wheels Came Off. *Updated*

by Alexa on June 3, 2012

Update:
Just back from appointment. Amnio a week from tomorrow at 37 weeks, and (pending results) delivery the next day! I will post the details later this afternoon, after a celebratory bagel and maybe some dancing, but needless to say I can’t possibly thank you all enough for your support. It made all the difference.
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(First, a warning: This post is heavy on medical detail but light on explanation of medical terms. There is no reason you need to read it at all, obviously, but if you do, I apologize for any wear on your Googling muscle.)

My pregnancy history is not pretty. First multiple miscarriages, then a twin pregnancy complicated by stillbirth and preterm delivery. My perinatologists believe that Ames’ death was caused by clotting issues–he was small for gestational age and had a thin, weird umbilical cord with a placenta full of fibrin, and even Simone’s placenta was abnormally wee, about the size of your average 17-weeker’s. I also tested positive for beta2glycoprotein1 antibodies, which can make a girl abnormally clotty.

So, THIS pregnancy the plan was daily Lovenox injections and baby aspirin to help insure a well-behaved vascular system. In addition, said plan included a repeat c-section at 37 weeks.
Why, you ask?

—Previous stillbirth increases the risk of stillbirth 2 to 10 fold, depending upon various factors.
—My clotting disorder (Antiphospholipid syndrome) ALSO increases the risk of stillbirth (I am being treated with blood thinners, however my understanding is that the risk is still elevated).
—Stillbirth risks go up at the end of pregnancy.
—I have a well-documented anxiety disorder that was sure to find pregnancy-post-stillbirth more than usually trying.

I suspected (correctly), that having a more-than-viable baby inside me, ripe for the picking, would be nerve-wracking. 37 weeks–term–seemed a sensible compromise between my need to GETTHEBABYOUTALIVEASAP and my more rational desire to let the baby grow fat and healthy and fully to term. My doctors agreed that this was reasonable. I see a different doctor nearly every appointment, but I discussed it with several of them, and Lo, it was Good. I was informed that because of a hospital policy on scheduled deliveries before 39 weeks, I would have to have an amnio the day before to confirm lung maturity—despite the fact that amnios after 36 weeks for the purposes of assessing lung maturity have been shown by peer-reviewed sources to be pretty dumb—but fine. Whatever. We also had contingency plans in place: I would have weekly NSTs and BPPs starting at 30 weeks, and if the baby looked to be doing badly, I would be delivered. To address the risk of preterm labor, I would be on progesterone shots until 36 weeks to soothe the contractions that began plaguing me at about 15 weeks. However, my perinatologists do not stop labor after 34 weeks, so should those contractions begin to produce an actual cervix-letting-the-baby-out situation after that time, I would be whisked back for a c-section without fanfare.
I would have been absurdly grateful, obviously, for a baby born at 34 weeks, but was shooting for 36, at which point there is no mandatory NICU admission. Not that a week of NICU time would be so awful, but I wanted to see how the other half lived. I wanted to hold my baby right away and have it in the room with me in one of those lo-tech plastic tubs.

So that was the plan.

Sometime early in the third trimester, I began having odd visual auras—like a migraine aura, but without the headache. I hadn’t had any migraines during pregnancy, and maybe two in the six months preceding it, but these episodes (during which my vision was terrifyingly absent or obscured, leaving me largely helpless) were coming in clusters, several in a week, then maybe none in the next week, then several more. I was referred to a neurologist who was concerned based partly upon the fact that the episodes were lengthier than your average aura (not to mention my clotting disorder and family history of stroke). He wanted to order an MRI and some MRAs (what he actually said when discussing whether or not to do the MRI was “How would you feel if the MRI showed you’d had just a teeny, tiny stroke?” holding his fingers ever so slightly apart), but my pregnancy complicated this and anyway it was probably nothing, so he started by ordering a bunch of blood tests. My Sed Rate came back very high–but that can be normal in the pregnant. My ANA screen came back positive, though it had been negative when tested during my post-pregnancy work-up several years ago. This worried me, as a positive ANA can be associated with pregnancy loss, but at least the titer was low…until they repeated the test a week later, at which time the titer had risen precipitously. There started to be a lot of talk about autoimmune issues and postpartum blood thinners and seeing a rheumatologist after pregnancy. I started, as you can well imagine, to become just a little bit unhinged.

To give a summary: I had increased risks of stillbirth from both my previous stillbirth and my clotting disorder, and I’d been diagnosed with gestational diabetes (which also comes with a slightly increased risk of stillbirth), and then the autoimmune weirdness began, and eventually I went and developed borderline polyhydramnios–a small thing, but it seemed like small things kept accumulating, things that each increased my baby’s risk of mortality by a tiny increment.

The tipping point came last Wednesday, at my growth ultrasound. Twyla was measuring splendidly, and I chatted with the tech while she took measurements and checked the blood flow through the umbilical cord. Unfortunately, the umbilical dopplers showed reduced flow due to increased resistance—a level of 5, which is well above the 95th percentile and a significant risk factor for Bad Things, significant and Bad enough that they scared me, veteran Googler, right off the Internet in tears. My doctor had assured me that if the resistance increased more, to the point of absent flow, they would take the baby out immediately–you know, to prevent hypoxia or death–but I was terrified. How fast could it go from abnormal flow to absent flow? No one seemed to know, exactly. They switched me to twice weekly monitoring, but would twice-weekly be enough to catch it if something went wrong?

I made it 24 hours before I called and begged them to get me in for a recheck the next day. Luckily, the resistance had decreased—still much higher than normal, but better, and not in the greater-than-95% zone that gets mentioned most ominously in clinical studies. Alas my fluid, which had finally moved out of the polyhydramnios range as of Wednesday (down to 22), had increased in the intervening 48 hours to just over 29. (Among other things, polyhydramnios increases the risk of placental rupture or cord prolapse if one’s water breaks. Helpfully, it also increases the chances of your water breaking! Then there’s the fact that I’ve been contracting painfully and semi-regularly—as often as every 4 minutes for as long as 24 hours.) (Related: do you know how tired I am of contractions? SO TIRED.)

Wednesday’s appointment was also when I was supposed to schedule my c-section, but instead I was informed that they could not, in fact, schedule it for anytime before 39 weeks, amnio or no. Minnesota has a new state law regarding delivery before 39 weeks in the absence of medical necessity, and “necessity” is being rather narrowly interpreted. My doctor told me she had just called to schedule another patient for 37 weeks and been shot down, even after she took her case to the medical director, because OMG STATE LAW. She didn’t think there was any way I’d actually MAKE it to 39 weeks, so wasn’t scheduling me for then, either (though she recommended I forgo my final 36 week progesterone shot, just to help things along), but scheduling the procedure for anything earlier was now out of the question. Instead, I have to wait until I either go into labor, or something goes more, emergently wrong—i.e. one of my risk factors bears fruit. Never mind that the Minnesota statutory language doesn’t actually itself prohibit anything, instead directing hospitals to develop policies. Never mind that I’ve been contracting with no result for weeks, so I am not optimistic that I will go into progressively-cervix-changing labor any time soon, or that labor might not be such a swell idea for me anyway, given both the polyhydramnios and the blood thinners, which I have to be off for a certain amount of time before delivery (or else I’ll be put under general anesthetic, and I really, really want to be awake for the birth of my baby). Never mind that by the time routine testing turns dire, the baby may already be compromised, especially in cases of abnormal flow. Never mind that abnormal flow often indicates the same placental issues that beset my last pregnancy. Never mind that scheduled c-sections are safer than emergency c-sections, or that I actually have several of the conditions that appear on the Joint Commission’s list of medical indications for early delivery (PREVIOUS FETAL DEMISE! ANTIPHOSPHOLIPID SYNDROME!). Never mind my mental health, and the very real panic I am experiencing as I wait for this baby to be born, white knuckling it through one neverending day at a time. Never mind that the motivations for this policy are not exactly All About the Babies, but rather as much about reducing cost (morbidity is so much more expensive than mortality!), or that it is enormously insulting to women and doctors. Never mind that the group that first pushed for these “hard stop” policies regarding early term delivery has written a new paper that essentially says “Oops, it looks like people may be construing this a bit too strictly:”

Our concern is that a misinterpretation both of our policies and of the nature of our specialty’s opposition to purely elective early term deliveries may result in inappropriate reluctance to deliver women who are at risk for serious complications…How close must the blood pressure be to 160/110 mm Hg level to justify delivery at 37 weeks gestation or even before? How poorly controlled must the diabetes mellitus of a noncompliant patient be to justify delivery at 38 weeks’ gestation? In the absence of hard data to guide the clinician, physician judgment and informed consent will continue to play a major role in such cases.

No, never mind all that. The hospital administration is too spooked by the fact that this policy is now STATE LAW! to allow for scheduling me for delivery prior to 39 weeks.
And that was the occasion of my first full-on Ugly Cry in a doctor’s office.

I have a lot more to say about less-than-39-week hard stop policies in general and the legislating of them in particular, enough that I am writing a whole separate post on the subject. Please, if you want to debate the issue, or get stroppy about the plight of the poor 38-weeker, wait until that post to do so (and remember, too, that as the mother of a 25-weeker I am hardly insensible to the risks of prematurity). For now the issue is more immediate than philosophical. I am scared. I am angry too, but mostly I am scared in a very real way that my not-at-all-theoretical baby is going to die before she is delivered. It may not be logical, but it isn’t exactly ILLogical, under the circumstances, is it?

Tomorrow morning, Monday, I have another doppler check, BPP, NST, and my 36-week perinatologist appointment. I have no idea which doctor I’ll see–some I love dearly, some less so. Some enter not having read my chart, and a few I still haven’t met. I am going armed with every study and recommendation and so forth I can find, all printed and at the ready in my handbag. I fully intend to explain, calmly and pleasantly, my history and why I am so very concerned. I intend to advocate strongly for myself and my baby, and to ask for opinions and decisions in writing. I intend to pay visits to administrators if necessary. And if it IS necessary to visit these administrators who are so terrified of review committees and liabilities under EEK! STATE LAW, I fully intend to make it clear that the liability they should be worried about is that which will result if my baby dies in utero at say, 38 weeks, after I requested intervention that was deemed reasonable by my medical team and is indicated by published guidelines.

That is what I intend, but what I expect, alas, is different. I do not expect the appointment to go well. I expect to become flustered and lose every ounce of my reason and gumption and forget the measured arguments I intended to make. I expect to fold quickly, to shrink with embarrassment and pretend to be doing better than I am, so afraid am I of appearing crazy. I expect to leave feeling defeated and scared, and to cry on the way home. I expect this because that is what usually happens to me in these situations–I am reduced to a shred of myself, and I start to think about how neurotic I must seem, and maybe I am overreacting, and some part of me is determined to be liked and to seem cheerful and sane.
I’d like very much to exceed my own expectations.

It’s true–probably nothing will happen if I go all the way to 39 weeks. Probably everything will be fine. It’s just that right now, I don’t believe in probably, and it seems cruel to ask me to.

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{ 124 comments… read them below or add one }

Jane June 3, 2012 at 10:09 pm

Oh, sweetie, I am so sorry! I wish your mom were there to hover, but you’ll have to make do with cyber-hovering and constant positive thoughts from your thousands of well-wishers. As in all anxiety (via Claire Weeks), “let time pass; do not be impatient with time.” It will all be well…soon.

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Red Stethoscope June 3, 2012 at 10:16 pm

Oh my goodness, I’m so sorry. I was so happy for you when you said in an earlier post that you were doing the 37 week C-section, because it DID seem like a good compromise. I’m not a real doctor (yet), but the politics of medicine already PISS ME OFF. I will be praying and thinking happy thoughts that all goes well until 39. I’ll also try to be a better, more compassionate doctor who makes good decisions. You’ve already been through so much, and quite frankly, this just isn’t fair.

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ivfcycler June 3, 2012 at 10:18 pm

Oh, Alexa.

WHY DO LEGISLATORS INSIST ON PASSING LAWS ABOUT MEDICAL CARE??? Oh, they only pass laws about medical care of pregnant women. AAGHH!

Perhaps you should get the card of a medical malpractice lawyer and slip it in your file?

Bon courage.

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Veronica June 3, 2012 at 10:18 pm

Oh Alexa, what a crapshoot.

Can you take someone with you to advocate for you, or to hold your hand at the very least?

I am thinking Very Good Thoughts for you – for all the use they’ll do. But I’m thinking them anyway. x

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heather... June 3, 2012 at 10:24 pm

The 39 week thing is supposed to apply to women who are uncomfortable but healthy, not women who have LEGIT MEDICAL ISSUES. The 39 week thing is supposed to apply to doctors scheduling births around vacation schedules, not doctors who have patients with LEGIT MEDICAL ISSUES.

I am infuriated on your behalf. I feel your fear – I’ve HAD it, and if I ever am lucky enough to carry a baby that far again, I will have it again. I wish I could help. I am so sorry, Alexa. I am thinking about you constantly. Good luck tomorrow. xoxo

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Rachel June 3, 2012 at 10:25 pm

Oh dear. This sounds like a truly awful situation. If you are really worried about coming unhinged during the appointment (and why wouldn’t you? It’s a baby after all) what about just printing this blog post and bringing it along? During IF treatments I have definitely resorted to written requests when I felt like my words were not being heard (perhaps because I had no unders on, but who knows, maybe just in general). You are a wonderful writer and I think that writing a clear explanation of your fears, what you’ve heard, and what YOU would like to have happen ought to convince any doctor to at least consider the situation carefully. And if that doesn’t work, you can always go all crazy like I did and threaten to abscond with baby still in tummy via greyhound (what? we live in the city, we don’t have a car) to a state with more options for the delivery …

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jen June 4, 2012 at 12:57 am

oh dear lord. I was about to write just what Rachel did. Print the post, bring it with you, don’t leave the office until you get somewhere. I am so, so sorry you have to deal with this legalistic idiocy.

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Megan June 4, 2012 at 2:30 am

Seconding Rachel and Jen — you don’t sound unhinged at all. You sound like a well-educated advocate for your child, with some very reasonable concerns.
You’re an excellent writer, and quite likable in print (I’m sure you’re also quite likable in real life, but as random lurker, this is what I know). If the written word is the most efficient way to get your concerns across, write the doctor a letter detailing everything you want him/her to know. In that letter, be as calm, polite, and insistent as you need to be. Explain that you’d like him/her to read it, and then the two of you will begin discussing your case from that point.
I’ve heard of other people that do this; it’s not unheard of, insane, or in any way unreasonable. It will make you feel better.
Also, I’m sending lots of positive thoughts to you tomorrow, for strength and good health, and “hospital policy be damned” thoughts towards your doctors. Free Twyla! (Safely, healthily, and happily)

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Tamara June 3, 2012 at 10:26 pm

I have a string of fucks I’d like to unleash on Minnesota right now, but that would not help. I am over here instead thinking good thoughts, hoping for calming news for you tomorrow and putting all of my energy into hoping you get one of the doctors you like tomorrow. xo, lady.

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Amanda June 3, 2012 at 10:29 pm

These issues have been so front and center lately. With my first, I wanted to go all the way to whenever the baby decided in her own sweet time to emerge. And then my ultrasound looked a little wonky, (ready very wonky) at 37.5 weeks. They all stated that this baby must come out NOW! It was a shock to my natural birth wanting to have soul. After that, and with a healthy but teeny-tiny for gestation age baby, I reassessed, and put in in my doctors hands for number two. They insisted on waiting until 39 weeks for an induction due to all the changes. In this case, the pregnancy was fine, so no biggie. But legislate? How stupid.

This is my long and meandering way of saying, OMG, HOW COULD THEY! I’m so sorry, and I hope that all things get worked out tomorrow. I’ll keep you close in my thoughts.

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Aurelia June 3, 2012 at 10:29 pm

Feeling sick for you….stupid law—shutting up now.

That said, if you want anyone on the phone with you, on speaker phone, or if you want anyone to help you YELL to get whatever you need. I’ll be there. Just ask.

As for the no epidural on blood thinners rule–as my OB and I discovered, no one on earth has ever studied this one way or the other. no proof at all. Just a theory. It might be safer to have an epidural on it for us clotting people. Who the hell knows?

Trust your body, trust your instincts, do what you think is right for you and your baby. And know that yes, the internets have your back.

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marly June 3, 2012 at 10:31 pm

I so wish I could go with you tomorrow. We would not leave till something was DONE. I am a praying grandma and I will pray that you are heard tomorrow. Just go ahead and stage a throw down in the administrator’s office if necessary. Do it, Alexa. Pitch a hissy. If ever one is called for it is now.

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kristin June 3, 2012 at 10:40 pm

Oh, Alexa, how excruciating.

Can you put your thoughts in writing – advocate for yourself and your baby even if wordlessly handing over a letter while doing the ugly cry? Your request should legally be documented in writing, anyway, and maybe it will make the appointment feel less impossible?

I’m so sorry. Sending good wishes for a massive strike of the clue-by-four to your medical team. xo

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melaniek June 3, 2012 at 10:41 pm

OMG so so sorry…

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Rosalie June 3, 2012 at 10:48 pm

I am rooting for you guys so hard right now. <3

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velocibadgergirl June 3, 2012 at 10:50 pm

It is so very cruel to ask you to trip merrily along believing everything will be fine just because the doctors say it usually is, when you’ve lived through so much unusual tragedy already. I’ll be thinking of you and Twyla tomorrow and pretty much stalking your Twitter for updates. Hugs and hugs and hugs.

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Yatima June 3, 2012 at 10:54 pm

Good Christ on a handbike, Alexa, this is making me, a stranger on the Internet, weep with anger and frustration for you.

May your doctors and administrators see reason. May Twyla be safe, safe, safe and well.

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jonniker June 3, 2012 at 10:59 pm

No. NO. No, you are not being unreasonable or hysterical. COME ON. It is UNSPEAKABLY cruel for them to carry on this way, and I wish I could teleport with you to the doctor, giant matching belly and all, to support you while you tell them JUST HOW UNREASONABLE THEY ARE BEING.

The 39 week law is meant for ELECTIVE CESAREANS, not women with legit medical issues and a history of, you know, FETAL DEMISE. Come the fuck ON now, doctors. COME ON.

I would bullet this shit out, carry it with you, and take as many deep breaths as you can. Can Scott come with you? CAN I?

Love you. Thinking of you constantly.

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Alexicographer June 3, 2012 at 11:01 pm

Geez, Alexa, I’m so sorry. What a ridiculous set up for you to have to deal with. Please add my name not only to those out here cheering you on and confident in your abilities but also thinking that (a) taking a written document and (b) threatening to cross state lines to get the care you and Twyla need are both good suggestions. Also of course having an advocate (and believe me, if I needed an advocate I’d want Aurelia on my side, no question).

In far less pressing settings I have myself to good effect told folks, “I am not leaving here until XYZ happens,” whatever XYZ may be — a definitive answer, a written plan, someone being contacted about something. Perhaps even if you are a whimpering mass of tears — and really, who wouldn’t be — that phrase can be used to good effect?

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MissRed June 3, 2012 at 11:13 pm

I will keep you in my thoughts and prayers tomorrow. Don’t be afraid to make a scene!

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Kara June 3, 2012 at 11:16 pm

Oh Alexa. I wish so many things right now. I wish I could be with you at your appointment tomorrow. I wish I could be your adopted sister for the day so that would be reasonable. I wish that you lived in a state with a less FREAKING IGNORANT legislature.

But here’s the thing: wishing aside, YOU HAVE POWER. You are not crazy. You are not overreacting, unfortunately. You have every right to break down every door in that hospital tomorrow and scare the ever loving SHIT out of every administrator that you need to. For the sake of your baby, just think of that baby, be as brave as you have ever been in your life, wave those studies and stats and conditions around, and threaten them with a big, scary lawsuit if they don’t do what a patient and her doctor deem best. You can do it Alexa. As a woman who has had two scary c-sections and almost lost two babies, I beg you to do this thing. To advocate for yourself and your child, and make yourself heard.

*climbs down from soapbox* ahem. I do have a question, though. Can’t your doctor just say, “oop, things are bad here, we’re going in for an emergency c-section right now” ? And then justify it with all of those conditions and stats? It doesn’t seem like such a stretch to me, for one of them to just make the executive decision and do it. Ask about it! Tell them your husband has Simone, your bags are in your car, and you’d be fine with a c-section today! Hint hint!

But most of all, I’m just so sorry. I am hoping for the best for you guys.

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Lorraine June 3, 2012 at 11:19 pm

Time to contact either your representative or somebody at the local paper. Just send this post to the editors, I think this is plum journalism backstory.

Otherwise, maybe you are probably right about it all being fine in the end. But the what-ifs are too important to ignore. Would you be more comfortable on hospital bedrest? (I mean mentally, obviously.) THAT would show their little law how to cut down on costs by denying C sections that have been deemed medically prudent.

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Alyssa June 3, 2012 at 11:20 pm

Can someone go with you to help you stick to your guns?

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Katy June 3, 2012 at 11:25 pm

As someone who had things go spectacularly wrong at 37 weeks–after a perfect pregnancy–I complete understand the mental dance of wanting baby to be healthy but also feeling like that would be so much easier to manage if the baby was just OUT!

Perhaps you should plead with your OB for them to check you into the hospital for 24 hour monitoring. Huge PITA, obviously, but it would probably provide some peace of mind and they wouldn’t have deliver until they felt confident about it.

And don’t even get me started on the fact that they are legislating so much of our health care these days. The law is exactly why that is so dangerous–too much is left open to interpretation and the needs of the patients are lost in shuffle.

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S June 3, 2012 at 11:26 pm

I seriously wish the Internet could come with you and give you support and help give you a voice. Seriously, this is unreal. It’s very rare that I read things on the Internet that get me so riled up that I get that feeling in my chest, but this is just infuriating me. I am rooting for you, we are all rooting for you. Sending you as many good thoughts as humanly possible.
(I’m not sure that I’ve commented too much, but I’ve been reading since your last pregnancy, just in case this sounds weird!)

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Jen June 3, 2012 at 11:36 pm

This just stinks. I am so very sorry that the State of Minnesota decided to add to the drama when you are already going through so much already. I don’t know if it’s any help, but my anti-phospholipid antibody syndrome was wholly untreated past week 12 in my pregnancy with A., and he was fine born at 38 1/2 weeks–small, and with a clotted-up wonky placenta, but otherwise just fine.

Fervently hoping that all goes well tomorrow–please know you are in my thoughts.

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Li June 3, 2012 at 11:36 pm

Walk into the ob department, right now, crying hysterically and tell them you have the worst headache of your life and are seeing auras.
Worked for me.

-lupus
-anti phospholipid syndrome
-severe preeclampsia

I lost to many babies to roll the dice

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Courtney June 3, 2012 at 11:49 pm

Long time lurker, first time commenter, if only to say this is FUCKING BULLSHIT!!!!!! (times eleventy billion). If this is no “medical necessity” I don’t know what is. Give ‘em hell tomorrow, and then drive to Wisconsin, or North Dakota, or Iowa or any other state that borders Minnesota ad have that baby. And then send the Minnesota state legislature the bill, for everything from gas to snacks for the drive.

Please update tomorrow, as I’ll be thinking of you!

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Sharon June 4, 2012 at 12:09 am

This is where you take a deep breath, another adult to hold your hand if possible, a print-out of this post, and refuse to leave the hospital until your daughter has been safely delivered! God knows your previous history and current symptoms are bad enough but lay it on with a trowel. If that still doesn’t work ask to see the hospital Administrator, chief bigwig, whatever and tell them you are going to sue if anything untoward happens because of their lack of proper medical treatment regardless of the stupid (insert own expletive) State law.

Adding to the love, support, good vibes from out here in the ether, I have everything crossed that all will be well and Twyla will arrive fit and healthy within the next couple of days.

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StacieT June 4, 2012 at 12:20 am

I am sending you strength for tomorrow. Advocate for yourself and your baby. You can do this!

Many, many hugs to you.

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Crystal June 4, 2012 at 12:21 am

Im sitting here feeling like my little comment can’t possibly mean that much to you; but just in case, here it is: I am behind you. I am standing there, invisible, but present saying “don’t back down, tell them! Don’t let them bully you! You are a smart, well informed person and you are not crazy. You will NEVER regret pushing and advocating for yourself and your child. NEVER, no matter what. But there is a chance you will ask yourself why you didn’t push harder.

So push Alexa, and damn the consequences. Imagine this league of people behind you and don’t let them make you feel inferior. Just don’t fucking let them.

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Amelia June 4, 2012 at 1:03 am

For future reference, one begins a post like this with a; “everything’s fine right now but…” if they don’t want their readers to freak out.
Sending light and love that you get through this.

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Cara June 4, 2012 at 4:35 am

Oh yes, please. I had to skip to the end and read that before I could read the post. Though, we all understand why you wouldn’t think twice about such things right now.

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Alexicographer June 4, 2012 at 9:54 am

I did the same thing — skip to the end and then go back and read the whole thing. But, of course, we do all understand.

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Paula / Hamburg June 4, 2012 at 1:07 am

Sorry for my comment two weeks ago, ‘t was not the right time and place. I did not know about all those severe medical issues you have to consider.
I would take my bag to the hospital and would not leave it until my baby was born. I would tell the doctors that you or your husband would definitely make them personally responsible if something went wrong within the next two weeks. And I would choose the doctor, maybe the head of the department, and pay privately, no matter how high the bill would go! And do not go alone, you need support!

I cross my fingers for you and wish you good luck.

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Jessica June 4, 2012 at 1:10 am

Longtime reader first time commenter. I live in MN and just had a baby 5 weeks ago. It’s not entirely the same, as I developed pre-eclampsia at 38 weeks but I was induced. I realize what you’re saying is that it has to be emergent but that seems to be up to the doctors discretion/hospital discretion.

I don’t know that there’s anything you can do at this point re: hospital choice or doctor but I have an amazing OB who is an fierce advocate for the health of moms and babies…if you’re looking for a second opinion (though it seems like you’re not lacking opinions in your clinic).

My prayers and new mama vibes are with you.

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Jessica June 4, 2012 at 1:24 am

I think this is a hospital by hospital basis. If you need to get a second clinic/hospital opinion, do it. I was induced a week early due to pre-eclampsia…granted that’s an emergency, but I agree with you and think that most thinking people would as well…that your combined risk factors constitute an emergency.

I am in Minneapolis and have an OB that I love and I just had a baby 5 weeks ago. She’s amazing and is the strongest advocate for mom AND baby’s health. If you’d like her info, you can email me.

Otherwise, my prayers and new mama vibes are with you.

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Betty M June 4, 2012 at 1:49 am

If I was looking for a text book case indicating an early deliveryyours would be it. I hope that your drs get serious with whichever bit off the hospital is getting nervous about the law (which appears here to be a total ass).

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Cara June 4, 2012 at 2:49 am

Alexa, dear Lord, find an advocate. Please, please find an advocate. You can’t be expected to do this right now and it needs to be done just as you described. If you don’t know a likely choice for this type of thing, try the League of Women Voters or whatever local women’s group has volunteers used to advocating calmly and rationally.

I am so, so sorry. I wish I could do something.

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Rachel June 4, 2012 at 3:25 am

This is the time to be crazy.

Print this blog entry out and make them read it and refuse to leave until your baby is in your arms.

X

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Lise June 4, 2012 at 3:36 am

Sending many good thoughts toward you. I agree with other commenters that taking in a written account of your medical issues, your concerns, and your wishes is a good idea. It may also be time to lawyer up. The threat of a lawsuit may be the only thing that the hospital administrators will listen to.

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QoB June 4, 2012 at 3:47 am

I can only echo everyone else here – this is so unreasonable. Can you switch practices to somewhere with a more evidence-based attitude to high-risk pregnancies? You don’t need an expert perinatologist for the delivery, surely, just someone who can do a good c-section?

Otherwise I’m willing you the very best of luck and articulate-ness and the best Ugly Cry ever today, if it helps.

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Swistle June 4, 2012 at 5:17 am

This is awful. This is all AWFUL. I do the same: I fall apart. I would make sure that every single point I wanted to make was written down the way I wanted to make it, so that if necessary I could hand someone the letter and have them read it, instead of talking. I might bring a copy of this post, as well.

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Clueless But Hopeful Mama June 4, 2012 at 5:52 am

It IS cruel to ask you to just assume everything will be fine. You have been through so much and have so many valid concerns. I wish you strength and a supportive, understanding Dr. today and a healthy, beautiful baby at the end of this.

I agree with so many of the previous commenters: if you can, bring an advocate, someone who will hold your hand and state your points forcefully if you can’t. If you can’t bring someone, know that there is an invisible circle of your loving readers who are standing behind you and beside you and we will lend you any strength you need.

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Amanda June 4, 2012 at 5:52 am

Go forth! Advocate! Kick ass! We like you and don’t think you’re crazy, anyway, so who cares what they think. *cheers you on*

I hope your appointment today goes well, and I will be thinking of you often these next few weeks.

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It Is What It Is June 4, 2012 at 6:24 am

Ugh. This legislating of women’s health is so offensive, so outrageous, it borderlines on criminal.

Wishing you firmness of resolve and clarity of mind during your appointment(s) today and looking forward to your update.

Completely gobsmacked by the depth and breadth of knowledge you have regarding how the tangle of conditions interrelate and could affect the outcome of your pregnancy. There is nothing about how you laid this out that makes your case for delivery at 37 weeks seem the slightest bit unreasonable.

Go forth and advocate. We are with you!

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Heather June 4, 2012 at 6:24 am

I can’t wrap my head around how insane that hospital policy is. I understand it being in place for healthy, elective pregbancies, but what about you says “taking advantage of an early elective delivery”? My mind is blown that you have to deal with this ridiculousness.

I’m thinking of you and sending positive vibes. Hugs & love to you & your family.

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Lee June 4, 2012 at 6:42 am

I’m so sorry to read this post. I had different medical issues with my most recent pregnancy, but I had a similar experience (not in MN, but in NJ) with first being told we’d deliver at 37 weeks and then the hospital changing their policy. I made it to 38+6, and it was the longest 2 weeks of my life. I understand why they want to prevent elective deliveries between 37 and 39 weeks, but for those of us with documented, serious complications, this policy change SUCKS.

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Sarah June 4, 2012 at 6:56 am

This all makes me so angry. I have an extremely similar pregnancy/fertility history with you (six miscarriages, one still birth, one baby with twin demise at 10 weeks, one miscarriage, then my second child) and I remember the politics of my second’s birth being so much more complicated than my first. As you are pregnant and don’t need to hear anyone else’s scary details, Suffice to say all your symptoms send pangs of empathy through my spine.

Keep breathing, relax, and write everything down that you want to tell your doctor. Get your articles and your other materials together, then write a bulleted list of points you want to use to make your point. If you get emotional and overwhelmed ask if one of the doctors you care for is in the office, then give them your bulleted list and ask them to read it and call you later in the day. I did this and was able to convince my doctor and specialist team to schedule a C-section for my son at 36 weeks gestation even though the law of the land at that time for my hospital was 38 weeks minimum. He had other plans and was born at 35 weeks, but I still felt heard this way.

I am sending positive thoughts of productive conversations your way, and I hope you meet Twyla soon, on your terms, and everyone is crying and smiling.

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RG June 4, 2012 at 6:58 am

Can you get a lawyer to get you an injunction? (Says the lawyer.) I want to fix it. I wish I could. Being a lawyer and not a med-type person, this is what pops into my brain. I wouldn’t call this early delivery “elective” in any case, not in the true meaning of the word.

If you do weep in the office, it’s ok. You are carrying a heavy burden, and are bound to feel that you’re coming up short no matter what you do – the inevitable mom guilt. You should know from here, from the outside, it sounds like you are being a rational, forceful, and passionate advocate for your child. You are armed with scientific data that is informing a balancing test that no one should have to weigh, and you are doing it in a very rational way. The presence of emotion does not equal lack of rationality, and don’t let our patriarchal society tell you otherwise. Be strong, breathe deep, and call on us if we can help.

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tash June 4, 2012 at 7:05 am

What I’d like to do today to male state legislators is unprintable.

And may I just say what I find so frustrating in this whole “No More C-Sections!” movement is the total failure to recognize c-sections NOT as a surgical procedure developed in the last few decades by insurance companies and women wanting to deliver around sports playoff schedules, but a procedure designed under duress eons ago for the primary purpose of *saving the mother and the baby.* And that, hey, guess what, it’s still useful today for that very same reason.

I wish I lived closer so I could scream and curse and then speak reasonably for you so you could lounge which is what you should be doing right now. I’m so very sorry. You have enough on your plate without having to worry about the whims of politicians and the insurance suits who slide them $$$$. Would that they all had uteri. Much love.

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JoAnn June 4, 2012 at 7:06 am

Thinking really good thoughts/saying prayers/wishing really really hard for you.

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Leigh June 4, 2012 at 7:24 am

Oh, dear. I am so sorry, and I am wishing you strength and forcefulness and all the gumption you need to fight for your baby.

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A'Dell June 4, 2012 at 7:32 am

If you want to turn heads and get the attention of the administrators that are backing you into this really unpleasant and pretty stupid corner, perhaps write to your state representative?

If it’s the law they’re afraid of, perhaps a little attention from a state congressperson would help. At the very least, it might get them to re-evaluate your file. I’d just ask your congressperson to read this very post for all the details. And then I might contact the PR department at the hospital and ask the same. And maybe then I would request an interview with someone at the local newspaper! Because I am the kind of person that figures if they won’t listen to ME or my DOCTORS maybe they will listen to people that control BUDGETS and PUBLIC OPINION.

Because really, talk about ridiculous and dangerous and stupid. Dealing with bullshit while pregnant is the part that should be illegal.

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