Friday, July 31, 2009

Disappoinment and Frustration- latest medical issue

I am not really sure how to preface this post. Let me just start by saying that this has been a relatively easy pregnancy, text book to some extent; no worries about fetal issues, no placental problems, no worries about medical problems with the baby. I have had my share of bumps in the road with finding out about the septate growth and wondering whether or not the baby will turn, but in terms of Bella, she has been fine the whole time, it has been my body that is presenting/causing any and all of the problems. Once again, my body has become a problem. This is going to seem scarier than it is at this point, and realize, please, I am not at all worried about my health or the baby's health. I debated even going into the situation and decided that I have told every other detail, might as well share this one.

I went to Labor and Delivery on Wednesday, despite feeling like a hypochondriac and possibly overreacting about certain symptoms, it turns out that it was a blessing that I went in. The drew blood at the hospital and at my regular, weekly doctors appointment the next day, Thursday, the doctor came in a little worried about the results. I could tell right away from his demeanor that something was not copacetic. It turns out that I have developed "gestational thrombocytopenia" or low blood platelet count; I have developed a possible clotting disorder. Quick Biology lesson of the day: Platelets (thrombocytes) are colorless blood cells that play an important role in blood clotting. They stop blood loss by clumping together and forming plugs in blood vessel holes. Platelets are small, sticky, components of the blood formed in the bone marrow (the soft, porous tissue found in the long bones of the body). Their job is to maintain the integrity of the blood vessels and seal small cuts and wounds by forming a blood clot. If the blood doesn’t have enough platelets it is unable to clot as rapidly as needed. One would never want to administer an epidural or any other form of regional anesthesia to a woman with a clotting disorder. The risk of hemorrhage at the site or into the cerebral spinal fluid could be disastrous. If your platelet count is below 100,000 epidural anesthesia will not be permitted. No one knows why pregnant women develop this, and there is nothing you can do to bring the count up, aside from having the baby. Doctors are not sure if the body stops making them or if the body starts destroying their own for some reason. Gestational thrombocytopenia is still somewhat of a mystery.

The average person has a platelet count of 160,000 to 400,000, and it is common with pregnancy for that number to fall a little. At the 28 week of the pregnancy, I had blood drawn to do the Gestational Diabetes test, and my platelet count came back at 151,000. A little low, but nothing alarming, the OB didn't even tell me about the results since it wasn't problematic. Well, the results came back from my CBC blood draw on Wednesday, and the number has dropped significantly to 104,000. This is considered mild thrombocytopenia, but if it continues to fall, and falls below 100,000 (only 4,000 to lose) then it becomes a moderate case. They drew more blood yesterday and I am hoping to get the results back today at some point. They are hoping it was a fluke, and that the numbers aren't really that low, but we will have to wait and see. So what does this mean for me and baby?

At this point, after months of not wanting a c-section due to BellaReese being breech, and then a few weeks of celebrating her achievement of turning into the proper birthing position and finally being excited to be have the birth I wanted, my birthing dreams/plans/goals have been shattered once again, and this point, it doesn't get much worse. I was told by the OB that I most likely will not be allowed to get an epidural. This might seem insignificant overall, but I am just tired of having my damn body interfere with the happiness of the pregnancy. One thing after another is making this pregnancy such a burden. I have always been the first person to raise their hand when asked if they wanted an epidural; my best friend Erin and I have always joked about the fact that as soon as we walk into the hospital on our delivery day, we will ask for the anesthesiologist. I have dreamt of a near pain-free delivery since finding out about Isabella, and now, I have that carpet ripped out from underneath my feet because my stupid body can't hold onto its platelets! This might seem superficial and stupid, and I should be looking at the positives of having a healthy baby, but now I am dreading labor and scared to death to have this baby. I realize that the prize at the end is "worth" all the pain, and that women for centuries have been giving birth naturally, but it doesn't make the situation any better, really. Hell, even in movies about where dentists have to yank a tooth back in the day before novacaine, they get the guy all drunk and buzzed up before pulling….I don't even get to get drunk! I am so scared of pushing out this baby now; I am starting to not look forward to having her! I feel guilty for feeling angry about having to give birth!

It turns out, this only occurs in about 5% of pregnancies. One concern is over whether or not my blood will be able to clot during delivery and that I will not continue to hemorrhage afterwards. At the level it is at right now, I should be ok, the doctors aren't too concerned with that, if they were, I might be getting induced asap, since the more platelets I lose, the higher the risk of clotting problems. He didn't seem too concerned about this though, and truth be told, neither am I, not in the least! Like I said, I am still considered mild, on the border of moderate risk, and plenty of women have this and have no problem clotting. At this point, the doctor was concerned about how I would handle this news: "No epidural"; most anesthesiologists will not give an epidural to a woman who is at 100,000 for fear of blood getting into the spinal column upon the needles removal, which could result in nerve damage and worse, paralysis. A c-section at this point is more dangerous as well, since there is more possibility of blood loss, so it is imperative that BellaReese stay head down.

There is mixed findings on what the lowest number of platelets could be to still administer an epidural, some doctor’s say anyone over 80,000 can still have one, but our doctor and hospital stick to the 100,000 level. My OB said that it could be a “day of” decision, that certain anesthesiologists will do one at the point I am at, and some will not, but Brian and I discussed this, and while he, of course, leaves the decision up to me since it is my body, we have decided that it is not worth the risk and that we will go at this naturally. I am just so frustrated with things not going how I envisioned them.

There are other ways to recieve pain meds while pregnant, but they all have a negative effect on the baby, making them drowsy and sluggish after birth, and I really don't want that for my baby. I want her to be 100% her when she enters the world.

Can I do this? Yes, of course. Will I do this? Yes, of course, the baby has to be born! I am just so frustrated. At this point, I would rather have her now so I don't have to focus on the fact that I will be practically splitting in 2 in the near future, I just want to get it over with. I hope my feelings of stress and anger aren't being passed on to the baby.


In other news, I am not yet dialated, the baby has not dropped and I have only slightly started to efface. It was a rather depressing day at the doctors.

2 comments:

Erin said...

First of all, regardless of your situation medically, it is totally normal to feel scared and angry at the thought of having to push her out, especially when you feel like you have little control over the situation. Here's my advice: find a natural birth class/doulah asap!

The Oettikers said...

Just a thought - a mild dose of demerol may take the edge off during those last few centimeters and remember that your baby will be noticeably drowsy and lethargic for about 24 hours after delivery simply due to the trauma of being born, so you may not even notice the effect from a little bit of pain medication.