Part 13 - The 20 Week Scan and Placenta Previa

It wasn’t long after the morning sickness eased that I felt my first fluttering.  It was the strangest feeling because it was ever so gentle yet strong enough to catch my attention. You could easily have mistaken it for trapped wind, but the more it happened the more I came to recognise that it was the baby moving inside me. Quite amazing!

By 19 weeks, I was feeling much more my usual self to the extent that I even toasted my thirty eighth birthday with a glass of champagne – never has champagne tasted so good!  Up until that point the mere thought of wine and champagne had been enough to turn my stomach, but now the sickness had eased, my taste buds were back to normal again. I also had a lot more energy so I wasn’t having to crash into bed early each evening.

I was jubilant to be pregnant, although I’d come to realise that being pregnant didn’t necessarily mean that I was constantly happy as I may have once imagined. That was another lesson.  I had spent so much of my adult life longing to meet the man with whom I could have a family, that I felt my happiness depended on it. I’d searched the world twice over and spent a lot of time praying to the angels for this dream to come true.

I lost track of the number of conversations I’d had with my best friends about us finding our respective Mr Rights, and about the children we would one day have (one of those friends ended up with Mr Wright incidentally, oh how we chuckle about this!). I’d also lost track of the number of failed relationships we’d had between us in our search for ‘the one’. It wasn’t necessarily that we weren’t happy with our lot, but we figured it would make us and our lives complete to have the ‘ideal’ partner and our child in it.

And now here I was pregnant and with a loving partner and yes, there was a certain feeling of completeness that came with that, but it didn’t mean that I was constantly happy. There were days when I was very happy and incredibly joyous about he new life growing inside me, but equally there were days when I felt out of sorts and a little miserable and I found myself praying to the angels for guidance.

It reminded me that our state of happiness and sense of wellbeing is not dependent on anyone or anything else, but on our state of mind and our perspective. After all we choose the thoughts to which we give our attention.  So, even pregnant, I still had my moments.  Plus, I may well have realised the dream of meeting my partner and becoming pregnant, but now I dreamt of a home vaginal birth – there was always another dream, something else to work towards.

The truth is, I thought that a vaginal home birth was the only way I was going to experience the spirituality in birth. I had this image in my head of me birthing on my own in the darkness of the bathroom, all primal and earthy.  I expected to drop my awareness deep into my body and into the sensation of the pain I would inevitably be experiencing so that I could gain insight into the very essence of life and the birthing process. In so doing I imagined a spiritual awakening, a journey into the light, a state of enlightenment.

E wasn’t so sure about this home birth malarkey.  Understandably he wasn’t particularly bothered about my need for spiritual awakening, he was more concerned about the health of the baby and s/he arriving Earth side safely. I was concerned about this too, but it wasn’t my only consideration. I was adamant that the only way I would experience what I wanted to experience was in the home environment. I certainly had no intention of birthing in a hospital as I wanted zero intervention.

Little did I realise how much I was setting myself up for a fall. I figured I was being all spiritual and open minded about birth but now I look back, this was farthest from the truth.  I was in fact incredibly close minded and judgemental.  I just couldn’t understand the reason women would choose to birth in a hospital, and I certainly couldn’t get my head around them choosing to have a Caesarean section, or induction and would be a little vocal about this at times.

A week or so after my birthday, we had an appointment for the 20-week scan. As the date approached I became increasingly anxious and short tempered. It was ridiculous really, but I couldn’t help myself.  I felt on edge and no amount of praying to the angels or Goddess of the Moon was easing this.  I certainly couldn’t sit still to meditate and I was distracted in my yoga practice too. Fear had taken hold and I couldn’t seem to shift this.

We were greeted by the same Australian sonographer who had undertaken our twelve-week scan and her colleague who was undertaking some training with her. This scan is carried out in the same way as the twelve-week dating scan with gel on the tummy and the sonographer passing the ultrasound device backwards and forwards over your skin. I proudly bared my just visible baby bump and lay back on the bed with E sitting beside me.

This scan looks in detail at the baby’s bones, heart, brain, spinal cord, face, kidneys and abdomen, and allows the sonographer to look for physical abnormalities in the baby and specifically for eleven conditions, some of which are very rare. In most cases the scan will show that the baby appears to be developing normally but sometimes the sonographer will find or suspect a problem – some problems can be seen more clearly than others.  

This scan also tends to present the opportunity to discover the sex of the baby, although this isn’t the intention of the scan per se and there is no certainty that it will be 100% accurate.  I’ve known two couples who were told at the twenty-week scan that they were carrying girls, only to end up with boys upon delivery, causing quite a shock and a little adjustment, certainly in terms of pink themed nurseries and pink clothes!

We didn’t want to know the sex of the baby and made sure that the sonographers were aware of this. This didn’t stop me being curious however, especially as the image of the baby was so clear on the screen. It was amazing really. Here was our little bean visible to the naked eye, wriggling around and doing his/her thing and looking like a proper baby. It was very exciting.

The lady sonographer guided us through the process as she carefully checked the baby’s organs and took the necessary measurements required by this scan to determine the size of the baby and check everything looked well. The male sonographer had a look too and fortunately the baby appeared fine, no obvious abnormalities were found. However, the lady sonographer was concerned about the positioning of my placenta, which was still lying low in my uterus.

I’d already researched this a little and had read that one of the most common problems spotted at the twenty-week ultrasound is placenta Previa. The placenta is the pancake-shaped organ, normally located near the top of the uterus, that supplies the baby with nutrients through the umbilical cord. Placenta Previa is where the placenta is nearby, or actually covering some or all of the cervix.

It’s a potentially dangerous condition because if the placenta covers the cervix, it blocks the baby’s way out, requiring a Caesarean section to deliver the baby. More seriously, as the cervix dilates towards the end of pregnancy, the placenta can be torn and bleed, which can be life-threatening to mother and baby.

Complete or partial placenta Previa, where the placenta covers at least a quarter, or even all of the cervix, occurs in around 1 in 200 pregnancies, and requires careful monitoring by a doctor. More common is a marginal placenta Previa, where the placenta is close by, or touching the cervix, but not actually covering it.

At twenty weeks, when the placenta is relatively large compared to the size of the uterus, many women appear to have placenta Previa. However, as the uterus grows, the placenta moves further away from the cervix and by the time they have another scan, 90% of women with marginal placenta Previa at twenty weeks, will likely be given the all-clear and be able to try for a vaginal birth.

Sadly, it looked unlikely that I would be in that 90% as my placenta appeared to be completely covering the cervix. This meant I had to have yet another internal vaginal examination so that the sonographer could be absolutely certain of this. It wasn’t quite what I had in mind that morning and I was slightly daunted by the fact there were two sonographers present, but one does what one has to do in the circumstances.

Much to my utter dismay, the vaginal scan revealed my fears; I had complete placenta Previa. This meant that the placenta was completely covering the cervix and in such a way that it was very unlikely it was going to move from this position. I knew that it wasn’t going to move, I could feel it in my heart, and no amount of people telling me it would, or praying to the angels and the Goddess of the moon was going to change this. It was my fate.

Clearly there were still lessons to be learned on this quest to procreate and become a Mum.  Going through IVF was not enough. And in many respects looking back, I can see clearly the potential blessings in the curse. But back then I was absolutely bereft and it was all I could do to hold it together in the scanning room as the sonographer told me that I would be referred to a specialist and that I should immediately telephone the hospital if I started to bleed.

Once outside the hospital building I burst into tears.  Poor E had no idea what was going on, as far as he was concerned the baby was okay, so why was I crying? And that was the point I missed.  Of course I was delighted that the baby was healthy, but if I’m honest, I fairly much took that for granted.  I hadn’t anticipated a problem with the baby, and perhaps I wasn’t as grateful as I should have been.

All I cared about in that moment was the fact that I was going to have to have a Caesarean section. The baby was going to enter the world in the completely opposite way to the one I had intended, namely early, in a theatre, with lights and noise, and drugs and strangers. This was absolutely not how it was meant to be. I wanted spiritual music and candles, the darkness of the bathroom, and the opportunity to truly go within, birth without fear and have a spiritual experience.

I had a lot to learn.

The Goddess of the Moon was dancing, but I most definitely wasn’t dancing with her.

I telephoned my parents from the car and burst into tears all over again.  They were concerned something was wrong with the baby and were relieved when they found out the problem was with my placenta instead. They tried to help me realise that I should be feeling relieved, not distraught. But I just couldn’t see beyond the Caesarean section, it was like a neon light in my mind flashing, “Caesarean section, Caesarean section, Caesarean section”.

I was angry, very angry. It just didn’t seem fair. What was the Universe playing at? Not only had I had to have a clinical conception (albeit conscious, but it took me a while to recognise this) but now here I was going to have to have a clinical birth too. Plus, there was now an increased chance of painless vaginal bleeding during the third trimester and with that the risk of being hospitalised.

The bleeding happens when the cervix begins to thin out or open up (even a little), which disrupts the blood vessels in the area. What happens after this would depend on the stage of pregnancy, the heaviness of the bleeding and how the baby and I were doing. If the baby was still premature, s/he would be delivered immediately if the conditions warranted it or if the bleeding was so heavy that it didn’t stop.

Otherwise, I would be watched in the hospital until the bleeding stopped. If the baby was less than 34 weeks’ gestation, I would be given steroids to speed up the baby’s lung development and to prevent other complications in case s/he ended up being delivered prematurely. If the bleeding stopped and I remained free of bleeding for at least a couple of days, then I would probably be sent home (it’s likely that the bleeding would start up again at some point and, if that happened, then I would need to return to the hospital immediately).

However, if both of us continued to do well and the baby didn’t need to be delivered right away then a Caesarean section would be scheduled at around 37 weeks, unless there was a reason to intervene earlier. When making the decision, the medical staff would need to weigh up the benefit of giving the baby extra time to mature against the risk of waiting, with the possibility of facing an episode of heavy bleeding and the need for an emergency Caesarean section.

Furthermore, after a baby is delivered by Caesarean section, the obstetrician delivers the placenta and the mother is given medication to encourage the uterus to contract, which helps stop the bleeding from the area where the placenta was implanted. However, with placenta Previa, the placenta is implanted in the lower part of the uterus, which doesn't contract as well as the upper part so the contractions aren't as effective at stopping the bleeding. This may result in heavy bleeding and the need for a blood transfusion.

Also, women who have placenta Previa are also more likely to have a placenta that's implanted too deeply and that doesn't separate easily at delivery. This is called placenta accreta, which can cause massive bleeding and the need for multiple blood transfusions at delivery. It can be life threatening and may require a hysterectomy to control the bleeding.

Finally, if you need to deliver before term, there is a risk that the baby will be at risk of complications from premature birth – such as breathing problems and low birth weight and the need for neo-natal care. It wasn’t ideal. Certainly not the stuff of dreams and it brought with it not only the anger and frustration, but a huge amount of fear too.

Once I’d calmed down and accepted my reality (as much as I ever truly accepted it), I realised that I needed to do what I could to limit the chances of bleeding.  I absolutely didn’t want to end up hospitalised and I had no intention of the baby arriving early. I had read far too much about the implications of premature delivery on a baby’s gut and lung development and the resulting affect this would have on their overall health and wellbeing and I didn’t want this for my baby.

I resolved therefore, that my baby was not going to be delivered early.  I was going to make it my mission to carry on life as usual and do what I could (intuitively) to ensure I didn’t bleed. I was still very angry – and would be for a further three years – but I came to recognise that this condition presented me with yet another opportunity to drop deeper into my spiritual practice and be guided by my body and the messages it was conveying to me.  

Crying on my yoga mat was a good start and from there I resolved to figure out a yoga practice, which would help to keep the baby inside me for as long as possible.  This meant practicing in the completely opposite way to the usual pregnancy yoga sequencing which aims to prepare the body for birthing vaginally and opening everything up accordingly. It was time to put the books aside and go within again.