What Do You Do When Fear Takes Over What Should Be One Of the Happiest Times in Your Life?

I’m scared….

Its very hard for me to admit that I am carrying fear inside me on a daily basis right now.  I am a go getter, a self starter, usually an optimist but at least a realist who was raised to believe I could overcome anything if I had faith in God and worked hard enough.  However, I find myself now daily trying to figure out how to live in a situation I can’t control.

At the beginning of this year I was the mother of four beautiful, sweet, healthy children and wife to an amazingly supportive husband, all of whom are the center of my world.  I have never had easy pregnancies but God has miraculously gotten me through four with only one preemie and what I would consider minimal long term complications of my own.  When we had number four my husband, who is an Orthodox priest and Army chaplain, and I both prayed about whether we were finished. Neither of us felt at that time that God was definitively telling us we were done and my fourth pregnancy was by far the easiest of them all.  So we left it in God’s Hands.

At the end January we took a wonderful family vacation along with my parents.  It had been almost a year since the birth of our last child and I had just turned 37 in December leading me to comment to my husband that God must be done with our childbearing years.  He laughed at me just a few short weeks later when I started feeling sick and sure enough a pregnancy test revealed that number five was on its way.  Unfortunately, 7 short weeks into that pregnancy I woke up miscarrying. I was scheduled to work a 24 hour shift in the ER of a critical access hospital in rural KY and was only able to spend 10 minutes crying in my shocked husband’s arms before having to get back up and get on the road to make it to work on time.

Losing that baby was very hard on both of us. I don’t feel like I had really even started processing it when I started feeling sick again.  It had been less than a month since my miscarriage and my husband was due any day to deploy for a month long training mission with his battalion.  In addition, we were due to PCS to San Antonio at the end of May.  However, a home pregnancy test confirmed that we were indeed expecting again.

I saw my OB and had an Ultrasound which looked great.  At 10 weeks they drew a new NIPT test to look for genetic issues due to my advanced maternal age.  They told me to to expect the test results in 7-10 days.  However, the day of our move arrived and I still hadn’t heard the results.  In a last ditch effort, I stopped by the clinic but no one was available to find them for me so we headed out of town.

Later that day while on the back roads of Tennessee with poor cell phone reception I received a call from the OB clinic.  My test had come back and it was borderline for Down Syndrome.  The OB who called apologized that she was calling with the results even though she had never seen me and that she really didn’t know what the test result meant as she had never seen this result.  I spent the next several hours on the road desperately trying to figure out what it meant.  The next day I called the company genetics manager and found out there had only ever been two borderline results in the five years of the test and they didn’t know what happened in the first case.  My MFM was able to get more info in that these tests have a normal range and an abnormal range and a small area in between.  My result was just outside the normal range but not close to the abnormal range.  He recommended a repeat NIPT once we arrived in San Antonio.  So I talked to my husband, we already knew the diagnosis wouldn’t change anything for us and so we decided against an amniocentesis and to wait and see what happened later.

I had been having a bad feeling since the start of this pregnancy and honestly, thought that was it.  However, upon since our arrival in San Antonio we have realized that whether the Baby is affected by Down Syndrome is absolutely the least of our problems. As with any move it took a few weeks to get settled.  We lived in a hotel room with four children and a puppy for over a month while finding and then moving into our new home. Getting a Texas medical liscence is a long process and so I was still flying back to Tennessee to work every few weeks and it took several weeks to get back into the OB.

My first Ultrasound after the move really started my current nightmare.  The baby looked great and they found no markers for Down Syndrome though we still have a 30% chance that she has it.  However, I had a Placenta Previa.  This happens when the baby’s placenta implants over the internal opening to the cervix.  We had had a partial Previa before in my first pregnancy but the placenta grew over time towards the top of the uterus where there is more blood supply.  Unfortunately, this time it was completely covering the os and unlikely to migrate as we were already 20 weeks along.  In addition, I have had four previous c-sections and it was covering my scar as well.  Initially, other than the placement everything looked good.  However, I walked out of the appointment still feeling like I had been punched in the gut.

As a physician, my husband often complains that I know too much about the potential for bad things.  This was one of those times.  My husband listened to them say no evidence of acreta and start pelvic rest and we will recheck in 4 weeks and took it at face value.  I get in the car, immediately call my best friend who is an OB and told her while trying not to cry.  Her first response was the same as mine. Oh No! With four previous c-sections my risk of developing a placenta acreta was 61-67% depending on the medical resource I looked at.  My husband just looked at me and said “What is an acreta?”

According to ACOG’s Committee Opinion Number 529, July 2012:

Placenta accreta is a general term used to describe the clinical condition when part of the placenta, or the entire placenta, invades and is inseparable from the uterine wall (1). When the chorionic villi invade only the myometrium, the term placenta increta is appropriate; whereas placenta percreta describes invasion through the myometrium and serosa, and occasionally into adjacent organs, such as the bladder. Clinically, placenta accreta becomes problematic during delivery when the placenta does not completely separate from the uterus and is followed by massive obstetric hemorrhage, leading to disseminated intravascular coagulopathy; the need for hysterectomy; surgical injury to the ureters, bladder, bowel, or neurovascular structures; adult respiratory distress syndrome; acute transfusion reaction; electrolyte imbalance; and renal failure. The average blood loss at delivery in women with placenta accreta is 3,000–5,000 mL (2). As many as 90% of patients with placenta accreta require blood transfusion, and 40% require more than 10 units of packed red blood cells. Maternal mortality with placenta accreta has been reported to be as high as 7% (3). Maternal death may occur despite optimal planning, transfusion management, and surgical care. From a cohort of 39,244 women who underwent cesarean delivery, researchers identified 186 that had a cesarean hysterectomy performed (4). The most common indication was placenta accreta (38%).

Over the next few weeks we met with several physicians and it just kept getting worse.  We now know that the placenta has attached abnormally at my c-section scar and has not only grown through the wall of the uterus but is also invading my bladder.  We still don’t know the extent to which it has encroached on the bladder or possibly any other organs or vessels in the immediate area.  My case is also complicated by the fact that I have had DVT’s in the past and am on blood thinners to prevent a recurrence.  This gives me a higher risk for bleeding both from the previa and the percreta.  Initially, I tried very hard not to be alone with the kids in case something happened.  Thankfully, my mother has a job which allows her to work from home and has come for an extended visit which has alleviated that concern.

Currently, I am 30 weeks and 2 days and hoping that we make it to a scheduled C-section/hysterectomy at 34 weeks as this will hopefully give both the baby and I the best outcome.  I have had new symptoms with the pregnancy that I didn’t have with the other four including mainly a dull pain in my lower abdomen that intermittently becomes very painful and then regresses back to the low dull pressure feeling.  I have had increased anemia compared to prior pregnancies causing significant fatigue and recently underwent an iron infusion which has seemed to help at least halt the downward spiral I was on.  I have also experienced intermittent light spotting and blood in my urine which we continue to monitor at this point.

Maybe most importantly, I have struggled with the fear of not being here for my four sweet children and husband, of leaving my parents without a child and my siblings without a sister. Initially, every time I went to the Doctor I came home anxious, depressed and frustrated.  I felt like I wasn’t being given the information I needed as a physician myself, that the healthcare providers I was seeing were hedging and trying to make it seem better than it was.  Honestly, they probably were and in their position I would likely have done the exact same thing.  We are taught to only tell patients that which we are sure about and to gather the facts first.  What I was looking for was their experiences and gut feeling about an outcome that I realistically know they can’t predict.  Plus, I was angry with God.  I didn’t understand how he could have allowed this to happen when I was trying so hard to follow him faithfully.  Why have me go through all these years of training and sacrifice to be a physician in order to help others, given me those four loving children and husband and then take it away. It just didn’t make sense.

It has really taken the last month for me to figure out how to cope with my current situation. I have often thought of Job and the trials that he went through for his faith and have realized that God is not doing this to me but that doesn’t mean he is not allowing it to happen.  We are not promised a life free of suffering or pain when we choose to follow Christ.  We are promised everlasting life. We are promised a loving father who will carry us in his arms during the tough times.  We are promised that he will be there with us no matter what we go through or what the outcome is.  Suffering should bring us closer to God, it should strengthen our relationship but only if we allow it to. I have made the choice to turn to him rather than away and this has allowed me to find if not complete peace at least a lifeline to hang onto.  I know that I am not perfect but he is and I trust that he has a plan for me and my family at this time as long as I have the courage to turn my fear over to him and trust.

I hope though long that this post will help my family and friends who have been so worried and prayerful to understand what’s going on and that it may help others going through this same situation to see that there is still a light to hold on to. I will keep everyone posted as things progress. I would appreciate greatly your thoughts and prayers not only for me and the Baby but also for Jason, our children and my family as they travel through this dark period with me. I could not make it without them.