1. The subchorionic hemorrhage had grown significantly, infiltrating into the placenta.
2. Placenta insufficiency and abruption. Because of the hemorrhage, the placenta isn't attached appropriately to the uterine wall, so it is difficult for the nutrients to pass from me to the baby as well as they should. There are also little black spots all over the placenta on ultrasound, a sign that the placenta isn't healthy. The same appearance is commonly seen in babies with "lethal" chromosomal abnormalities such as trisomy 13 or 18 or bad infections.
3. No nasal bone. This is a common indicator of Down Syndrome. It is seen in 80% of Down's babies and only 1% of normal babies.
4. Intrauterine Growth Restriction (IUGR), meaning the baby is too small, < 3%, the size of a 22 wk old (440 grams or less than 1 lb). This could be due to a chromosome problem or the problems with the placenta.
5. The most ominous sign of all: Absent End Diastolic Flow. This is a problem with the blood flow through the umbilical artery. Basically, there is a momentary stasis (stoppage of flow) with each heart beat. This will eventually progress to a longer pause in flow to the point that the flow reverses in the wrong direction and compromises the health of the baby. This process may take weeks or days and has two end outcomes: delivery by c-section or stillbirth if no medical intervention is performed.
Blindsided with all of this new information, we had to make some tough decisions on this day about how aggressive to be with the little peanut who wasn't (isn't!) ready to leave my womb yet. My care was quickly transferred to the maternal fetal medicine (MFM) specialists and classified as "High Risk." We spoke with another MFM doctor, a genetic counselor and neonatologist, and every outcome was very bleak. I asked if there is any chance I would carry this baby to term, and the doctor looked at me as if I had three heads and said, "No way. We'll be lucky if we can get you to 28 weeks. You may not even make it to this weekend." We were told that this baby may need to be delivered within the next couple of days because they couldn't determine how quickly the blood flow problem could deteriorate. The neonatologist gave us mind numbing statistics. There is only a 40% chance an IUGR baby delivered at 24 wks will even survive. Of those that survive, there is a 100% chance of mental retardation, blindness, deafness, and malfunction of every major organ system.
While in the waiting room, I picked up a parenting magazine, looking for some good fluff reading to try to take my mind off things. The first thing I opened up to was a letter a reader mailed in saying her son was born at 24 weeks, and he was in the NICU 83 days and then died. I later realized God put that message in my hands at that moment for a reason. It became clear to me that I couldn't subject this sweet baby to that kind of life, and James independently came to the same conclusion. James and I are both doctors, so don't get me wrong. We know the importance of utilizing modern medicine. But at what point does it become torture? What kind of a life would we subject this baby to? What if God just wanted us to peacefully love this baby for a few moments of life before giving him back to our Heavenly Father? Who are we to "play God" to try to extend a life that may not have been meant to live? So many questions rushed through our minds.
Much later, we were finally given peace when we realized we were putting too much pressure on ourselves to decide whether to try to save this baby or let him pass away peacefully. Who do we think we are? As if we have any say in the matter of whether he lives or dies! God has this child's days numbered, whether it's measured in days, months, years, or decades. We have no control over that. As long as we are prayerfully aligning ourselves with His plan and seek His guidance every step of the way, we have nothing to worry about.
Psalm 139:13-16 "For you created my inmost being; you knit me together in my mother's womb. I praise you because I am fearfully and wonderfully made...All the days ordained for me were written in your book before one of them came to be."
Ultimately, we decided to go home on strict bedrest after getting an amniocentesis to look for chromosomal abnormalities and other potential problems. We realized our most feasible, as well as "best case scenario," was Down Syndrome. I wasn't worried about that. While it isn't the first plan we dreamed of for our baby, it was very acceptable. I have never met a Down Syndrome kiddo that I hadn't fallen in love with. I would be honored to parent such a lovable child! Our "worst case scenario" seemed to be what they kept referring to as the "lethal" chromosomal disorders, Trisomy 13 or 18, because most of those babies die shortly after birth. While that would be devastating, we didn't see it as too unbearable. My niece, Callie, has Trisomy 18 and is one of the rare cases of survival, and she is such a joy. I love her so much, and I just can't get enough of her. So if that's the worst it can get, we can handle it!
We waited it out over the weekend, soul searching, praying, and garnering prayer from friends all over the world. Knowing there was nothing for me to do besides bedrest, I decided to be the best bedrest patient ever, giving it 110% and trying to make it 23 hours a day, beyond the prescribed 22 hours of bedrest. We called in the cavalry, and James' family came down from Denver right away to help out, and my mom and dad soon arrived from Minnesota, canceling their annual month long snowbird trip to Florida to come help us. The ladies from my Bible studies immediately stepped up with prayer and encouragement and a meal delivery schedule, so our family has been well fed right from the start. We couldn't ask for better support!
It is now two weeks later, and we passed the 26 week milestone (26 weeks + 3 days, but who's counting?). Our preliminary amniocentesis results came back as normal, so there are no chromosomal abnormalities, which shocked the experts. The secondary results relieved us from any concern with infections. There were a couple of confusing positive results (for those who want to know, AFP and ACHE) which have stumped the doctors and geneticist, but everyone feels these are most likely false positives because they don't correlate with the baby's normal organ appearance on ultrasound. I will, therefore, not get concerned about that.
I go in for monitoring every Monday, Wednesday, and Friday with my suitcase packed each time, ready to stay in the hospital if the blood flow issue takes a turn for the worse, which could happen at any point. The baby's growth can only be measured every three weeks, so we aren't sure how he is growing, but they are watching the bloodflow closely. So far, after six scans, bloodflow has remained abnormal but stable, and the baby doesn't appear to be in any distress. He is moving like a champ, entertaining me with each kick and cheering me on to be diligent with bedrest. Praise the Lord! We just continue to pray that he will stay in my womb as long as possible. We celebrate each day that he remains in utero. Please continue to pray with us for the health and growth of this sweet baby. We found out that in rare cases, the blood flow can improve as the baby gets bigger, so we are praying we will be one of those rare cases. For now, we're just happy every time they let me go home after a check up. As one of my friends put it so well, status quo is a good thing. No bad news IS good news!