People are supposed to honor instinct, to listen to their little voices. But the problem with instinct is that in bad times it can come off as chicken little, wings flapping and eyes bulging as it shrieks again and again of danger. In contrast, denial can seem so polite, quiet and reasonable. During crazy times, it is easy to decide that denial is your very best friend, while instincts are just plain annoying. That's what I did in Little A's pregnancy. I mixed up which voice was the right one to listen to.
For several weeks, I lived with my scar hurting in secret and waited for it to go away. When it stubbornly stayed there, I eventually blurted out the news to my OB. My doctor felt the spot. Most likely nothing, she said. But she'd consult with the perinatologist and see what he thought. Maybe we ought to have me go in for a scan or something later in the week.
I left the office kicking myself and wondering why I had to be such a drama queen. Yet while I was thinking elaborate thoughts about how I'd just blown things out of proportion, I found myself driving straight from the doctor to a toy store rather than going directly to work. Big A's birthday was a week away and suddenly it felt urgently important to get her a present right then. The doctor called me on my cell phone as I left the store. The perinatologist she consulted with wanted me to go straight back to the hospital for monitoring.
So in week 29 of the pregnancy I entered the schizoid existence that many women who struggle with infertility know too well. It was the everything is wonderful right now (but could go to shit any second!) stage. The good news: ultrasound scans and biophysical profiles showed the baby was healthy. The bad news: nobody knew if things would stay fine. Ultrasound could show if my scar was still intact or had catastrophically failed. But ultrasound couldn't tell me if the currently intact scar was holding together well or about to shred. The thing that could do that was a CT scan. Except CT scans are many Xrays layered together. Since Xraying a gravid uterus was a no no, we were flying blind. Several perinatologists debated whether an MRI might be the best course, but eventually that idea was dropped. There were no studies to fall back on regarding treatment, so everyone was making it up as they went along.
We settled into watchful waiting, a weekly regimen of extra doctor appointments, nonstress tests, and scans. DH and I told our friends about our dilemma in a very "oh, this is one of those annoying worries that will turn out to be nothing" sort of way. At first I was very worried -- my gut told me this was serious. But after the first couple weeks of living with the pain and the uncertainty , I began to ignore my freaked out feelings. It's not as though I wanted to fret. I was so busy trying to cajole contractors into finishing a kitchen renovation that had dragged on for months. I needed to finish up piles of work before I went on maternity leave in January. And God, here was Christmas looming. By the time bouts of preterm labor started in November, the whole scar issue had slid onto the back burner.
From this point on, the pregnancy really went in the crapper. I had a few bouts of strong contractions that sent me into the hospital for medication and monitoring until they could be quieted down. I was diagnosed with a sudden onset of polyhydraminos, too. They thought that the extra amniotic fluid from that probably made my uterus irritable and kept triggering contractions. As for why I suddenly had so much fluid -- well, nobody was willing to guess about that. After each episode of strong contractions, I would spend the next day on the couch, so sore and worn out I could barely move.
If I were at 36 or 37 weeks, they would likely have done a c section to get the baby out and stop the downward spiral. But in weeks 32 and 33, the best course of action for the mother and baby is not so clear cut. The baby seemed altogether happy in there, and while I was supremely ill, it didn't seem to be life threatening -- no infections or blood loss as far as we could tell. So we opted to try to leave the baby in and avoid a NICU stay if we could. I started on anti-contraction medications at home, quit work, and tried to stay off my feet. I just wanted to get past week 34, at which point most babies have mature lungs.
In retrospect I can pick out the thread of what happened each step of the way when my uterus finally gave out. The sharp jolt that woke me up one morning in the 35th week was the baby kicking through the overstretched perforation scar. I know the contractions started up right after that because my uterus was rightfully miffed about Little A poking through alien style. And that stabbing pain I felt after the contractions? It was a symptom of internal bleeding, as fluids were pooling where they ought not be. It all makes sense. It seems ludicrous that I didn't immediately call 911 and go the the hospital in an ambulance.
But when I was living through it none of these issues clearly came together in my head as related. DH and I had been side tracked by the other contraction episodes, which no one thought were related to the scar issue. I thought this was more of the same thing. And although the contractions after the rupture were much, much worse than any others I'd felt -- even full-blown labor with Big A had not felt so bad -- the preterm labor episodes with Little A had been getting progressively more painful each time I had them, so it's not like what I felt that last time didn't fit the overall pattern. Also, I saw no blood or fluid to clue me in that there was a big problem. All of that was emptying into my belly rather than draining out my cervix.
All this is my way of explaining that rather than go straight to the hospital, I stuck around my house. I popped an anti contraction pill and tried to wait it out. For several hours, I sweated, winced and shook through the pain. DH kept asking if we should go to the hospital, but I was in the crazy zone. I didn't want to go through the trouble of getting to triage only to be sent home again like I had been the other times. I wanted to wait it out.
Eventually contractions started to come back despite the medication I took. It was only then I realized this wasn't the same as before. Plus, I couldn't tell what the baby was doing anymore. She might have stopped moving entirely, or could have been tap dancing, for all I knew. There was too much agony to comprehend what was happening anymore.
I finally said I thought I needed to go to the hospital. The first people we called to take care of Big A were out enjoying their Saturday. They asked if we could wait another hour before going into the hospital so they could return from their day trip and pick up Big A. DH asked me the question, and I stared at him, unable to think, unable to decide. "No," he finally said. "We need to go now." He dropped off Big A with our neighbors and within minutes we were speeding toward the hospital.