Digging Out of the Rubble

The past three days have been an abyss of fear, anger, and panic. Fear that my water will break and we won't get to the hospital fast enough to save the baby. Anger at the midwives for not telling us how serious this was back at 20 weeks, anger at the universe for sending more "extremely rare" crap our way, anger at being a walking time bomb with no control over the fuse. Panic that everything has to go just right to get a live baby out of this and someone along the pipeline--nurse, doctor, anesthesiologist--could waste precious seconds that make the difference.

Yesterday I wanted steroid shots to mature the baby's lungs NOW, immediate hospitalization to put me as close to the operating room as possible in the event of rupture, and a c-section as soon as possible after 33 weeks (because our 33-weeker turned out so well and emergency vasa previa babies don't). The medical world is very well-versed in caring for premature babies; in contrast, vasa previa is practically an unknown. A baby has about a cup of blood coursing through its veins (250 mL); in a minute's hesitation or confusion, half could be gone. The difficulties a mild premie faces seem to pale in comparison to those of a baby who's lost half his blood.

No way were we able to wait until February 15 for our next appointment. We called for something earlier and met today with Dr. Schoot at the Catharina Hospital, which is 8 minutes and 42 seconds from our house under regular midday traffic conditions, including one minute inside the house. We went early and scoped out the ER, then the NICU. Both were reassuring.

The NICU staff were welcoming and helpful, though we dropped in without warning. A very friendly and well-informed nurse (she knew what vasa previa was!) gave us a tour. There are sixteen spots on the NICU ward, and during our visit we counted eight or nine nurses. It was peaceful and quiet, no sense of panic or rushing around, no dinging and beeping. Parents and siblings are welcome 24 hours a day and the nurses thoroughly encourage breastfeeding. There are three rooms (space for two babies each) for infants who are close to being able to go home, where the mother can even room in to facilitate round-the-clock breastfeeding.

Our meeting with Dr. Schoot was just what we needed. An experienced obstetrician in his late 40s or 50s, he knew about vasa previa and took it seriously. He spoke to us on an intelligent level and was reassuring without being blasé about the real risks involved. He took another look with the vaginal ultrasound and even my husband and I could see the blood coursing through the vessels on the black-and-white images. Color Doppler showed a thick red artery. It's not quite crossing the cervix, but runs just beside it.

We discussed steroids, hospitalization, when to schedule a c-section and what to do if my water breaks. Dr. Schoot said it's unlikely that an initial tear will rupture the blood vessels, that usually the tear will initially run along a vessel instead of through it because the membrane is less resistant than the vessel. Initially--so we can't afford to lose any time, but my doom scenario of immediate gushing, spurting fetal blood is not as inevitable as I imagined.

We agreed on a scheduled c-section at 36 weeks plus a day or two. Dr. Schoot wrote down specific instructions for us if my water breaks or leaks or I have any kind of contractions: we call the maternity ward at the number he gave us and tell them per his instructions that we're coming in and to get an OR team ready. He'll make sure everyone on the floor is apprised of the situation at the next weekly staff meeting so our call doesn't come out of left field. In the ten minutes it will take us to get from home to hospital, the team will be ready to whisk me away, and Dr. Schoot said within five minutes they'll be operating. It can't be done any faster than that, so there's no added value to my being in the hospital just-in-case.

He also measured my cervical length: a nice, long, far-from-labor 4.6 cm. From here on out I'll have weekly visits to measure cervical length; if it starts to shorten, we'll reevaluate the plan.

We were worried that if rupture happens at night, the obstetrician will have to be called in from home. Dr. Schoot said that half the team overnights in the hospital when on call because they live too far away; the other half live within six minutes of the hospital. Moreover, there's always a resident who is qualified to carry out the c-section, so we shouldn't have to wait on anyone to arrive.

He wrote "Vasa previa!!" in big letters surrounded by bright pink highlighting on a form and added it to my folder. Then he gave us the anesthesiology forms to fill out and turn in so there won't be any delays there. We confirmed our appointment for the 15th and traipsed down the hall, where an anesthesiologist answered our questions, took my blood pressure, listened to my lungs and wrote "healthy" on my form. Then it was off to the bloodwork lab.

My husband and I are feeling much better now. Feeling like we've got a plan in place, that we're doing what we can to produce a positive outcome. Feeling reassured that our health care providers are on the same page and up to date on our situation.

I'll be feeling even better when we pass 32 weeks and my water doesn't break. Then 33 weeks, 34 weeks, 35. Cross your fingers . . . it's still a high-stakes waiting game with an uncertain outcome.