Little Boo Update: 15 Weeks, 3 Days

We had an ultrasound today! Little Boo is 15 weeks and 3 days. 🙂

Daniel and I made a date of it. I believe that makes 7 dates so far this year. (My goal is 10 for the year, and since it is only September and we have one scheduled for October and our anniversary is in December, I’d say we’re doing pretty well!)  We dropped off the kids at 7:15 AM and drove up to Starbucks for a sandwich and coffee before I drank my 20 oz. of water for the ultrasound at 9 AM.

I will call him/her a “he,” since Mara is convinced she is having a little brother.  (Although calling him/her a “he” makes me more convinced it will be a girl!)

He was pretty calm during the entire ultrasound–very little movement, despite the coffee I had on our early morning Starbucks date. I love seeing “his” tiny, tiny hands.  Everything looks good so far–healthy heart, stomach, kidneys, bladder–all those necessary organs . . . They also checked my cervix for cervical shortening (3.4: within the normal range).

After the ultrasound we were scheduled for a consultation with a high-risk specialist, Dr. Smith, who went over my pregnancy history and discussed with us how to proceed during this pregnancy.

He said that while they do not know what caused Micah’s preterm delivery, it is clear from my records that it was not cervical incompetence or insufficiency. It was preterm labor, caused by weeks of contractions (for whatever reason). This is important to us, because it rules out the “need” for ultrasounds every two weeks. (We were very grateful to hear this, from a financial perspective, since these ultrasounds can be super-expensive!)

The only thing that has been proven to reduce preterm delivery is progesterone treatments. If we take this approach, I would have weekly shots starting between weeks 16 – 20, up through week 36, when delivery would be much safer. There are not really any side effects of the shots, other than the swelling/tenderness at the injection site. And thankfully, in the big scheme of things, progesterone shots are not terribly expensive. (The cost of the shots throughout the entire pregnancy will probably be less than the cost of one ultrasound.)

Dr. Smith says one of his pet peeves is doctors recommending bedrest or limiting other activities, as precautionary measures for someone who has had a preterm delivery. There have been no studies or research to show that those measures are effective in delaying preterm labor.

That said, he added, “However: this is not the time for you to, you know, go out and run a marathon. I can see you out there with the two-kid stroller [laughter] . . . You have to use your head.”

You know me and those marathons!!!! I guess I’m going to have to cancel all the ones I signed up for this fall! 😉

My Chances of Another Preterm Delivery

According to Dr. Smith, on average, pregnant women have a 12% chance of having preterm delivery. Once you have had one preterm delivery, your chances are 25 – 30% (roughly doubled). Women who take the progesterone shots typically see their “preterm delivery risk” reduced by 1/3.

So Dr. Smith concluded:  in my case, I have a 25-30% chance of delivering this baby prematurely, and with progesterone, my risk is reduced to a 15 – 20% chance.

Timing of Subsequent Preterm Deliveries
I asked Dr. Smith about what I had heard: Often the subsequent preterm delivery is even earlier than the initial preterm delivery. (For example, Micah was born at 32 weeks. Does this mean the next one, if preterm, would have a greater chance of being born even earlier than 32 weeks?)

He said that actually that is not true. The subsequent preterm deliveries are often within a week or two (on either side) of the initial preterm delivery. If my probability for preterm delivery were shown on a graph, he said, it would be a bell curve, centered around week 32. If I have preterm labor again, it is likely that it would be between weeks 31 – 33. That was a little comforting.

Delivery Options

Mara was delivered vaginally, full term after a completely normal pregnancy. Micah’s c-section at 32 weeks was due to his oblique presentation, and he was delivered “double footling breech,” so there was nothing about me (physically) that required the c-section. I had the low transverse incision, so the risk of widening of the scar on my uterus is between 0.5% to 1%. The risk of uterine rupture during labor is about 1 in 1,000. Dr. Smith said while this is very rare, we should know that it can happen, and in such cases, the baby could die during delivery. But he emphasized that this is very rare.

After going over all the risks and possibilities, he said he thought I was an excellent candidate for a VBAC and saw no reason why I shouldn’t pursue it.

Once again, very encouraging!

Recommendation

Dr. Smith recommends the weekly progesterone shots and is hopeful we will have a good outcome. He would recommend another ultrasound in four weeks or so. If the baby is to come early, he would foresee it being again around week 32. But for now, we should just treat it as a normal pregnancy, as far as calling the doctor if I’m having a lot of contractions and so on. If contractions do come, despite the progesterone, at that time, we would look at bedrest or other medications.

So that’s about it.

Thank you, to all of you who are praying for our little one!

I really am encouraged! And I know the baby is in the Lord’s hands no matter what. There is no safer place to be!

You hem me in, behind and before,
and lay your hand upon me.
Such knowledge is too wonderful for me;
it is high; I cannot attain it.

Psalm 139:5-6