I am sitting in the new glider in the yellow nursery feeding Peanut when my phone lights up. I desperately want to ignore the call, but I can't. I know it's my doctor and I know he is going to ask if I took the medicine he prescribed last night. The medicine that is supposed to help stop the heavy bleeding I'm still experiencing three weeks post-partum. The medicine that carries a label advising against breastfeeding while taking it. The medicine that I did not take last night.
"Hi, doctor," I say into the phone.
"Good morning! How are you feeling? Crampy?"
I only met this doctor eight weeks ago, when I transferred to his Long Island office from Westchester at 35 weeks, but I really like him. I don't want to disappoint him.
"No, not crampy..." I trail off.
"Why not? You didn't take the medicine?"
"Well, I didn't think I could take it while breastfeeding, and I'm just starting to establish a good supply, so..."
There is dead silence on the other end of the line. I feel like I'm back in the fifth grade, being reprimanded by my favorite teacher for rolling my knee socks down.
The doctor speaks slowly. "I don't think you understand. You need to take the medicine. I know breastfeeding is important to you, but this is a matter of life and death."
My doctor isn't one to overstate the truth, so this grabs my attention.
"I don't think you realize how lucky you are," the doctor continues. "We just got the placenta back from pathology, and that baby you're holding is a miracle."
I think to myself that after the pregnancy and delivery I just experienced, there is nothing that this man can tell me that will surprise me. If my pregnancy with Minnow was textbook, my pregnancy with Peanut was a horror story that included four hospitalizations: Two for unexplained bleeding in the first and second trimesters, one for acute food poisoning and dehydration, and one after a low-impact car accident at 32 weeks. In addition to all that, I was also diagnosed with a low-lying placenta at my twenty-week anatomical scan, and for most of the pregnancy we believed I would deliver Peanut by scheduled C-section. The placenta finally moved far enough away from the birth canal at 37 weeks, and I was cleared for a natural delivery. I was thrilled to deliver Peanut naturally four weeks later, but, unfortunately, after she came out things went very wrong. The doctor could not control the bleeding after I delivered the placenta and I was rushed to the OR for emergency surgery to treat post-partum hemorrhage. There was talk of a hysterectomy and I was scared out of my wits, but, thankfully, the doctors were able to stop the bleeding. Sort of. Three weeks after the surgery I am still experiencing heavy spotting, which is why my doctor has prescribed the medicine I refuse to take.
But all of this has little to do with what he tells me next, and it shakes me to the core.
"The pathology revealed that the baby had a velamentous cord insertion that ran for eight centimeters, resulting in a vasa previa."
I don't speak Latin, so I ask the doctor to explain.
In a normal pregnancy, the baby's veins run from the middle of the placenta to the baby through the umbilical cord. The umbilical cord protects the veins from rupture. In velamentous cord insertion, the baby's veins traverse the placental membrane unprotected before coming together in the umbilical cord. Peanut's veins ran unprotected for eight centimeters and actually crossed the birth canal, which is what is meant by vasa previa. If at 28 weeks during my food poisoning episode, at 32 weeks after the car accident, or at 41 weeks during labor and delivery these veins had torn as a result of contractions or membrane rupture, Peanut would have bled out in a matter of minutes. She would have been stillborn.
In fact, when vasa previa goes undetected, as is it did in our case, the infant mortality rate is between 50-95%. It is called the silent killer because it affects mothers and babies who enjoyed otherwise healthy, uneventful pregnancies.
When vasa previa is detected, usually by color Doppler, the survival rates jump to 50-95%. That's because when vasa previa is detected, the baby will be delivered by C-section at about 35 weeks, before the mother goes into labor. Vasa previa is so rare (1 in every 3000 pregnancies) that it is not screened for unless the mother exhibits warning signs. I've learned that I exhibited many of the warning signs for vasa previa, including unexplained late-term bleeding, low-lying placenta, and a history of non-abortive uterine surgery, but my former doctor in Westchester did not screen me for the condition.
I don't know why my former doctor didn't test me for vasa previa. I don't know why Peanut survived a natural delivery when the great majority of babies with her condition do not. I've been taught not to question miracles.
I wasn't sure I'd ever share this story on the blog, but October is Pregnancy and Infant Loss Awareness Month, and I want to raise awareness. One in 200 babies is stillborn and, sadly, some of those stillbirths cannot be prevented. But some can be, if we inform ourselves about the causes of stillbirth. If I had known about vasa previa, I would have asked to be tested for it after my first unexplained bleeding episode at 11 weeks. I would have insisted on a scheduled C-section at 35 weeks. I would not have put my baby, and myself, at risk.
To learn more about vasa previa, please visit The International Vasa Previa Foundation. My story is not meant to scare, but to inform. Vasa previa is rare, but if you or anyone you know is experiencing any of the warning signs listed on the website, insist on being screened. It may seem like another unnecessary test during pregnancy, but it just may save your baby's life.
Before we hang up and after the doctor convinces me that taking my prescription is what's right for both me and the children I need to care for, he says one more thing that deeply impacts me:
"Do you believe in God? Because I do."