Complications

Well, that didn't take long.

This decision we've made, to continue this pregnancy, is just so fraught with unknowns. Only God knows how long Gracie's little heart will continue to beat. Only God knows what complications may lay ahead. Only God knows when the delivery will occur, or how things will go. You make peace with the few "knowns", you give the unknowns to God, and you try to prepare as best you can for a variety of imagined scenarios.

But then some huge wrench is thrown into the mix. As soon as you think you've got a handle on things, "things" change.

One of the concerns with a triploid pregnancy is an increased risk of early preeclampsia. Preeclampsia is defined as elevated blood pressure (systolic greater than or equal to 140 OR diastolic greater than or equal to 90) PLUS either protein in the urine OR one of a list of organ function abnormalities (kidney insufficiency, liver function abnormalities, visual changes... among others). In a "normal" pregnancy, elevated blood pressure that develops before 20 weeks would not qualify for a diagnosis of preeclampsia, but because of the established increased risk of early preeclampsia in this type of pregnancy (due to placental abnormalities), it's on the table for us. As a result of this increased risk, my OB wants to monitor my blood pressure more closely, so I was instructed to measure it at home at least once a week. Being a medical student with the necessary equipment and knowledge, she's letting me self-monitor rather than come in to the office for weekly BP checks.

Today was my first BP check, and sure enough, it was elevated. Not too dramatically elevated, but definitely high for me (I typically run in the 110's/70's). I rested in bed for 10 minutes and repeated it, but it only got higher. Preeclampsia high. I laid down for a nap (having worked overnight last night), and tried again 6 hours later when I woke up. Even higher. 140/100. At that point I knew that I had to call. *SIGH*

So we spent a few hours this evening in a labor & delivery triage room getting BP measurements every 15 minutes and sending off blood and urine samples. The good news is that a) as long as I lay on my left side, my BP comes back down beautifully and stays down, and b) my blood work was perfect - no concerns for organ function abnormalities. The bad news is that a) every blessed time I turn onto my back or my right side, my diastolic pressure pops right back up above 90, and b) I have protein in my urine. So essentially, I would meet the diagnostic criteria for preeclampsia if I were 20 weeks, though I technically don't because I'm 19 weeks and 5 days, but I have a triploid pregnancy so there is a known risk of this happening prior to 20 weeks... you can see that there is a bit of a diagnostic dilemma there. I technically don't fit the published criteria because there are no published criteria for my specific situation. Bottom line: I'm teetering on the hairy edge of preeclampsia.

So... what's next? The midwife and OB in triage this evening were comfortable enough to send me home to follow up with my OB tomorrow to make some decisions about how to proceed. We will likely discuss increased monitoring, further definitive testing, and perhaps bed rest. And I know that the conversation will ultimately turn toward plans for delivery. Preeclampsia is, by nature, a progressive process. It progresses at different rates in different pregnancies, but what often protects normal pregnancies from serious complications is the fact that it typically develops much later and doesn't have nearly as much time to progress to a dangerous level. We don't know how long this pregnancy will last or how quickly this process will progress, but I could have as long as 20 more weeks for this thing to worsen.

One thing is becoming increasingly clear to me: It's only a matter of time. Gracie's heart is likely to stop beating at some point between now and 20 weeks from now (likely sooner than later), at which point we would deliver. My condition is likely to worsen to the point of very serious danger to my health between now and 20 weeks from now, at which point we would deliver (unfortunately even in a healthy pregnancy, there comes a point with preeclampsia beyond which it is safer to deliver a premature baby and care for him/her in the NICU than to leave that baby in the uterus under such conditions, so it's not that we would be forced to deliver only because we have a terminal diagnosis). The question is, which will come first? It's only a matter of time before one of these two end-points is upon us.

Where does one draw the line in a situation like this? How much risk to my health is acceptable? I know that there are those who would argue that until the baby is clearly viable (a distinction which is impossible to make even for a "normal" baby, if we're being honest - you just never know how well a preemie will do), it's just not right to end the pregnancy. There is also the risk to the baby, especially in severe preeclampsia, and eventually the risks of staying in the womb outweigh the risks of premature birth, and early delivery makes sense. But how do you make that decision when the baby will never be viable, even at term? When the baby is already at maximal risk even within the womb? You can't measure risk:benefit ratios when there is no scenario under which the baby will survive. Ultimately, it feels better to me to continue giving her a home to survive in for as long as she can survive, but ultimately, realistically, there is nothing I can do that will change the outcome for my little girl. It's an awful reality for any mother. This choice to preserve her life in the womb for as long as I can really is all I'll ever be able to give to her.

As an aside (but I do have a point here)... the decision to carry this baby until her natural end may seem to be purely religious to many people. Let me clarify, though, that it really isn't. My religious convictions do preclude the ending of human life, and I would consider choosing to terminate this pregnancy to be ending a human life. But more importantly, it would be ending my daughter's life. Not just any human being, not just any fetus... my baby girl. That is not a decision I feel prepared to make. Not only do I feel that it's not my place to decide when her heart should stop beating (because I believe that it's God's decision), I also feel that I DO NOT WANT to be the one to decide. I can't. I can't be the one to decide that her existence is over. She's my baby girl, and I can't stomach that any better than I could stomach doing the same to Eli. I may not have met her yet, but my emotions simply can't handle that. I watched her bounce around on that ultrasound screen like Jacoby Jones doing an endzone dance. I listen to her heart beat and her movements almost every night with our fetal doppler. That's my little girl in there. It's not like my religious convictions have forced me into this decision - it's that I simply can't imagine deciding to end her.

And yet, I am now faced with the reality that we may have to make a decision. It's all still in God's hands, and God is in control of this preeclampsia business just as He is in control of her every heart beat. God has a purpose in introducing this complication to our scenario. I don't know what it is, but all I can do is pray on it and plead for guidance and wisdom for myself, my husband and our doctors. I don't believe in shunning all medical intervention and trusting God with our health because "He is in control". He is in control, but that doesn't mean that He doesn't want us to vaccinate our kids, get screening colonoscopies, wear seat belts, and otherwise protect ourselves with the resources with which He has blessed us. This entire issue just gets extra muddy when an extra human life is involved, and I cannot begin to claim that I understand the intricacies of His will in these circumstances in which we have newly found ourselves. It is all beyond my human understanding.

My hope is that you all will pray for guidance and wisdom for us as we move forward. All we can do is seek His will and lean on Him. I don't know how to prepare for the decisions that lay ahead for us. I just don't know where to begin. It's all so impossible. It's not just about me and this baby. I have another baby whose well-being I have to consider, who deserves to have his mommy around. I have such a strong desire to trust God in this, because I know how ill-equipped I am to manage this situation on my own - I know how much I need Him. At the same time, I have such a strong desire to protect my son, to preserve my health for him. I don't believe that the two have to be mutually exclusive, it's just that I don't know what God's will is for this situation, and to be honest, I'm terrified.