Friday, November 14, 2008

Preterm Labor/ Unknown Causes

There are so very many factors and conditions that can ultimately lead to premature births. Some of them are completely preventable- like drug use and inadequate prenatal care. Some aren't preventable but they are predictable- like carrying high-order multiples or diagnosed incompetent cervix. Others are not determined until much later one- like Pre-eclampsia or HELLP syndrome. And in some cases, something suddenly happens that kick-starts labor- like preterm premature rupture of membranes (PPROM) or placenta abrupta or previa. And then, sometimes, nobody knows. It just remains a mystery.

When I went into labor at 23w5d pregnant, it came as a shock to me as it would any woman. My water didn't break. I didn't have any significant pain or cramping. My blood pressure and vitals were fantastic and the baby was never in distress. It was odd.

One OB Resident suggested that perhaps it was incompetent cervix. The head of the department pointed out that I carried an 8-pounder for 41 weeks. It didn't seem to be my cervix.

The nurses suggested to me that perhaps it was the placenta. Maybe something had gone wrong. It seemed possible. And, given the excessive amount of blood I lost just before the birth of my daughter, it made sense.

Still, because I seemed so healthy and because I had successfully carried a pregnancy to term before, they sent the placenta to pathology. The medical team performing my C-section couldn't really "see" anything wrong when they performed the surgery. So they sent the placenta off to be analyzed, to be gone over with a fine-tooth comb so that we could get to the bottom of this premature birth.

It wasn't until a few days after C's birth that I thought to ask about it. The NICU nurse caring for our daughter called over to the lab.

The verdict?

Preterm Labor/ Unknown Causes.

There appeared to be nothing wrong. Nothing went wrong through my pregnancy. Nothing really went wrong in my labor (except that it happened way too early). The placenta appeared intact and healthy. They wrote it off as a "fluke".

What does this mean for me? Well, it means I have no resolution. I will never have any idea what caused my labor to start so early and, as a result, there is no way I can be proactive in trying to prevent it should we ever have a third child. That's kind of scary.

But, at the same time, it means just what the doctor told me at my post-partum check-up. Most likely it wouldn't happen to me again. Most likely I could sustain a subsequent pregnancy without incident. Of course, because of my classic C-section, they wouldn't allow me to go past 36 weeks (because of the risk of rupture), but- still- it's doubtful I would give birth extremely prematurely again. And that's kind of comforting.

And, so, like so many things, it's a double-sided coin. Preterm labor with unknown causes gives you nothing to blame... but it also leaves you with nothing specific to fear.

I thought I'd be away for a bit due to surgery. Turns out my lab-work revealed that I'm not able to have the surgery safely right now. Figuring I'd be out of commission, I have some great guest posts all lined up. I'll still be running them next week becuase they are truly excellent and informative. Some wonderful, brave women have taken the time to write about their own journeys. Over the next week we'll have posts dealing with infertility, miscarriages, preeclampsia, HELLP, and PPROM. On the quest to become pregnant, stay pregnant, and carry to term, there are sometimes bumps in the road. Let's talk about some of them together and maybe learn a few things...


Blessings From Above said...

"Preterm labor with unknown causes gives you nothing to blame... but it also leaves you with nothing specific to fear."

I love this line. It would be a blessing and a curse to not know what really caused it.

slbriggs said...

I'm so glad you were able to find so many guest speakers. As you know, I am amazed and grateful that someone is taking a view on HELLP! Anyway let me know if you still want someone to do something on IUGR. It wouldn't be done this week, but I'm sure if you give me some time I would be able to come up with SOMETHING.

-Liz B. (Destiny's mom) 10 hospital admissions so far... almost 6 months old.