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Saturday, June 6, 2015

The one that comes after...

Most of the things I've read on the subject of pregnancy after miscarriage are meant to be reassuring. Most women go on to have healthy, normal pregnancies even after one ends sadly. But the way our society treats miscarriage, it's hard to talk about, and there are few articles that actually highlight the emotional toll it can take, not only at the time of the miscarriage, but long after. Into the next pregnancy. Perhaps even more anxiety arises when getting pregnant again, because all of the fears about the unknown resurface, and especially if there was not an identified cause of the loss.

I lost our second baby January 3, 2014. It was early, around 6 weeks. And at the time I brushed it off, telling myself it was best that it was over quickly, and I wasn't as attached. I hadn't known the sex. We hadn't thought of a name. We'd barely known about it, and then it was over. But as time went on, it settled in. A son or daughter we'd never know, not in this life. A sibling for Norah she'd never meet. A piece of us that would never join our family in this world.

I'm currently 10w2d with our 3rd pregnancy. And from the moment I saw two lines on the test this time, I felt afraid, anxious, worried. I worried about the possibility of it ending so soon, I didn't want to get attached to the idea of being pregnant again, let alone acknowledging that we could have another child in our family by the end of the year. I worried about all of the things that could be going wrong in the very earliest stages of development, right under my skin, and I'd have no control over the outcome. I was afraid to bond to the baby, because honestly I just assumed there was a greater than average chance that this one would end, too.  I was immediately aware of how tenuous the entire thing is, and how stressful and all consuming and terrifying pregnancy could be for me, given my experience the last two times. Then, the fears of another traumatic and life threatening delivery loomed over me as well. I don't want to go through that again. I don't want Matt to go through that again. I can't bear to think of Norah losing her mama, for something we could have chosen not to do again. I felt responsible for causing not only myself, but my family, potential grief and anxiety, for wanting to do this again, and for getting pregnant at all.

Fast forward to this week. We had our first prenatal appointment on Monday, my 32nd birthday. We talked about my history, reviewed my birth records and pathology reports and discussed risks of recurrence. We were able to see the baby on a quick ultrasound, and confirm a little beating heart and a fully formed teeny babe. It was a relief. The past 5 weeks of anxiety felt lifted, and I just felt a calm sense that this time would be different. This baby was here to stay. This baby, as surprising as it was to get here, this baby I wanted and needed to be in my arms eventually.

Then, Friday, my midwife called to discuss my lab reports. My glucose was normal, my A1c was normal, indicating the gestational diabetes is still at bay. But, I had tested positive for a rare antibody called the Kell antibody (my titre level is currently 128). I either acquired this through one of the multiple blood transfusions I had after the post-partum hemorrhage, or was sensitized through my pregnancy with Norah (if she is +Kell). Matt now needs to be tested, and if he is positive for the antigen (heterozygous would give 50% and homozygous would give 100% chance the baby will also have the +Kell antigen) we will need to transfer from the midwives to high risk for extensive monitoring. If the baby has the antigen, we will need to have ultrasounds and special dopplers done every 2 weeks to monitor for a condition called fetal hydrops and severe fetal anemia, both of which could be fatal either before or just after birth.

Essentially, it is similar (although more severe) to Rh incompatibility.  One difference is that with Rh factor incompatibility, there is a shot the mother can receive (rhogam) which greatly improves outcomes. There is no such treatment for the Kell antibody.  The Kell antibody in my blood crosses the placenta and enters the baby's body, and if the baby has the Kell antigen, my antibodies are essentially fighting off the baby.  It makes it difficult or impossible for the baby to create its own red blood cells. So, the baby could have a severe lack of red blood cells, and become significantly anemic, requiring intrauterine blood transfusions. One of the risks is that these babies are often delivered early, between 33-37 weeks, because the risk of doing further transfusions after that point outweigh the risk of early delivery.

This could all be a non-issue, if Matt tests negative for the antigen. From what I've read, about 45% of kell+ moms got the antibodies from a transfusion, and the other 55% were sensitized from a first pregnancy with a Kell+ baby. So, it's about a 50/50 chance that this baby will have the antigen. If it's negative, I believe we will still monitor serial titres on me throughout the pregnancy, and if they continue to rise there may still be a reason to monitor the baby for anemia. All we can do right now is wait. Have Matt's blood tested, and wait.

It makes me so sad and angry that I have another stressful condition to monitor, once again, in this pregnancy. My relief from Monday was fleeting, and all concerns I had about bonding to this baby have instantly gone out the window. I am now all-in. I want this baby to make it through this crazy thing, to be in our arms this winter, for Norah to meet and love and play with. It just seems unfair that one person should have such bad luck when it comes to pregnancy. Sure, I can GET pregnant. I only have a 50/50 record of staying pregnant so far. And I have a 0% batting average for uncomplicated, low-risk pregnancies. I feel like I am just not made for this. If this pregnancy ends in any other way than a baby we take home with us...I am not sure I'm ever doing this again. I don't know that my body is capable, and to be honest, I don't know that my heart is either.

I'm not a spiritual or religious person, but I believe in the power of shared strength. Please, if you wish, think good thoughts, pray if that's what you do, but send your good energy out into the universe for this one thing to go OK. For the test results for Matt to be negative, and for this to proceed as an uncomplicated, low risk pregnancy. It takes a village, doesn't it?

1 comment:

  1. Sending all the positive energy there is. As if you needed any proof that life was not fair. Pregnancy after a loss if tough enough because, much as you'd like to, you can't go back to being happy and stupid. Keep me posted. Know I am sending the best possible vibes to all of you. Lee