Baby Bean's eventful journey to date

I'm really not quite sure how to start this blog update, or for that matter, how it will end. It's been on mind to write it all down, as it has been quite the journey so far, but at the same time I don't want to jinx things! Our Baby Bean couldn't possibly be more wanted and more loved already, but our journey to meet her has been quite some!!

Perhaps we shouldn't be surprised about this eventful journey, given the experience that we had with our gorgeous Nate - both his entry into this world, and his and our subsequent challenges as a 'special needs family'. But then again, Nate's diagnosis of Trisomy 9 Mosaic is quite literally 'one in a hundred million' - a completely random, and super-rare occurrence - so why would we possibly think that a second time round would be any less challenging?! That just doesn't seem to be our way!

So without wanting to make our story to date too long or too emotive, we can safely say that Baby Bean has been on our minds for sometime. In fact if things had gone as we intended, then Baby Bean would have arrived not long after Nate's second birthday, and not as Nate approaches 3.5years this August.

Within our Baby Bean journey, we have experienced four miscarriages. The first was so early in the piece that it almost didn't register, while the second and third although still pretty early, caused the expected anguish. That might be a bit of an understatement. The third was pretty upsetting for me, and I spent a weekend in tears and a lot of time beyond that in quite some thought and contemplation. While we obviously knew that as an older couple we had a higher risk, it seemed unfair to have both a child diagnosed with a super-rare and completely random disorder, and then be unable to progress a second successful pregnancy.

Naturally at that point, we did some research and also had a whole bunch of tests. However no reason came of the miscarriages. Just one of those things, and likely just reflective of the higher rates of miscarriages associated with being of an older age. Pure and simple. The advice given? Just keep trying until you quite literally find a golden egg.....or embrace science.

We opted to embrace science, and that in itself is a story. But to cut a long and complicated story short, we progressed with IVF supported by pre genetic screening (PGS). PGS basically screens embryos on their genetic health, and therefore significantly improves pregnancy viability. After our first round, we were super excited to find ourselves pregnant, and confident that we would soon have a new addition backed with all the benefits of fabulous specialists and modern day science! Our second baby was due to be born on April the 21st, 2016 - which seemed even more special and appropriate as April the 21st had been Nate's original due date (prior to his early entry into the world on March the 9th 2013). Sadly though, at just 8 weeks in-utero, our wee bub was found to have no heartbeat. Pretty devastating, as the IVF journey is not the easiest to go through, especially when you lose your precious gift. What followed in terms of treatment at that point is pretty standard I guess and not much fun to expand further on, suffice to say pretty heart-breaking.

And so came IVF round two, and the successful news of Baby Bean. We were reluctant to share our news, given our history, and spent the whole of the first trimester pretty much on tender hooks. We successfully clocked the heartbeat stage (6-8 weeks) and as the first trimester progressed, we started to feel more hopeful. We had registered with AOC again, and they had us on regular fortnightly checks given our history (although I think at that point, this was more to help ease my anxiety than for any other reason, as in reality there isn't much they can do should something not be right). Every time we went in, I'd be holding my breath until we heard the heartbeat. But the weeks went on and everything seemed to be progressing well.

Well right up until just on the twelfth week that is, when I started bleeding. We were away on holiday in Omaha, relaxing with Nate and my folks when it happened. That prompted a trip down to Warkworth for an urgent scan. We were told that this was the result of a small sub choronic haematoma (commonly referred to as a SCH bleed), which is pretty unusual (that figures). We were told that a SCH bleed can lead to miscarriage depending on it's extent, it's placement and it's growth, OR can be simply safely absorbed back into the body. So what to do? Nothing, wait and see. Excellent I thought, I'm great at just waiting - not.

As it turned out by our follow-up scan in 12.5 weeks, which also happened to be the all-important nuchal scan, the SCH bleed seemed to be gone and Baby Bean was measuring well! Phew! What a total relief - the first trimester was over and we were through the major miscarriage risk time. You can see Bean's pic without our earlier post - we just neglected to mention the associated drama in that earlier blog.

Around 15 weeks, we announced our pregnancy, and we started to feel a whole lot more comfortable that it might actually happen for us! We knew from the PGS testing, that we were having a little girl and we were greatly excited about her impending arrival. Our follow up 16 week scan showed everything was progressing perfectly :-).

The next milestone in our journey was the 20 week anatomy scan, which took place on Wednesday the 30th March. Baby Bean measured well - everything was perfectly in order with her estimated weight of 328g (putting her in the 60% percentile for her gestational age). Here she is....

The less welcoming news on the day though, was that my cervix was apparently shortening. At 16 weeks the length was 2.9cm, while at 20 weeks it was 2.7cm and had some signs of funnelling. Comparatively with Nate, it had been 3.3cm at 15.5 weeks.

AOC called me the next day (Thursday the 31st March) and said that they were referring us to the Maternity Fetal Medicine (MFM) at Auckland Hospital, and that someone would call with an appointment time for me. They reassured me that anything above 2.5 was okay, although still considered short for 20 weeks and worth a check with MFM. Naturally I googled for more. I quickly learnt that shortening and funnelling of the cervix is normal with pregnancy, but not typically until 35weeks and later. Shortening and funnelling at around 20 weeks brings with it a significantly increased risk of pre-term labour, and depending on the pace of shortening, this could mean labour pre viability (approximately 24 weeks). Scary. Oh and wouldn't you know it, apparently that this is rare - happens in about 1% of pregnancies. Yip that would also be right!

By the Tuesday the 5th of April, I had yet to receive a phone call, so I followed up. AOC suggested I come back in for an appointment and scan on the Wednesday, advising that I would see the MFM team the following Tuesday (12th April). Unfortunately the Wednesday scan showed that the cervix length had already further shortened to 2.2cm, and the following day I received a phone call asking me to come to MFM that very afternoon. Late that afternoon, the MFM team recommended I have a cerclage placed first thing on Friday the 8th of April and also start progesterone. So at 21w1d (Friday the 8th of April), I was back at the hospital at 7.30am and underwent the day-surgery.

Recovering afterwards, waitng for feeling in my legs to come back!

While it went absolutely fine, it struck me that with our last pregnancy, I was fine and Tadpole was the risk, while with this pregnancy, Bean was absolutely fine and I was the risk. Google put the odds of success of preventative cerclages at 80% (usually placed 14-16weeks), and between 40-60% with emergent cerclages. There just weren't any guarantees, sometimes they worked, and sometimes they failed.

I was worried, and three days of googling while recovering on the couch, really didn't help that! Robin kept telling me to stop - the googling that is. I'm not sure that would have ever been possible, I like to know the facts :-). He would have had to turn the internet off quite frankly. But I was really pretty stressed and worried about it - it's been a super long journey to get this far, and I was terrified we might lose Baby Bean. Nate kept me company throughout though - here I am hanging out with the little man on couch-rest, while we waited for the Tuesday the 12th follow up appointment.....he was only too happy to cuddle with and entertain his Mummy (along with his iPad :-))...

We had a follow-up on Tuesday the 12th back with the MFM team at Auckland Hospital, and the specialist said the cerclage was holding up with no visible change. Over time (and that's the unknown, as everyone is different), some women continue to funnel right down to the stitch, others find the cerclage holds, while a rare few also seem to get even better measurements with the cervix stabilised and progesterone support helping. To not have funnelled further at this stage was a relief, but I was still in tears while in with the specialist and afterwards (that's the less emotive and favourable way of explaining it - truth be told I was a bit of a blubbering mess). The level of emotional anxiety building up to the appointment was a bit intense. Actually most of the past week has been!

 

I also knew that we needed to avoid any funnelling until viability stage (approximately 24-25 weeks), because at least then Bean would have a fighting chance. And so at just 21.5 weeks, that meant bed rest with a goal of reaching 25 weeks. After that, we could go back to normal living (albeit no Saturday morning walks as we used to do, avoiding stairs, or just generally trying to do too much), and keep our fingers crossed. Unfortunately the procedure comes with no guarantees - we were told that if we got past 25 weeks, we could just as well get to 38 weeks. (Although my googling shows that the cerclage success stats (the stats I noted above), are based on reaching 37 weeks, before the cerclage fails. Shoot, after a 33w6d'er last time, we'd happily take a 36 weeker! Here's hoping we can be so lucky).

 

And so here we are back on the appointment roller-coaster - twice weekly visits with AOC, a weekly scan, and scheduled follow-ups back with the MFM team at Auckland Hospital. Outside of that, bed rest at home, weight and pressure off the pelvis. I've been fortunate enough to be able to keep up with work (mostly) through managing emails and phone meetings at home. It's not completely ideal, but helps keep me sane and stops me worrying about what I'm not getting done!

 

So updates on all the follow-ups...

• On the 18th of April (22.5 weeks), I had another tummy-scan, followed by an AOC visit. The cerclage seems to be holding (although not officially measured, for fear of aggravating), and they are pleased with how both I and Baby Bean are doing. Bean is measuring pretty much bang on average, and sitting at around 440-450g at this point.
• A further follow-up appointment on Thursday 21st April (now officially 23 weeks), shows that we seem to be tracking fine, although again that didn't include a proper measurement (as that in itself can cause an acceleration of issues or irritation that can prompt contractions, so not worth the risk to do too often). But the big appointment is timed for this coming Tuesday morning, back at Auckland Hospital with the MFM team, followed by AOC. We expect that to give us more insight as to how we are going and what the likely risks are from here.
• Well the big appointments of Tuesday the 26th of April came and went...and long story short...we are still on bed rest until we hit 28weeks. Baby Bean is looking brilliant, bang on all her measurements and growing really well, and the cerclage is holding up well at this point. However my OB said we have a 50/50 chance of being hospitalised before 30weeks, if I don't take it easy now - but of course it's all very unpredictable and unknown, I could well be admitted even with taking it easy! Anyway end result....I'm allowed to work from home, but no heading out and about, no stairs or anything physical really. A light amount of up and down occasionally throughout the day, is pretty much the extent of it. Oh and twice weekly AOC checks, along with weekly scans, and continued progesterone. And from 28 weeks, THEN apparently we will get to do/be 'normal' - back at work, allowed some short walks, out and abouts permitted. Bring on 28weeks and 90% viability odds! (Although this week, we clocked over on to 24 weeks on the Thursday, so thankfully we're at least at 50% now).
• Follow up appointments on Friday the 29th April, Monday the 2nd May, and next big scan and appointment scheduled for Thursday the 5th (when we clock over 25 weeks!)......and of course loads more appointments still to come. So for now, we are ALL FINGERS CROSSED! Watch this space for updates.....

Me at 24w3d with Nate

Nate at 3y1m, negotiating one more time along the wall!

Nate helping Daddy clear the lawn