A fourth time mum-to-be seeks a second opinion after diagnosis

My husband and I had been toying with the idea of a fourth child for some time but in early 2009, we decided that we would love to try for another baby. One morning I felt a familiar lightening when bending down and sure enough, a pregnancy test came up quickly with 2 pink lines. I was so excited about this pregnancy. My previous three children had been born very close together. This time, my youngest was in school and they were all at an age where they were great fun and less work. We had a little bit more money this time too. I was going to do all the things I had always wanted to – to treat myself – to celebrate and enjoy what was to be my last pregnancy. On the top of this list, was book a homebirth.

My previous three babies were all born without complications and while my previous experience in the local maternity unit was quite positive, I felt being in hospital was un-necessary and that hospital based care simply wasn’t a good fit for me, the way I birth, or my family. I find negotiating in labour very distressing and the CTG is something that seems to always been an issue of contention. I wanted to avoid all of this by birthing at home with a midwife.

I immediately started ringing midwives and instead of the excitement of being booked in for a homebirth, instead I heard “I’m sorry, I don’t work during that time” over and over as I choked back tears. You see, my baby was due on Christmas Day, and not a SECM in the Country works that time. As my hospital does not have a DOMINO homebirth service, I had to go for plan B, the MLU.

I was amazed by the difference in care – did I want to use the pool? Next time bring your husband and kids to visit! And when going over my birth preferences, “Oh don’t worry, that is routine practice here” or for things I wanted to avoid “We don’t do that in here”. No CTG!!! Happy dance!

On paper, I was the perfect candidate for the MLU, I was healthy, had healthy pregnancies, spontaneous labours, and uncomplicated quick births. Only problem was that in booking in at 16 weeks, I was over their BMI limits. No MLU. My head started spinning. I could not face another experience in the consultant led unit. I contacted the head consultant and director of midwifery to challenge the BMI criteria. I was told that while this issue had been revisited several times to widen the criteria, local policy remained in place, as it currently stood, without exception. I decided to try to book into the other MLU slightly further away as they have a policy of self-referral. So at 19 weeks I made my way to the unit and was assessed for the MLU. To my delight, their scales gave a slightly lower number, and in my defiance, or perhaps more in a desperate act of self-preservation, I was ashamedly delighted when my height was not measured but instead I was asked “How tall are you?”…and I added on just a wee bit in order to meet the criteria. I was in the MLU.

My pregnancy was amazing. I was doing all the things I said I would and really enjoyed my time being pregnant. I felt fantastic and was walking daily. At 20 odd weeks we went to Oxegen and the baby danced inside of me while we danced in the mud. At 28 weeks we went on a camping holiday where I slept on the ground in a tent and we went for daily hikes and bike cycle rides. I was treating myself to Gentlebirth, reflexology, massages. I continued with my appointments in the MLU. I passed the GTT with flying colours and my pregnancy vitals were all normal and healthy. I was amazed by the difference in care – did I want to use the pool? Next time bring your husband and kids to visit! And when going over my birth preferences, “Oh don’t worry, that is routine practice here” or for things I wanted to avoid “We don’t do that in here”. No CTG!!! Happy dance!

At 34 weeks I had a routine appointment and then a scan to check the location of my placenta, which had been slightly low-lying at my 16 week booking appointment. I had my appointment with my midwife first, no problems at all. And then I was sent down for the scan. I was told I had to drink loads of water for the scan as they use a full bladder to measure against the placenta. I was ready to burst. I went down into the general scanning department and waited until I was called. The sonographer was lovely and we talked about the MLU and the fact that I was hoping for a homebirth initially. She took measurements and told me that she was a bit apprehensive. That the placenta seemed a bit low to one edge. She said she wanted to call in a consultant for a second opinion, which I agreed. A female consultant came in and looked at the scan images. She then performed the scan herself and took measurements. She then started asking me questions, how was I feeling, had I had any bleeding, had I had any issues with bleeding in previous pregnancies, what were my previous births like. After a little chat and another check of the scan images and measurements, the consultant told the sonographer “I’m happy with that” and signed me back into the MLU. The sonographer explained she just had to double-check as one of the edges of the placenta seemed a bit low, but that as the consultant was happy and I was asymptomatic, I was signed back out into the MLU.

Leaving the hospital I rang my friend shaking in the carpark – the gravity of the situation having hit me. “I think I just narrowly escaped a Caesarean” I whispered. After a little chat I got in the car and started driving the 1.5hrs to home. My husband was off work so I decided to stop off in town to do some Christmas shopping. I had just pulled into the Smyths carpark when my phone rang. It was the MLU. The sonographer was not happy with the scan nor the consultant signing me off to the MLU. I needed to come back to be RESCANNED by another consultant. In hindsight, I should have refused. But I had driven 3 hours, was hungry, tired, and my husband could not afford to take another day off, so I told them I would be there in 1 hour. And I turned the car around and made my way back to the hospital guzzling water the whole way.

Back at the hospital, I was immediately seen by the same sonographer and a new male consultant. A quick rescan was done. They were talking over me and discussing things and he said, “no, I’d give that a grade 2” I finally said “what’s going on?” and the sonographer told me she had been concerned and had wanted this consultant to look at the measurements and that he also thought one of the edges was low and they were diagnosing it as a grade 2 placenta previa. My head started swirling and they started telling me I was immediately to be signed out of the MLU into  consultant-led care, that I needed admitting, and that a Caesarean would be booked. I burst out crying. The consultant said “You aren’t crying cause you will be having a section are you?” and I just sobbed managing “this was meant to be my homebirth” as he said something about it not being so bad. I told the sonographer I wanted her to send the report to the MLU and I wanted to go up there to discuss my options and I was rushed out the door crying in front of a large queue of people in the general hospital waiting for scans. The MLU felt like solace. I was immediately comforted by the midwife and she made me a cup of tea to discuss my options. She told me that they measured the placenta as 1cm from the os and that it needed to be 3cm to birth vaginally. I just kept saying “I don’t believe it.”

It ended up that I had a posterior placenta and that at its lowest point, it was 3.5cm from the os not 1cm as diagnosed. That is a difference of 2.5cm in less than a week. This meant that not only was it not a placenta previa, but it was not even considered low lying. I was elated to be given the go-ahead for a vaginal birth.

They wanted to admit me but she told me that I should ask to wait to see if it became symptomatic (bleeding) before that. After a long discussion, we decided that facing admission and a Caesarean 1.5hrs from home with 3 small children added to the difficulty. I requested to transfer back to my local unit and requested a meeting the following morning with the head consultant. “I just don’t believe it” I kept saying.

The next morning I arrived to the local unit and met with the head consultant whom I had argued over the MLU with. I couldn’t help feeling like he must be feeling so smug, even though I knew he isn’t like that really! He didn’t have the full scan report – only a written summary of the findings but no images – and discussed my situation with me. He agreed I didn’t need admission as I had no symptoms of placenta previa but told me I could potentially bleed at any time, and if I do to come straight in. He also told me that unless the placenta moves, I would be looking at a Caesarean at 38 weeks. I repeatedly brought up the varying opinions from the two consultants within hours of each other, brought up the fact that I had no bleeding, and asked for a re-scan as he had no scan report. It was suggested I go on bedrest. I was told they would re-scan me for 38 weeks and I was given an appointment. (only to have them immediately ring to say there was no scans that week due to public sector actions).

I went home and spent the next 24 hours in bed. I was terrified. Terrified of bleeding. Terrified of surgery. Terrified of not knowing what was going to happen or when. It was like waiting for something bad to happen, afraid to move, breathe or live *just in case* I did something to set it off. But then I started coming around. I kept hearing “I just don’t believe it” in my head. I started looking online for some information. I just couldn’t get my head around two differing opinions in such a short amount of time. Surely one of them had to be wrong? And that night I told my husband that I wanted to seek an independent second opinion.

Finding someone to do a second opinion was another story. Many places will do ‘social’ scans but not diagnostic scans…particularly if it is as a second opinion of another unit. I finally contacted Mount Carmel and explained my situation. The secretary ran it past the consultant and he agreed to meet with me. I was booked in early the following week for a re-scan.

When we arrived at Mount Carmel, our consultant was incredibly supportive and warm. He told us we were not the first to query a scan diagnosis and introduced us to his team. He left as his sonographer took our history and started performing the scan. She went very quiet and told me that she was not seeing what the hospital diagnosed. She asked to do an internal scan. She then asked if she could bring a colleague in have a look and she said “look its at the top of her womb!”. They checked and they rechecked and they could not find evidence of the placenta previa. Neither could understand how the measurements were so varying in a 6 day period. It ended up that I had a posterior placenta and that at its lowest point, it was 3.5cm from the os not 1cm as diagnosed. That is a difference of 2.5cm in less than a week. This meant that not only was it not a placenta previa, but it was not even considered low lying. I was elated to be given the go-ahead for a vaginal birth.

4 weeks later, in the winter’s first fall of snow, our little girl arrived at 39+2 on December 20th 2009 in the CLU of the local maternity unit. Going to the CLU was bittersweet and not without incidents as we tried to navigate the system to avoid routine intervention. And Oh how I longed for that pool……During labour, we had a few bumps along the way – numerous requests for intermittent monitoring rather than CTG, and refusing oxytocin, and a change of midwives – but in the end, we had a fantastic birth with an amazing midwife. The midwife supported my requests to get off the bed and take off the CTG. She was a quiet force in the background as I stood and swayed by the bed. I had a tough hour in transition, waiting to feel the urge to bear down. But she was patient and helpful offering suggestions. She brought in a radio, a birth ball, and back massage tools. She monitored me intermittently. She was compassionate and understanding and gently supported me as I gave birth to my daughter standing by the bed and immediately brought her into my arms onto my chest. No surgery, no tears, no abnormal blood loss nor placenta complications. No recovery, or long-term admission, but home to bed and my family as quickly as possible. Just a normal, healthy, vaginal birth. I cannot describe the emotions, the relief, so thankful she was here safely – our ordeal with hospitals over.

Following the birth of our daughter, I felt I could not walk away from our experience. I asked a specialist to look over my notes and put in a complaint to the maternity unit in question querying the differing opinions in their unit, the diagnosis, and the management of the diagnosis. I have spoke to several women since with similar experiences. I also started researching placental placement and migration myself. At that stage of pregnancy, the norm for placental migration is about .5cm per week. Its also less likely to migrate if its posterior, like mine. Mine migrated 2.5cm in 6 days! Super-powers or what!

I struggle sometimes trying to put into words my experience. I feel for certain that had I not sought a second opinion, I would have had a Caesarean Section. This really upsets me. Not the actual Caesarean, but the fact that it would have been unnecessary. It upsets me that it was up to me to challenge it. That it was up to me to find a solution. That it was up to me to prove otherwise. The fact that I was not immediately re-scanned in my public hospital, despite the fact that there was no survey report and two very differing opinions at the time of diagnosis. What would have happened if I was a first time mother? Or if I couldn’t pay for an independent second opinion? Or most importantly, if I didn’t listen to that little voice inside me saying “I don’t believe this”.

It’s better to be reassured and wrong, then live with regrets. If it doesn’t feel right, please be sure to voice your concerns.

All birth stories and images featured in 42 weeks have been generously shared by members of the public in Ireland. If you would like to take part and share your story, we would love to hear from you. Get in touch through the website http://www.42weeks.ie, through Facebook at http://www.facebook.com/42weeks or follow us on Twitter at @42_weeks.

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One thought on “A fourth time mum-to-be seeks a second opinion after diagnosis

  1. Pingback: Ultrasound scans Part 2: Types of scans | 42 weeks

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