Vasa Praevia

“To think is easy. To act is hard. But the hardest thing in the world is to act in accordance with your thinking.”
- Johann von Goethe

I’ve read this quote so many times because it resonates so deeply.

The words sit quietly in my subconscious. They are ready to pounce the moment my actions don’t align with my beliefs. 

Most recently, I repeatedly hit the snooze button on this quote because I was so worried for Dia and our baby.

The belief in question was worrying is an absolute waste of time. 

Over the years, I’ve come to learn worrying is useless. Many times, the very things we worry about never come to pass. Other times, we worry about something that is completely inevitable. 

Regardless, I believe time spent worrying is wasted time. It does more harm than good. 

I think a better use of time is identifying and focusing on what you can control. Finally, the best use of time is taking the appropriate action to put yourself in the best position for when whatever you’re worrying about comes to pass.

Vasa Praevia

On December 19, 2019, during a routine ultrasound visit, our pregnancy was diagnosed with Vasa Praevia.

Noun. /vay zuh - pre vee uh/

In vasa praevia membranes that contain blood vessels from the fetus to the placenta lie across or near the entrance to the birth canal (the opening of the cervix). When the membranes rupture (near the start of labor), these blood vessels can be torn.

What Is Vasa Previa?

According to this report published by PubMed,  the approximate incidence of vasa

praevia is considered to be one in 2,500 pregnancies. The true incidence is not known, with a very wide range up to one in 10,000 pregnancies reported in literature. The incidence is considered much higher, one in 365 to one in 700, among patients who conceive through assisted reproductive technologies.

Dia and I used the help of IVF to get pregnant. Great. 

Treatment

Immediately after diagnosing us, the Doctor at the ultrasound clinic laid out a plan. 

“In cases like these, we check you into the hospital between weeks 30 - 32 and perform a C-section between weeks 34 - 36.”

With tears in her eyes, Dia asked the only question that mattered, “Is there anything I can do or stop doing to make this better?”

The Doctor said, “Unfortunately not. This is just how the placenta, vessels, and everything else inside the uterus developed. There’s no real way to fix it or even prevent it from happening in the first place. The vessels could move out of the way, but at this point, it looks unlikely.”

I couldn’t help but ask, “Vasa what? Can you spell it?” 

I don’t think I’ve ever heard these two words (vasa praevia) in my life.

The Doctor replied, “Don’t google this. You’re not going to like what you see. Just know we have a 0% loss rate when it’s detected early on”

The Doctor held Dia’s hand as she explained, “Everything is going to be ok. While inconvenient, hospital bed rest for a few weeks is a small price to pay to ensure a safe delivery.”

We left the clinic and spent a few minutes in the lobby consoling each other.

So many thoughts. Some said, some left unsaid:

  • Will Dia have to change her birth plan?
  • Go to the hospital in week 30?! That’s just one week after the baby shower. 
  • Is 34 weeks too premature?
  • What will this do to her Maternity Leave?
  • Will she be able to work from the hospital?
  • Money aside, being on bed rest for 4 weeks could be boring as hell
  • Money included, what will this hospital bill look like?

As soon as I got to my desk, I googled it. Here’s what I found in another study published in PubMed.

A recent retrospective, multicenter study showed new-born survival rates of 97% in prenatally detected cases of vasa previa and a fetal loss rate of 56 % in undiagnosed cases.

This was the silver lining. While it sucks to be diagnosed with Vasa Praevia, at least they caught it early on. If it had gone undetected, a coin toss would determine if our baby lived through the labor process.

Sharing The Story

I told my family immediately. We told a few friends over the following week. Lengthy conversations and a healthy amount of Google search alleviated most of our fears. 

We were heading to Mexico for Christmas so Dia decided to wait to tell her family in person.

By Christmas Day, we spun this scary condition into something good: We’ll be able to meet our baby sooner! 

It wasn’t enough. We said the positive words, but the negative feeling remained. 

Context Before Continuing

The Doctor who diagnosed us with Vasa Praevia works for the clinic that does ultrasounds. She is a specialist that is trained to identify symptoms related to high-risk pregnancy. These Doctors work in a completely separate facility from Dia’s OBGYN. The two facilities communicate, but they are completely different entities.

OBGYN: These are the Doctor(s) that decide what to do with the information presented to them by third parties. So when we go for ultrasounds or blood tests or glucose tests, the results are forwarded to Dia’s OB. The OB makes the final call on what the game plan should be. 

OBGYN

On January 6th, 2020 we had a routine appointment with Dia’s OB. This was 2.5 weeks after we received our diagnosis.

We were looking forward to this visit. We wanted to hear what they had to say about Vasa Praevia. 

By this point, we had come to terms with Vasa Praevia. Like most foreign things, our initial fear stemmed from a complete lack of information. We never heard the term. We didn’t know anyone who experienced it. We didn’t know... what we didn’t know. It was scary.

But, Christmas in Mexico + the initial shock wearing off + talking about it more and more equaled less anxiety. 

At least until the very moment our OB looked at our chart and verbalized our worst nightmare.

“It says here you were diagnosed with Vasa Praevia… That’s not good.”

“I hope you haven’t been going to the gym or having intercourse since being diagnosed…”

Dia and I looked at each other with our mouths open. I was sort of in disbelief with the bedside manner.

Dia planned on working out until the baby came. In fact, we had gone to the gym that very morning. This was going to be quite a lifestyle change for her. 

I managed to say, “The ultrasound doctor didn’t mention making any lifestyle changes. In fact, when we asked her if we could or should do anything differently to help our situation, she said no. There’s nothing we could do.”

Our OB replied with, “Well… I don’t want to alarm you, but Vasa Praevia can be catastrophic. I mean… This could be life threatening for you and the baby. The reason we require hospital bed rest is because if the vessels rupture, it’ll be too late before you even notice.”

… Bro! 

As I write this (weeks later), I can ALMOST say I appreciate the honesty, candor, and tough love. At the same time, I can DEFINITELY say this is not the best way to deliver a message of this magnitude.

We are now back at square one: worried sick.

Tying Up Loose Ends

We left that appointment on January 6th feeling worse than the day we were diagnosed. For some reason, the term “loss rate” didn’t trigger the same emotion as “catastrophic” and “life threatening”. 

Aside from the condition itself, we felt like we were running out of time:

  • How would Dia explain to her team at work that she’d be leaving 10 weeks earlier than originally planned? How will they feel?
  • How would she explain this to Human Resources? What will they say?
  • We still had to plan a Baby Shower, which was scheduled for Week 29.
  • Will we get the nursery done in time?
  • How will her being in the hospital affect my work schedule? I want to be with her.
  • I scheduled a long weekend trip with the boys in week 30. Will I have to back out?

At first, we were stressed and filled our time with figuring everything out. As soon as we got a grip, worry began to creep its way back in. 

An idle mind is a devil’s playground. 

For me, the quiet, liminal moments were the most difficult. When I was in the car without the radio on. When I got home 30 minutes before Dia and had nothing to do except wait. When I switched tasks at work and let my thoughts distract me.

These are the moments where my mind reverted back to all the things that could go wrong despite having a plan in place. Why did he use those words? Who says “catastrophic?”.

It was in one of these quiet moments, Dia said something that made me realize she was going through the same thing. I can’t even remember where we were when it happened.

Dia said, “If it comes down to me or the baby, you better pick the baby.”

My immediate reaction was anger. “Fuck that!”

I continued by giving all the reasons why that wouldn’t be my choice. After discussing it, we decided if the doctors ask her, she can say what she wants. And if the doctors ask me, I could say what I want.

In reality, the doctors probably wouldn’t ask either of us. This isn’t an episode of Grey’s Anatomy with time for intense drama built in. These decisions are likely made in a fraction of a second based on likelihood of successful outcomes. 

That conversation also solidified a concept I read in one of my pregnancy books. A woman becomes a mother the day she finds out she’s pregnant. A man becomes a father the day he meets his child. 

I’ve been worried about Dia this whole time. She’s been worried about our child. 

Follow Up Ultrasound

On Thursday, January 16, 2020, we had a follow up ultrasound. This is when we’d find out whether we’d be going to the hospital in week 30 or 32. 

The sonographer spent about 30 minutes taking images and checking boxes. 

Then the doctor came in to give us the news...

“So it looks like you won’t need to do the hospital bed rest. The vessels have moved up in the uterus!”

We were in disbelief. “What? How? Why?”

“Yeah it looks like the vessels have moved away from the opening of the uterus. Let’s get you on the schedule for a follow up in week 32 and we’ll go from there.”

Still, in disbelief. “Wait. So is a natural birth back on the table? And can we continue working out and other regular physical activity?”

“As of right now, a natural birth is back on the table. Why did you stop working out? I didn’t say you needed to do that.”

We told her the story about our OB and she wasn’t surprised. 

We wrapped up the ultrasound and left their office. 

Before heading out into the mid-January cold, we spent some time in the lobby just reliving everything that transpired over the past 4 weeks. We couldn’t believe it. 

Worrying is an Absolute Waste of Time

This story is yet another example supporting my belief that worrying is a waste of time. 

It’s hard not to worry when your wife and baby’s lives are at risk. Still, I can’t help but think how much better off we would have been without exercising that emotion. 

How many hairs turned white? How much of my teeth did I grind away? How much caffeine ridden anxiety did I promote? Who did I treat unfairly because of something completely unrelated?

We aren’t completely in the clear yet. Our week 32 ultrasound will give us a better picture. Until then, we’re trying to stay even keeled. As of right now, there’s less to worry about. At the same time, we’re trying not to get too excited. 

Sunny Shakhawala

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