Present, past and future

I'm writing this post to help myself process information.

*I've written a little about autopsy results so sorry if it upsets anyone to read.*

On Friday I saw my OB again. DH left work early so that he could come with me. We both cried during the appointment. I didn't have any physical examinations, but we talked a lot. I had three topics I wanted to discuss:

1) Getting two periods within ten days
2) Going over the autopsy and other tests again
3) Mangement of future pregnancy


1) Getting two periods within ten days - nothing to worry about. (I will worry if it happens again, though). I should expect the next one to be of a more normal timing.

2) Going over the autopsy and other tests again
Moksha had an autopsy from the head down. The doctor didn't think there was anything to gain from a brain autopsy. They checked all of his thoracic organs. They weighed them and took transverse sections for microscopic checks. His heart was perfectly normal with all the right valves and vessels. They checked his bones using a radiology exam. There was nothing wrong with his genitals, his oesophagus or his diaphragm. The pathologist determined that his size and weight was within the normal range for a baby in 41st week of pregnancy. They were able to eliminate trisomy 13, 18 or 21. He showed no sign of infection. He was perfect.

Of course, I asked to go over these results, so I've no-one but myself to blame if I now have images in my head of Moksha lying cold on an autopsy table with his thorax being opened and his organs being weighed. DH and I held hands very tightly throughout this information relay and also when the OB pulled out the chart from the last fetal heartbeat monitoring whilst explaining how they showed normal heartrate and movements. I remember lying in her office, the day after my due date, watching the needle scratch out that same perfectly normal trace. My mother was sitting with me.

I didn't see Moksha again after he left the maternity ward. I debated with myself for a long time before deciding this but EVERYONE advised me against it. I could have gone to see him in the morgue, which was at another hospital, or chosen to have his coffin open before his cremation, but I didn't. Afterwards I struggled with this decision, as if it meant that Moksha wasn't good or pretty enough for me to see. I've since read parts of this blog, which I found on Catherine's blog roll, and I suppose it wouldn't have brought me any peace to see him like that.

The cord was 35cm long. They found no thromboses (but Michelle told me this doesn't necessarily mean there weren't any). It was a normal three-vessel cord with no narrowing of any of the vessels. It was wrapped loosely around his neck like a scarf, but not in tight loops.

The placenta was a tiny bit smaller than the norm, but apparently this is inconclusive information as plenty of healthy babies are born with the equivalent size placenta. It wasn't inflamed - no infection - and was not calcifying anywhere. It had a slightly raised level of fibrin (substance used by the body in blood clotting).

There was plenty of amniotic fluid and it was clear. I asked the OB if the absence of meconium meant that Moksha hadn't been distressed. She said that meconium isn't always present during fetal distress. Great.

I had skin biopsies taken to make sure my PUPPP was indeed PUPPP and not indicative of anything else. (After the birth, I had a severe rash spread all over my body for one week. It was diagnosed as stress related). I had liver function tests. I was tested for antibodies. All my bloodwork was redone (for infections like CMV, rubella, listeria, toxoplasmosis, parvovirus etc.). My urine was restested. I had normal glucose levels.

All that has been found is my Factor V Leiden. It remains unknown as to whether Moksha dying had anything to do with it. But as the doctor said, now we know about it, we have to manage it. Which brings me to:

3) Mangement of future pregnancy.

• Induction at 37 weeks at the earliest. They prefer to wait until 38 if I can cope.
• Elective C-section can be discussed again nearer the time but in principle not recommended (for the same reasons as pointed out in the recent article in the NY Times that Kate posted).
• Low molecular weight Heparin shots for the Factor V Leiden during the 3rd trimester. I will have to learn to give myself the shots which I think would be daily
• Regular fetal blood circulation monitoring using Doppler at a specialist centre, starting at 20 weeks.
• Regular blood coagulation tests. In general I will be followed by both the OB and the hematologist, who I will meet on Wednesday. She'll give me more information about the Factor V Leiden.
• She said again that we should wait a total of 4-6 months before TTC again. Last time she said 4 months when I asked her how much of this wait was for physical recovery. She had even mentioned that if we had an accident earlier than that, there was always the morning after pill. God, if I get pregnant, the last thing I'll want to take is the morning after pill! So this time I asked if it would be a disaster if I was to get pregnant next week by accident (whilst reassuring her that I wasn't actively planning it that way). She smiled and said no. So I'm sticking with the 4 months.

The OB reiterated how we shouldn't feel bad if we change our minds about wanting her to follow a next pregnancy. She's said this a few times, so I asked if she minded following us for a future pregnancy. She said no, that she would follow us with pleasure. DH thinks that she just wants us to feel free about our choices and to let us know she understands that we might change our minds in the future.

So that's that. I'm not seeing her again for another two months since there is nothing else to discuss with her related to Moksha's death and birth.