Pregnancy Update: 39 weeks + 2 days

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39 Weeks + 2 Days Pregnant - concerns about low platelets, head not engaged, third stage and labouring alone
Today I’m 39 weeks & 2 days pregnant. I had my latest appointment yesterday. This pregnancy has gone well so far. My blood pressure is nice and low. The babies heartbeat is good. I’d say that running around after a toddler has meant that I’m a lot fitter this pregnancy than last. There are a couple of concerns – no, “concerns” is too alarming a word. There are a couple of areas that we are watching…

Low Platelets

A platelets count of above 150 is good.  My platelets count is currently 124, previously it 108. I would say that it is reassuring that it is going up, but the statistician in my husband notes that the error margin in these tests is 15%, which means that 124 & 108 are essentially the same level. But better than it going down dramatically I guess.  Why are platelet levels important?  Well, the higher your platelets count, the better your blood can clot. A low platelets count (less than 100), means that there is increased risk of bleeding. If I was to have an epidural (for pain relief) or spinal tap (for a caesarean), this means that the needle might cause bleeding into my spinal cord, which means I’d be at higher risk of paralysis, blood on the brain, etc. Still very low chances, but higher chances than normal, and higher than what anethetists are generally comfortable with.
So what’s going to happen, is when I go into labour, they are going to retest me to see what my platelet count is at that time. If it’s too low, then I’ll have to rely on other pain relief (such as gas & pethidine – what I was intending to use anyway) for a normal vaginal birth, or a general anaesthetic for an emergency caesarean. It’s this last case scenario that concerns me the most, because general anaesthetic isn’t that good for the baby. Apparently they would give me the general anaesthetic at the last possible second (ie, when the obstetrician already has the knife in his/her hand) so that the baby is only exposed to the drugs for about 2 minutes. This is still enough that the baby will be drowsy and will probably need help breathing initially, and will have ongoing drowsiness for the first week or so, which could impact on breastfeeding. Also, I would be drowsier for the first day or so as well. And neither Nathan or I would be able to be “present” (in the conscious sense anyway) when the baby is “delivered” which would be disappointing.
Hopefully we won’t need an emergency caesarean, and I’ll be fine with gas and/or pethidine pain relief, so this won’t impact at all. But it is nice to know in advance what may happen.

Babies Head is Not Engaged

As at yesterday, the babies head was still quite high. Usually the babies head drops down into your pelvis and pushes against my cervix before labour starts. I felt this happen the night before I went into labour with JJ, so fingers crossed this is what happens again. But, if my waters were to break whilst the babies head is still high, there is a chance that my waters will wash the umbilical cord underneath the babies head. Then subsequent contractions could mean that the umbilical cord gets delivered before the baby, which would be life threatening for the baby. So, until the babies head firmly engages, I’ve been advised to consider my waters breaking as an emergency, and come into hospital instead of staying at home as would be the usual recommendation. In the rare situation that the umbilical cord had in fact washed underneath the babies head, then they would do an emergency caesarean.

Managing the Third Stage

If you remember from JJ’s Birth Story, I had some complications with the third stage (delivery of the placenta) last time I gave birth. This time, the third stage will be “actively managed”. When I first go into labour, they will take some of my blood to establish my current blood antigens in case I need blood transfusions again. They already know my general blood type of course, but your blood antigens fluctuate. Knowing your blood antigens means they can do a more accurate blood transfusion match. While I am in labour, they will try to keep a theatre and staff available. Of course, they can’t know exactly how many emergency situations will arise on the day, but they are intending to stall non-emergency surgeries until after my third stage has been completed in case I should have a similar problem again. This may well be unnecessary. Hopefully my placenta will be delivered whole with no complications, but it is nice to know that they are taking precautions just in case…

Labouring Alone

This is not a medical concern, but it is a scary thought for me nonetheless! I keep hearing stories of second labours being much faster than the first. We have relatives on stand-by to look after JJ when I go into labour, but if I have a super speedy labour, or if I need an emergency caesarean, I’m worried that Nathan will be waiting for them to arrive and I’ll be in there all by myself. A scary thought! I have full faith in the doctors and midwives, but I’d still like my support person there just the same….
Of course, none of the above might happen, and there are a myriad of other things that could go wrong, instead. We’ll just cross each bridge as we get to it…

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