Prematurity Awareness Month 2010 prompted me to start this blog. Now, a year later, I’m not quite sure what to say. Peter’s story has been told, pictures have been shared, and facts have been listed. I’ve worked through the multifarious emotions that resulted from Peter’s early birth – shock, fear, hope, pride, guilt, resilience, faith. I’ve started pharmacy school, a new chapter in my life, and Peter has entered toddlerhood with a curious, active, and (generally) sunny disposition. I still find myself looking back every day, marveling at how far Peter has come, but more and more, I’m also looking ahead to the future.
I’ve had my uterine septum resected. I’ve had a “preconception consultation” with a maternal-fetal medicine specialist. I’ve dreamed about what it might be like to have a healthy, full-term pregnancy. And I’ve dreamed about what it would be like to have another preemie. I’ve dreamed about what it would be like to conceive twins again. And I’ve dreamed about what it would be like to lose a fetus again.
I’ve read that women with fraternal twins have a 1/12 chance of conceiving twins again. And that the probability that a woman will conceive twins increases with age. And that Massachusetts has the highest rate of twin pregnancies of any state in the U.S. (Granted, this is due to advanced maternal age and high usage of assisted reproductive technology – not the Bay State environment.) Part of me wants a second chance to be a mother of twins, but the rational part of me knows that twins would only make a high-risk pregnancy even more risky.
Even with a remodeled uterus, it’s hard to ignore the fact that the greatest risk factor for preterm labor is a history of preterm labor. I like to think that with careful monitoring by a high-risk specialist, I’ll be able to make it much closer to 40 weeks than I did in my last pregnancy. But at the same time, I have to acknowledge the fact that tocolytic therapy initiated at the start of my preterm labor with Peter only delayed his delivery by a day, and it’s unlikely that closer monitoring would have changed the outcome of my last pregnancy.
Of course, my hopes and fears are common among women who have experienced preterm birth. Some women decide not to have any more children for fear of another NICU stay. I’m not really afraid of another NICU stay, but I am worried that we may not be as lucky next time as we were with Peter, who was quite healthy for a 27-weeker.
I’m hopeful that 17-hydroxyprogesterone caproate (17P) injections will help me make it closer to term. For women with a history of spontaneous preterm delivery, 17P reduces the risk of preterm delivery by a third. That’s a significant improvement, but I find it hard to imagine myself as one of the lucky 64% who manage to have a full-term pregnancy, given that Peter fell into the “extremely preterm” category of preemies.
Risk factors for preterm birth include
- multiple gestation
- history of preterm delivery
- problems with the uterus or cervix
- black race
- chronic health problems
- certain infections
- cigarette smoking, alcohol use, or illicit drug use during pregnancy
- low socioeconomic status
- women younger than 17 or older than 35
- lack of prenatal care
- less than 6-9 months between birth and the beginning of the next pregnancy
I only had one significant risk factor during my last pregnancy after Peter’s twin “vanished”: a congenital uterine anomaly. I honestly didn’t believe that I would deliver before 35 weeks… until my water broke and Peter slid feet-first out my uterus. Now I have two risk factors: a (surgically corrected) uterine anomaly and a history of extremely preterm labor. With a little luck and a lot of progesterone, my uterus should be more amenable to stretching next time around, but I’m sure I’ll be holding my breath until I hit 28 weeks…
At which point, I’ll take a deep gasp for air and hold my breath until I hit 32 weeks…
At which point, I’ll take a deep gasp and hold my breath until I hit 34 weeks…
At which point, I’ll take a last gasp and hold my breath until I hit 37 weeks…
At which point, I’ll breathe a sigh of relief and marvel at how lucky I am to have made it to term.
That’s what I’m hoping, anyway.
For this first-ever World Prematurity Day, let’s give our preemie miracles a hug, give thanks for every week of pregnancy, and do our best to promote long, healthy pregnancies.