Wednesday, January 22, 2014

A Bicornuate Uterus: My Story

NOTE: This post deals with a medical anomaly and my experiences with it.

A bicornuate uterus is an abnormality most women find out that they have after becoming pregnant.  After reading so many forum stories about how much women go through courtesy of this unique condition, I've decided that it is time for me to put my story out there and hopefully make at least one woman feel more comfortable.

To start with - What is a bicornuate uterus?  It is an abnormality of the uterus, where instead looking like a rounded square/rectangle, the uterus looks more heart shaped.  This happens when two horns form while the uterus is developing.  There is a septate uterus, where a woman can have (as my friend likes to put it) "uteri".  I don't know as much about that condition.

** As a side note to this, my "disclaimer": I am not a medical professional.  Every woman, pregnancy, and situation is different.  Please keep this in mind. **

Now as I said, most women find out about this when they are pregnant and go in for an ultrasound.  I found out when I was 16 - yup first time seeing the GYN.  Basically the doctor tried to do an exam...and I totally wigged out (I felt really embarrassed at the time).  So, in lieu of an actual exam the doctor offered to do an ultrasound to make sure everything was normal.  After a really long ultrasound and a battery of other exams, I was informed I had a bicornuate uterus.  Outside of being pregnant - it wouldn't impact my life, but in the future, I could still have kids (very important for me, even then).

Fast forward a few years and I found myself pregnant with my son.  At the time I had recently moved to a new area, so I didn't have a set doctor.  I wound up at a local women's clinic and my OB/GYN was doing his residency there.

I told him about the bicornuate uterus, wondering if he was going to send me off to another doctor or even to a high-risk OB/GYN but he just nodded and notated it in my file.  He told me that as long as everything in my pregnancy progressed normally, then I shouldn't need to worry about seeing anyone else.  So instead of being immediately treated as "high-risk", I was treated more as "normal-with-the-potential-to-become-high-risk". 

Now here is the part where most pregnant women will hate (or strongly dislike) me - I never had morning sickness, acid-reflux, or any other typical pregnancy symptom the entire time.  I threw up 3 times the entire time.  The worst side effect of me being pregnant was pregnancy-induced gingivitis.  My son was growing perfectly with no issues and I was given no extra medications or preventative measures.
One of the bigger concerns with a bicornuate is the risk of a breach birth position - which comes about due to the limited space available to the fetus (half a uterus, instead of a whole one).  My son positioned himself head down and stayed there.

I went into premature labor at 34 weeks. Ready to hate me again?  I was in labor for 2.5 hours (from the time I realized I was in labor to the time my son was born).
It was a natural birth - the only drug I had was an antibiotic since didn't have a Strep test. 

For the record, my choice for a natural birth was largely because I didn't want anyone to stick a needle in my spine.  The idea of an epidural makes me uncomfortable.  However I know several people who swear by them. So, whatever makes the pregnant lady happy.

He weighed in at 4lbs 10oz, overall healthy, and spent 2 weeks in the NICU.

Ready - fast forward again - and pregnancy number 2.  This time a little girl.  New baby and new doctor - again.

I meet my new OB/GYN and tell her about my last pregnancy as well as the bicornate uterus.  She makes the appropriate notes and here's where the story changes, slightly.  After the second or third time seeing my doctor, she tells me about progesterone shots.  My doctor told me to think on it and let her know if I wanted to start these shots.  So, I did some research.

Progesterone shots are designed to prevent preterm labor.  These shots are used for women who have a history of preterm or who are at risk for preterm.  The shots are given, 1 per week, starting at about 14-16 weeks, and going for about 20 weeks.  The studies for this shot utilized women who have a normal uterus.  The effectiveness is something like, 33% of women the shot will work for and bring them to full term.
I then hunted through some forums catering to the bicornate crowd, trying to see if the shots worked for anyone on their second pregnancy.  The information I found was either A) "I'm taking progesterone shots now" or B) "It's my first pregnancy and my doctor is having me take these shots".  To me, that wasn't good enough information.  I'm not one of the "No Medications EVER!!!" types - honest - but I also try to be aware of what is going in my body and avoid over-medicating.

So, on my next visit with my OB/GYN, I told her I didn't want to take the progesterone shots.  Due to the limited information about it's effectiveness with bicornate uteruses, I wasn't comfortable with it.  (And as my mom put it - "If it's a real estate issue - the shot's not going to do anything anyway")  To my doctors credit, and the reason why I adore her, she just nodded and said "Okay, then here's plan B".  Plan B was to take a Fetal Fibronectin (FFN) test when I was between 30-32 weeks along and have weekly exams after 34 weeks to ensure proper fetal growth.

FFN is most useful when it is negative because that means you will not have preterm labor in the next couple weeks.  A positive is less useful because there are a lot of false positives.  But a positive could indicate that you will go into labor within the next 2 weeks or so.

If my FFN came back positive, there is a steroid that they can use to speed up the baby's development to help ensure that her lungs and everything finish developing.
I liked this plan a lot better.

My FFN came back negative and I stayed pregnant...and stayed pregnant...and very soon wondered when the hell my baby girl would show up.

Allow me to explain something to you.  When you have preemie one pregnancy and your next goes past that preemie week (in my case once I passed 34 weeks), at first you are happy.  Then when you hit full term - you are so ready to be done because last time, you were done.  The longer hit goes the more you are like "get it out!".

Now for everyone that decided to hate my easy first pregnancy, you can now laugh.  The duration of my pregnancy with my little girl - I had morning sickness for half the pregnancy and a weak stomach for the rest of it...which meant everything set me off.  I also had crazy migraines to the point that I stopped wearing my contact the last half of my pregnancy.  Everything hurt, was sore, and I was exhausted.  By the end of my pregnancy I couldn't sleep though the night - I was up 1-2 times every night and woke up early every morning.  Yeah - my friends and I said the next time I got pregnant I wouldn't get so lucky and I didn't.

I went into labor, 2 days shy of 42 weeks.  Yes, 42 weeks - my little girl took her sweet time getting ready.  But just like her brother, when she was ready to be born - she was ready.  I was in labor - start to finish - 2 hours.  One of my nurses heard how fast my son came, looked at me and said "When you come to the hospital to have a baby, you come to have a baby."
Once again I opted for a natural birth...though I was ready to throw in the towel for any non-epidural options.  As previously stated Epidurals scare me and they still do - I never want one. 
Now, for everyone out there wishing for an equally fast birth, there is a down side.  Normally as you go into labor your body will produce and release endorphins which helps to ease the pain.  With how fast baby girl came - I didn't get to produce that many, so it hurt a lot until I was ready to push.

When we arrived the hospital, I was asked if my water broke and what color it was.  The answer for the first was yes and a quick look at my discarded clothing showed green - a bad sign.  Green means meconium which is baby's first bowel movement.  When it happens in utereo, it can lead to some really bad issues for baby.  So the hospital had NICU doctors on standby.

She weighed 7lbs 14oz and was perfectly healthy - if in need of a bath.  It's been a blast these past several months watching her grow and seeing how her brother interacts with her.

So to recap: 2 pregnancies, 2 healthy children; 1 preemie and 1 late, 1 bicornate uterus, 0 cervical cerclages, 0 progesterone shots, and 2 natural births.

When I hear about all the preventative measure women undergo - just because they might become high risk, I wonder if they were given all the information.  The biggest thing I learned with both my pregnancies is that I only have the potential to be high risk and I need to work with my doctor to watch how they progress.
I trusted the medical team that worked with me and felt confident with every choice I made.  To me that is the important part.  I was confident with my choices.

Just as I started this essay - every situation is different so I don't expect everyone to make the same decisions I did.  They were the decisions that I felt were best for me and my children at that time.  And I'm happy with them.

** Please note: Medical information changes all the time, so please don't quote me outside of generalities - do the research and make informed decisions, always.  Again, I am not a medical professional and this is my personal experience.  **

Any thoughts, questions, or comments?  I'll do my best to answer as truthfully and accurately as I can.