At the delivery, my mom had noticed that her cord was very thin and fragile and the doctor had made the same statement to me and at the time I simply asked if that was because of the early gestation and she hesitantly said "ummm partly" but acted like there was something else she was thinking but didn't want to share. I just thought maybe she was thinking that it was also just fragile from all the stretching and trauma of being pulled so tight and she just didn't want to be too graphic with me. But as I've been reading Dr Jason Collins book "Silent risk: issues with the human umbilical cord" I read about straight cords. I had never heard of this.
A normal umbilical cord has one vein and two arteries and the vessels sort of braid over one another creating a helical pattern and then the whole thing twists around as if taking a braid and then twisting the ponytail. This coiling gives the cord extra strength against being compressed too easily. Then the vessels are surrounded in the white thick connective tissue called Whartons Jelly. The Jelly is there to also protect the vessels from easy kinking or compression. The book reads that cords that are straight and lack whartons jelly almost always end in fetal death because it is so easy to wrap around things and pinch off.
After reading this I wondered about her cord. I looked up a picture of another 16 week fetus and compared it to hers and they were VERY different. I truly think her cord was a two vessel straight cord with little to no whartons jelly.
As I read about these things I read that two vessel cords are often straight because having the three vessels is what makes them want to braid themselves in the first place. These cords are also associated with other congenital anomolies, but not always. Sometimes there can simply be an issue with the cord, but the baby is otherwise fine. I read online in a couple of places that they are associated with gestational diabetes, but couldn't find any solid information about this link.
After I read this information, I started to feel better about what happened. I wondered if she had had abnormalities and if so, then that would have been life altering for us to care for her. OR, if she was otherwise normal, the book says that babies who do get lucky enough make it to term with a straight cord can have neurological deficits from the cord being periodically compressed for short periods of time throughout the pregnancy; not enough to stop the heart, but enough to just slow it down occasionally until the baby moves away from it. This can cause insults to the brain and lead to cerebral palsy, mental retardation or worse. When I read this I realized that this may have been a bit of a blessing in disguise. When I was trying to get pregnant I would pray and pray for God to give me a NORMAL and HEALTHY baby and I would say that if I couldn't have a normal healthy baby, then I didn't want one at all. I started to think that God was actually answering my prayers by taking Brynn.
I felt that Brynn was right where she needed to be.I had wondered though that if God were answering my prayers about having a "normal" child then why would he have given me Brynn in
the first place? Why not just wait and give me a normal baby? I like to answer my own question with the rationalization that God knows I'm impatient and if I had not gotten pregnant that month, I would have been soooooo upset and frustrated. He knew that was not the right baby for me, but let me have the reassurance that I can and will get pregnant. I hate when other people tell me everything happens for a reason, but it's ok for me to come to these conclusions about my own life. Thinking that this was the reason for everything gave me some sort of peace about what had happened.
the first place? Why not just wait and give me a normal baby? I like to answer my own question with the rationalization that God knows I'm impatient and if I had not gotten pregnant that month, I would have been soooooo upset and frustrated. He knew that was not the right baby for me, but let me have the reassurance that I can and will get pregnant. I hate when other people tell me everything happens for a reason, but it's ok for me to come to these conclusions about my own life. Thinking that this was the reason for everything gave me some sort of peace about what had happened.
So, today when I went for my appt, I had really hoped that my doctor had some kind of report about what they found with the cord, but she didn't have anything like this. It didn't sound like the other doctor had reported any abnormal findings or written anything about the cord at all other than the fact that it was wrapped around the neck and that was the cause of death. It was as though she saw that the cord around the neck was the cause and saw no other reason to look for any kind of abnormalities or examine the cord or placenta any further. I'm a little frustrated about this.
My doctor came in and said that this is just a rare fluke accident. I asked if it was a two vessel or three vessel cord and she said she didn't know. HOW CAN YOU NOT KNOW?! Did anybody really look at it? I thought that was standard procedure at EVERY birth! This was a little frustrating for me because I was really hoping for some solid answers. My doc assured me that even if it were a two vessel cord, she has delivered many two vessel cord babies at term with no problems. So then I asked about it being a straight cord and lack of whartons jelly. She gave me the line about it being fragile because of the early gestation and that it was otherwise normal. Well, I'm not sure she KNOWS it was normal, she just knows that nothing abnormal was written about it, so she is assuming so.
I pulled out my comparison pictures of Brynn's cord and another spontaneously aborted 16 wk fetus and it's cord. VERY different. But she took a look at it, studied the differences for a moment, said "I see what you mean" and then quickly explained it away.
You see, I LOVE my doctor but she has one flaw and that is... if she doesn't think of something or come up with an idea on her own, she is slow to warm up to the suggestion. So, in other words, since she didn't know of any possibility of a cord abnormality prior to me suggesting it, she doesn't want to totally validate my point. She has to be the all knowing smart one. She IS the doctor after all ;-)
So I got the feeling that she sort of agreed with me but was hesitant to really make a diagnosis. She said that my baby had endured a lot of trauma from the way she died. She had a lot of internal bleeding and swelling and her cord was damaged, so it wasn't going to look normal.
I had wondered about her abdominal organs being abnormal because her belly was swollen and her organs were just sort of hanging out compared to the online fetus picture, but my doctor said that that is just from the bleeding and swelling and that the online baby looked like it was a spontaneous premature rupture of membranes (water broke early) but that the baby was totally fine.
She also pointed out that I had a 12 week ultrasound from a perinatologist who looked at those things and said they were perfect. I asked if E and I should have our chromosomes checked to make sure they are normal and we did not cause some kind of problem. She again reminded me that my 12 week genetic screening put me at VERY low chance of a genetic problem and the ultrasound was great. And we had one totally healthy baby already so the chance of our chromosomes being abnormal is low and she still did not see that anything was wrong with Brynn that would warrant that kind of thinking.
But as I went on asking about possible causes of her having a straight cord, my doc never directly argued with me saying "no she didn't have a straight cord". She was willing to talk about causes which tells me she DOES think she possibly had a straight cord, but just isn't willing to say for sure.
I asked about the GD link and she said this doesn't make any sense because GD occurs after the cord is already formed. I had agreed with this point, but just wondered what the association would be. She said she'd never heard of this and thought it was ridiculous.
But, I took metformin in the first trimester with Corynn. This med was originally prescribed to boost fertility/ make me ovulate more frequently. The thought is that I lack the normal amount of insulin receptors which makes me have a higher level of "floating" insulin in my blood... insulin is a hormone and it throws off my hormonal balance of estrogen and progesterone. Metformin makes you absorb less sugar, therefore needing less insulin and it's supposed to make your insulin receptors work better. Then I stayed on it through the first trimester to help my hormone levels and prevent miscarriage.
When I started trying to get pregnant with Brynn I was not noticing any more frequent ovulation on the metformin and it gave me nasty GI side effects, so my doc said I probably didn't need it and could stop taking it.
Well, I now wonder if this difference had any effect on the development of Brynn's cord. Maybe higher insulin levels or borderline high blood sugars? She wasn't sold on this idea, but said I could take metformin in the next pregnancy if it would make me feel better.
I also asked about Femara. This drug is used to induce ovulation but is KNOWN to cause birth defects if taken WHILE pregnant (it is given prior to pregnancy) and the FDA won't even approve it for this purpose because of this. It is actually a breast cancer drug that lowers estrogen but all reproductive endocrinologists use it now and most OB's are moving in that direction. It's half life clears it completely out of your system 10 days after taking it, so if taken cycle days 3-7, it should be gone by cycle day 17 and I did not ovulate until cycle day 35 so there shouldn't have been any affect on the baby, but I'm just suspicious of it now. I took Clomid and metformin with Corynn and she is perfect, so I'm just wondering if I should do the same thing next time as well as the GD diet from day one.
I have a friend who has trouble getting pregnant and she has been pregnant three times. Two times she used femara and miscarried both times. The third baby she got with no meds and carried that baby to term. Could be just a coincidence, but it makes me wonder.
My doc said she would do Clomid for the next baby if it would make me feel better but that she delivers healthy babies on Femara all the time and would prefer it because it has a lower risk of twins. I will have to think about this and do some more research before I make my decision.
My doctor wanted to emphasize that there is nothing I did or didn't do that caused this and there is no one thing I can change to make sure it doesn't happen again. She said
"I would love to be able to give you that answer and reassurance, but I truly think your baby just did too many somersaults and there is nothing that could've changed that. You are the perfect patient. Very careful, very conscientious. I have patients addicted to drugs that deliver perfect babies. This was just a rare unfortunate accident."
This is tough for me because I wish there were an answer. I wish there was something I could change or do differently. I took prenatal vitamins nine months before getting pregnant and religiously every day. I drink nothing but milk and water in the first trimester. No caffeine. No cold deli meat. No medicine, not even tylenol until 10 weeks. I ate extra spinach, lentils and oranges during 5-6 weeks because they have extra folic acid. I do everything PERFECT. This RARE accident should not have happened to my baby.
Without me even having to ask, my doctor said that she knows I will have very high anxiety with the next pregnancy and it is going to be a LONG nine months and said we will do very close monitoring. She said I will have an early ultrasound examining the make up and position of the cord. Then I will have weekly biophysical ultrasounds starting at 24 weeks and if at any time the cord looks to be in a dangerous position, I would then have the option to be placed on hospital continuous monitoring or deliver if I am far enough along that we think it would be safe. She will also induce me at 38 weeks just to cut two weeks off the time that the baby could get tangled in it's cord. This will be wonderful! I am going to be a nervous wreck and the thing I love most about my doctor is that she knows me well and gives me what I want!
So, overall I was a little disappointed in the lack of hard answers I got in my appt today.
Thinking that something was or might have been wrong with Brynn was really helping me, but my doctor kind of shot down my rationale and left me again wondering why this happened :-/
The thought that she and her cord were perfect and she would've been a normal baby makes me feel uneasy again.
But I am satisfied in her confidence that this is unlikely to happen again, and that she will monitor me closely to make me feel better.
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