Halfway down the Danube

Beginner's mistake

Well. It's a scary story. Don't read it if you're pregnant. Or, maybe, you should, if you're pregnant and living in Romania. Also, you should not read this if you are squicky about a woman's inner workings. You are warned.

In order not to jinx things, we haven't announced to you guys yet that I'm pregnant again. After Benjamin, it was a scary thing to do. Months of anxiety and endless hours of worry. I can not - did not - count the times I ran to the clinic to see the heartbeat of the baby. The weeks just wouldn't pass.

But, somehow, we got over the dreaded milestone of 18 weeks, and things seemed to be fine. Baby was kicking and growing and turned out to be another boy (the fourth one, really, what are the chances of that?), and we were happy to hear that he was fine and healthy and all his chromosomes were accounted for.

Everything went off like in a textbook pregnancy.

Next stop: the big 20-week-ultrasound for physical anomalies. If you know us, it won't come as a surprise that we were a little late with that, at the end of the 23rd week. Unfortunately, this was also the week when Doug was in the States on a business trip. It couldn't be helped, though, and I promised to send him a picture of the baby as soon as I got home from the scan. We didn't really expect any problems -- I had been feeling fine, just gained way too much weight but that was due to potato chips and ice cream, not to gestational diabetes or similar.

This being a country where certain things are cheap, we could afford to get an appointment with the leading ultrasound specialist in Romania. He's booked solid until October but I lucked out and got the appointment of someone who cancelled. Let's call him Dr. P., for legal reasons.

The clinic he works in is right around the corner from us and turned out to be very spiffy. In Romania, you often find even top class doctors in small, cramped apartment-style offices, but the new clinics that cater to the wealthy and the expatriates are mostly modern and big.

The doctor himself was the very taciturn kind. I'm the very talkative kind, especially when I'm a little nervous. It's hard for me to lie on a stretcher silently, while the doctor stares at the screen that I cannot see and does his endless measuring. Finally, I broke the silence by asking if anything was wrong with the baby. No, no, the baby was fine. He printed some pictures for me, and briefly showed me the kid rolling around and waving his little hands (with all five fingers).

He gave me a towel to wipe to goo off my belly and then sat me at his desk. The baby was fine, but.

But. The dreaded but. He diagnosed me with an incompetent cervix. For all males who've never been closely acquainted with a pregnant woman, a short explanation. No, it doesn't mean that the cervix gets tested on algebra and geography and fails big time. It means that the end of the uterus, the exit, is opening up. It's a big no-no this early in pregnancy.

Babies born at 23 weeks do have a small chance of survival and there are stories galore about those who made it -- but it's not the norm. You need a lot of high tech gear, and very good doctors, and very, very much luck to get a 23-week-old fetus to survive. Most of those who do beat the odds suffer horrible long-term damage such as blindness, mental retardation, severe lung problems, the works. It's not a fate you want for your baby. And you definitely don't want to have such problems in a country where the newest prenatal technology is just not available.

Dr. P. told me that I had 2.6 cm of cervix left (you ought to have at least 4 cm). This came as a total shock to me. I had anticipated problems with the kid, maybe. Not with my body, never. My body is a fierce pregnancy machine. I can tell I'm pregnant even before the test stick turns blue. It's as if my body jumps into each pregnancy with all throttles open. No slow starts for me. And no easy endings. I never did go into labor on my own and my cervix has always been extremely reluctant to open. And all of a sudden my body betrays me?

And what to do now? Was there a magic pill? Some treatment?

The solution is bed rest. Actually, he told me simply to rest. He didn't say anything about bed rest. I know, he said, not easy with two little ones. Try to rest some during the day, though.

Somehow, this didn't satisfy me. I called my regular German Ob-Gyn with the news and I could hear her heart sinking. She gave me detailed instructions: Strict bed rest. No lifting at all. Magnesium in high doses to stop the contractions. (Not that I had felt any contractions but a cervix doesn't open without contractions, so they must have been there, ergo they needed to be stopped.) She ordered me to keep this up until week 29, then fly off to Germany until the baby was born. At week 29, he would have a fighting chance.

Remember, I was home alone with two little boys and the husband away in the US. Poor husband.

Things were arranged. I hired another nanny to cover bed times (no lifting!), my friends outdid themselves and helped wherever they could, supplying a steady stream of supportive phone calls and tacky magazines. I tried to keep a positive attitude.

It was very, very scary. Being told that your baby is about to drop out of you is frightening in the best of times. Being told this after a miscarriage or a stillbirth adds another dimension, though. You start listening to your body. A pregnant body will do odd things but when you start paying attention, these odd things take on a sinister meaning. Twinges everywhere. Odd pulling sensations. Sharp stabbing pains. After two days, I started feeling the contractions. Four times an hour, six times an hour, up to seven times an hour. The contractions hurt like hell. The baby himself was very restless, turning and kicking like mad, seemingly without a pause. Then, I got lower back pain. That's when I went into panic mode because lower back pain can indicate back labor and that basically tells you your body is trying to give birth. Now.

I called my doctor in Germany, and another doctor here in Romania. They both said, get yourself on the next plane to Germany and into a hospital. My German Ob-Gyn added, "and make your trip as little stressful as possible. I don't want you to give birth on the plane."

Easier said than done.

I had to leave my kids behind, buy the most expensive air fare ever, order wheelchair service but not tell the airline I was in labor (since they wouldn't have let me step on the plane, of course), ask my parents to pick me up and drive me to the hospital, and inform the hospital that I was coming in with problems. No stress at all.

The trip was uneventful, if long. We started an hour late, leaving my parents in knots at the Frankfurt airport whether or not the plane had made an emergency landing for their daughter. Then, it was stop and go traffic on the autobahn until Schweinfurt. All the time, I had contractions and was in pain, and scared.

The Leopoldina Hospital in Schweinfurt is wonderful. I've given birth to all my three boys there. The doctors are great, the equipment state-of-the-art, the nurses are the best you can get. They've dealt with Benjamin's birth and death in a gentle, thoughtful, and compassionate way that helped me enormously. I love this hospital (my only gripe is the food but heh, nothing is perfect).

So I waddled into the maternity war, and the doctor on duty looked at me and said this:

"Frau Muir, I know you. Your body doesn't do labor. Your cervix never opens up by itself. I've just checked your file again. I cannot believe that there is something wrong. But - let's have a look."

And she did.

And she cursed.

Loudly.

She called it a typical beginner's mistake.

She said many things about how you cannot make such a diagnosis merely based on an abdominal scan, such as Dr. P. had performed. That you always have to back up with a vaginal scan but even without that one, she could see that the cervix was fully closed and 5 cm long. What Dr. P. saw, obviously, was just a fold in my lower uterus. She showed it to me and it looked like an opening cervix -- but I'm not earning loads of money for being Romania's No. 1 ultrasound specialist. That's why my second opinion in Romania didn't hesitate to send me to Germany - he had trusted his famous colleague's diagnosis.

Nothing was wrong. Nothing at all.

So, in the end, I was out of well over 1500 bucks for the flights but not in any danger. The contractions stopped the moment I heard the good news. Stress. It was all the stress. The lower back pain? That was just lower back pain, from lying around so much. The pain during the contractions was caused by my prior c-section scars. There had been no danger, although over time, the stress and the fear might have had the exact same result as an actual incompetent cervix. At some point, the contractions would have had an effect. So, it wasn't a harmless misdiagnosis.

The doctor himself is going to suffer little. Some of my friends have cancelled their appointments but, as I said, he's famous and booked solid, so he won't notice. "Sue him," is the American response, but that won't fly here.

I'm upset and relieved at the same time. I'm writing a letter to Dr. P., complete with copies of all the scan pictures and a full description of the diagnosis. If I'm lucky, he will pay more attention in the future and not just tear the letter up and throw it away.

The fear, the panic, the tears - they were in vain but they were real. After Benjamin last year, this was a nightmare. Not only I, but Doug, our families, and our friends were shocked, scared, panicked. As I said, this wasn't a harmless oops. This was a serious mistake that could have had tragic consequences.

Please don't get me wrong. I've had wonderful doctors here in Romania. I had dental work done and it was great. We will still frequent our regular doctors just as we had before this happened.

That said, it is true that the overall prenatal care here sucks big time. I do have a regular Ob-Gyn here and he's never wanted to know my blood pressure, tested my urine for proteine, or watched my weight. No blood tests for toxoplasmosis, rubella, or diabetes. Where in Germany I have a big file with all the available data at the doctor's office and at the hospital, there are no records kept here. And this is not a simple hole-in-the-wall doctor, either.

Yes, there are cultural differences even in medical procedures. In Germany, many more ultrasound scans are performed during pregnancy than in the UK or the US. We also do more amniocentesis tests, and have more frequent routine visits. Not everything that is done in Germany is necessary or obligatory.

However, I've gotten very interested in antenatal, postnatal and maternal health in the last years. In the meantime, I know quite a bit about it, so believe me when I tell you that Romania has some catching up to do. I'm not saying this because I have my own axe to grind. I say this because the future of every nation lies in its mothers and children. It's important to take good care of them.

And yes, I'm stepping off the soap box now, thank you very much.

Posted by claudia at July 7, 2005 11:01 AM