I wrote this post a long time ago, and I am just now brave enough to post it. Saying it out loud to the internet makes it real, somehow.
You know how the first question everyone asks after you get married is "When are you having a baby?" Well, after you have a baby, all anyone wants to know is "when are you having another?" This question is asked with increasing frequency once your child turns one. Evan and I have been understandably reluctant to make a decision on having another child. I decided to see a perinatoligist (high-risk ob) in December to get an opinion on what my chances are of having a healthy pregnancy, delivery and baby a second time.
I had a preconception appointment with the MFM (Maternal Fetal Medicine specialist/perinatologist). I basically told him not to make it pretty for me - I wanted to know the real deal. He said my chance of recurrence of pre-eclampsia, based solely on when I developed it last time, is 30-40%. I asked him if I was his wife, would he recommend I have another baby. He said no. He thinks the risk to my life is too great, and his personal feeling is that, for him, his wife's life is too important to risk for a baby he doesn't know and love yet. It was an interesting and appreciated opinion.
In a nutshell, my HELLP came on really suddenly (as far as I knew) and was very severe. From my first symptom to when Marino was delivered was about 3 hours. My blood pressure was through the roof (200s over 100s) and my liver was swollen into my lungs. After my c-section, I lost a lot of blood in an abdominal sheath hematoma (basically a pocket of blood that covered my entire abdominal wall) which was really confusing to my doctors, since the bleeding was not at my incision site. They did an MRI and found the hematoma, as well as other pockets of fluid in my abdomen. They gave me a transfusion and antibiotics (up until today, I thought the antibiotics were needed because of the transfusion, but the MFM said it was because they thought my incision was infected and antibiotics are not normally given with a transfusion). I promptly contracted c.diff (a serious bacterial infection of the colon, which plagues me at this moment), which required a 13 day hospital stay and I ended up having c.diff for 5.5 months and then again this September and currently.
The MFM said he thinks that I was going beginning to go into DIC (http://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation) and that was why the hematomas occurred. DIC is often fatal. Because of the DIC, even if he found a clotting disorder (which often is the cause of HELLP Syndrome), Lovenox or any other blood thinner would not be an option for me, since if I required a sudden delivery again, I would likely bleed to death (apparently, patients with a history of DIC are never given blood thinners). I also could not take baby asprin because of my colitis (no NSAIDs).
He also said the c.diff carries a big risk. My GI doctor said its likely I will just keep carrying c.diff in my colon and it will flare up anytime there is an imbalence in my immune system. C.diff causes serious dehydration, which in pregnancy carries a huge risk of pre-term labor. The MFM said he had just delivered a 32 week baby the previous week as a result of c.diff. The mother became septic and went into pre-term labor.
Another interesting thing he said was that he thinks I had pre-eclampsia at least several weeks before all this happened. I had a growth ultrasound and checkup 48 hours before Marino was born, and they told me he was fine. The MFM said based on Marino's size at the growth ultrasound, he would have been seriously concerned (he was about a pound smaller than he should have been). He also said its not possible for Marino's placenta to have gotten in the condition it was in when he was born in the 48 hours that had passed since the ultrasound, so he thinks they did not look closely enough at the blood flow to the placenta. When Marino was born, his placenta was smaller than the 10th percentile for his gestational age. He said it is absolutely not possible for that to occur in just a couple days, and he thinks development stopped around 30 weeks because of the lack of blood flow to the placenta. Interestingly, Marino also had a true knot in his umbilicial cord (which is extremely rare, it only occurs in about 1% of all pregnancies). This could have been problematic, regardless of the other issues we faced and particularly if I had delivered him vaginally.
I asked if he thought pre-eclampsia in a second pregnancy would be less severe and he said usually in cases like mine, if he sees it again, it presents in a similar way.
He said he would take care of me if I wanted to have another, but his official recommendation will be to look into adoption or surrogacy if we decide to have another child. He also said to definately not get pregnant for at least another 2-3 years to let my body completely recover from what we went through. He basically said I am incredibly lucky to be alive and have a live child. I do feel some relief at getting an honest answer that doesn't downplay what I went through (as I felt I was getting from my regular ob).
Last month, I saw my regular ob, who a year ago was optimistic about my chances of having another baby. This year, he said he agreed with the MFM and he thinks my body has been through too much. In fact, he said he would not be willing to do Essure or tubal ligation on me either...he thinks my body is too unstable for any unnecessary medial procedures. His words to me were "I think you should focus on the idea that your son needs his mother." And who can argue with that? If something were to happen to me due to another pregnancy, how would Marino feel? The thought of him thinking "why wasn't I enough?" is heartwrenching.
It's been almost 2 months since I got this news, and I still shed plenty of tears about it. I do believe there is a reason for this and that the reason just has not presented itself. I'm grateful to have Marino, and in some ways, I love the idea that he will never have to compete for my attention or affection. Certainly, he will always know he is my greatest joy in life. But it's still painful to not be able to make a choice about the size of our family (or at least, a choice between only having one child or getting pregnant again and potentially facing an untimely death). I know that many women would love to have one happy, healthy child and I am so grateful for what I have, particularly knowing what I know now about how dire my health was before/after delivery. But I still feel like I need time to process this information and move past it with a peaceful heart.