Velamentous umbilical insertion q's... - Mothering Forums

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Old 12-08-2008, 01:08 AM - Thread Starter
 
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Friday brought some happy news (it's a boy) and some scary news. Namely, the baby's cord has a velamentous insertion, which is where the umbilical cord inserts slightly off the placenta, rather than smack in the middle. After speaking with the doctor who did my ultrasound, I was assured that I do not have vasa previa (a risk with velamentous insertion). We had been planning to birth at a midwife-run birth center (I hate my apartment, I'm sure as hell not giving birth here), but now I'm wondering if that's the best course. While the doc "assured" me that there shouldn't be any "major problems" if I wanted to continue with that course of action, he also very carefully pointed out that a common problem with velamentous insertion is that babies can be smaller, and have a higher likelihood of being pre-term.

In doing some research I was, of course, terrified at first. Vasa previa is almost always mentioned in correlation with velamentous insertion, but I called that ultrasound doctor back and he assured me that I do not have vasa previa. Phew on that front. On the other hand, velamentous insertion carries higher incidences of pre-term labor and low birth weight babies (about 8 in 100). I spoke briefly with our midwife and she has seen one velamentous insertion before, although she mentioned that that baby was small (6lbs, 4oz). Our next visit isn't until Friday, and I'm wanting to go in well informed. Obviously it rules out any kind of cord traction for placenta delivery, but are there other details I should be asking about?

Basically, does anyone have any experience with this? Did you have complications? Was the baby okay? Were you okay? This is our first child, and while we were ecstatic just a few days ago, we're downright petrified now.

Thanks!
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Old 12-08-2008, 01:52 AM
 
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I had a velementous insertion and my baby was 40+2 gestation and 7lb 12oz. I did have complications due to a retained placenta (a totally separate issue), but if that hadn't happened, it would have been a lovely, uncomplicated homebirth.

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Old 12-08-2008, 03:09 AM
 
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I had the same with my last birth. No problems whatsoever, didn't even find out until I delivered the placenta. My midwife said it was rare but didn't seem to think it was much of a cause for concern during pregnancy.

Oh and FWIW baby was born at 41 wks, completely healthy, no weight issues.

Blessed Mama to 4 and expecting one more!
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Old 12-08-2008, 05:08 AM
 
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I had a homebirth just seven weeks ago with this type of cord insertion - a long start and stop labour at 41 weeks 3 days, and a healthy 7+ pound boy who latched on within minutes of birth and has yet to let go.

We didn't know until the placenta was out either (no ultrasounds), but had we known beforehand, I wouldn't have done anything different; for our birth, we were most definitely safest at home.
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Old 12-08-2008, 05:25 AM
 
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My DD2 had a velamentous cord insertion. She was born full term but a little sooner than we were expecting, around 38-39 weeks (sooner than my other two). Quick 2 hour labor, she was 9 lb 9 oz which was a little smaller than we were expecting, but about right given her gestational age. I had some retained membranes (ROM when she crowned and the amniotic sac was pretty much shredded) but I took a little angelica tincture, there were no problems.

If it were me then even though the doctor said there was no vasa previa, I would still avoid AROM like the plague.

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Old 12-08-2008, 03:22 PM
 
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My precious 9lb 14oz son was born August 15th and died August 16th due to VCI and Vasa Previa. It was undiagnosed. He didn't have any problems during labor until 5 hours after AROM. Then, out of the blue his heart rate dropped and it became an emergency. He lost more than half of his blood in no time and all that they did after he was born was not enough to save him. I will miss him forever.

I believe the VCI tore and that is where he lost most of his blood. The vasa previa also tore at some point but not when my water was broken (that info was from the pathology report on the placenta). Not sure which is was, could have been both. As I was delivering the placenta my midwife pulled lightly on the cord and it completely tore off - it looked like a horse's tail.

If I were you I would insist they check for vasa previa often - your placenta can migrate and expose the vessels even more. Is your placenta high or low? Mine was low lying until 37 weeks. A lot of docs and midwives don't know how to treat vasa previa and a lot don't know the relationship with VCI and vasa previa. I would find a doc worth his/her weight in gold that knows how to diagnose it and treat it.

Go to vasa previa dot org and there is also a yahoo group that might be able to provide you with more info (and help you find a doc at least for a second opinion).

I know there are a lot of babies born naaturally with VCI that are fine. Many think it is an incidental finding after birth. But, I would treat it seriously since it has been diagnosed. I know first hand the risks are too high to be casual about it.

What I would have given to have been in your shoes - to have known ahead of time the dangers we faced before our birth. You've been given a gift to know ahead of time - one that can save your baby's life.

Edited to add - AROM or even natural rupture of your membranes can cause the umbilical vessels to be unsupported and they can tear, kink, etc. Even without vasa previa present I would still be concerned. Those precious vessels, without whartons jelly, are very fragile.
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Old 12-08-2008, 05:11 PM
 
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With my 7th there was a little bit of cord going through the sac right near the insertion (sometimes those cords can go all over the sac). It didn't cause any problems. But we did notice that there was a tear in the cord. My mw thought it probably happened after delivery but who knows. He was 9 lbs and 42+2 weeks. I had so much to worry about that pg cause I had a SCB too so I am really glad I didn't know about that, I would have worried myself sick. They are fragile though so I wouldn't be doing anything to augment labor or putting too much stress on it. Ditto what red sonja said, I would avoid arom, cord traction and any ves (cause it can cause rupture) jic. If you are really wanting to know where the cord is you can ask to be seen by a perinatologist who can do some in depth u/s with really good machines. Something with color doppler might not be a bad idea.

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Old 12-08-2008, 10:38 PM - Thread Starter
 
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Like I said, first pregnancy, so forgive me if my questions seem silly.

I'm not positive if what I had was the color doppler. The majority of my ultrasound was in black and white, however, when the doctor was looking at the cord, he used something that displayed the normal black and white and then showed the blood supply in red and blue. Would this be color doppler?

Also, the doctor assured me "no, you do not have vasa previa." Should I be looking to get a second opinion on this? The vasa previa site doesn't list doctors who are experienced with this. How does one even go about finding a perinatologist? Is a perinatologist necessary if I only have VCI and NOT vasa previa?

So confused/scared/pissed here...
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Old 12-08-2008, 10:46 PM
 
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No advice, this is my first baby too so I can't answer any questions. Just wanted to offer It must be pretty scary, I hope everything turns out alright!
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Old 12-08-2008, 10:59 PM
 
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You're off to a great start because you know about the VCI. Find the Yahoo group and join. There is a database on the group's site that lists docs that have diagnosed Vasa Previa (sorry I didn't make it clear in my first post). It's a good place to start.

Next, talk to your doc about your concerns. If he seems to blow you off or is patronizing then maybe it's time to find a doc that will take your concerns seriously. It would be worth a second opinion, at least. Tell him you want a second opinion - that you want someone else to take a look with the ultrasound. If he is a good doc he won't mind at all. If he's a jerk about it then you've at least found out at a time when you can make changes and not when you're in the heat of labor and delivery.

And, find out where your placenta is located. Do as much research as you can about VCI. The net has some scary stuff on it but there is a lot of good medical info. It can help you figure out what questions to ask.

Best wishes!
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Old 12-09-2008, 05:28 PM - Thread Starter
 
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I think my first problem is my total fear of hospitals and doctors. The doctor who did the ultrasound is my ultrasound doctor. He is NOT who I want delivering my child. He may be totally qualified to do so, but I chose to work with midwives because I wanted to know who would be at my birth, and I wanted to know that whoever that person was, they would be female and would be supportive of avoiding drugs and interventions, and supportive of my desire to nurse.

The women I know who've had natural births (no pit, no c-sec, no episiotomy) all gave birth with a midwife. A few of them were with nurse midwives in hospitals, but the rest of them delivered either at home or in private birth centers.

In contrast, of the 15 or so women I know who have given birth in the hospital (not all the same one, of course), every one of them has had issues with interventions, and only two of them escaped without episotomy or c-section. Most of them had issues with nursing.

I don't know what to do here. I'm terrified of giving birth to a dead son. I don't think I could go on after something like that. But I don't know how I would give birth in a hospital. Doctors and nurses hate birth plans. They don't give two hoots about whether you end up with a deep episiotomy. They don't really care if you breastfeed or not. I just don't think I can be a militant and deliver a baby at the same time.

I've always felt that normal birth doesn't belong in a hospital. But my birth isn't "normal" now, it's a less than 1% anomaly. Everything I've read says that this is dangerous, yet most babies end up being fine. The thought of going to the hospital completely changes my feelings about having children, about being happy with my pregnancy. I've dealt with depression in the past, and I was trying to stave off postpartum depression. Now it looks like I'm doomed to the things I was most afraid of. I'm just not equipped for this...
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Old 12-09-2008, 11:54 PM
 
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1341 - you are prepared for this. You can do this. I had two hospital births. My first was with a midwife and went well. I wanted to birth without pain meds but after being stuck at 5cm for 5 hours and fighting a migraine I chose to have an epidural. Not ideal but it was what I needed at the time. By the time I was dilated the epi had worn off and I was able to push my 10lb 11oz baby out in just 45 minutes.

My second birth was an induction. I was told that in order to have my midwives attend I had to be induced by 40 weeks because I had gestational diabetes. We chose to go with the induction though it was not what I had planned. If I had not had VCI/Vasa Previa it would have been a beautiful birth just like my first.

I'm thankful I was in a hospital. If not, my son would not have lived the 12 hours he did. At least he had a chance to be saved. If we were at home he would not have gotten a blood transfusion fast enough.

Your plans have been affected by this but it doesn't blow it all out of the water. It will just require more time to search out and find the right care providers. Also, you'll need a strong person to advocate for you during your birth. Probably one of the most important things.

Post about your worries and concerns in Birth and Beyond. I know there are other moms who have been in similar situations and can offer you great advice on how to navigate (and how to try and avoid depression issues).
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