A risky proposition

December 2002 -- Bleeding and nervous

I am with Carmella in the waiting room of the Maternal and Infant Care Clinic (MICC) on the third floor in the UWMC, waiting for her biweekly Tuesday checkup. She has been bleeding on and off since last Thursday and is worried it could indicate a placenta previa, a condition in which the placenta blocks the cervix and can lead to emergency complications.

Though she is nervous, Carmella is her usual upbeat self. Her 4-year-old daughter, Murianna, is here too, steadily getting bored as the minutes tick away. A half-hour has passed since her scheduled appointment time, a normal occurrence in the clinic.

Survival of her baby is hardly guaranteed at this point. The fetus is fewer than 3 inches long, and it has only recently developed a beating heart.

Difficulties with high blood pressure and diabetes were anticipated, but problems with her placenta clearly were not part of the plan.

Finally, we are called into a small exam room.

A "trimester-by-trimester view of pregnancy" poster hangs on the door alongside an old wood-finished desk. In the middle of the room sits an exam table -- very sterile.

After her blood pressure is measured -- it's not too bad today -- and another brief wait, her obstetrician, Dr. Tom Easterling, enters. He makes jokes, asks how things are at home and then gets down to business.

It is a routine I will see every two weeks for about five months, and something with which Carmella is intimately familiar, having seen Easterling for six years through two pregnancies.

"Let's see your sugars," Easterling tells Carmella, and she produces a booklet in which she has meticulously recorded her blood-sugar readings and the times she has eaten meals.

Carmella's gestational diabetes is an uncommon condition affecting only 4 percent of pregnant women. It is caused by an imbalance in a hormone that diminishes the effect of insulin, thus freeing up more sugar for the fetus.

Carmella follows a strict diet of five small meals a day, low in carbohydrates and sugars, and she must take insulin if her blood sugar levels are high. Though the diabetes can cause high birth weight in babies, Carmella's hypertension will probably lead to a premature Caesarean section delivery before the weight becomes a problem.

Carmella asks him about the possible placenta issue, but he's not worried. The pregnancy is only 17 weeks along, and placentas tend to move upward over time.

After Carmella hops on the exam table, Easterling applies a Doppler probe to her belly, and from a tinny speaker it emits a steady whooshing sound. The noise persists as he moves the telephone-looking device left, right, up and down, searching for a heartbeat. Today it is taking longer than normal. A minute passes in a procedure that typically takes 15 seconds.

"Now I'm really nervous," Carmella says, and she stares at the ceiling.

Another minute elapses.

Easterling's face has not changed and I am nervous, too. Should it be taking this long? I am out of place. This could be serious. Is this serious?

I am not as concerned as Carmella -- I have only known her for a couple weeks -- but I am afraid for her.

Then, at last, a faint thump, thump, thump. Coupled with the sound of the blowing wind, it sounds like we are driving across a bridge. Thump, thump, thump.

It is the baby's heartbeat.

We breathe a collective sigh of relief, but the appointment is cut short. Easterling has just been called to perform an emergency Caesarean section.

"That's just fine with me," Carmella says. "If I were up there, I'd want him to leave his patients down here, too."