A Placental Tale


Her light brown hair was long and tied in a little pile on the top of her head like a haystack about to topple. Her cheeks were rosy, her eyes were bright, and her face was lit with the jubilation that only the young experience at the start of a journey. She was happy –her whole body trembled with the joy of a recently discovered pregnancy. Her smile was so infectious and irresistable that my mood changed the moment I saw her in the waiting room. It’s one of the many benefits of my profession –like a gratuity, almost- to experience her exhilaration vicariously.

She could hardly sit in the chair in my office she was so excited. I congratulated her on her first pregnancy and after taking her history and filling in the antenatal forms, sat back in my chair to chat less formally. It’s an opportunity for both of us to get to know each other, and for her to ask me questions: management questions, fear questions, rumour questions… Even silly questions she would have been afraid to ask at the beginning. “You know,” she started hesitantly, but obviously more comfortable talking to me, “You know, when I first thought about it, I really assumed we’d strayed too far from our roots…”

I smiled encouragingly. “What do you mean?”

She stared at the ceiling for a moment before continuing. “I mean, nothing’s natural anymore.” She let her eyes fall on my face for an instant to check my reaction before letting them wander again. “Pregnancy’s sort of, you know, compartmentalized .”

An interesting observation. I hadn’t thought about pregnancy in compartments before. But I didn’t say anything; I didn’t want to break into her stream of thoughts.

“You know… First there’s the Missed Period stage and then the Discovery stage…the Nausea stage, then the Feel Better for a while part, the Big and Clumsy part…  And each part is framed by some test or other.”

“You’ve been reading, Marilyn…”

She shrugged noncommittally and sighed. “But you know, I’ve come to like the idea of compartments. It’s a more interesting and useful way of dividing up pregnancy… I mean, rather than into the more traditional trimesters.”

“I think that doctors tend to medicalize things too much; it’s an unfortunate byproduct of our profession.”

She smiled, but warily. She was testing the waters. “I’ve been thinking about documenting the stages online. You know: feelings, physical symptoms, test results –that kind of thing.”

I nodded encouragingly.

“I thought I’d try a video blog…” She let her eyes sit firmly on mine and left them there. “I might see how it goes and then edit them all into a short documentary for YouTube.” She searched my face for a reaction.

My expression obviously suggested I was digesting the idea, but I suspect she saw some suspicion of the whole process, because her smile widened to engulf her face. Her enthusiasm was captivating.

“No, I don’t want to film all our visits, or anything…” She hesitated and then her eyes twinkled mischievously. “Just some of them. It’d be too boring and time-consuming to do them all.”

I am usually up for adventuresome projects, but I admit I couldn’t keep the doubt off my face. The question of privacy, and physician/patient confidentiality ran through my mind, to say nothing of the medico-legal implications. “Well, I…”

She giggled and her whole body seemed to relish the sound. “Just testing,” she said, almost shaking with her delightful laughter. “We’ll just do one visit; you can choose…” She stared at me with a merry expression. Then a change: not more serious perhaps, but more cautious. Uncertain.

“Actually, this has all been done before,” she said with a sigh. “So there has to be a point to my documentary -a twist: a different view of the process of pregnancy and delivery…” She looked down at her lap for a moment, as if summoning the courage to explain. “I’ve always been fascinated with the idea of the placenta as an intermediary. A facilitator. A gatekeeper. I want to document the pregnancy from the placenta’s point of view… You know -give it a name, sort of. Time on the pedestal…” She made eye contact briefly then withdrew her eyes for a moment. “Does that sound crazy?” She shrugged her shoulders and then studied my reaction hopefully.

“That sounds absolutely fascinating!” I said, honestly enthusiastic. “The placenta is something that has always interested me as well. It’s an active and important organ, not just a passive filter.”

“Exactly,” she said as her face lit up. “I’d like to film parts of the labour and delivery for the documentary if that’s okay with you… Especially the  Delivery.”

I cocked my head and looked at her. “The Delivery? I don’t…”

She shook her head in mock exasperation. “The placental delivery! And ,” –she really emphasized the ‘and’- “I’d like to keep the placenta as well. Will they let me?”

I nodded. “And” –I thought I’d try my own emphasis- “you get to keep the baby, too.”

She chuckled and her face pixied. “Oh yeah. I forgot about the baby…” She looked at me mischievously. “What about the filming?

I looked at her for a moment, wondering how to respond. “Well, if it’s okay with the staff in the room. You’d have to get their permission… And don’t forget we’re on a call schedule, so it might not be me who’s there for the delivery… But we’re a pretty liberal group. I’ll bet they’ll be as fascinated as me.”

Her smile never waivered, but her eyes did roll upwards a bit when she shook her head as if she were confronted with a particularly slow student. “I know all that, doctor. Don’t you think I’ve looked up you and your colleagues online already?”

                                                   *

The days, as usual, unfurled thickly but rapidly after that, and the quotidian details, written so densely on each hour, meant that I inevitably forgot about Marilyn’s plan. Even when she returned with her partner for the scheduled antepartum visits they blended into the background of a crowded waiting room and the endless round of weights, blood pressure measurements and fetal heart rate checks that fill each day to overflowing: Samsara.

I don’t mean to suggest that I forgot Marilyn; she was just too enthusiastic and happy to overlook. But I did forget about her video blog. I did forget about her placenta.

I did not forget about her compartments, though –she wouldn’t let me. And one day, during the Big and Clumsy division, she arrived with a little video camera and asked if her partner could film the visit. I glanced at her otherwise unremarkable chart, saw how completely normal her pregnancy had been up until then and shrugged. Why not?

He filmed her getting weighed, and even her sample of urine being tested with the little dipsticks we use to measure protein and sugar. A little embarrassed smile ran briefly across his face when her back was turned and he saw me peeking around the corner at the production. I didn’t mean to stare, but I have to admit I was curious.

The problem began when I measured her abdomen to gauge the size of the baby –all captured on the camera, of course- and I had to explain to them why it didn’t seem to have increased in length from the last visit. There can be many reasons the measurement can vary from expectations, actually: position of baby for one, and minor discrepancies with measuring technique from visit to visit for another. Of course we always worry about a decreasing amount of fluid around the baby or lagging foetal growth, but common things are commonest, as the saying goes. If the change is small, it usually merits only observation at first. If it persists over time, it shouldn’t be ignored, though. Wouldn’t be ignored… Investigations then would become necessary.

I explained this to them in as reassuring fashion as I could, ever mindful that I was doing so on camera. But even so, the questions poured out as I knew they would. It was a small difference, I explained, but they were so anxious I felt I needed to begin an investigation rather than waiting to see if the changes represented a trend, or mistaken measurements. At their insistence, I ordered an ultrasound to check the amniotic fluid around the baby as well as parameters of baby’s growth and well being. But I could see they were still worried –her especially.

“Do you have any other questions?” I asked, trying to keep the smile on my face.

“Do you think it might be the fluid around the baby?” she said, her smile weakening considerably.

“It’s a possibility, I suppose,” I said, trying to stay neutral. “But I really think it’s just baby’s position…”

She strengthened her smile, but I could see it was an effort and she hesitated at the door. “The fluid is the responsibility of the placenta, isn’t it?”

I nodded carefully. The placenta plays a roll in amniotic fluid production, but the whole process is complex and interrelated with multiple other contributing factors. And yet her pregnancy had been, and continued to be otherwise unremarkable. She was only a week or two away from her due date so even if there were problems developing, induction of labour was not out of the question…

She shrugged –also carefully, I thought- and left the examination room holding her partner’s hand.

The ultrasound was normal of course –normal fluid, normal growth of baby… all parameters were normal. I’d also sent her for an NST (Non Stress Test) –a form of monitoring for the baby that correlates its heart rate with various things such as movement, contractions, etc.- and it, too, was normal.

She came to the office the day after the tests without the camera. Her smile was back, and she wore her enthusiasm like a brightly coloured blouse.

“Where’s the camera?” I asked in mock surprise. I hoped she hadn’t been so frightened by the tests that it had discouraged her video blog.

Each time I see her, I am amazed that she can extend the width of her already face-swallowing smile when asked a question. “I’ve decided to shift the focus” –she rolled her eyes at her unintended pun- “and concentrate on the compartments…” I must have looked puzzled, because she explained immediately. “Some things are just meant to stay in the background,” she said. “Important, yet anonymous.”

I didn’t pursue the reasons. I suppose some things –background things- feel more comfortable in the shadows and away from public scrutiny.

As luck would have it, I was not on call for the delivery. And because it occurred over a weekend, she was not even in the hospital when I returned on the following Monday. I only saw her several weeks later for her post partum check.

She was the same ebullient woman, though; nothing could dampen her enthusiam –not even the crying infant she was snuggling as she came into the office. Everything had apparently gone well and she had no complaints or problems. But I just had to ask. “Did you manage to video the delivery?” I said with a smile. She nodded excitedly, obviously pleased that I had remembered. “And the Delivery..?”

She looked puzzled and her forehead furrowed, but only briefly. “Oh, the placental delivery, you mean?” She immediately shook her head and her unstoppable eyes twinkled yet again. “It’s so…disgusting,” she said after searching for the best word. “And once it came out, they put it in a little bowl somewhere in the background and I guess we forgot about it… We didn’t even name it.”

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s