A Mother's Worst Fear

This week marks 27 weeks pregnant. I'm not quite in the third trimester, but I'm feeling very big and emotionally done. Here's why:

Due to the nature of my educational background and my previous job, I've learned a lot about pregnancy. I've also learned that a lot can go wrong during a pregnancy. Seriously, it really is a miracle that any of us are alive when you think about it. Some things are preventable just by diet (think getting adequate folate and other vitamins/minerals and drinking plenty of water), staying active, not smoking or drinking, that kind of stuff. Other things are just out of our control. That is my story.

At 12 weeks pregnant, I learned that my routine lab results came back with something unusual. My bloodwork showed that I was positive for the anti-kell antibody. While not unheard of, it's certainly not a common situation. In fact, my doctor hadn't seen anyone with this particular antibody since her residency nearly 10 years ago. Thinking that it could possibly be a lab error, she had me retested around 14 weeks. A week later or so, I learned that I still tested positive for the anti-kell antibody. Not feeling comfortable with treating this particular case, my OB soon referred me to a Maternal Fetal Specialist in Lubbock, a trip that would take two hours one way.

For those of you, like me, who don't know what an anti-kell antibody is, DON'T google it like I did. You'll find all sorts of horror stories and worst-case scenarios that would make any expecting mother to worry. I don't know everything about it (in fact, not a ton is know about it in general), but I have the basic idea of what it is and what it means. First off, it has nothing to do with the Rh factor in blood types (think O- as apposed to O+). Everyone asks me about that. Completely different. In fact, treating someone who is Rh negative (like me) is very easy nowadays and simply requires some shots during the pregnancy and oftentimes afterwards, too. It's very treatable and almost never a threat to the fetus or mother. Anti-kell, on the other hand, is not so easy to deal with.

About 1/10 people have the Kell antigen in their blood. I was Kell-negative but somehow got exposed to Kell-positive blood. Most of the time, this happens through a blood transfusion, but that was not the case for me since I have never had one. Likely, my first child is Kell-positive, and I was exposed to his blood during pregnancy and delivery. My body didn't recognize this antigen, and so it created antibodies to fight and destroy them. That's why I have the antibodies now but not with my previous pregnancy. The problem occurs when a mother with these antibodies is pregnant with a Kell-positive fetus. Those antibodies can cross the placenta and cause severe anemia for the baby by affecting how the red blood cells are formed. This, in turn, causes a whole host of issues affecting things such as muscle development and can even be fatal for the baby.

Not exactly something an expecting mother wants to hear about.

But, there was a chance it wouldn't happen. It came down to one blood test. If it came back negative, we would be in the clear with a near 0% chance that the baby would be born Kell-positive. If the test came back positive, then there would be a 50/50% chance. In order to have this blood test, however, we had to do a lot of waiting and jumping through hoops.

So, after waiting a few weeks, I got an appointment in Lubbock to see the high-risk doctor...except my first appointment was with a nurse, asking me all of the same basic health questions that my other OB had already gone through (there was definitely a lot of miscommunication going on). And I got another basic pregnancy blood test. Then about two weeks later, I got to see the "regular" OB, who THEN referred me to the high risk doctor. And got another blood test (because apparently they didn't get enough blood the previous time, so a couple of the tests couldn't be done). Finally, at 22 weeks, I got to see the high risk OB and had an ultrasound done. All seemed fine there. Finally, it was down to that single blood test I mentioned earlier.

At 25 weeks, we finally got the results back. Yeah, it took three weeks to hear back about them. There was confusion at the lab they sent the blood to, and then once the results came back, no one felt the need to call to tell me about it.

The result? It came back positive: we were in that 50/50% chance of the baby having the Kell antigen.

During this whole time, I had had moments of freaking out, of worrying. I had several priesthood blessings of reassurance and peace. By 25 weeks, I actually was feeling kind of numb about the whole thing. I felt like I had been waiting forever, kind of in limbo, not knowing what was going on.  I felt like I was always calling someone, trying to figure out what I was supposed to do next. There was a definite lack of communication between me, the doctors in Lubbock, and my OB here in town. And while I had had those blessings telling me things would be fine with the baby, I couldn't seem to shake that nagging feeling that something was still going on.

Finally, another appointment was made, fairly quickly, actually, for me to go back to Lubbock. Just a couple of days ago, at 26 weeks, I had another ultrasound done. From what I could see, everything looked fine and normal. The baby was moving, heartrate was healthy, everything seemed normal. The doctor, however, saw and measured things that I didn't know anything about.

During the ultrasound, they can measure blood flow through certain major arteries in the baby (kind of cool, huh?). For us, they measured the middle cerebral artery (MCA) peak systolic velocity. In other words, they measured the velocity or rate of blood flow of a major artery in the brain of the fetus. They then compared that value to my previous ultrasound and noticed that there was a significant increase in the velocity of blood going to the brain. What does that mean? That my baby was already showing signs of anemia. Not severe, but working it's way there. Basically, that 50/50 chance of the baby having the Kell antigen became a near 100% chance.

Not going to lie, I kind of lost it at this point. Not while I was with the doctor, but I cried most of the drive home, that night, and the next day. It's like in my head I had this gut feeling that the baby would indeed have to go through this, but when the doctor actually explained things to me, it really hit me. It's hard for a mother to think that her own body is attacking her unborn child, and she can't do anything about it, and for me, it's likely to keep happening for any future pregnancy.

So, what are our options now? I have another appointment two weeks from this one I just had. They will again do an ultrasound to see where the baby is at. However, my doctor feels that after that, I'll probably have to go in every week to get monitored. If the MCA velocity gets too high, then interventions will have to be taken. Depending on the gestational age of the baby, an early delivery might be possible, but if we're too early still, then the baby will need a blood transfusion. Neither of these options sound particularly great, but, oddly enough, I do feel like we'll still be able to have a healthy baby after all of this is over. 

I'm not sure why I feel the need to share all of this. I think it's just my way of processing what's going on. You know, life is so precious. I don't think I truly got that until I had a child of my own. Babies and children are resilient, but situations like this make you realize also just how fragile life can be. You realize that the worth of a single soul, even one not born, is priceless.