Boy or Girl?
R. and I have been debating over whether or not to find out the sex of the baby. “If you don’t want to know, don’t look in your file,” my doctor said. “It’s in there.” Tomorrow we have the anatomy sonogram, where surely the proof will be clear. At the last sonogram, the technician told us to look away while she examined the posterior view if we didn’t want to know. It all feels a little silly — we have to make an effort to avoid the information.
Whenever I tell anyone I’m pregnant (a relief to explain my expanding frame), the first question is “Is it a boy or a girl?” We don’t know, I say, further explaining that this is by choice. The reaction varies. Parents usually say, why not? and I feel as if I have to explain my unpopular decision which is — I just don’t want to know. At first I thought I didn’t want to know because the entire pregnancy (plus six months) has been one of too much information, and not knowing is sort of a relief. Let’s keep something traditional, R. and I told each other.
A couple women have told me that they felt the pregnancy was so much work that they wanted a reward, and finding out the sex was that reward. Right now I feel that being pregnant is enough. I don’t want to rush into any realities. Perhaps finding out the sex would make this more real. Maybe I want the fantasy of it a little bit longer. R. said a lot of people don’t understand what we’ve gone through to get here. For most people, finding out the sex is just another step in a natural, spontaneous process. We are still catching our breath from months of treatments followed by months of nausea.
But lately we are tempted by the information in the file and on the screen. R. says he is 60/40, leaning towards finding out. I’m still holding out. I think my desire to not know also has something to do with possibilities. Is it a boy or a girl? Will it rain tomorrow or will it be sunny? Will we find a larger apartment by December or will we buck up and squeeze one more (little) person (with lots of accessories) in our small one bedroom? For some reason, I like not knowing any of it.
Final Amnio Results
The lab didn’t screw up! Yesterday morning I checked my voice mail at work and received an unceremonious message from my doctor’s office that “your lab results came back okay.” The woman on the machine sounded tired and the news lost some of its punch but still, we are relieved that the waiting period over.
Now R. and I are in the “this is real” mode and acting uncharacteristically giggly and sweet, imagining what it will be like to hold our new baby, to see it’s little mouth make sucking motions, or cuddle up on R.’s chest to sleep. I know it won’t be all sweet and heartbreaking. I know it will be hard and stressful, too. But for now we need to have this happy period that we’ve denied ourselves for so long.
Still, I am only at the end of my fourth month and the remaining five feel endless.
Preliminary Amnio Results
Dr. L. called today with good news. Yippee! The preliminary results mean there is a 99% chance that all is well. Darn. There’s that one percent again. But we are thrilled with the results, even if we have to wait another two weeks for the 100% okay. Dr. L. explained that there is a 1/1000 chance that preliminary test (they stain the cells) produced an incorrect reading. For the past ten years, their labs had a 100% accuracy rate. But three months ago one woman was given a-okay preliminary results and the conclusive testing showed otherwise. Poor woman. But we couldn’t have had better news today so I will stop whining and worrying for now. And try to be happy without being suspicious.
Adventures in Amnio
On Tuesday we had the amnio. Over. Done with. Now we wait.
But back to the amnio…it started out promising with an ultrasound pre-show. This was especially nice because R. had only seen the rapid and blurry CVS ultrasound a few weeks ago. But this time we made sure the technician took her time and pointed out what was going on, not that we needed much help identifying the punching fists, the fish bone spine, the shadows of his or her brain. And it was the first time R. saw the heartbeat. Sigh. It was a little emotional as our blob is becoming more and more real. Which makes this test all the more annoying.
Dr. L. told me I’d feel the needle go in and a little discomfort for about a minute. I deal with these things by not thinking about them and by not looking at needles. I watched the monitor — the baby was quiet, not moving around. Then I felt the needle go in and thought, that wasn’t so bad. Then it keep going in and I felt a pop which must have been the puncture of the uterus. I jumped. I watched the needle dive into my uterus on the screen and wake up the baby. As Dr. L. said, “You weren’t supposed to jump” we watched the baby swat at the needle with both fists. R. panicked. “Did you hit it?” Dr. L. said, “Don’t worry, the needle can’t hurt it.” Was that a definitive answer? We still debate. Once the needle was in, the baby kicked into action, curious, we think, about this new event in it’s environment. Think about it. If a giant needle plunged through your roof, wouldn’t you try to touch it or push it away?
Later R. told me he had to turn away. Again, he sat to my left and behind me so I couldn’t see him during the procedure. Still, last night, he questioned whether the baby was hit by the needle or not. I never thought it did. Because the ultrasound was 2D, it was hard to tell where all the bits and pieces really were. After R. brought up his doubts for the tenth time since the procedure, I started to doubt it to. But I know it is silly. Everything went fine, if not a little surprising.
No cramping or frightful gushing of fluids after the procedure. For that I am thankful because I’ve come to expect the 1% things to happen to me. The fluid she extracted looked like it was tinged with iodine (anyone remember sunbathing with baby oil and iodine?). She said it was the pigment from the blood in my hematoma which is still there (darn) but looks like it is healing. Again, can’t get too worked up about things. Heal, hematoma, heal.
We just want good test results so we can start enjoying this pregnancy because the further along we get, and the bigger I get, the more excited we become. I want to let myself sink into that excitement, but I still have the brakes on.
CVS day
This morning R. and I arrived at Columbia-Presbyterian for our CVS. Being a good patient, I arrived with a full bladder (as instructed). Unfortunately, we then had to wait an hour and a half. Advice to others — don’t start sucking down the water until you get there. But that’s the least of the day’s worries.
First, the technician performed a quick ultrasound. R. and I had been looking forward to it since he hadn’t seen one before, but the technician barely took notice of us and didn’t bother to point of the heartbeat, the size, or give us any “cute” views. While she was poking around, I caught sight of the heartbeat and was relieved.
After Dr. R. arrived, things happened fast. We told him we were concerned about my bleeding and wondered if the ultrasound showed anything. He said, yes, and pointed out a small subchorionic hematoma. A what? A small clot between the placenta and the uterus. Okay, so that caused the bleeding. He explained that any bleeding in the first trimester increased my risk of miscarriage. So that put me at an increased risk of miscarriage with the CVS. So what did I want to do? Could I handle waiting three more weeks for an amnio since I am at a “high risk” for Down Syndrome? What options! What a decision to make laying on your back with your skirt hiked up to your armpits. I didn’t like anything he was saying, but my gut said to wait. I’m more concerned about maintaining the pregnancy then any chromosomal defects. That choice wasn’t immediately clear, but it’s the one we ended up with. When the doctor presented our options, it almost felt like a game. He wasn’t giving anything away. He couldn’t tell us what to do, but he gave some aggressive hints. We got it. Slowly.
Dr. R. came to talk to us after I changed. He had texted my OB (they are in the same practice) as we had requested. The doctors had given us different opinions on whether or not to continue taking the baby aspirin I’d been taking for the past two months. When I started bleeding last week, we thought we should stop the aspirin. But she said the benefits outweighed the negatives. Dr. R. felt differently. In fact, he said he wouldn’t have performed the procedure anyway if he had known I was on aspirin. The fact that this information hadn’t been relayed to him by our doctor or the genetic counselor ticked us off. By the time we left, we had decided to change doctors and hospitals.
But we calmed down. At home, we both got on the phone with Dr. L. who talked us off the ledge. She assured us the small clot didn’t pose a big threat to the pregnancy. It should resolve itself and slowly absorb (into the bloodstream?). The risk is it could get larger and cause a separation of the placenta. I like this doctor because she knows how to talk to patients, and she is not an alarmist. Dr. R. wasn’t as reassuring, but he was also the one who was about to perform a risky procedure on me.
I was feeling okay about all of this until I started googling subchorionic hematoma and reading about the 50/50 chance of miscarriage. Three things can happen: 1) the clot will go away on its own, 2) the clot will get larger and the placenta will separate causing a miscarriage, or 3) we could have a very premature birth. I’ll write more about all this later but right now I need to chill out. All in all, this appears to be somewhat common occurrence and my clot isn’t large so things should resolve themselves. But it’s our new worry of the day.
Prenatal screening
On Monday, I had my NT (nuchal translucency) scan. The test results will indicate the chances of Down Syndrome and a host of other chromosomal abnormalities. Last week my doctor was optimistic: I might have an excellent score and we could forgo further screening. Or it could be in the middle and we might opt to wait for the amnio. Or it could be not great and she’d recommend a CVS, the earlier, slightly riskier procedure.
The test itself is simple and non-invasive. In fact, it was kind of fun. The technician was a friendly, Eastern European woman who obviously enjoyed her job. She needed to get a clear shot of the neck away from the uterine wall (or whatever it was pressed against). The little guy was sleeping. She pointed out the encouraging, strong heartbeat. Good sign. The size of the fetus had doubled since the last screening less than two weeks ago. “I need him to wake up,” she said. “I need him to turn over.” She pressed her paddle into my abdomen and shook it around. I felt a little bad about waking him up from his nap, but we needed to get down to work. “There he goes,” she says, and points out the feet and arms (two of each!) kicking and punching back and forth. I wasn’t prepared for that. Legs? Kicking? In quick paddle like motions. Kick, kick, kick. Pause. Kick, kick, kick. And the little arms and fists scrambling in the air (or fluid). It was a Disney moment. Aw, isn’t that adorable! How wonderful. How amazing!
Then she switched views and showed me the 3D version. This I was not prepared for. This I had not seen in my “What to Expect” book, nor the books Dr. L gave me last week. “What’s that?” I asked, watching this tiny birdlike creature stretch and claw under a sheath of tightly pulled skin. “What the heck is that?” She explained it was a 3D view and more like what the fetus actually looked like. I felt a little sick. I wasn’t prepared to see the un-Disney version. It was real, it was fascinating, but it was a little too much for me. Later, I walked most of the way home, despite the 95-degree heat wave. I stumbled along Broadway in my flip-flops, soaking up the Dominican ambiance, watching all the people who started out as blobs of flesh and bone.
Later, R. said, what did you think? That they start out fully formed? No, of course not. I guess I hadn’t really thought of it. The technician presented me with a handful of snapshots from the session. Two of 3-D view and the rest from the regular ultrasound. One of the latter was particularly clear and showed a shapely little skull with rounded forehead and button nose. I placed that one on the top of the stack and posted it on the refrigerator.
For the next day or two I kept talking about how disturbed I was by the 3-D image. R. scolded me, telling me to stop obsessing about it. I told friends how detached I felt from the pregnancy, how seeing that image had made it more real but more unsettling. I’d lie in bed and think about the creature growing, quickly now, and that half formed face, that alien head without every feature in place. It will grow, R. assured me. And maybe that is what I found most disturbing about the image. That it wasn’t fully formed. That I’d seen it in a state of growth, unfinished, and I fear that that is how it will remain. But I was thrilled to see two arms, two legs. Even fingers and toes.
Yesterday a work, while interviewing a very nice programmer from India, my doctor called me on my cell phone. I knew if I didn’t answer it would be another day or so before we connected. I left the poor guy in the conference room for fifteen minutes while I roamed the halls trying to find a hot spot where my phone worked. Dr. L. assured me that the bleeding I’d experienced the night before was probably nothing to worry about since I’d had a good scan on Monday and she wanted to talk to me about my NT scan. At 3:30am, I’d woken up terrified to see what looked like a heavy menstrual flow. How could she be sure nothing was wrong.? She went on to tell me that my NT results were in line with my age. Basically, we didn’t get the reassurance we wanted. When she told me my range from the test and the range from my age, I quickly calculated that my test, in fact, scored lower. I looked back in the glass enclosed conference room and watched the interviewee click away on his PDA, glad that he had a distraction. Standing in a sea of empty cubicles, I remembered that someone was having a going away party in the larger conference room. I could talk about the risk of Down Syndrome openly, without walls or glass enclosures.
Dr. L. was recommending the CVS and for next week. Rattling off numbers and risks, she assured me the procedure was safe and that their facility was top-notch. I knew I would do it, but said, I have to discuss with my husband. Of course, she said, probably knowing that my decision had been made. I didn’t cry on the phone with her. How could I? I had to get back to my interview. She suggested R. and I meet with a genetic counselor the next day (today) that, she said, would make us feel better about the risks of the procedure. Sure, I said. Of course, more information.
When I went back to the interview, our time was up. I apologized profusely, and wondered if he could read the notes I had scribbled on his resume, the only piece of paper I took with me when I left: CVS, 1/38, 1/ 35, genetic counselor.
I told R. he had to come to the appointment with me on Friday, and that he had to come to the CVS. I’m through doing this alone, I said. I refuse to go to one more appointment by myself and swallow my heart as I watch the ultrasound monitor search for the heartbeat, and hold my breath until I see that fluttering heartbeat pulse on the screen. I realized the last time he’d come to appointment with me was the retrieval, and he had to be there for that. I was feeling very alone.
Talk it one day at a time, he reassures me. And I think, easy for you to say. You aren’t living, breathing, thinking this pregnancy every second of the day. You aren’t the one being prodded and poked, waking up in blood soaked underwear, reading books and searching online for risk factors and what every gurgle and strum of your body means.
Last night I went for a walk in Riverside Park. With the break in heat, the park was busy with dog walkers and joggers and kids coming home from softball games. My irritation with R. for not being there festered. But I realized as I walked along that I wasn’t alone. That I’d been feeling this way, accompanied?, for some weeks now. It’s a strange comfort to know that I’m not alone. And maybe I wouldn’t have felt this way if I hadn’t seen that disturbing image of protoplasm and bones. However unformed, it’s hear with me, every step of my day. Which makes the thought of something being wrong sadder than I can put into words.
First OB visit: a whole new world
Babies in the waiting room, women with bellies stretching against pleasantly pliant fabric, smiling nurses and aides in floral print scrubs. I felt like an intruder. Where is my solemn waiting room? Here, at the Columbia-Presbyterian Maternal Fetal Medicine group, pamphlets with cute baby faces prevail. At the fertility offices, intruders with babies were quietly whisked away to back rooms. But now I am pregnant. No need to be shy or protective. Here they act as if all will be well. The inverse of the thinking I’ve become accustomed to: all is treacherous; all is uncertain; all is risky.
I like my new doctor, but I’m suspicious of her lack of scrutiny. No ultrasound today? No, and I find out I might only have two or three during the entire pregnancy. But I’ve had three in 9 weeks! The fuzzy black and white images have reassured me, the fluttering heartbeat, so fragile and real.
Dr. L. asks me what I want to do about screening. No, she asks me if I want to screen. Of course, I say. What do you want to do, she asks? My god, I have to make a decision. Isn’t someone going to do this for me? She presents the options clearly, offering up an NT (nuchal translucency), a CVS and amnio. I’ll take all three, I think. She explains my options and only advises on the NT for now. It is the least invasive and the one we can perform next week.
I jump on a Monday appointment. The NT (or nuchal fold scan) can help assess the risk of Down syndrome, and hopefully some other chromosomal abnormalities. I think of that little neck in last weeks scan — amazed that it had even formed so early. It was more like a curve that connected the torso and head, that huge head.
Here’s a description of the test from www.babycenter.com:
“The NT test uses ultrasound to measure the clear (translucent) space in the tissue at the back of your developing baby’s neck. Babies with abnormalities tend to accumulate more fluid at the back of their neck during the first trimester, causing this clear space to be larger than average.”
Okay, seems simple enough. Non-invasive. No risk. Dr. L. says if the results look good, I may decide not to do further screening. If it looks so-so, I can do the amnio. If it looks poor, we go for the CVS. The CVS presents a higher risk of miscarriage, but if we think there is a problem it is better to find out sooner rather than later. This all seems like a bit of a crap shoot. I know I will want the amnio no matter what, but she is right to point out the NT may ease my mind for a few more weeks.
I ask her if she ever advises against an amnio. She says never.
