Genetic Counselor

January 14, 2008
11:49 am

We were supposed to see a Genetic Counselor right after our Level II ultrasound on Wednesday, but since my consult with the perinatologist* started late and lasted longer that expected and John had to go back to work by the time the u/s was actually over. I was tempted to cancel my apointment with the GC altogether (because at the time I saw no value added in talking to her) but John pleaded with me that I talk to whoever I could about my anxiety, so I rescheduled my appointment with the GC to Friday morning. John picked me up at home at 9:45 and we headed downtown to Hartford Hospital. I was a bit skeptical about the whole thing, but I've gotta say, I had a GREAT consult with the GC: I feel much better about my blood and u/s results (she did a great job in explaining those to us), while, of course, continuing to understand that they offer me no guarantees (but, refreshingly so, she didn't focus on the possibility of what could go wrong - no matter how unlikely - but on the fact that everything was very positive).

THE CONSULT: She started it by asking John and I about our family history (whether everybody was healthy, etc. - John's family is 100% healthy but I have 2 cousins - that I learned genetically don't impact my baby - with mental problems). She then went over our blood test results and explained to us, in detail, what each of the 4 elements of the quadruple screen meant. My main questions was in regard to timing - I had my AFP at week 21 and 3 days when the cut-off is at 22 weeks (the lab doesn't have data past that time) - I was concerned, in the event I had miscalculated my conception date and I was actually later in on my pregnancy, I asked her if the results were still true considering the facts and if the data had been compromised, as a result. She reassured me that I am OK there, as the lab wouldn't have performed the tests if they didn't have data to measure my blood count against. Then we went over the level II u/s results. She said that the doctor (perinatologist - for definition, see below) who performed it was one of the most experienced doctors in the Hartford area, that my results were fantastic, that the machine was very accurate and that the odds, of us having a baby with special needs, based on these tests were much lower than a risk of a miscarriage with us having an amnio. She asked me to think rationally about whether the amnio would make sense - and even though "rational" is not a word that is in my personal dictionary these days - considering the results and how against it John is, I've decided not to have it.

The hard thing about this pre-partum depression is the unpredictability of how I'm going to feel. I've been doing really well for the past couple days but I have no idea of what's gonna hit me in the next few days. As a result of doing well, John and I were able to pick colors for the baby's room (pink, light brown and the paneling will be ivory), we bought a car seat at Target, we decided that we would try and work on organizing the house to get ready for baby, etc... The crazy thing is, I feel so good when I'm doing things for her, I love it when she throws kicks and punches and shows me that yes, she is here to stay and I love looking at my belly and actually "seeing" how fast she's growing now (I believe at this point, babies grow quite rapidly - weight -wise it is about 6 ounces/week)... It feels so real. I am just hoping that I can keep this up and that I can somehow stay somewhat positive for the next 3 and a half months... We'll see

* Perinatologist: An obstetrical sub-specialist concerned with the care of the mother and fetus at higher-than-normal risk for complications. Since the perinatal period, depending on the definition, starts at the 20th to 28th week of gestation and ends 1 to 4 weeks after birth, a perinatologist logically could be a obstetrician or pediatrician but, in practice, a perinatologist is an obstetrician. The comparable area of pediatrics is neonatology. A high-risk baby might be cared for by a perinatologist before birth and by a neonatologist after birth.

Level 2 Ultrasound - The day After

January 10, 2008
6:13 pm

Why am I a wreck? (Well, I am a wreck for many reasons, but episodes like the one I will talk about don't help me at all!) Because even after we had what is considered a great ultrasound, the baby looks great, she didn't show any "soft markers" and the doctor now reduced our chances of having a baby with abnormalities from 1:1400 to 1:2800, the OB, who knows that I've even been offered MEDICATION to ease my depression, said to me: well, OF COURSE these screening tests don't mean much in terms to giving you any guarantees, that is because the only way for you to know for sure that your baby is OK is by undergoing an amniocentesis or waiting until your baby is born. Okay, at that point I thought to myself - so why did I bother coming here and having this u/s? I u-n-d-e-r-s-t-a-n-d that of course those tests are merely screening tests and that they are not diagnostic and that of course, on a rational level, I understand all that. But what I really needed to hear from that doctor was that we are OK, that our baby girl is OK, that I can now go ahead and enjoy our pregnancy as opposed to what I actually heard, which was that those tests could be wrong…

Furthermore, why are there so many medical professionals out there against the amnio and why do doctors tell you to do the screening tests 1st and only after decide if you want to go ahead with the amnio (and I know, of course, that many people can and do elect to bypass screening tests and go right to amnio) -- Could it be because the amnio has a 0.5% chance of causing a miscarriage?!!! Gosh! Arrrrrrrrrrrrgh. Anyway, I spent the day today at home, working, and yet AGAIN today I didn't study, (cuz I'm still very unmotivated to do so), but overall I really did have an OK day (which in my book means: not overly obsessing in a bad, bad way over my daughter and it means no crying - except for when I watched "A Baby Story" on TV and saw the successful birth of a couple of beautiful babies - but even so, that was "good crying"!!!). I caught myself watching my baby's ultrasound pictures and smiling away AND my husband came home at lunchtime and we sat together and talked for 30' - a very rare occasion - at which point he said to me: you know, now that you've been staying home, I should be coming home at lunchtime more often to see you. My definition of a GREAT day, actually! In reality, if John will really be able to come home at lunchtime, God only knows, (even though I know he honestly has every intention to, but I also know how crazy work can get so I kinda doubt that he'll be able to, at least as much as he wants to), but it doesn't matter. I SO cherished my time with John today and I was very thankful for that time too.
And, the truth is that it is moments like these that I think that no matter how our baby turns out to be, she is a product of the most beautiful love story of John and I and she'll be so lovely, as well as wanted, loved and thoroughly cherished during every second of our lives.

Level 2 Ultrasound

January 9, 2008
12:02 pm

I am now one hour and 28 minutes away from my level II ultrasound* and I am getting more and more anxious... Will my baby be OK? Will I be able to - finally - picture her as a healthy baby? Am I going to be able to enjoy my pregnancy, once and for all? Is my anxiety level going to either disappear or at a minimum go down? * The level II ultrasound is also called a targeted ultrasound, because it refers to a 'targeted' examination of the fetus – this is possible because those u/s are much more accurate than standard screening ultrasounds. “Level II ultrasounds are typically conducted by a perinatologist, fetal medicine specialist, or someone else who specializes in high-risk pregnancies and who is trained to look for the markers of chromosomal disorders.” Level II ultrasounds look for structural markers are abnormalities in organ and bone formation.

Placenta Previa

January 7, 2008
9:13 pm

Another Monday is here and yet one more day that I didn't leave my home. Here the culprit: on Saturday, 12/29/07, John and I woke up, made love, talked and right before we went downstairs to have coffee, I went to the bathroom and then I realized that I was spotting -- but only slightly, and since sex hadn't been painful and the quantity of blood was so small, I didn't really worry about it. We went about our business; we had breakfast, shopped, prepared some appetizers for a friend's New Years' Party, etc. That night, at about 9ish, we had dinner and right after I took my 100th trip to the bathroom that day I realized that I was still spotting and that the blood was actually turning brownish in color, like the way it got to be towards the end of my period. I told John what was going on, but also that I wasn’t worried at all about it, John told me to, at a minimum, call my OBG-YN to let them know what was going on with me (I had had spotting early in my pregnancy and it was no big deal to my OB - they couldn't pinpoint the cause and it was business as usual, hence us not worrying at all about it this time}. The doctor on call called me back right away to know what was going on and when I told her about the spotting, she got a bit aggravated and was like: "You are 6 months along, you can't mess with these things at this point and you have to come to the hospital immediately!" So, John and I got in the car and drove to a deserted maternity ward at Hartford Hospital. I guess people don't get sick or have babies around New Year's Eve?!

When we got there, I was taken to a room where a jolly nurse helped us get settled and a very nice doctor from Nigeria puts this contraction monitor on my belly (I was not having any contractions). He then decided to do an ultrasound on me to make sure the baby was OK. As he is looking at the monitor, he decides to examine my cervix and to do an intra-vaginal u/s (VERY uncomfortable!). Just as he is looking cautiously at the monitor, the lady doctor who had called me, comes into the room. We were having small talk when she looked at the monitor. She stops talking to me and starts talking to the nice doctor in doctor-language. So the 2 doctors start to talk like: - Look how low it is? Think it’s placenta previa? Oh, I think so! At this point John and I are looking at each other and I finally say: What’s going on? Think you can explain it to us in like layman's terms? The doctor tells me that my placenta is lying unusually low in my uterus, next to or covering my cervix and that until they had a Level II u/s done on me (which will be in a couple of days - this Level II u/s, BTW, had already been scheduled due to my incredible fear and inexplicable anxiety that my baby has a congenital malformation) that I should be in total and complete bed-rest. She even threatened to keep me overnight in the hospital, but since I wasn't bleeding anymore nor having any contractions, I asked her to please let me come home.

So here I am. It’s been 9 days now and I’m beyond bored but I've been really good about not moving much. I am loving the "working from home" part but hating the "not doing anything except sit on the couch" part. I am beyond anxious about the Level II u/s, in reality for reasons other than the placenta previa (because of my irrational fear that my baby is not developing like she should). I have a couple days to go and I can’t wait for some assurance that things are OK with both of us girls. It’s actually 40 hours and 17 minutes to be exact.