Week 22 Update: Meeting the Perinatologist

Well, there's lots to update you all about...

I have been dealing with a great deal of pain in my back, hip, and leg.  It seems like it could be sciatica or possibly what they call "pelvic girdle pain".  I already struggle with this leg because I have congenital hip dysplasia in the left hip which has also caused all sorts of issues with my left knee (in addition to injuries from a horseback riding accident) and back.  That is why they think that the issues have started so early in the pregnancy.  Yay for me! *rolls eyes* 

But, I had a WONDERFUL prenatal massage this morning.  This was a Christmas gift from Brian.  Felicia Gaines Sachs from Healing Through Bodywork came to the house for my appointment.  She was amazing: compassionate, empathetic, gentle, thorough, and knowledgeable.  She had excellent "table-side manner", communication, advanced knowledge of anatomy and pregnancy, and the "magic touch".  I hope that I can afford to have her come back.  She was able to work on the areas that are causing me problems and I am hoping that I get some relief tomorrow.  For today, the muscles got sort of irritated which meant that I had some issues with the sciatica.  No numbness in my foot or leg, though, which was a treat.  I felt very relaxed afterward and had a nice nap. 

I had my blood drawn on January 10th for the Glucose Tolerance Test.  Then we had an appointment with the midwives on the January 12th.  Things with my health are really going well.  My glucose came back normal, which is wonderful considering the high risk I am at for gestational diabetes.  They will check my glucose levels again around 28 weeks.  My blood pressure is still great, my weight is still the same from losing fat at the same rate as the baby is growing, and my regular blood work was normal.  I wound up having to see the midwife that I don't like, but the appointment was rather quick, and we had to prepare for another appointment the next morning so I was distracted. 

We did hit a bit of a "speed bump".  They had run a Quad Screen on my blood to screen for birth defects and the results came back abnormal.  I was referred to the Antenatal Testing Center at Monmouth Medical Center for an appointment with a genetics counselor and with a perinatologist from the Maternal-Fetal Medicine Department.  Maternal-Fetal Medicine is a group of obstetricians who specialize in high-risk pregnancies.  A perinatologist is an ob/gyn the specializes in problems in pregnancy.  The Antenatal Testing Center has more sophisticated equipment to test for issues in pregnancy, including more in-depth and sensitive ultrasounds.  Because our anatomy ultrasound was incomplete, a Level II ultrasound was included in our appointment. 

We met with the genetics counselor first on at our appointment on January 13th.  She went over our family histories and a brief summary of the test results.  The marker that is used to screen for spinal abnormalities was a tiny bit high (one tenth of a point).  Our risk was very low that there was any spinal abnormalities, but due to the fact that we got no good images of the end of the spine in the last ultrasound, there was a concern about spina bifida, which is where the backbone and spinal canal do not close.  She felt that the anomaly on the blood test results did not warrant further testing besides the Level II Ultrasound. 

Next we had the ultrasound with the ultrasound technician.  She got lots of good images for the doctor.  The baby was much more cooperative this time.  Peanut was head down and stretched out which made it much easier for the tech to get images of all of the anatomy.  She did have some difficulty because of the extra abdominal fat that I have from being overweight.  I spent most of the scan lying on my left side, faced away from the monitor.  I didn't get to see much of what was going on, which made me a little sad.  What I did see was great, though, because this type of ultrasound has much more detail.  Peanut looked like an actual baby and not an alien!



This is Peanut at the 20 week anatomy scan.  This is the only printed image we were given.  Looks like an alien...or Skeletor!

The perinatologist, Dr. Nath, came in to finish the scan.  He took lots of measurements and got extra pictures of the spine.  Then we met with him in his office to go over everything.  It turns out that the midwives were not clear about the concern over the test results, and the one result was not the only one that was abnormal.  Dr. Nath is concerned because ALL of the hormones that they measured were abnormal.  Apparently, the placenta is "leaky".  It is producing unusually high levels of hormones and pumping them into my blood stream and into the amniotic fluid.  The good news is that they were able to see through the ultrasound that the placenta is otherwise normal.  It is good size, has a normal shape, has a nice smooth texture, good blood flow, no tears or abnormalities, the umbilical cord insertion was great, and the umbilical cord had normal blood flow.  The level of amniotic fluid was also normal.  Dr. Nath felt that Peanut looked healthy and normal with no spinal abnormalities.  But he is concerned about the hormone levels from the placenta and will be keeping a very close eye on us from here on out.

So, we will most likely not be able to see the midwives anymore and will be followed by Maternal-Fetal Medicine for the remainder of the pregnancy.  We are a little sad that things have become more complicated, but we felt really comfortable with Dr. Nath's expertize and are confident that his care will increase the likelihood that we prevent any further problems and effectively handle those that we know we now have.  This doesn't mean that we will have more problems, I could go on to have no other issues at all.  It just means that we will be watched closely to catch any problems from the very start if they should crop up.  It is sad, though, because we were really hoping to avoid this type of medical involvement.  With the high level of stress and added emotional content from the miscarriage and fertility issues, it would be nice to avoid the high-drama and high-stress situations which come from including specialists.  That being said, we want the very best for Peanut and will do whatever it takes to make sure that we are both safe and healthy. 

Here is Peanut at the Level II Ultrasound

          Dr. Nath gave us other news, too...

PEANUT IS A

GIRL!!

Please keep me and this little girl in your thoughts and prayers.  We are hoping that everything stays normal and healthy and that this placental issue turns out to be a nagging worry and nothing more.

Thanks!  We'll be keeping you updated when we can...

Week 20 Update II: Anatomy Scan

One would think that being pregnant after struggling with infertility would be a relief.  I truly wish that were the case.  What seems to be reality for most is that the struggle with infertility permanently changes how you relate to your body and how much you trust "nature", your body, and yourself.

In my case this has meant that I have a strange and overwhelming feeling that I am deluding myself into thinking that I am pregnant when I am really not.  I got past the constant fear of miscarriage, but not the fear that *something* is wrong.  I feel movement, have heard the heartbeat, and have seen the baby on the ultrasound screen; yet, I can't seem to shake his sense that the whole thing is unreal, that I am "making it all up".  It has made it extremely difficult for me to bond with the baby and I have felt really guilty about that.  I just don't trust my body anymore.

We were hoping that the anatomy ultrasound would help remedy some of these issues.  I hoped that seeing that everything was fine and seeing the baby in there would stop the doubts and that knowing the gender would help me bond with the baby.  I thought that seeing that my body had managed to support the pregnancy thus far and created a healthy baby, placenta, and umbilical cord would help me begin to trust the process.

We invited Brian's mom along to the scan.  She had never seen a pregnancy ultrasound before and we thought that it would be a nice experience for her.  My mom lives eight hours away and wasn't able to be there, so we planned to call her on the phone so that she could be a part of things.  We waited a long time for our appointment as they were busy and running behind.  We finally got our turn and the ultrasound tech got started on taking the images that they needed.     

The point of the anatomy scan is to determine whether the dates are correct for the pregnancy, that the baby is the appropriate size for the gestational age, and to check to make sure that there are no defects, malformations, or other issues with the fetus' anatomy, the placenta, amount of amniotic fluid, or the uterus and cervix. 

Here is a list of what they want images and measurements for:

• Face (profile, lips, nose)
• Brain (ventricles, choroid plexus, mid-brain, posterior fossa, cerebellum, cisterna magna, measurements of anterior and posterior horns of lateral ventricles)
• Skull (shape, integrity, Biparietal diameter-BPD and head circumference-HC measurements)
• Neck (nuchal fold thickness)
• Spine
• Heart (rate, rhythm, 4-chamber views, outflow tract)
• Thorax (shape, lungs, diaphragm)
• Abdomen (stomach, kidneys, liver, bladder, wall, umbilicus, cord and cord insertion, abdominal circumference- AC)
• Limbs (femur, tibia, fibia, humerus, radius, ulna, hands, feet femur length- FL)
• Genitals (gender, abnormality)
• Cervix (length and opening)
• Placenta and amniotic fluid

The ultrasound tech was able to get good images and measurements of:

• The placenta, which has a fundal location.  That means it is at the top of the uterus, which is great. 
• The amniotic fluid level was fine.
• The umbilical cord and cord insertion looked good.
• The baby's abdomen was normal, though they need more images for liver, kidneys, and bladder.
• The heart was perfect.
• The top of the spine was looking great, though we need more images of the end of the spine.
• The neck looked OK and she got clear nuchal fold measurements which will indicate the risk of Down syndrome
• All of the brain and skull measurements were normal and images were clear.

The baby was in a longitudinal lie in the breech position with it's legs crossed underneath it, its arms held tight to the body, and it's head down and leaning forward (sort of like it was looking at my cervix).

Peanut was in this position with its head down, tough it is MUCH smaller

It made it so that we weren't able to see or get images of the face, thorax, limbs, genitals, and cervix.  The ultrasound tech tried changing my position, having me walk the halls briskly, and having me use the restroom.  Nothing was getting Peanut to budge.  Despite all of the pushing and pressing from the transducer (which is the paddle that transmits the waves through the abdomen), Peanut was enjoying a cozy nap.  We were there for a really long time trying to get the images before the tech decided that it was time to give up. Peanut was not going to cooperate.

They made us an appointment on the 18th to come back for a follow-up ultrasound to get the rest of the measurements and images.  We'll hope that Peanut is less stubborn and more cooperative at the next appointment. 

We went out to lunch after the ultrasound and when we were riding in the car on the way to the restaurant, I felt Peanut start moving around.  Of course!  Peanut was also active after I ate my lunch.  Maybe the fact that the next appointment is after lunch will be helpful. 

I left the appointment disappointed.  Not because I didn't know the gender, which is the impression that people seemed to get.  It was a letdown because I can't say that I know that everything looked fine and I can just relax.  I am trying to remember that our parents and grandparents survived their pregnancies not knowing what was going on "in there". It is difficult, though, as I already pointed out, when you spent your entire adulthood dealing with hormone imbalance, convinced you would never conceive or have a normal pregnancy.  I am doing my best to relax and enjoy the process.  But it is HARD.  And Peanut is stubborn.  I guess I will have my hands full.  :)

Week 20 Update: Happy New Year!

20 weeks

It's January 1, 2012 and we're 20 weeks today. 

We're very much looking forward to all that 2012 has in store for us! 

2011 was a mixed bag:

We got married, got pregnant, lost a number of family members, had friends and family move away (and one very important one move back), made some new friends, lost touch with a few friends, were reunited with some family members, dealt with illness, had friends welcome new babies, saw friends lose jobs...it was a roller-coaster sort of year.

I was not at all sad to see 2011 come to a close since it was such a whirlwind.  I am imagining, however, that 2012 will be nearly as chaotic, though infinitely more happy, with this baby on the way.

Our holiday was really wonderful, despite the fact that I felt pretty rotten when we started our travels to Maine. I was still struggling with the cold and feeling totally exhausted. The exhaustion only increased, but I was able to enjoy all of the celebrating and visiting despite it. We were able to spend lots of quality time with our five-year-old niece, my Mom, and my step dad. It was the first that I saw my Mom since finding out that I was pregnant. I was not really "showing" still when we arrived at my Moms, but Peanut decided to make its presence known while I was visiting. I think it was nice for my mom to be included in that since she is so far away. She was the first to notice how much I had "popped". She said, "How in the world did you grow so much in three days?!". I think it might have had something to do with the nausea and vomiting finally abating and all of the eating the occurs at Christmas.

Me and Punky on Christmas Eve

My Mom & Step dad gave me maternity clothes...so now I don't have to go and buy them

We were able to visit with my step dad's wonderful family, most of whom I hadn't seen in years. It was so nice to spend time with all of them and get to see how much they enjoy spending time with my niece. I am sure Peanut will enjoy the same amount of love that she does. We also had a nice time visiting with my other stepfather, who took us out for a nice dinner with our niece. We would have liked to do more visiting and see more family, but I was just too tired and felt that it was most important that I spend whatever time I could afford to with my niece. Brian and I are extremely close with her and it has been hard being so far away from her. I have also been struggling with the changes that I know are coming once Peanut arrives. Next Christmas, I will have an infant to care for and won't be able to give her much undivided attention.

Me and my niece on Chrismas Day

The Peanut has become quite the wiggly worm!  I feel lots of movement these days, which is so nice.  Brian hasn't been able to feel it yet, though our niece swore she did.  It doesn't really matter if she did or not; thinking she did was enough to make her feel special and included.  Peanut definitely can hear pretty well.  When our niece had two rough nights with very loud tantrums, the baby went NUTS.  I think Peanut must have enjoyed all of the bedtime stories that we read together.

The clothesline was so cute!

We made a stop in Connecticut on the way home to attend my cousin's baby shower.  We were able to squeeze a visit in with my Dad, who lives in Virginia but had work in Connecticut while we were there.  I hadn't seen my Dad since we found out, either, and it was great to spend what time were we able to with him. I was able to see some of my Dad's family at my cousin's shower.  My Aunt even had a gift there for us.  She crocheted the cutest little hats and two blankets for Peanut.  We stayed for a little while, but then pushed on home so that I could sleep in my own bed.  We had hoped to do more visiting in Connecticut, but, after all of the travelling and visiting, I had had it.

Peanut's hat & blankies

I slept for nine straight hours that first night home!  It was so nice to sleep through the night for a change.  Brian and I had a very low key New Years Eve.  We spent the day and night together at home, cuddling on the couch, watching TV, and resting.  It was lovely. 

We have one more Christmas left to celebrate tomorrow with Brian's family.  We are looking forward to seeing them.

We hope that you all enjoy a happy, healthy, and prosperous new year filled with love.