16-Week Doctor's Appointment

What would otherwise have been a quick and routine appointment was quite amusing. Although most of our past appointments have been on Friday afternoons, and yesterday's mood should have been no different, the staff was just downright giddy and chatty. It could have been all the drama, which was above average the nurses were saying, and had been occurring non-stop throughout the day. I pressed for details about what had been going on. The latest was an induced pregnancy that wasn't progressing quickly enough and when the baby's heart rate dropped suddenly, an emergency c-section was ordered and the doctor I was supposed to see a mere half an hour later was summoned upstairs. (The clinic I go to is on the ground floor of the hospital - one of the reasons I chose it.) Uh oh. Sorry I asked. But no one seemed too alarmed. Just an average day at the hospital for them.

While I was assigned a primary doctor, the clinic uses the early appointments to introduce the patient to each doctor in the practice, because depending upon who's on call when you go into labor, any one of them could end up delivering your baby. With my doctor called away to perform that emergency c-section, I met instead with a nurse, who answered questions and listened to the baby's heart. At 151 beats per minute, the baby is doing fine.

Like everyone we encountered at that appointment, the nurse was bubbling over with advice. My next appointment will be the big and long-awaited 20-weeker, and the first opportunity we'll have to learn the sex of the baby. As you know from previous posts, Chris and I are still "in discussion" about whether we want to find out. This is the main question nearly everyone - stranger or friend - has posed. The majority of folks, well, the ones who have had kids, fall into the "We just had to know" category, while a small, small minority confidently report that they had wanted it to be a surprise.

What I find interesting is the people who have more than one kid and have done it done it both ways. Chris's Aunt Judy said they found out the sex of the baby with their last child and the excitement of finding out was the same as it was with the first two, except instead of happening at birth, it happened a couple of months earlier. I had never thought about how finding out early doesn't "ruin" the surprise, because it's a surprise whether you found out at 20 weeks or at the birth. Aunt Judy insisted it's still as special and emotional of a moment no matter when you find out.

The nurse we saw yesterday had kept it a surprise until birth with her first child, but for whatever reason, she and her husband decided they wanted to find out early with their second child. She helped put the issue of keeping the sex of the baby a "surprise" in perspective. To her, the sex is just one of many surprises. Even though she knew at 20 weeks she was having a girl, the excitement and anticipation of having another child wasn't lost. What was she going to look like? Who was she going to take after? What was she going to be like? What were they going to name her?

Unlike many who act like you're nuts if you don't want to do things exactly as they had done, the nurse left it at the decision being ours, and there's no one right decision. Chris sat on the far side of the exam room with the biggest grin on his face. He who hates surprises, looked as happy as a kid who'd been told he could open his Christmas present a early. However, before he turns too optimistic, no matter how much he had begged this past Christmas, he wasn't allowed to open his present from me even one day early. The present sat under the tree and stared back at him until Christmas morning.

The rest of my appointment was quite routine. I had blood drawn again, this time for the Alpha-Fetoprotein (AFP)screening, a follow-up to the Nuchal Translucency (NT) screening, sometimes referred to as the first trimester screen. Since the results of the first test were good, only the AFP was recommended. This test provides information about the risk of neural tube defects, such as spina bifida, Down syndrome and other genetic problems. The AFP test is only a screening test, not a diagnostic test, so even if I test positive, most likely I'm still carrying a healthy baby. The only way to tell a false positive result from a true birth defect is through diagnostic testing, such as amniocentesis.

The name of my favorite podcast - Pregtastic - is pretty funny, but the shows have provided a lot of great information. Some of the topics, had I come across them in a baby book, I would have just glossed over. Two issues came up recently: blood cord donation/banking and newborn screenings.

I was brought up to believe that regularly donating blood is part of your civic duty, like voting. When I heard about cord blood donation, I felt like it was something I couldn't not do. Because the blood is collected from the umbilical cord after the baby is born, donating doesn't hurt me or the baby and the umbilical cord is going to otherwise be discarded. It seems like such a waste of an opportunity in which you have one shot (unlike blood donation) for so much potential. Cord blood is rich in blood-forming cells that can be used in transplants for patients with leukemia, lymphoma and other life-threatening diseases. Cord blood is one of three sources of cells used in transplant; the other two are bone marrow and peripheral (circulating) blood. Finding a matched bone marrow donor can be difficult and time-consuming (have biological relatives be tested, having them donate) but cord blood does not have to match a patient's tissue type as closely as donated bone marrow does. It has the potential to be stored for decades and can be put into use relatively quickly. Even if the cord blood is not suitable for transplant, it can still be used for research.

Unfortunately, Minnesota is one of many states that does not have a system for collecting and donating cord blood, and this really surprised me. I live in a major metropolitan area with one of the largest medical schools in the country, so this is just something I assumed I would be able to participate in. The nurse gave me some ideas for other ways to donate cord blood, which I'll look into. Marrow.org is a good resource for learning about cord blood donation: http://www.marrow.org/HELP/Donate_Cord_Blood_Share_Life/How_to_Donate_Cord_Blood/index.html

Parents can also choose to bank their baby's cord blood in the event that the baby, a future sibling or a family member related biologically to the child develops a disease that can be treated with cord blood. In light of the new movie My Sister's Keeper, based on the book of the same name by Jodi Picoult, about a girl who was conceived in the hopes she would be a bone marrow match for her sister sick with leukemia, cord blood banking rises above as the more ethical alternative. While banking is available to us in Minnesota, it costs around $2,200 in the first year and then $125 a year for every year after. You can find more information at http://www.viacord.com/.

At least there was some good news when it came to newborn screenings for certain genetic, metabolic, hormonal and functional disorders. Twenty-nine diseases can be screened for in newborns, yet not all states automatically perform or require the complete set of screenings. The baby is tested for hearing loss and the 28 other disorders (such as phenylketonuria (PKU), hypothyroidism, galactosemia and sickle cell disease) by collecting droplets of blood from a prick in the baby's heel. This is all done before the baby leaves the hospital. Most of these birth defects have no immediate visible effects on a baby, but, unless detected and treated early, can cause physical problems, mental retardation and, in some cases, death. Thankfully, not only are Minnesota hospitals required by law to screen newborns for all 29 disorders, so I know our baby will be taken care of, (one less thing to try to remember to look into in the chaotic hours and days after the baby's birth) but it's not easy, according to the nurse I saw, to nonchalantly opt out of the screenings. This ensures that nearly every baby in Minnesota will receive proper treatment for these rare, but life-altering, conditions.

On our way out of the clinic, the nurse at the reception desk scheduled me for my next appointment, (scheduled for June 3 in my 21st week instead of 20th week due to scheduling conflicts) and upon noticing it'll be my 20-week appointment, asked without fail whether we want to know the sex of the baby. Dressed in hot pink scrubs, she fell into the aforementioned "We just had to know" category, because she needed to know whether everything was going to be all pink or all blue. Chris said I looked like I just wanted to vomit.