Even more drama

So, when I had the amnio done, I had been experiencing cramping (much like menstrual cramps, only not quite as severe as mine can be) all morning long.  Which I told the doctors.  What I didn’t say (because I didn’t think it was significant) was that I was having to go to the bathroom A LOT.*  And most of the time when I did, there was very little or no pee.  In my defense, they didn’t seem concerned or much interested in the cramping other than the fact that it might interfere with the amnio so I figured it was nothing to worry about.

Yesterday, I woke up with more cramping and nausea.  I looked in my pregnancy book about contractions and, guess what?  Cramping + frequent (but often ineffective) urination = Go to the doctor because you probably have a bladder infection (UTIs can cause uterine contractions due to the bladder’s proximity to the uterus).  So, I called the ob and made an appt. for that morning.  Since they were squeezing me in, I wouldn’t see my OB but another one.  The doctor was lovely and she checked everything out to make sure everything was as it should be (pelvic exam and vaginal probe ultrasound + regular ultrasound), had me pee in a cup and did a quick test for UTI (negative) and sent the urine sample out for cultures.  She was kind and respectful and the whole thing was in every way the antithesis of the damn amnio office.

The result is that if the culture comes back positive or if my symptoms get more severe in the next day or so I will be put on antibiotics.  In the meantime, I should take it easy and continue to follow the post-amnio instructions:  no lifting anything over 20 lbs, no air travel, no exercise and no sex (considering how painful the insertion of the probe was, that will definitely not be a problem).  But, I didn’t need to continue bed rest and I could use a heating pad and acetaminophen for the cramps if I wanted.  So, I’ve been taking it easy and trying to drink a lot of fluids to flush this thing out.

The worst of all of this is that, before all this drama, I was getting to a place that I didn’t mind being pregnant.  I didn’t feel as bad as in the first trimester, I wasn’t sleeping all of the time, and I didn’t have a nasty cold.  Things were looking pretty good.  Now I’m back to the feeling that pregnancy sucks.  I told Husband today, “The only way we are having a second child is if you get pregnant because I’m not ever doing this again.”


*Really, bladder infection didn’t even occur to me because 1) no burning when I peed and 2) pregnant women are supposed to have to pee a lot.

Amniocentesis, or Why I Sometimes Hate Medical Doctors

I have passed the mystical age of 35 (by 2 years) which puts me into a “higher risk” group for just about everything pregnancy related.  Particularly, doctors are concerned about increased risk of genetic abnormalities.  Apparently, at 35 years old, you cross a threshold in which the risk of having a baby with a genetic abnormality is greater than the risk of miscarriage from amniocentesis.

Husband and I talked a long time about whether we wanted to do amnio or not.  Pretty much, it came down to the question of, “Were there any circumstances in which we would terminate the pregnancy?”  I originally thought there weren’t, but then I read a little on some of the nastier trisomies (fortunately quite rare).  Husband and I decided that if our baby had a genetic condition that caused 50% of babies to be stillborn, 80% of the ones who lived to die in the first month, and 90% of those survivors to die in the first year, well, frankly it would be a mercy to the poor little tyke to terminate now rather than have it go through all of that suffering and damn the Pope and the Church for thinking otherwise.

So, we scheduled an appt. for my 16th week.  My ob doesn’t do amnio herself, she refers her patients to a specialist, Dr. M,  with whom she has been associated with for at least 15 years.  So, Husband and I went to Dr. M’s office and talked to the genetic counselor* who recommended blood screening for cystic fibrosis for me and Tay-Sachs for Husband (who is of French Canadian descent; apparently, being French Canadian increases your risk for being a carrier of Tay-Sachs to 1 in 30).  Then, it was time to do the amnio.

In case you are unfamiliar with amniocentesis, the procedure is done by doing an ultrasound to determine the position of the baby so the doctor knows where to insert the needle.  A pretty comprehensive set of sonograms were taken and Dr. Assistant I  (perhaps a resident or a fellow?) took all kinds of measurements on the baby (bone lengths and such).  He also measured my ginormous fibroids.  Then, Dr. M (a white-haired man who conceivably could have been doing amnio since it was first offered) came in to do the procedure.  Well, he moved that ultrasound do-hickey around for a long time but between the position of the baby and the apparent minefield of little fibroids I have (not to mention the big ones), he was having trouble finding a good spot to poke me with the needle.  So, Dr. M recommended I come back in two weeks to allow my uterus to grow more (evidently, fibroids do not grow as much in the 2nd and 3rd trimesters as they do in the first) to give him more surface area to work with.  So, I scheduled another appt.

That appt. was today.  In contrast to the previous appt. when we had a very good experience with the staff and doctors, this appt. was fairly disastrous.  First, I had been having menstrual-type cramps most of the morning, so I wasn’t in the best state going into the appt. (though glad I coincidentally had a doctor’s appt. that day so I didn’t have to call up my ob).  Second, the office was running an hour behind and the waiting room was so small that there were not enough chairs and husbands were all standing.  Then, I was taken into a much smaller and less attractive exam room than my previous appt. (seriously, it looked like something you might find in an ancient, abandoned clinic somewhere) and Dr. Assistant II did all kinds of measurements AGAIN.  I told her about the cramps.  She seemed completely unconcerned, which was fine except that she kept asking me if I had been having contractions (yes, I think that’s what the cramps are!) and then proceeded to push the ultrasound do-hickey hard on one spot and ask if it hurt.  Yes, thank you, it hurt quite a bit!  So, she tells me I’m having a contraction there, but her primary concern about that seemed to be that it would interfere with the amnio.  Okay, fine, I know you can have contractions pre-labor, though I didn’t think would start so early.  However, I was starting to get very irritated and was about to say the following:

1.  Stop asking me whether I had a contraction the last time I came in.  I have already told you three times that nobody mentioned anything about it and I sure as hell didn’t feel anything.  My answer is not going to change.

2.  Stop telling me to relax.  It’s very hard to relax when you have someone constantly admonishing you, “You must relax!  You have to relax.  Relax.  Relax the muscle.”

3.  If you don’t stop pushing that damn ultrasound thingy on the spot that I am apparently having a contraction I am going to take it from you and choke you with the cord.  The contraction doesn’t hurt, you pushing on it does.

So, then Dr. M comes in with Dr. Assistant I.  Now, there are three doctors, me, and Husband in this tiny little room in which I am supposed to be relaxing.  Dr. M starts scanning my belly and looking for a good spot to do the amnio in between my field of fibroids.  He says I have low fluid volume.  I ask if it’s still safe to do the amnio in that case and he says, that it makes it more “technically challenging” is all and low fluid volume has “nothing to do with the amnio.”  Um, excuse me, if I’m not mistaken, you are about to remove some of the fluid which you have just pronounced to be at sub-optimal volume.  How can that not be related to whether the amnio can be done?  So, he’s looking, looking, looking and he says that the contraction is making it difficult to find a good spot to do the amnio so he’s sending me out to the waiting room to “relax” and to sign a consent form for the use of terbutaline which they will give me to relax the uterus to make it easier to do the amnio.  And he leaves the room.

Dr. Assistant II left some time ago.  Dr. Assistant I is rushing us out of the room.  “What are the risks of taking the medication?” I ask him.  “What?” he says.  “Are there risks associated with taking the medication?” I ask.  “Yes, yes, of course there are risks, that’s why there is the form for you to read.”  And he ushers us out into the waiting room and hands us a clipboard with a form on it.

It is now 1.75 hours since we entered the clinic.  The amnio is not done.  The doctors are not talking to me.  I’ve been given a consent form (with several typos in it, not the most reassuring thing in the world) that explains what the medication is, what it’s supposed to do, what the side effects are, and the risks to the baby but I have no time or internet access to research the drug myself.  I’m feeling rather overwhelmed.  That’s when Husband asks if it’s okay if he goes outside to do a teleconference (!) until the doctor calls me back.  I say no.  He tries to persuade me it will be okay, he’ll come right back in when the doctor comes.  We argue.  In the waiting room.  Where I’m supposed to be “relaxing.”  Suddenly, it’s all too much and I start crying silently.  Another woman in the waiting room disappears back behind The Door to the examining area and comes back with a box of tissues to give to me.

At that point, I go to the desk and say, “Look, I’m freaking out here and the longer I wait, it’s only going to get worse, so I want to speak to the doctor right now or I’m going to leave.”  But, instead of the doctor, I am taken into the back (blessedly out of sight of the rest of the people in the waiting room) to talk to the genetic counselor.  So, I explain what’s going on, that the doctor hasn’t talked to me about this AT ALL, that I want to know what the risks are of doing the amnio under these conditions, that I’m being made to make a decision about a medication I know nothing about and nobody has asked me if I’m currently taking other medications in case they interact badly, and frankly, I’m no longer sure that I’m willing to take the risk of doing the amnio under these conditions.  The genetic counselor (who looks to be too young to need amniocentesis, and therefore I don’t believe she can understand where I’m coming from) is trying to tell me that the risks haven’t changed.  This makes no sense to me whatsoever (and I tell her so) because the doctor has already stated that the amnio will be “technically challenging” that it will be difficult to not nick either the fibroids or the baby and that I’m having to take some medication for this to even work at all so this should put me into a different category than the one in which the original risk was calculated.  My cost-benefit analysis has changed and I’m not sure how and I’m not being given enough time to decide if it’s what I want and I’ve not been given privacy to discuss this with Husband and the damn doctor won’t talk to me!**  Nevertheless, the genetic counselor tells me that the worries about the drug are that it can cause increased heart rate and dizziness in me, that taking it will make the procedure easier and that if there still isn’t a good spot, the procedure won’t be done.  Husband is okay with all of this and as I calm down, I’m starting to be more okay with it.  But, as I told Husband, if there was any hemming and hawing on the part of the doctor, we were outta there.

So, we go back down to where the exam rooms are and Dr. Assistant II is trying to rush me into the third-world exam room because the good one is taken again.  I insist upon going to the bathroom first and when I come out, husband says they are now talking about sending us to another one of their clinic locations.  That is so not happening.  So we’re in the waiting room, AGAIN, and I tell Husband I am waiting exactly five minutes and then I’m leaving.  Nobody else is in the waiting room, I am now the last patient of the day, even though it’s only around 12:30  (it seems they go to another clinic location in the afternoon, this is why they were talking about sending me over there).

Finally, I’m back in the rinky-dink exam room.  Dr. Assistant I tells me they are going to look with ultrasound to see if there’s a good spot.  When I remind him this has already been done (did he forget me already??) he tells me that the baby moves sometimes after you walk around a bit and so the situation may have changed!  Why the hell didn’t they mention this before?  Why wasn’t that the first suggestion?  Dr. M does his scanning thing again and, lo and behold, the contraction is gone, the baby has moved, there’s a good spot for doing the amnio and the thing is done without any medication whatsoever.***

So, now I am at home, on bed rest for the rest of the day as is routine post-amnio, complications or not, and I am supposed to take it easy the rest of the week (no exercise, no lifting over 20 pounds, no air travel, no sex).  The results are supposed to be back in 10 days (they need to grow the cells, first, this is the longest part of the wait).  If I wanted FISH done, I could have results back on trisomies in 2-3 days but it’s an extra $350 and we have some time yet if the results are bad.

So, that was my experience.  I have to say, from a patient-friendly point of view, it was appalling.  The clinic only does ultrasounds and amniocentesis and they seem to do them in a rather drive-thru-like manner.  They had clearly overbooked for the day.  There is no time or opportunity to sit and talk with the doctor doing the procedure.  If the doctor had taken five minutes to tell me exactly what was going on and to address my concerns, everything would have gone much more smoothly.  The fact that they send you back out into the waiting room to make a fairly important decision instead of giving you privacy and the fact that they expect you to sign a consent form without speaking to a doctor is inexcusable.  Really, as soon as this all started happening, we should have just left.  Left and rescheduled or left and decided against doing the procedure.  It was not a life and death decision.  There was no need to make the decision right now other than not wanting to have to go through this all over again.

What this whole experience has done (aside from convinced me that I never want to step foot in that clinic again) is reinforce my conviction about having a birth doula (which, it turns out, my insurance will pay for so there’s no reason not to).  There really needs to be someone who is not emotionally involved to make sure that my rights as a patient are being respected.  I still would like to have an ob do the delivery (although, if I wasn’t taking so many medications, I’d look into switching to a nurse midwife just to avoid ridiculous doctor and hospital mentalities that are so pervasive in the United States).  But, I’m bringing along my own advocate.



*In which the following exchange happened:

Counselor:  How familiar are you with genes and chromosomes?

Me:  I have a PhD in cell biology.

Counselor:  Ah, well, I guess I’ll just skip this next part, then.

**I should mention that mixed in with this mess was the fact that I’m currently taking a master’s class at a local university that meets 8 hours a day for three weeks and that I was already missing one day of class and I didn’t want to miss another.

***It was fairly uncomfortable and nerve-wracking to have the needle shoved into me, but not especially painful, though Dr. M did warn me that if the needle touched a nerve ending I could have pain in, “all kinds of unexpected places,” whatever the hell that was supposed to mean?

An open letter

Dear Maternity Clothing Designers,

I am writing to ask you to reconsider one of your Summer 2011 design choices.  Please know that I appreciate your attempt to provide a stylish alternative to dowdy and/or childish maternity clothing.  However, I think you may not have thought through one of your designs very well.

I am 4.5 months pregnant and have a bit of a belly.  I am assured that I will continue to gain weight throughout my pregnancy and that the weight will not all be distributed in my belly and bust.  Some of it will undoubtedly settle on my thighs and butt.  Therefore, dear Maternity Clothing Designers, your contribution of itty bitty short shorts with a belly band is most unwelcome.  And given that, in every maternity section I go to, there are racks upon racks full of itty bitty short shorts, my fellow pregnant women agree with me.

Please put some capris and walking shorts on the market.  I think you will find they are better sellers than the itty bitty short shorts.


Mrs Whatsit, Phd (+1)

Unsolicited, unwanted advice–check!

I have hear from several sources that something happens when you become a parent in which the normal rule of other people minding their own business suddenly gets replaced by other people imposing their advice and words of wisdom on you as though it is their God-given right.  Fortunately, my mother, grandmother, and mother-in-law have blessedly refrained from doing so thus far.  However, two nights ago, at knit night, I was whacked upside the head with unsolicited advice in a surprise attack by a friend who is the mother of a 5 month old.  Let me give you some background.

I have thought quite a bit about the sort of childbirth I would like to have.  Primarily the words “calm” and “pain-free” come to mind.  “Natural” makes it on the list, but it’s somewhere after calm and pain-free.  I have pretty much rejected whatever method it is that has you breathing short, gasping breaths (popular on TV shows) because it does not seem to be pain-free.   Ever since I heard of it in college, I have been intrigued by the notion of self-hypnosis as a means of coping with childbirth.  Therefore, I picked up a hypnobirthing book at the bookstore and have read it cover to cover and looked up childbirth and hypnosis on pubmed (not too much data there, unfortunately).  There is a lot that makes a very great deal of sense in the book.  The basic premise is that childbirth does not have to be an extremely painful experience and actually isn’t in many non-Western cultures, and, indeed, a woman’s body is designed for childbirth.  However, the notion of childbirth as a horrible, excruciating experience is so ingrained in our culture that women (whether they realize it or not) experience quite a bit of fear going into childbirth.*  During the fear response, blood is directed away from non-essential organs (such as your uterus) to essential organs.  Therefore, the muscles in your uterus will not be able to function at an optimal level and this causes you pain.  If, however, you can teach yourself to relax and remain calm during the birthing process, your uterine muscles will function better and you will have an easier birthing experience.  The exact mechanism of how this all works is mostly supposition, of course, but it seems as though it does work for quite a few women.  The relaxation necessary is achieved via self-hypnosis, though I suppose how you become relaxed is less important than being relaxed and staying relaxed.

Given that I have anxiety problems to begin with,  I am all for learning techniques that will help me relax.  Husband is on board with this approach as is my psychiatrist.  Not sure how my OB will react, but hopefully, she will be supportive.  My mom and grandma seem a bit dubious that it will work but are mostly supportive.  In fact, my mother primarily experienced pain-free childbirth herself.  She didn’t use any specific technique–she reports that, for whatever reason, she didn’t feel her contractions.  Recordings showed her contractions were off-the-charts, yet she had to have a nurse put her hand on her stomach to tell her when she was experiencing a contraction so that she knew when to push.  She felt very little pain overall except for when my brother was born and the doctor used forceps to yank him out (standard at the Army hospital at that time).  So, there is hope.

So that is my reasoning.  However, upon mentioning that I was going to be going to a hypnobirthing class, my friend, M, began to tell me what a bad idea it was.  Apparently, she had some friends who tried hypnobirthing and it “didn’t work” for them.  What she meant by “tried” is unknown (Did they attend classes or only read the book?  Did they practice the relaxation exercises every day for several weeks as is recommended?) and I don’t know in what way it “didn’t work” (Did they end up using a different technique, getting an epidural, having a C-section, getting induced?).  M said several times that she wasn’t trying to tell me what to do while at the same time telling me what, exactly, she thought I should do.

During the course of our “discussion” it became clear that M did not know much about the hypnobirthing method beyond the fact that it didn’t work for her friends.  Her main point seemed to be that you should learn many techniques because “you never know what is going to work for you,” and, “you don’t know how you’re going to deal with childbirth until you are in it.”  The ideas of using different positions, breathing techniques, visualization, and time distortion were all things she mentioned that were necessary and, although I pointed out that hypnobirthing incorporates all of those things, continued to try to convince me that hypnobirthing was not the way to go.  In the end, I just smiled and nodded because it was clear nothing I said was going to register with her.

I think I would have been somewhat more receptive to what she said if it had been couched in terms of her experience (“this is what worked for me” kinds of phrases) and not absolute statements (“this is how it is,” “this is what will happen to you”).  Or, if she was the mother of, say, five children instead of one.

I’m absolutely willing to accept that hypnobirthing might not work for everybody, that, in fact, it might not work for me.  What I object to is being told that it absolutely won’t work based on the limited experience of one person.


*This reminds me a lot of panic attacks.  Panic attacks are triggered by an automatic negative thought which can pass through your brain so quickly, you don’t even notice it.  The panic attack then seemingly comes from out of nowhere.  Cognitive behavioral therapy then often focuses on learning to become aware of these automatic negative thoughts.