Today we got back from our trip to Hawaii. Because Fred just took a bunch of time off, we had to schedule the nuchal for today so he didn’t miss work again. We were home by 9:30am and really tired, so we napped before our 3:30pm appointment.
I found out which doctor was on the unit that day (the perks of going to the hospital where you work) and texted her in the morning. I wrote, “are you in FEU today?” She wrote back and said “yes, see you at 3:30! :) “ I was really happy she knew already I was coming, even without me telling her. The wait time to be seen wasn’t too bad (I’ve heard otherwise at times). The tech we got was not super friendly or talkative. She barely spoke to us through the scan. It was so different than our first ultrasound. I told her my due date and she said, "well we base it on your period." I said fine and didn’t argue, knowing I would talk to the doctor afterwards to get it revised. Midwife note: An accurate due date is really important, especially for a first baby. The most accurate time to have a pregnancy dated by sonogram is around 7-8 weeks. At this time, the due date is based on your last period, but if there is a discrepancy of more than 5 days, the due date is changed. At 9-13 weeks, the due date is based on your last period, but if there is a discrepancy of more than 7 days, the due date is changed. An accurate due date is important, especially for women who go past their due dates. It can help you to avoid an early induction (the cutoff for induction is no more than 42 weeks in most cases, but often practices say even earlier like 41 weeks). The fetus was in there and now looks like a baby! Crazy! The fetus was also not very cooperative. It wouldn’t move in the right position for the nuchal. Finally she got it and it was normal. Phew. She printed us two pictures (that honestly aren’t very good). Midwife note: The nuchal fold is an area of the back of the baby's neck. This is measured as a screening for chromosomal abnormalities. In things like Trisomy 21 (Down's syndrome) the nuchal fold can be increased. It is still considered a screening and there are times where the neck fold is elevated that things are normal with the fetus. If it is elevated, further testing (like NIPT or invasive testing) are recommended. I asked that the doctor come into the room and she did. She was super friendly and awesome, as usual. We talked about the due date and showed her the first scan. She changed my due date in the system. I’m so happy because it would have been 10 full days off had we not changed it, and the new measurement wouldn’t have indicated a change from last period. Long story short, really happy we had the early scan. We left, happy with everything. We went to dinner at a place called Empanada Mama, which is an old favorite restaurant, and had a great dinner. We sent pics to our parents which they were very happy about.
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We had been trying to tell Fred's sister about the pregnancy for a few weeks, but we kept getting delayed.
I searched my brain for a good, creative way. Finally, I just came up with printing a picture of an ant and writing “Linda” under it. We were going to give it to her and ask her to help us solve a brain teaser. I printed that paper and carried in my purse a few weeks before the actual date. We got to their house and his sister had so much to talk about, we could barely get a word in! Finally, we asked Fred's mother to go play with his niece to distract her (since we weren't ready to tell the kids yet) and we were able to get his sister alone. Fred asked if she would help with a brain teaser and handed her the folded paper. She opened it up and screamed “I’m going to be an ant?!”. We shushed her and his niece (from the other room) said, “what?”. His sister quickly made up something about having ants in our house (which we don't, btw) and it wasn't questioned. Here is the picture we gave her below. Today was our first official prenatal visit with the midwife, Jo.
We scheduled our visit first thing in the morning so as to (hopefully) avoid any of our clients seeing me. I had already done my bloodwork the week prior, which was all back for Jo to review. My Panorama test is still pending though, which is nerve wracking. I found out yesterday that the lab hadn’t even started to process my results yet, and that made me go crazy. I basically called the lab, talked to whoever I could and even reached out to the lab rep, about it. It’s still pending without a result date. I completely understand the feelings people have about this test now (and we aren’t even finding out the sex). Midwife note: Non-invasive prenatal testing (NIPT) or cell-free fetal DNA (cffDNA) is a test done as early as 9-10 weeks. This test screens for Trisomy 21 (Down's syndrome), Trisomy 18 and a few other chromosomal abnormalities. This test is quite accurate as a screening (NOT diagnostic as it doesn't test for everything), with 98-99% accuracy. Many people like it because you can also find out the sex of the baby. This test is relatively new (within the last 5-10 years) and was originally offered to only to high risk women (those over 35, family history of abnormalities, etc). Now it's becoming more of the standard of care. It is similar to the sequential screen, which tests for abnormalities and is also not as accurate. In our practice, we pretty much offer this test to everyone. Our visit was a pretty standard first prenatal visit. We talked about my medical history, medications/supplements and what to expect for the pregnancy. Jo catered a lot of the visit toward Fred and focused on what he didn’t know. We then attempted to listen to the heartbeat. Since we were able to hear it already last week at home, I felt confident we would find it. It sounded normal. We did see one of my clients on the way out. I had attempted to have Fred leave first, but it was probably kind of obvious what was going on. Luckily, our clients probably won’t ask questions. Even though I’m still really early (just over 9 weeks), I brought home the good doppler from the office today so we could try to listen to the heartbeat.
After some searching, I was able to find it! It was so exciting to hear the heartbeat for the very first time. Before I got pregnant, I prepared myself for the worst nausea and vomiting (N/V). As a midwife, I’ve obviously seen varying levels of N/V. For myself, I expected the worst because I have such terrible motion sickness. Anytime I get on a boat with serious waves, I lose my lunch. So I thought that would transfer over to pregnancy.
I was wrong. I have not had a day of sickness. Maybe a tiny bout of nausea here and there, but mostly that’s associated with not eating or being on the subway. So yeah, no morning sickness for this girl. Of course in the early stages, I was actually nervous about this lack. Most people attribute N/V to surging levels of HCG and healthy pregnancy. I think there is one study that actually says N/V is related to intelligence in children. Many people feel that nausea is a good sign because it reminds them they are still pregnant and things are okay. So when you don’t have that (or really anything besides some breast tenderness/swelling), you kind of start to think about it. Most of the time, I felt fine about it and often would forget I was pregnant (kind of). But occasionally I’d have moments of panic being like, “is it in there?”. Once, at about 7.5 weeks, I was at the hospital and actually snuck a sonogram machine into an empty triage room and checked to see the heartbeat (yes I found it and it was there). I can’t wait til I’m “out” at the hospital and I can ask that nurse if she remembers that night and wondered what I was up to. As I moved through the first trimester acting quite normally (exercise routine the same, etc), I frequently reminded myself that no sickness was a blessing. I am happy to report I was able to continue to exercise at least 4-5 times per week with very little change to my routine. I was able to eat normally and healthy (as healthy as I usually am which I’ll admit could be better). So many people can’t exercise or eat like that in their first trimesters and really beat themselves up for it. I am grateful for the easy first trimester that I was blessed with having. As a midwife who can often work long hours and overnight, it was especially helpful to not be sick all the time. I can’t even imagine having to throw up during the day at our tiny office, with people definitely starting to wonder. I am pretty sure none of our patients suspects a thing. Midwife note: N/V in pregnancy is quite common, even though I didn’t have it. So many (the majority actually) of women do have some degree of nausea and many have some vomiting. What can you do to keep it at bay? Well, there’s lots of suggestions out there and here’s some top choices.
If your N/V is getting severe or you can’t keep food/liquid down for prolonged periods of time, please contact your provider to discuss options that are best for you. When we found out about the pregnancy and figured out the EDD, we realized it would be so fun to tell our parents on the same day when they were together on Christmas.
The waiting proved to be difficult to some degree, because my mom arrived on 12/21. After lots of fake drinking and some other hiding, we actually managed to keep it from her. Thank goodness she’s not very observant! And it was well worth it. On Christmas, we arrived at their house. Lucky for us, very shortly after arrival, my mother in law suggested we open gifts. We saved the best for last. We framed the picture (which really looks like a little blur, haha) and bought two matching frames. We insisted that they open them at the same time and for his parents, to open it together. Fred’s parents noticed first. They both jumped up and ran to us. My mom was a little slower to realize, maybe even from a bit of shock about it. I caught her with a little tear and she stood up too. Everyone was extremely happy! Hugs all around :) Fred’s dad did say he had a slight suspicion from the week before. He had made a whole pitcher of whiskey sours and I kept saying no. He said he wasn’t sure, but there was a glimmer of hope and thought about it for him. My mom was the most surprised since we had been with her for 4 days already and she hadn’t noticed. We pointed out some of the funny things she missed (fake drinking, especially the night Fred drank two beers), mentioning my breasts looked bigger, etc. Midwife note: There are actually several websites devoted to fake drinking and how to do it. I'll spare the links, but a quick google search should yield plenty of options. We were so happy to give our parents this wonderful gift. Fred's father said, “take all the other presents back, this is the only one we need.” and his mom said “you guys will make great parents." My mom said she couldn’t believe “my baby is having a baby.” As expected, Fred’s dad would be periodically grinning when I looked at him for the rest of the day. Midwife note: When to tell people about the pregnancy is a very personal decision. There is no right or wrong time or too early. We chose to tell our parents at just over 6 weeks. This was based on many factors, but most importantly was that if I were to miscarry, we would tell them. We wanted to be able to lean on them for support. My philosophy as a midwife is the same and I tell my clients the same thing. If you would share your miscarriage, why not share the news of the pregnancy? Fred and I had both taken off the day since my mom was here visiting. We decided that it would be good to have the first ultrasound that day so we could have proof to tell our parents over Christmas. So we lied to my mom and told her we were working.
The tech was really nice and chatty. I told her who I was and what I did. I was really, really nervous (is the embryo in the uterus, does it have a heartbeat, is it twins). I was a bit shaky. I held Fred’s hand really, really tightly. Midwife note: A pregnancy outside of the uterus is called ectopic pregnancy. This is most commonly found in the fallopian tube. It can be very dangerous if not diagnosed early. First we saw the gestational sac. I said “thank god”. The we saw the embryo and then the heartbeat. She even played it a little for us. And just one embryo in there. Phew. I watched pretty intently. I noticed I had an ovarian cyst and I said “is that a cyst?”. I was really chatty and kind of distracted her, I think. She actually forgot to get the heart rate reading and had to do it again. Luckily the uterus is tilted up and she could do this abdominally. Midwife note: At early gestations, the ultrasound will likely need to be done transvaginally. This is because the uterus and embryo are still small and it is hard to visualize abdominally. We asked her for the extra pictures and she happily printed them for us. The ultrasound showed my EDD to be two days earlier than I calculated. I requested that the estimated due date reflect my measured results from ovulation tracking. They did this for me and I was happy about that. Two extra days makes a difference! Midwife note: A later EDD is usually preferred because of the common occurrence of going "late" or past your due date. A few extra days can make a difference at the late stages of pregnancy. It was so great to see the heartbeat and just confirm. I have no idea how people wait until 12 weeks or don’t do scans at all. I definitely understand why someone would want to go for an early ultrasound! Today was our celebration of Christmas with some of Fred's family since they were going to be away for the holidays.
We had planned to keep it a secret and so we were hoping nothing would come up to give it away. Fred’s father always makes his "famous" whiskey sours. He made a full pitcher and offered to me. I declined (I almost always have one). He asked me at least 2-3 times more to have one and each time I had to decline. Midwife note: Don't drink alcohol when pregnant. This is usually a no-brainer. His brother-in-law also offered me cider, which I had to decline. It was amusing because Fred’s family usually isn’t so pushy about drinking. I'm wondering if anyone suspects. “It’s positive." This is what Fred said when we saw the positive pregnancy test today. We didn’t expect it. I mean, we wanted it. We had been “trying”. I was feeling weird (more about that later). But we had some negatives last month and even a few weeks ago, so we weren’t getting our hopes up. It was an odd combination of happiness, surprise and also reinforcement (ah yes, that’s actually why I felt weird). I stopped birth control in August, right before we moved to the house. We had sex a few times and called it roulette, but it wasn’t really trying. My first period was 28 days from the prior one. Okay, great, the cycle is regular. Midwife note: The average cycle is 28 days from period to period. An estimated due date is based on this 28 day cycle. For women with longer or shorter cycles, this could affect the due date and an early ultrasound is often recommended to be sure the due date is accurate. The second period was….not. I was due for my period on my birthday and we planned to go to a spa in NJ called SoJo. I woke up and no signs of it. I even brought a tampon with me. We went and enjoyed the spa. It was great. We had taken several home pregnancy tests (HPT) and we even bought some from the store (most were taken from the office stash...#midwifebenefits). On 10/16, I even made Fred do my blood at home. I helped him do it then snuck it to the office to send it without the receptionist noticing. Then I checked my results and signed them before another midwife saw them. My progesterone was kind of low, which of course made me worry I have some kind of issue. Turns out it was probably because I was about to ovulate. This is part of why we don't routinely check progesterone levels. It makes everyone nervous. I had started tracking my temperature already, but it was mid cycle when I started and I was still trying to learn what it meant. Then my period still didn’t come. My graph of temps was all crazy and finally it spiked around day 34 and we had sex around that time. It was strange - I had a desire to have sex around that time. I also had some weird nipple pain around ovulation. I complained about that. It felt like they were chafing all the time. During this time, I also talked to my midwife partner and even to an Ob/Gyn about potentially seeing me to figure out why I wasn’t getting a period. They both reassured me, as I would have done if I was counseling someone. My temp went down and I started spotting only 10 days after ovulation and I got my period finally on day 45. Now I started analyzing short luteal phases. Oy. Also I had PMS again and another zit (it is important to know that this is bothersome for me since I was not a person to get acne ever). I started to wean off coffee a bit during this time and got down to one cup of regular. I didn’t do much else though - still drinking my occasional beers and definitely exercising the same. Midwife note: Caffeine is considered safe in pregnancy, in moderation. The safe amount is 200mg per day which is about one regular sized cup of coffee. However, it is important to note that it's known that caffeine crosses the placenta. This means some women choose to give it up. Cycle number 2 of monitoring temp had to be better, right? I was good about the temp taking. We had sex a lot around day 12, hoping ovulation was at the “normal” time. I had mucus signs too. But alas, the temps remained low-ish. Then I had a crazy work week and couldn’t monitor them for a whole week. That was frustrating since last cycle had been really consistent and I wanted to know what was going on. Around day 23, we started having sex again (after I had slept for days basically). We had sex twice. It seemed that my temp went up and I ovulated on day 25. The app thought I ovulated on day 12, but that doesn’t seem to be the case. I had gotten this red mole (called an angioma) on my neck and then after googling it, found they were associated with pregnancy so we did take a preg test on day 29, but it was negative. I had also started snoring, but that also correlated with buying a new bed. On day 31, I had a low temp. I got really crabby that day and emotional, very much like my PMS self. I think a few days later I had a zit and again PMS. I was getting my period, too soon, again...or so I thought. The next day the temp was back up. The temp stayed up. I was counting the days past the probable ovulation. I decided to finally order that cycle monitoring bracelet, Ava, since I figured I would need it. Even with the temps up, a friend was in town visiting and we were busy with him and I wanted to wait until almost day 16 post ovulation to take a test. On day 13 past ovulation I had some left lower quadrant (abdominal) pain, very mild, but noticeable. On day 14 past, I had a weird sensation in my abdomen. Basically it felt like I had done a bunch of crunches and my abs were sore. It didn’t hurt, just noticeable. I was googling like a person who is not a midwife, spending time on Baby Center. I had a feeling this was not my period, but also in heavy denial. I went to the dermatologist to get the red mole removed and she was like “are you pregnant?” and my response was “I don’t know.” I had it removed. Midwife note: It is important to note that getting a mole removed in pregnancy and having local anesthesia are both safe. If someone had skin cancer in pregnancy, it would be important to know! On day 15, December 5, we talked about taking a test. I was trying to convince myself we needed to do a first urine of the am. I also was trying to wait until day 16. Finally we decided to just do it. I had taken some pregnancy tests from the office. Midwife note: The hormones of pregnancy (HGC) are strongest in the morning, with the first urine. When Fred got home I was making dinner. I had to pee before we ate, so I left urine in a cup. Then we ate and Fred was done before me. I told him to go in and dip the stick to let it sit and we would look when I finished. Midwife note: Pregnancy tests should be left for five minutes to get an accurate reading. We went in the bathroom and looked at the same time. “It’s positive”, Fred said. I said nothing. We hugged. We looked again. We hugged. Holy shit, it had happened. We dipped another stick, just to be sure and see how fast it turned. Then we went to pick up the laundry. We talked a little about the pregnancy, but also the normal stuff like getting the laundry. It took a few hours for me to say that I was pregnant. I can’t believe it still. I wonder if this is how everyone feels. We are thinking of when we’ll do first ultrasounds, appointments, etc but also thinking way far ahead to next year. I am trying to stay grounded, because we never know what will happen. Let’s get through the next few weeks. Midwife note: The risk of miscarriage is highest in the first trimester. Each week, the risk gets lower. What’s really fun though - my mom is coming for Christmas and we will all be together. It’s a good time to potentially tell our parents since they will be together. It will definitely be really early, but we have decided we want to tell them early since it’s not like we wouldn’t tell them about a miscarriage. I have a thousand things racing through my mind now and just trying to process it all. I guess I’ll read some pregnancy books now. I have always told my patients “Oh I never read those" which is true. I have only read one book ever and that was because it was required for school. |
ElaineA pregnant midwife living and working in New York City Archives
April 2019
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