Moving on

So I made a baby. The path I took to get there was only slightly unconventional - it would be incorrect to call this an "infertility" blog, it's more of a "trying after a loss" blog, but my experience has inextricably linked me to the IF/loss/etc. community. I have empathized with and appreciated and internalized the struggles of many others and have learned so so much in the process. There are so many of us who have struggled to bring a healthy baby home and who continue to struggle to do so, and there are almost as many reasons for the struggle as there are stories so it's difficult to put a label on this community. It's not just IF, and that in itself contains so many unique challenges. It's also different varieties of loss, and includes adoption stories, SMC stories, AI and the many strata that that term entails, so many different approaches to the ultimate goal - and for that reason I think it is the goal that unites us, in a way, more than the particular challenges we face. Sure there is nothing like sympathy and advice from someone who has actually walked in our shoes, but my perspective has been broadened, my appreciation heightened, by the breadth of experiences in "these halls," moreso than communicating with people who have, for example, been through a molar pregnancy. Both are equally valuable, those who have walked in my shoes make me realize that I am truly not alone and that there is hope for my particular situation. But the larger community has made me a more sensitive, more educated, more appreciative individual. A better person. And for that I will be forever grateful.





This is my story, my adventure, and I've documented it here for anyone that might come across similar issues in one way or another. For anyone who can benefit in any way from what I've been through. It is a story of babymaking.





For the first time in my life, I feel like I've been handed the moon. Like I'm not the unfortunate statistic but rather, one of the lucky ones. Like I've been accorded my wildest dreams - there is nothing in my life that I've ever wanted more than a healthy baby and that's exactly what I got. It wasn't as easy as it is for some, but far easier than it is for many. And thanks to others in this community I believe I can properly appreciate this miracle in a way that I could not have had I never gone through my struggle. This is where the unspeakable misery and fear and anguish that we all share pays off. We are better people for having been through it, and we do enjoy and appreciate parenthood more (and thus make better parents), I am sure of it. All along this journey I was told about how susceptible my plight made me to post partum depression. I was depressed pre-partum for god's sake, there was definitely potential for disaster once the baby arrived. Would the end justify the means? Would I be depressed at the disappearance of the intense anticipatory process? Would I wonder, like my friends have wondered (momentarily usually) "what have I done?" No. I couldn't be more alive, more rejuvinated, inspired, in love. I am in love with my baby and in love with my circumstance in life, notwithstanding my anxieties which, I suppose, will always exist.





So I am moving on from this. My struggle has changed and so I feel there may be a better forum for further musings. A new blog. A new name.





I've entitled it "Everything After." I considered a few other titles - one that I nixed was "Afterbirth," ha ha ha, gross. Also falling by the way side "Happily ever after" (too optimistic for me, don't want to jinx anything) and "The other side." This last one I initially thought as incredibly appropriate because it's the phrase I've always used when approaching a particularly difficult challenge. Like finals, or a speech,...or birth: "See you on the other side," ...just to remind myself that it will be over soon, I will survive to see the other side...or sometimes "see you in the sunshine." But the phrase is most effective when you really are inextricably and necessarily on the other side. When you're done. When that experience is behind you forever. My experience in this forum is more continuous than that. My future in parenthood will continue to be informed by my loss - I am on a continuum. For one, there may be another baby in my future. I'm not "on the other side" with respect to my struggle, struggles in this area will continue, I'm not there yet, so to speak, so I've decided against proclaiming that I've arrived "there." "Everything after," I feel, properly includes everything after the birth of my first child. It's not overly rosy, it doesn't lock me into having more babies or not. It's the other side of my babymaking struggles but a continuance of my life story and just the beginning of my story of motherhood. I've overcome that brick wall. It will be motherhood-focused, infused with thoughts on anything babymaking related, parenthood related, and of course anxieties and true-life adventures. I look forward to the new forum as a clean slate. A new beginning. A new chance to make the best of whatever life throws my way. And a chance for renewal and resolution. A chance to be more present and enjoy more of the moments for what they are rather than living in fear of what the future may or may not bring.

As a side note I didn't realize until a couple days after I chose this title (and after I wrote the bulk of this post) that I probably subconsciously derived it from a Count!ing Cr0wz song called "August and Everything After." I was obsessed with CC for a good many years and derived a lot of meaning and fuel for teenage/undergrad angst from many of their songs. I had a relationship in college that was built in large part on our shared interest in the band. How funny that this would pop up in my head now...and that the title is August and Everything After. Of all months. How funny and how appropriate.

The link is here. Welcome to our new beginning. And thank you, a million times, to all of you for helping me immesurably along this journey.

Birth Story (belated...sorry)

Since the birth wasn't particulary eventful, this is more like a "birth and hospital stay story." I warn you, it's on the long side.

The c-section was a piece of cake. I had fretted about it a little in the couple days before, I started ruminating and panicking about the epidural and the looming recovery process, but it was seriously nothing. It hurt when they put the IV in during prep but that was the worst of it by far. The rest was just weird. The numbing agent before the spinal felt like a tiny pinch, I didn't feel the spinal at all, and I had an anesthesiologist with an awesome, bubbly personality, he really made me and DH feel comfortable and excited. DH was offered the chance to watch the baby being pulled out and to cut the cord and to my surprise he said yes to both. He said it was like something out of the discovery channel. I'm not sure how he didn't pass out. The only other unpleasant part, after the IV, was feeling the pressure of them pushing the baby out from the top of my ute. I felt like I might break in half. I couldn't feel any pain at all but it still took my breath away to be manipulated like that - there were bruises on my stomach from the ordeal. They held the baby up for me to see once he was out. He wasn't crying, he was all blue, he looked like an avatar baby. No one was acting like anything was out of the ordinary but I needed to hear that cry. "Why isn't he crying?" I asked after what seemed like an eternity of patience. "It takes time, this is a big transition, blah blah blah" came the answer. I was asked to have faith once again. Every minute felt like an eternity. This is it, this is when we find out, after four months of this CPC occupying at least a fraction of every thought that passed through my head, this is when the truth becomes known.... He did cry eventually, they had to get a lot of fluid out of him before he could. And his cry sounded healthy. I knew the doctors would be quickly examining him as I lay there on the table and I didn't hear anything alarming coming from the other side of the drapes...only happy sounds. They finished me up, brought the baby closer to my face momentarily so I could see that he had turned from blue to pink, I gave him a kiss, and then they promptly sent the baby and DH to the nursery while I was wheeled into recovery. The whole thing lasted about 40 minutes. 9:30 appointment, baby was technically born at 9:58.

All along, at birth classes and even in the surgery prep room I was told that in the event of a c/s, "if everything was ok" the baby would be brought to me in recovery after a brief trip to the nursery for a bath and a quick check, that we could start breastfeeding and bonding, etc. I lay there in recovery - stunned at what had just happened. A little life had been pulled out of a 6 inch incision in my belly. DH had seen it all. I heard him cry. He was 7.2 lbs. We had a child. And the most exciting thought, he seemed healthy.

The wait was long and as I lay there, marveling at how pregnant I still looked and trying not to freak out that I couldn't move my legs, I resolved to be more positive going forward. I resolved not to worry as much, to enjoy every moment despite there never being a guarantee. And to definitely not worry that the nursery was taking so long to return my baby. He was in good hands, I told myself (more on the nursery later). My parents and sister arrived and they and DH kept shuttling back and forth from my bed to the nursery reporting that he looked fine, that now they were bathing him, now they were weighing him, etc. etc....but they were keeping him for some inexplicable reason - where was my baby? Don't freak out, these things take time, no more obsessive worrying, have some faith for once Astrid. I was keeping it together pretty well 20 minutes into this waiting game but then the surgery nurse tending to me mentioned, "It never takes this long." My heart sank. Something was wrong. And no one was telling me what. Once again my hard-won inspiration to be more positive was met with a slap in the face. I felt so stupid for having mustered some actual faith for those few minutes.

Finally the word came. There were a couple problems - rapid breathing that wasn't normalizing and low blood sugar. For all I knew these were signs of impending doom and when they told me they were both pretty common, particularly in c/s babies, it was hard for me to believe. But it turns out, once again, I should have listened. The baby did spend a good 2.5 days in the NICU but his 'issues' were easily and completely resolved. Every nurse and doctor I've talked to since has been reassuring that they are nothing to worry about, he needed a boost of glucose and some monitoring, his breathing stabilized on its own, and now it's all in the past. He's a healthy baby. I cry every time I really stop to think about it and every time someone reminds me that he's healthy and strong. This is all I've ever wanted.

Once he was released from the NICU and I got familiar with the operations of the nursery staff I kind of wanted to send him back to the NICU just for the level of care and attention he was paid there. The regular nursery was a nightmare. I had heard such good things about this particular maternity unit and maybe I caught them in a bad week but it was seriously a problem. I opted to do 'demand' feeding during the nights which means that I would send the baby to the nursery in the evening and they would call me when he wanted to eat during the night and bring him to my room for a half hour or so and then bring him back to the nursery when the feeding was over. DH had to stay at the house with the dogs during the nights and I needed to rest and recover and was not very mobile so this was the best option. Anyway, during the first night the first feeding went fine, but after the second feeding I called for the nursery nurse to pick him up and nobody came. I waited 20 minutes and then called again. Frustrated because I got SO little sleep in that hospital (if it wasn't a nurse stopping in to wake me up it was the food service or the janitors or the doctors or the photo company or the baby's doctors or the baby's nurses or the lactation consultants or administrators...I could go on. The nurses kept telling me to 'get some rest' because I would have a better chance to rest at the hospital than I would at home. That was a fat lie) that I resented them eating into the next shift by taking their sweet time. Turns out my nurse was on break so they told another nurse to pick him up. Then another 20 minutes went by with no nursery staff. I didn't want to call again, because if I had to call a third time, what kind of people was I sending my baby back to? What disasters could befall us at the hands of this kind of incompetence. Three times I had to call? Seriously? I did call though, I didn't really feel like I had much of a choice. I still didn't feel confident taking care of him by myself - I could barely stand, I didn't know how their particular blankets swaddled, I was terrified of hurting him - dropping him, wrapping him wrong, terrified of suffocation, etc. while I was sleeping. But I knew I had to sleep if for no other reason than to keep myself from getting sick and to make sure my milk production stayed on track. These are all the rationalizations that went through my head as I dialed a third time. I also considered chewing them out on the phone but decided to wait until after we were discharged. I didn't want to upset the people handling my newborn. Once they picked up:

Me: "I've called a couple times now to get my baby picked up, I was just wondering what was going on."

Instead of apologizing, the girl at the other end got defensive and blamed the nurse - it was so unprofessional.

Nursery Girl: "Hmm, I don't know why, the nurse I told is standing right here, I'll tell her again [I could hear her eyes roll over the phone, like this wasn't her problem at all]."

The nurse that arrived didn't speak much english and could not recall from one second to the next what I had told her about "how long on each breast" and whether his diaper needed changing. "20 minutes on each breast?" she asked, after I had slowly and distinctly told her it was 15. Then she picked him up by the armpits without supporting his head and I almost lost it. I actually had to say "Watch his head!" I wanted to run down the hall after them, what kind of mother was I? Fortunately the night ended a few hours later and the baby was returned to me unharmed.

And then the next night, our last at the hospital, the situation repeated itself. I called twice and no one came. Before I had a chance to call a third time my nurse offered to bring him to the nursery. I hesitated but then allowed it on the condition that she make sure they know he's there, that she leave him with someone. I liked my nurse and I trusted her and away they went. That was around 4:30am. At about 7 am I got a call that set my entire body into a panic:

"This is the nursery [awesome, I thought, right on schedule, they're sending him back for a feeding and I'm just going to hang onto him this time], we were just wondering if you could send M back to the nursery, the doctors are making their rounds."

FUCKERS YOU HAVE HIM! Is what I wanted to scream into the phone. I can't even remember what I actually said, it must have been something close. They said they'd check again, great. I asked them to kindly call back when they found him. And they did find him. Again no apology. Their excuse was that part of one name tag was covering part of another name tag, I couldn't believe the incompetence. And all was well with the world again. I asked them to send him back as soon as the doctors were done because he was due for a feeding and they said it would be about 20 minutes. Then nine o'clock passed and I called again. "Sure right away," was the response. Then ten o'clock. And I called again. This was getting ridiculous. It had been almost six hours since his last feeding. They kept assuring me that he was sleeping soundly so I tried not to worry but I was pretty firm about wanting him NOW during this last phone conversation. Sleeping or not, six hours was pushing it - call it maternal instinct. When they arrived with him they mentioned he was slightly jaundiced, not badly, not anything to really worry about. "What should I do?" I asked, knowing next to nothing about jaundice except how common it is. "Just feed him more often," was the answer. HATE !!!! I hated them. All of them. Fucking Idiots. I had been trying to feed him for the last three hours. What. the. fuck. I am still contemplating writing a scathing letter. The comment card I got doesn't have room for all the above colorful stories of incompetence and the resulting "maternal stress."

Anyway, it's been two weeks and I am recovering well. I could stand upright and walk a few steps by the night of the c/s. I stopped pain meds at one week. I could function pretty normally as soon as I got home - doing laundry, getting around fine, just no lifting or bending. By two weeks I feel pretty much back to normal, I pick stuff up off the floor, I go on long walks, but I'm still afraid to lift things like the carseat and stroller - anything in the 20-30lb range still seems scary - I've heard some horror stories about c/s incisions opening up, getting infected, milk drying up, etc. and I don't want to risk it. So I feel fine but am being cautious. My dr said I could lift any weight I want as long as I just use arm strength and don't strain my core muscles. Stooping over to disloge the carseat from the base and lifting it up and out I think definitely strains the core muscles, at least a little. So I'm waiting on that one. I might try the baby bjorn soon because not being able to run errands is a pain. I need more onesies! And some sleep sacks. The LO has already decided that swaddling isn't really for him.

I've decided that for me, c-sections are easy. I would definitely do it again. Labor seems so incredibly challenging and scary and daunting in comparison, I do sometimes feel like I took the 'easy' way out. But I have no guilt about it - it's just the way things went for me.

Most importantly, I am so in love. Every moment of every day. I've gotten no more than 4 hrs of sleep at a time since we left the hospital - and usually it's more like 2 - but I don't care. I have no complaints. I have plenty of worries as a new mom of a tiny fragile infant, but I'm refusing to let them rob me of the moment, so to speak. Come what may I am going to enjoy every moment with my son as many or as few as those moments may be. I haven't had a touch of the baby blues or anything close to PPD (knocking on wood now). I think my gut feeling about all of that is proving true - my relief and heightened appreciation of how miraculous a healthy baby really is has vaulted my mood into the heavens, I am full of awe and appreciation and humility and there just isn't any edge of depression. Like I said, there's plenty of anxiety about whether this breathing pattern is normal, whether I'm doing everything I can to avoid SIDS, how to dress him in this heat wave, whether or not to take him into public this young, how to politely protect him from kids for the first month when we have a seemingly never-ending stream of people wanting to visit. I'm dealing with this aspect of myself the best I can, unfortunately I feel most comfortable when I can control all these elements and I have no doubt that it's irritating DH but he appreciates what I've been through and is being heroic about the whole situation. But like I said, these are not things I internalize. I do everything I can do to protect him and I let go of the things I can't control. And I don't feel the least bit depressed so far. It helps that feeding is going perfectly and has from day one. And that he sleeps according to a pretty reliable schedule. And that DH and I were pretty much home bodies from the beginning so we don't see our lifestyle as cramped by this new addition - I always wondered whether I would be able to sympathise with my friends who insist that "you can't do anything when you have a baby." I'm happy to report that I still find that remark incredibly naive, ignorant, and irritating. I know how lucky I am. I don't take any aspect of this for granted. I am soaking it all in. It's a really refreshing side of myself and I love how it makes me feel. I love having something more important than myself to occupy my thoughts and actions. I love being a mom.

Quick update - he's here!!

I will send a more thorough birth story when I have the time and facilities - I'm writing in a rare quiet moment at the hospital...

He arrived this morning as scheduled at 38w 4d and weighed in at a respectable 7lbs 2oz. I don't have a length measurement as yet. It's been kind of chaotic.

He has the face of an angel and tons of hair. I wish I could say he's perfectly healthy in every way but he had low blood sugar and was breathing too fast when he came out so he was whisked away to the NICU, although I've been told by the nurses that these are common problems with cesarean and breech babies. I'm having a hard time coping with these first few crucial hours without him, this is not how it's 'supposed' to be (but when is it ever?) but his breathing is fine now and he's getting glucose until they ok us to start breastfeeding - maybe tomorrow - at which point they'll assess how he does without the supplement. The hope is that we'll both be discharged at about the same time.

It physically hurts to be without him (after the delivery room I got to hold him briefly once while I was flat on my back) but he is doing quite well by all accounts and for that I feel so fortunate and thankful.

Ding!

All done. 37 weeks! This baby is ready for the world.



37 seems like a very long number when you're talking in terms of weeks. Weeks waiting, weeks wondering, weeks talking and planning and making the biggest decisions of your life in anticipation of the biggest life change imaginable. It's a long wait for anyone. Probably a first-time-mom in particular. This is a pretty amazing milestone. There's a full size, all-ready baby in there! I'm trying to get the last of the nursery together today and keep imagining him on the other side. Holding him in the rocker, trying to transfer him into his crib without waking him up, will he be able to enjoy the mobile if I put it this way or that... It's so strange. I installed the car seat base with C yesterday, we have a LATCH system so it was pretty easy. Strange again though.

And I just had my 37 week checkup. Baby is still in persistent breech. And get this. We got a date.

August 10, 2010.


THATS ONE WEEK AWAY.

AAAAAAAAAAAGGGGGGGGGGGGGGHHHHHHHHHHHHHHHHHHH.

Un-be-freaking-lievable. Still have a lot to do but am glad it's as soon as it is. I am ready for the next chapter.

Thirty Six Weeks

Unbelievable how long the last 36 weeks have been. Well, the last year and a half. I have never spent so much time just waiting. And it's no way to live, let me tell you. I've been trying to turn over a new leaf by spending more time living and less time waiting, but man, it's not easy if you're not used to it.

I had my dr's appointment today. Fundal height 36, perfect. I needed that. Having not heard the measurement last week and getting a new dr this week - one who measures under the clothes instead of over like my obg, I was prepared for the number not to match the week. But it did. Thank goodness for small miracles.

The new dr was dry as toast, but nice enough. He said it looked like my pregnancy had been going well. I corrected him by explaining the two hiccups - the cpc and breech position. He said what the other two or three dr's I've talked to about the cpc have said. That it's relatively common in terms of findings that "require a phone call," as he put it. I didn't bother mentioning that I hadn't received a phone call. He said he'd never seen it, by itself, result in a problem, he knows it's unsettling, he can't for sure say everything is fine. He confirmed that common practice around here is to not follow it up and that consistent fundal height growth is a good sign.

He's also the third doctor to say that breech is not a warning sign to be read into at all, even given the earlier cpc. He was more pleasant than my regular OBG, and explained the various reasons babies can be breech. I didn't have to play 20 questions with him to get information, he just offered it up. Pelvic shape, cord placement, where the baby happens to be when it gets too big to move much anymore...he said the real question is why more babies aren't breech.

But I found another blog recently of a girl just like me who had cpc's at her u/s, also a 2 vessel cord, and her baby ended up being breech. The doctors assured her the breech had nothing to do with chromosomal issues, she blogged about being relieved by that. But then the baby did have chromosomal abnormality. Not T18, something even rarer. Sure there are also stories I've found that go more like this: cpc + breech = healthy baby, but as the days wear on and new developments make themselves known I'm finding myself in a smaller and smaller universe of people who have been through it. It makes me so angry in the 'life's not fair' kind of way. Why me? Why do I have to worry about this sh---.

But then I also saw that one of my birth club members on B@by C3nter lost her little boy at 36 weeks to a cord accident and it broke my heart. And it made me feel guilty that I haven't been embracing every minute I have with this little one who seems to be growing and strong and probably just fine. In my self-pity I've neglected to look at the positives and to embrace what I have, what makes me lucky. As angry as I am that these remote possibilities are landing in my lap, my LO feels entirely compatible with life from what we know and from what we've seen and that makes me lucky and I shouldn't pass that over in search of a guarantee that will never come. Not even after he's born, I realize.

In true fashion, I continue to avoid anything 'normal' going wrong in my pregnancy. Half my birth class had GD, I didn't. And the percentages for things like pre-e and group beta strep are high relative to the percentages for CPCs and breech and I don't have those either. Why do I win the 1:4 and 1:10 risks and not the 1:100, or 1:1000+. Of course the rational side of me says there's no way I can just be prone to bad luck. I'm not actually more likely to lose when the odds are more remote, but the consistency of how things have worked out that way makes my head spin.

I never thought of myself as superstitious until I realized that the day I turn 39 weeks - the target date for a planned c/section, is Friday the 13th. Again with the odds. If I truly wasn't superstitious, I don't think I'd care...but as it stands, I might care. I haven't decided. Part of me thinks "screw it, it's just a day, probably won't be a very busy one, maybe I'll get some extra attention." But the other, very small part of me still insists "what if...." The bigger reasons I think I'll try to avoid that day are three-fold: (1) one of my co-workers said that statistically, more botched surgeries happen on a Friday than any other day, (2) even if Friday the 13th is perfectly innocuous in and of itself, the reputation of that date might make the doctors and surgeons more nervous or distracted, even subconsciously, so indirectly, it would be a bad day to go under the knife, and (3) do I really want my kid to have a friday the 13th birthday for his whole life? I know it won't always fall on a Friday, but still.

I think I will use my hesitancy as an excuse to make it a few days earlier. My dr is really going to think I'm a nutjob now.

My baby shower was yesterday. It was pretty fun. I really tried to let go and enjoy it and I did. Exhausting though, I was standing for most of the event. And thanks to my SIL expanding the invite list almost 3-fold, presents took a ridiculous amount of time. A few people had to leave in the middle, it was kind of embarrasing. And there weren't enough games. I love games at these things.

I got some great things - most of the essentials on my registry plus some things I didn't know I needed. It's not like a wedding registry where you know you're going to need a matching plate set at some point and you know you could really use that fancy mixer or serving platter. I have no idea what I need. I was trying to register for bottles last minute and was kind of bewildered by the 7 pages of choices. I eventually gave up. There was a bottle in the middle of my diaper cake I can use I guess. I asked a colleague about this most impossible of choices and she said babies can be really picky anyway so don't go nuts on a whole set, try a couple out, see what they take to. That's kind of been my theme for registering and shopping. Don't go overboard. It's so easy to think you need all the stuff they sell. But you don't. I plan to figure it out as I go as much as possible, rather than over-spending now.

That said, I am now the proud owner of a swing, a p@ck n' pl@y, a d!aper genie, a really nice car seat, more outfits for a 0-9 month old than there are days in 9 months, a baby tub, an exersaucer, blankets, swaddlers, baby toys and books, more decorations for the nursery than I can possibly fit in there (including TWO jungle animal mobiles)...it's overwhelming. I'm not totally sure what to do with it all. I am feeling serious pressure to get everything completely ready before he arrives because of the likelihood of surgery. I will not be able to do many last-minute decorations and cleaning and shopping when I'm in my first few days of recovery. But I still have not been able to bring myself to clip tags and do loads of laundry. I haven't been able to click "confirm order" on my almost $300 breast pump. I keep imagining how it would feel to have the nursery perfect for the arrival of a tiny person, to have his clothes folded neatly in their drawers and his toys opened and organized on their shelves, his swing assembled, his diapers stocked, only to arrive back from the hospital empty handed. I know it's normal to worry a little about this and at the same time, not normal to let it consume you. And people keep telling me I will always worry about something, like this is just some run-of-the-mill anxiety. But this isn't. This is the biggest fear I've ever had, the longest waiting period to resolution, and the most important stakes imaginable. This is not "normal" fear but it's also not "normal depression," and I am looking forward to being on the other side.

One of DH's cousins has had two children and in the course of birthing them, has somehow acquired every birth story known to woman. Medicated and not, c/section and not, interestingly, both of her kids were breech - she tried the version with both, it worked with the first and not the second. She was encouraging me to try it. She said the doctors are very good at taking into account the well-being of mother and baby and for her it was the best choice because her c/section recovery wore on for 6 weeks. She did add the qualifier that she's always been "slow to heal" from things, physically speaking. Weird. And she was around 40 at the time of her c/section. I appreciated her sharing her experience and reassuring me of how common breech is, but I still think the version is not for me.

Genetic counseling

I spoke with a genetics counselor today. I can't say it allayed all my fears, but it did provide that invaluable second opinion - or rather first opinion from someone that actually knows about this stuff.

Starting with the CPC, my OBG has said that the CPC maybe increases my risk by, for example a factor of 1.5. Another time she said it might be increased from 1/100,000 to 1 in 70,000. And she said based on this she doesn't think my risk rises even close to the amnio risk and thus that I shouldn't get an amnio. The numbers I've seen on the internet suggest a CPC increases your risk by more like a factor of 7-9. The genetics counselor said to use a factor of 10. Score one for Dr. Google. This means that my "less than 1/100,000" which, incidentally I was just informed is the lowest you can get at their facility (which is where I had my first tri screening calculated), turns into "less than 1/10,000....or lower [she added, taking into account that if I was at a more sensitive facility my risk might have been even lower than 1/100,000]" Still lower than the general population. About the same as my age-alone risk for having a live T18 birth.

She didn't comment to much on the breech situation because she said it's considered more of an obstetrics issue. She said that they do not change your risk numbers for trisomies based on breech presentation. It's not a marker. It doesn't increase my risk. That was nice to hear. I tend to believe it when I read that babies with chromosomal problems are breech with a little more frequency than the general population, but it was around this point that she asked if I had been reading the internet. I took this as a good sign that I was getting into 'crazy' territory and should try journeying back to reality. I told her that the numbers I had read for breech in the general population at term were around 2-3%. She said that sounded low to her. She thinks it's higher.

So that's the good. The bad is that it sounds like the second tri quad screening could have added some value. I'd feel a lot better if I'd had those results to back up my first screening, but I still think, based on my research, that the second tri screening is less reliable in picking up T18 and more susceptible to false positives so I'm not beating myself up over not having gotten it.

The other bad was when she said sometimes they do get a baby with just a CPC and NO other findings and it ends up having T18. It happens. I know this. I asked with misguided hope whether there have been babies with extremely low risk screenings like mine and a CPC and T18 and she answered the same way - i.e. what she meant by "no other markers" is no other indication on any screenings or scans that anything was wrong. So it could happen in my case. 1 in 10,000 though, right? She didn't really have an answer as to whether I could take comfort in how well he seems to be progressing at this stage - I think she works mainly in the land of 12-24 weeks -- prime diagnostic territory, she works in CVS and amnio land, by 36 weeks most patients that are sent to peri's have resolved whether they have the problem or not and they stop counting markers.

She asked whether anyone had offered me an amnio back at 19w. Here it comes I thought, a whole new attitude towards amnios over here in high-risk land. I said "first they didn't call me with the results of the ultrasound until the quad screen window closed and then they recommended strongly against an amnio." And I named names. The geneticist said she respected my obg and thinks she's good, which was nice to hear, but also mentioned that while some people look at cold hard numbers when deciding whether to do an amnio, some need it for peace of mind and reassurance regardless of what the numbers say. And it's true, of course, some people have amnios with NO risk factors at all. I do wish I knew for sure that he was ok, but that's fantasy land. Not only can we not see the future, but we don't get to have it work out the way we want it either. And I do not regret not getting an amnio. Given my low risk numbers (and that's what this woman classified me as - "low-risk" for T18) I could not justify putting the baby at risk. And I don't feel any differently now.

She asked if my husband was worried about any of this - another signal that I was crossing into crazy paranoid first-time-mom territory, or maybe she was hinting that my litany of questions and fears were so irrational that they must have been driven by someone else. Nope, just my overactive anxiety which gets kind of out of control when I have four months to google. I said no, he wasn't worried. I still maintain that he's not as worried because he doesn't understand T18. It's really sad. REALLY sad. I have this hunch that if he knew more about it he'd be more concerned. But I wouldn't wish my anxiety on anyone so I've spared him the details.

She finished the conversation by saying that she could look into getting me an ultrasound or even an amnio if I wanted it. She sounded very energetic about this which I wished she hadn't. This is where I wished she would act more like my obg - like, you can do it if you want but I really don't see the point. But I have to realize that the peri's and geneticists get paid when I come in, and these ultrasounds and amnio's are what they do. That's the whole enchilada pretty much. Of course she'd offer. She said she hoped I hadn't been worried about this since 19 weeks and I admitted it's been pretty bad. I said I'd call if I wanted to pursue this further but that given the breech situation I may be 2-3 weeks out from the birth and it seemed a little late. She then mentioned that unless the baby had visible problems at birth, difficulty breathing, etc. they probably wouldn't pursue this further. I think she was trying to sell the amnio or additional ultrasounds, but it really just confirmed what I expected - no one is treating my risk factors as high-risk. No one will without more information. And I think I'm ok leaving it at that for now.

Update on peri appointment

My obg called and said a consult with the perinatologists would be covered. A follow-up ultrasound would not be. I wish she had left it at that. THAT's what I wanted, I quickly realized. To talk to people that know without the opportunity to find additional markers or some other issue. I'd probably freak out over something as minor as the baby measuring a few days behind at this point. It was kind of a relief that an ultrasound wouldn't be covered. Why didn't I think of this before? Actually I had, I was just to chicken to admit that I was too scared to have another ultrasound and just wanted a second, more expert opinion on my risk because I have trust issues with my obg.

But then my obg said something kind of tactless. She explained that no kind of follow up would have been covered if the CPC was the only flag that had been raised. But now that there was an "additional finding," i.e. the breech, the consult would be covered. I really didn't want the breech to be ever classified as an "additional finding." In fact I think I would have preferred for insurance not to cover this at all. I would have found some relief if they'd said "don't be ridiculous Astrid, you cannot direct your own medical protocol, if there are no indications for follow up, you don't get any follow up, and breech is not an indication." But now it's enough I guess... I think my obg has had to do some major convincing that I am freaking out and that the consult is for peace of mind, and I know that plenty of CPC-only follow up is covered, so I shouldn't be alarmed that they're letting me do this visit after all this pushing. But still, if there's something to worry about, I will worry about it. I prefer to think of it as: given the "additional finding" they can understand why I'd need to talk to someone but they refuse to do an u/s on the basis that there is most likely nothing to be found and thus nothing to worry about.

In any case, this has settled my decision, I am going to do the consult. They'll probably give me some cold-hard statistics, may review my first u/s, may adjust my risk numbers in some arbitrary way. But at least whatever they say will be coming from people that know.