24wk checkup

It was uneventful - compared to last month's.

If you're tired of the CPC stuff, and I wouldn't blame you if you are, skip down to the bolded sentence. I told my OBG that I was still concerned about it (understatement of the year) and she said some things that were reassuring and some that were not. She emphasized that given my first trimester results, even if the CPC were to increase my odds by 100x we still wouldn't be in the range of recommending an amnio. She thinks the first tri blood screening + NT scan are a much better indicator of anything being wrong but then tried to say that ultrasound is not a very good diagnostic tool for T18 which compromised her credibility a little. I have taken some comfort in the fact that T18 is recognizable on u/s and the idea that, if my baby had it, would have shown more signs at the 19 week scan. My research has shown that around 78-80% or higher of T18 babies have markers other than CPCs evident on u/s. So I pushed her on this and asked what signs could have come up that would make her concerned. She mentioned the facial abnormalities like cleft lip/palate and size problems and reiterated that these are 'perfect' with my baby. I think (I hope) what she was trying to say about the u/s is that it can't diagnose T18, not that other signs wouldn't come up.

The more troubling things she mentioned was that "we used to get more worked up about these, but the literature just isn't there and the insurance companies don't cover follow up anymore because there just aren't studies to support it." I don't know about yall, but it doesn't give me much comfort that the insurance companies don't think my baby's cyst is their problem. But again, I can rationalize this remark based on my own research: in the early/mid 80's CPCs were thought to be a normal variant. Period. Then they were found to have a higher incidence in T18 babies than in the normal population and the obstetrics community jumped on the association. Lately the literature (which is there, it's just favorable, typically - I'm hoping this is what she meant - that there's no literature supporting follow up of isolated CPCs not that there's no literature at all) has started to show a very small or no increase in t18 risk with isolated CPCs, especially with a normal NT measurement, serum screenings, etc.

The other thing she said that disappointed me was something like "some parents don't even want to know..." I wasn't listening for part of this and found myself wondering - does she mean they don't want to know about the CPC? or they don't want to know if their baby has a condition that's incompatible with life? I have been very careful not to allude that I have a head-in-the-sand attitude about this. As far as she knows, I want to know it all. Who is she to decide what I do and don't want to know? Especially since she's already done me the disservice of throwing me into this nightmare by telling me about the CPC in the first place. She can't then stop and put her own head in the sand as to other signs. Understanding that there's no real way to get a diagnosis other than an amnio, I want to know everything that comes up because I don't want my hope, whatever its magnitude, to be false. Right now my hope is fairly robust, there really doesn't seem to be any problems with my baby. The anatomy scan was otherwise "normal," fundal height is perfectly on track, great first tri screening. I can feel the kicks getting stronger and movement getting more frequent. I am starting to relax a little bit again. But even if my OBG noticed more troubling signs that would cause my hope to wear a little thin, I still want it to be real. I don't want to glide into labor on this bed of robust hope if there really are indications of a problem. I'm just another patient though, and this pregnancy is going by far more quickly for her than it is for me. So I suppose I really am in her hands and I just have to deal.

She started talking about L&D and whether I had signed up for classes, etc. I asked about whether I would need to fill out a birth plan, thinking of course the answer would be yes. Nope. Her attitude was: sure if you want, but only if you have real specific preferences and needs and gave a few examples that almost sounded as if she was making fun of patients with specific preferences. She apparently doesn't think much of birth plans. I was shocked that she didn't even pretend to care about them but at the same time, I am not a real contrived birth plan kind of girl. I will definitely fill one out to the extent I feel strongly about any of the entries (like no Hep B injection at birth and no episiotomy unless it's necessary), but I told her (and this is the truth) that my 'plan' was very simple and it's to get the baby out safely. This is probably the ONE thing we agree on. That is the goal, all other goals only matter to the extent that that happens. This is one thing I am really giving myself over to. I don't know if I will have disagreements with her approach to L&D down the line, e.g. if they are suggesting induction that I don't want. But right now, I'm not worrying about it.

When she listened for the little guy's heartbeat she noticed an 'acceleration' where the hb jumped from the 140s to the 160s. I've noticed that on my doppler at home and chalked it up to the baby moving around and the frequency differing depending on how far away the heart was to the wand. So much for that theory. Apparently it's a good sign and means plenty of oxygen is getting to the baby. I thought that was interesting.

I also learned that the whole "one lb per week" weight gain recommendation hasn't actually started yet. Oops. Whenever I get weighed the assistant always says "so...you've gained one lb per week, right on track." But during this visit the OBG slipped and said a HALF pound to a pound per week is normal until 28 weeks when the lb/wk ratio becomes official. Hmm....so I've gained a few more than I could've limited myself to. Not a crisis but would've been nice if someone had pointed that out. Maybe I would have resisted some of that chocolate and junk food. Maybe not. In any case, I've gained 10-12 lbs total with the biggest gains in front of me. Since I started at a healthy weight, I'm not worried about any of this per se, but it did make me think about my nutrition plan from here on out a little. Maybe-fruit-tonight-instead-of-ice-cream-for-the fifth-night-in-a-row kind of thing.

I've been taking Expect@ DHA supplements lately (took one-a-day DHA for the first half of pregnancy before realizing that they're fish-based) and asked my OBG's opinion on those. She's a skeptic. Doesn't think it improves brain function, thinks the one study that says it does (by only 4 iq points, btw) are skewed by the fact that it was funded by the industry that sells the pills, and warned me against using them during the last few weeks before birth because they act as a blood thinner. Good to know. I think I'll keep taking them for now because as a vegetarian I get precious little omega-3 otherwise and that seems to be an important nutrient.

Finally, I asked about my DH's awesome veggie/fruit garden. So far in pregnancy I've been too scared to eat anything because of the toxoplasmosis risk. That hasn't been too hard since DH's winter garden is more limited than his summer garden, but now he's starting to put the summer stuff in and I don't think I can go on declining things without explaining to him why I'm being so paranoid. So I wanted to get the real scoop on vegetable gardens during pregnancy. She said I probably shouldn't be working in the soil but that as long as I wash the produce, it should be fine. I'm still dubious. Veggies can be awfully dirty, even when 'washed' which usually entails holding them under the faucet for a few seconds. Especially the ones that kind of sit on the ground like squash, cucumbers, etc. and the leafy stuff that gets dirt stuck in the crevasses....but I don't want to offend DH or deprive myself of tomatoes for three months if there's really no need. If there's one thing I'm looking forward to about the end of pregnancy it's being able to dial down this paranoia a little. It's exhausting.