Monday, January 22, 2007

19-Week Sonogram: The Bean is Jumping (Fri Jan 19)

We went for the 19-week ultrasound today at 1:30 pm. This is a standard test prescribed for all pregnancies to measure the development of the internal organs and bone structure of the baby.

We saw the spinal cord, bones in the arms, legs, hands and feet (10 toes), the four chambers of the heart (!), etc. The baby's arms were bent and hands were in front of its face a lot during the screening, so it was difficult to see the face. This is the second sonogram at which the radiologists commented that the baby is very active and so was difficult to measure! She asked if I had eaten just before the appointment (I hadn't). She also mentioned she felt a hardness on my left side and asked if I have a cyst or have had one in the past (I said no). She said it was nothing to worry about. I will investigate after the baby is born.

An ultrasound technician looked at the Bean from all angles, took measurements and said everything looked normal. The Chief Radiologist on staff followed up to check measurements and agreed that everything looks good. In total, we spent an hour in the ultrasound getting screened. The radiologist said the baby is still on track for a delivery date of June 15th (size-wise).

From the radiologist's point of view, everything is developing normally so they are not recommending the need for any follow-up. Since we elected not to find out the sex of the baby, the radiologists hid the screen for part of the examination.

Now that the baby is getting bigger and I've seen it moving, I'm more aware of having a baby inside (vs what had felt mostly like an unpredictable medical condition). Things have progressed smoothly so far, my bump is noticeable, and I'm more conscious now that everything I eat is feeding two of us.

Saturday, January 13, 2007


This week (week 18) my stomach stuck out more than my chest. The doorman in our lobby noticed I'm expecting.

Wednesday, January 3, 2007

4-Month Check-up (Wednesday, January 3, 2007)

16-week checkup: weight 148 pounds; blood pressure 117/70.

Today was our 4-month visit. My weight has gone up 10 pounds (what?!). Blood pressure remains low. My trousers fit the same so hope the extra weight is due mostly to bigger breasts, the bump and the clothes I was wearing. The results of the blood tests from the last visit were all negative (HIV, anemia, STDs, etc).

It took awhile for the nurse to find the Bean’s heartbeat but she found it low in my abdomen. The heartbeat would fade as the baby moved away from the monitor, but the nurse tracked its movement and charted the heart rate between 145 – 152 beats per minute, which she said was good.

The fetal heartbeat sounds ike a "sh sh sh sh" sound (vs. thump thump thump). The nurse said it's fetal bowels we're hearing.

Dr. Holden told us there was a mix-up with our final CVS test results (!). The preliminary lab results that were given to us were accurate. The first set of final results that the geneticist gave me via a phone message were actually for a different ‘Melissa’. However, during the follow-up phone call to discuss final results in person, the results she shared were ours, and were normal as well. Although there was a mix-up, there has been no harm done.

Mentioned to Dr. Holden that it is easy to wonder about the health of the baby since I can’t feel anything yet. He said this is a common concern for women in the early part of the second trimester -- ‘no mans land’ -- since there are no direct signs of progress other than the bump getting bigger.

We can expect to start feeling the Bean move in the 5th month (February). At the next visit, he will teach me tactics to feel the baby and look for signs that things are ok.

We are scheduled for an ultrasound on January 19th and the next monthly visit on February 1st.

They took blood before I left the office to test spinal cord development in the baby. This time I laid on a table during the test and had no problems.

I noticed that another woman who had gone in for an appointment ahead of mine was laying on the floor with her feet propped up on the wall after having just given blood. Happy to see I'm not the only one who struggles to stay upright for blood tests.

On to more interesting news: an article published by Finnish scientists in New Science Magazine reported that women who eat chocolate regularly during their pregnancies are more likely to have placid babies. Big thanks to Carey -- a friend in Australia and new mom for the 2nd time -- for mentioning this study!

"Six months after birth, the researchers asked mothers to rate their infants' behaviour in various categories, including fear, soothability, smiling and laughter.

The babies born to women who had been eating chocolate daily during pregnancy were more active and "positively reactive" - a measure that encompasses traits such as smiling and laughter. And the babies of stressed women who had regularly consumed chocolate showed less fear of new situations than babies of stressed women who abstained.

The researchers point out that they cannot rule out the possibility that chocolate consumption and baby behaviour are both linked with some other factor. But they speculate that the effects they observed could result from chemicals in chocolate associated with positive mood being passed on to the baby in the womb."

Journal reference: Early Human Development (vol 76, p 139)

Ate some Hersheys Dark Chocolate tonight in support of the research. :-)

What's Happening In There? (Tuesday, 2 January 2007)

Tomorrow is the first of ongoing monthly check-ups with Dr. Holden to track progress. Am keen to hear the Bean’s heartbeat. Can’t feel any movement yet, so wonder if everything is ok. When I bend over quickly with a full stomach, does he/she get squashed?

We are approaching the 4-month mark and the bump is starting to show. I can wear my normal trousers and jeans as long as I pull the waistband below the equator.

Kim (friend in Australia) is pregnant too, and her due date is two weeks after mine. We received pictures of their recent 3-D sonogram, but I decided not to look at them… Not eager to see pictures of other babies or watch documentaries of other women giving birth because it provides more data by which to worry if our own experience isn't similar.

There was an hour-long documentary on TV the other day tracking the experience of a woman going into labor with her second child. She checked in at the desk and was put onto a hospital bed with an IV that included pitocin to accelerate contractions, which looked like it made her uncomfortable. A doctor came in to assess how many centimeters she was dilated by putting a glove on and putting her whole hand up the women's v***** (ouch). Then they discussed an epidural and I saw the woman sitting up in bed hugging her husband while an Anesthetist advanced behind her with a very big needle (ouch again).

Got queasy and turned the TV off. In my case, less information is better, so there is less to fret about.

Good news confirmed (Friday, 15 December 2006)

Jennifer and I spoke by phone and she confirmed the good news. All is well genetically speaking.

We elected not to find out the sex of the baby, though it is very tempting. She and Dr. Holden have copies of the results, so if we change our mind, we can ask either of them and they’ll tell us.

I find myself referring to the Bean as 'him' but hope that we'll have a girl, though we'll be thrilled with a healthy baby, period.

Preliminary good news... (Monday, 11 December 2006)

Jennifer, the genetic counselor who works for Dr. Wapner, left a voicemail message today saying “Excellent news. Your preliminary test results are in. Good news. Please call me.” I knew she wouldn’t say ‘excellent’ in a voicemail message if there were any problems with the results, which are 95% accurate. Got teary with relief about the good news on the plane as we taxied to the terminal. The lady who sat next to me asked if I was ok, and I told her I had gotten good news in spite of looking like I was crying. I can cry at the drop of a hat these days... the news (good or bad), certain TV commercials, etc. I've been like this since September, and now I know why. Hormones.

CVS Test (Thursday, 7 December 2006)

I returned to the Columbia-Presbyterian offices to get the CVS test. The first step was a level II sonogram. The radiologist was a woman who has worked with Dr. Wapner for years and was very easy-going. Because she was upbeat and calm, it helped me relax. She showed me the baby on-screen, and we saw legs and arms moving! She took measurements, confirmed we were at 12 weeks and 5 days, and performed Nuchal Fold measurements saying the baby looked normal and there were no indications of Down Syndrome. She gave me two copies of sonogram pictures.

The Bean still looks like ET.

After approximately 20 minutes, Dr. Wapner came in, and they agreed that the transabdominal version of CVS would be safest in my case, based on where the baby was located within my uterus (the alternative is trans-vaginal). Dr. Wapner looks like Dr. Who – tall with a lot of curly hair. He used a transducer to insert the needle, and in less than 60 seconds, was finished withdrawing material. We talked movies while he performed the test, and he recommended I see “The Queen” starring Helen Mirren, because of the years I lived in Windsor, England, near the castle.

The use of a topical anesthesia is not used for this procedure. At least half of women who have undergone CVS in the past indicated the pain caused by an anesthesia shot was not worth mitigating the pain of the second bigger needle used for the procedure. With my general phobia of needles, I was onboard with using as few needles as possible and willing to have more pain if it meant getting through the procedure as quickly as possible.

When the test was done, Dr. Wapner said the procedure could not have gone more smoothly and indicated I'd have no problems as a result of getting the test. Preliminary results will be available early next week, and final results within 10 days.

Because my blood type (Rh) is A negative and Michael may have a positive blood type (we don't know his), I was given a shot of Rhogam (1) in the rear end before leaving the office, and will now get a Rhogam shot around week 26 and once more after delivery. In this case, I received Rhogam during pregnancy because the CVS procedure (like Amniocentesis) introduces the slight risk that the baby's blood or DNA could interact with mine, and cause my blood to create antibodies against the baby's blood (if the baby has a positive blood type).

I got dressed and felt surprisingly steady on my feet. Took the subway home, laid on the couch, ordered pizza for dinner and watched TV. Slept soundly for the first time this week!


(1) Rhogam: Rh0 immunoglobulin, also called anti-Rh or anti-D immunoglobulin. An injectable blood product used to protect an Rh-positive fetus from antibodies by its Rh-negative mother. The idea underlying Rhogam is if anti-Rh antibody is given soon after delivery, it blocks the sensitization of the mother and prevents Rh disease from occurring in the woman's next Rh-positive child. Rhogam is now given routinely to Rh-negative women after pregnancies in which they carried Rh-positive fetuses to prevent the mother's immune system from reacting to the Rh-positive blood of any subsequent fetus. Rhogam was developed in the 1960s by Dr. Vincent J. Freda (1927-2003), professor of obstetrics and gynecology at Columbia University.


3-Month Check-up: Finding a Doctor Who Delivers! (Wednesday, 6 December 2006)

3-Month Checkup: weight 137.5 pounds, blood pressure 110/70.

My cousins and friends gave us recommendations for obstetricians, but those that I could track down were unavailable – no longer do deliveries, were booked for the next six months, not accepting new patients, or don’t accept any form of insurance. Who knew it would be such a challenge to find a doctor that delivers in Manhattan?

Today I met Dr. Holden for the first time, and the visit coincides with a 12-week checkup. He is part of an obstetrical practice associated with Columbia Presbyterian Hospital – reputed to be one of the best in the city for delivering babies and providing neonatal care. He reviewed the test results from the first doctor visit and took a history of my health, Michael’s health, and the events leading up to this visit. He looks young…younger than us, but seems competent, cheerful, and mentioned he is married with a young son. That’s a good sign… at least he’s married and has been through one birth of his own! He gave me all his office numbers and his cell phone number and encouraged me to call anytime for any reason.

I was directed to an exam room, where a nurse took my vitals and put a fetal heart monitor on my abdomen to listen for the fetal heartbeat. Initially, we couldn’t hear anything and I started to worry, but the nurse assured me that when the fetus is small, as it is at week 12 (about 3-4" long!), it takes time to find the heartbeat. Within a few moments, she found the heartbeat, and it was very rapid. Pelvic exam normal.

After the exam, Dr. Holden and I regrouped in his office. He advised me that because of my age, we should decide whether to get genetic testing – either Chorionic Villis Sampling (CVS) or Amniocentesis– -- to confirm the health of the baby.

Women who are 35 or older at the time of delivery are encouraged to take either the CVS or Amniocentesis test (and insurance companies cover the cost). While there are risks associated with both procedures, the probability of finding a genetic problem with the baby is greater than the probability of complications resulting from either procedure because of the statistics associated with maternal age. Before I left the appointment, Dr. Holden and I agreed to meet once a month going forward for progress visits.

I am not going to look further for a doctor – glad to find someone who is positive, seemingly trustworthy, and makes himself available to answer questions anytime. My initial thinking about wanting a female OB has gone out the window; other worries eclipsed any hesitation I had about a male doctor performing pelvic exams, and Emma and others assure me that when the Bean is born, any shyness I had about strangers seeing 'my business' will disappear.

Before I left the office, I gave several vials of blood for tests, including HIV. The nurse asked me to sit in a chair in a very small office (claustrophobic). When she was done, I fainted, and woke up on the floor with my feet propped up on the wall. After a few minutes of laying down, my equilibrium was back and I was up and ready to go home. The nurses told me its pretty common, but it's a bummer that it's a challenge for me to stay upright for blood tests.

Tonight ranks as one of the most stressful I can remember in recent times. Lots of crying on the phone to Michael, my parents, Emma, and my brother. The CVS procedure is scary and I dread the risk to the baby, as well as the decisions we face if the results aren’t good. At what point (if any) would aborting feel like the humane thing to do? In cases of Trisomy 13 or 18 where the baby would suffer severe birth defects and would not be projected to live longer than 12 months (in pain and on life support systems)? The risk of CVS complications is slightly higher than amniocentesis, and the safety of the test depends heavily on the experience of the doctor performing it. On the positive side, the geneticist, also a Melissa, told me Dr. Wapner pioneered the procedure, has performed more than 22,000 of them, and does about 80 a month. She said if she had to get the test, he’s the only one she’d trust, and he comes to Columbia every Thursday to perform the test for those that need it.

I’m 12 weeks and 5 days, so this is the last week of opportunity for me to take the test. Need to do it tomorrow, or wait until week 18-20 for Amniocentesis. After discussing the options with Michael by phone tonight (he is on a business trip this week), we agreed that CVS would be the best plan because of the ability to get results more quickly than amniocentesis, and Dr. Wapner sounds like the best man to do it.

Michael won’t be back until the day after this test, so I’ll be on my own tomorrow.

A Due Date and Nickname for Baby! (Friday, 17 November 2006)

Today we visited a radiologist to get the trans-vaginal ultrasound. Trans-vaginal scans are usually prescribed for early pregnancies or to diagnose ectopic pregnancies, tumors or cysts.

After inserting a large probe (easier than expected), we all watched the screen. The screen looked like a TV with bad reception -- a lot of snow. At least one or two minutes ticked by and neither the Doctor nor nurse showed any expression or said anything as they watched, so I started to worry.

Me: "Is it ectopic?"

Dr. S: “Are we LOOKING for an ectopic pregnancy??”

Me: "I don't think so..."

Dr. S: “Women these days! They get pregnant, read books and horror stories on the internet, and before they’ve had their first formal doctor visit, they’ve prepared themselves for every disaster! Millions of women get pregnant every year. It’s a perfectly normal process and there is no reason to assume the worst!”

Moments later a picture came into view and we were surprised to see what looked a black bubble with a 'bean' inside that had a large head and four appendages – little arms and legs! Dr. S said “There is the baby, and there is the heart beating!”. I felt such overwhelming relief that there was really a baby there, I started to cry and found it difficult to continue looking at the screen. This was the first time since we discovered I'm pregnant that we could see the baby and hear it, so it is starting to feel real.

Dr. Subramanyam activated a ruler on the screen to take measurements of the fetus, and indicated we were 10 weeks along. The due date is listed as June 15, 2007.

This surprise ranks second only to discovering the pregnancy last week. Within a few seconds of receiving this news, we realize I have been pregnant since slightly before our wedding in September. Immediately, I started reeling through the things I'd done since September and October that I wouldn't have done if I'd known I was pregnant: drank at the wedding, drank a bit over the honeymoon, took a fair amount of flu medicine/decongestant in Sydney in order to clear my ears for the flights back to the U.S....etc. These got filed in my head as things to raise with a doctor as soon as we find one.

The doctor gave us a print of the sonogram. Our first baby picture!
Nickname for baby is ‘Bean’ (aka 'the bean'), and 'it' looks like E.T.

Pictures: me at 10 weeks; sonogram of the Bean at 10 weeks

Pregnancy Confirmed (Tuesday, 14 November 2006)

Today Michael and I went to see Dr. Capalbo, a gynecologist, to get confirmation of the pregnancy and a pelvic exam. A nurse ushered us into an exam room, requested a urine sample to confirm the pregnancy, and took my vitals (blood pressure 120/80, weight 137).

A few minutes later, the nurse poked her head back in and said “Congratulations, you are definitely pregnant!”. Dr. Capalbo came in, introduced herself, and said she no longer performs deliveries so could not be our Ob/Gyn throughout the pregnancy, but would administer the first exam and order the relevant tests. She congratulated us on being pregnant, but warned us not to get our hopes up until we had passed the 12-week mark as it is possible to miscarry or experience a ‘chemical pregnancy’. On the positive side, she indicated that my pregnancy symptoms (nausea, tiredness, tender breasts) were good signs that the pregnancy was healthy. We told her we estimated we were about 5-6 weeks along based on the honeymoon dates.

She performed a PAP smear, took blood, did a manual exam and said my uterus was soft and enlarged – another good sign that the pregnancy was healthy. She prescribed a transvaginal sonogram (ultrasound) and sent us on our way, wishing us luck.

Discovery (Monday, 6 November 2006)

A 5-day road trip (business) started today, and the first stop was Dallas, Texas. I woke up this morning feeling nauseous and off-kilter. Par for the course these days since we got back from the honeymoon and Sydney trip in October.

It isn't normal to be nauseous for two+ weeks. Did I catch a parasite from petting stray dogs and cats in Tahiti (honeymoon)? I haven't had a proper physical in at least 15 years. Is there something wrong with my head/brain? (Worst fear.) Before heading to the airport, decided to take a pregnancy test. This is the one positive possibility I could come up with to explain nausea, dizziness, and the need to pee frequently that I can diagnose from home.

For the test I took, a positive result would reveal two lines, and a negative result would show one line. My test stick showed two lines, but one line was very faint, so it was difficult to interpret the result.

After landing in Dallas and checking into the hotel, I went to a pharmacy and bought a variety of pregnancy tests, including a test with a digital readout that would say either “pregnant” or “not pregnant”. No room for confusion with that one.

$110 dollars, 20 minutes in the bathroom, and 4 pregnancy tests later, all said ‘positive’!

SO excited but struggling to believe this! The medical information about fertility for women over 35 indicates that it can take longer to conceive, so Michael and I expected to ‘try’ for at least 6-12 months, or possibly even need fertility treatments. We haven't started ‘trying’ yet. Hard to believe this has happened so fast. While hugely excited, am trying not to get hopes up until this is confirmed and we get through the first three months. If it is true, we are lucky.

Also realized that the honeymoon could now be the first and last big trip we took (and will take?) as a married couple without any big responsibilities… There could be three of us before the first wedding anniversary.

The first call was to my parents. Dad answered his cell phone and said they were on a shopping trip at IKEA. Mom and Dad sounded truly pleased and excited by the news (though not nearly as surprised as we are?!).

The next phone call was to Michael, who is on a business trip this week. He was thrilled, but we agreed to see a doctor before getting our hopes up.

Lastly, I rang Emma, who became a close friend after I moved to New York. She married Alan in California and they moved to New York a few months after I arrived in New York in 2005. Emma and I miss California and bonded over the challenges of trying to find a routine and a new circle of friends in NY. Emma was my sidekick to find a wedding dress, and has been a great friend this first bumpy year in Manhattan. She and Alan have a handsome boy - Senan - who will celebrate his first birthday early next month. She was very excited for us, encouraged me to make a doctor appointment as soon as possible, and told me what to expect on the first visit.