Wednesday, January 3, 2007

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.

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