Tuesday, October 6, 2020

First, Do No Harm

I didn’t know what maternal-fetal medicine even was until I became pregnant with our embaby through IVF.

Essentially, it’s a practice for high-risk pregnancies, which IVF patients sometimes have. Babies conceived through artificial reproductive therapies (ART) are more likely to be born prematurely, have low birth weight, and have congenital heart defects. Because of this, it was standard practice for Dr. Baby Maker to refer IVF patients to a maternal-fetal medicine clinic for genetic counseling, a mid-pregnancy anatomy ultrasound, and an echocardiogram (basically, an ultrasound of the baby’s heart).

The sad little clinic had chairs and carpet the color of puke. The windows looked out into the hallway of an office park, but were shrouded with brown curtains, so it was dark in the waiting room. It was unclear to me if the curtains were meant to protect patient privacy, but they felt shaming, like no pregnant woman would want to be seen in the place.

A top-40 radio station was on and in between songs, the morning DJs chatted about the most heinous news stories. One involved a man in prison who sliced his tongue in half so that it would look like a snake’s. I wondered why they didn’t have relaxing music on, given that any pregnant woman needing care from a maternal-fetal medicine clinic was probably stressed out enough.

The receptionists seemed oblivious to the unwelcoming ambiance. They were chatting about patients who were either no-shows or who had canceled appointments at the last minute. This made no sense to me; if you’re going to the maternal-fetal medicine clinic, it’s because you have a high-risk pregnancy. Who’s not showing up for their baby (or babies, as was likely the case for some of them)?

On the wall across from where my husband and I sat, there were pamphlets that proclaimed “Powerful Choices” on the cover. I wondered what these powerful choices were, but was not curious enough to get up and grab one. 

The first part of our appointment was genetic counseling. I didn't understand what the point was given that our genetics were not at all involved in this pregnancy, and what we did know about our baby genes was minimal.

Our genetic counselor was a young man who looked like Dennis the Menace pretending to be an adult. It was weird talking about our baby’s genes and my bleeding and how I was feeling to a guy who seemed like he should be selling me a smartphone. I was polite, but guarded. Meanwhile, my husband refused to take off his coat and sat there with his arms crossed and a scowl on his face.

Though I had done the quad screen, a basic blood test that checked for Down Syndrome, and it had come back normal, Dennis tried to sell us on a pricey test called Maternity 21, which tests for Down Syndrome and other (extremely rare) chromosomal abnormalities. He also asked if we were interested in amniocentesis. It seemed a little late in the pregnancy to address these things; even if I was willing to spend the money on the former and undergo the invasive procedure of the latter (which involves a huge needle sucking amniotic fluid out of the womb), if we got bad news back from either (very unlikely), I couldn't imagine aborting our child.

I didn't say any of these things, so Dennis continued his sales pitch and showed me a chart with the rates of Down Syndrome by age. This was not new information, but it was also pretty irrelevant since our gametes were not involved in making this baby. I got the feeling that Dennis didn’t work often with donor-conceived pregnancies.

“Our donors were both in their early 20s, so I really don’t think we need any further testing,” I said. And that was that. We had nothing more to talk about. It was a total waste of time.

Up next was the anatomy ultrasound. At this point, our baby had had so many ultrasounds that they were starting to feel unnecessary, too. When I was pregnant back in the early aughts, preggos got one 2D ultrasound halfway through the pregnancy and that was it, unless something seriously wrong was suspected. Now it seemed like ultrasounds were mandatory at almost every OB appointment. While each ultrasound was reassuring, especially in the first trimester, I occasionally worried about the unintended or still unknown side effects of all that monitoring. 

The sonographer at this appointment was nice enough, but she dug the wand so deeply into my abdomen that at times I shirked back in pain. After 30 minutes of this, the wand started feeling hot, too, and I wondered if any of this was really good for the baby, who was seen frequently onscreen throwing up her hands and arms, as if trying to shield her eyes.

As soon as the sonographer declared everything looked normal (baby was measuring four days ahead with a heart rate of 153 BPM and a weight of 10 ounces), I was ready to go, but then she launched into another 10 minutes of 3D ultrasound imagery to give me some “glamour shots,” which felt downright abusive to me and the baby. I didn’t even like the 3D images and I really didn’t care for her poking and prodding my body to get them, given that they weren’t medically necessary. I guess my Minnesota Nice side got me again because I didn’t speak up.

The third and final part of our maternal-fetal medicine odyssey involved chatting with the in-house OB, who had zero bedside manner. 

“Everything looks normal on the ultrasound,” she said. “Though your placenta is kind of close to your cervix…”

I knew that a placenta covering the cervix was bad, though I wasn’t sure what would need to be done about that.

“I’m not concerned, though,” she added, which made me wonder why she bothered bringing it up at all.

A few weeks later, I returned to the maternal-fetal medicine clinic for the echocardiogram. I now felt fully confident in the viability of the pregnancy and the health of the baby and really didn’t feel the need to go. (All those no-shows and cancellations I’d overheard about now made sense.) But show up I did because that’s what responsible preggos do.

If the previous ultrasound was uncomfortable, this one was downright excruciating. The sonographer was rough, almost as if she was trying to hurt me. But, of course, I didn’t say anything because I’d never had an echocardiogram before and I didn’t know if this was normal. But it sure didn’t feel normal.

My body was stiff and clenched with tension. I tried to practice progressive relaxation, where you start at the top of your head and work your way down to your toes, consciously relaxing each body part along the way. It kind of worked, as did my silent reminders to breathe.

At one point, the sonographer asked me to turn to the side because she needed the baby to roll over. I did, and when she pressed her wand into me, my body jerked in response, like I’d just been punched.

 “Oh, is that tender spot?” she asked.

 “It’s all a tender spot, lady!” I wanted to scream back.

I couldn’t wait for the procedure to be over. The sonographer only spoke to give me directions, to tell me the heart rate (156 BPM), and to inform me that the baby was breech (not unusual at 22 weeks). After determining that the heart was completely normal and healthy (thank God), she tried to get a few 3D face shots. All she was able to manage was an image of the baby shielding her eyes and one of her scowling.

“The baby’s not in the best position for this,” she said.

“It’s OK, baby,” I thought. “I don’t like getting my picture taken, either.”

Besides, she had a cute scowl.

I was so done at this point. Why didn’t I just tell the sonographer I didn’t want any more images? Why did I have such a hard time advocating for myself – and my baby – in the presence of medical professionals? Assertiveness in these situations was something I really needed to work on.

I did follow up with the clinic and aired my grievances to the appropriate person, who apologized profusely and seemed to sincerely appreciate the feedback. Still, this experience made me wonder: Do I trust the medical establishment at all?

I hoped a tour of the hospital where I was supposed to deliver and my 24-week visit with Dr. Baby-Maker would offer up an answer…or would they leave me with more questions?

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