Saturday, May 8, 2021

2020 A.D., Part 1: The First Trimester

One thing I can say for certain: Pregnancy is the hardest thing I have ever put my body through and that includes cancer treatment!  I don't know how so many people manage to do it more than once.  Honestly, radiation was a breeze in comparison.

When I left off, I had just gotten my first ever BFP ("Big Fat Positive" pregnancy test in the TTC world) after several days of unsettling period-like cramping.  At my doctor's appointment the following morning, the physical exam yielded no abnormal findings and my blood work came back consistent with early pregnancy.  My HCG was 178, suggesting 3-4 weeks gestation, and my progesterone was a strong 40.8, eliminating the need for supplements (a very common thing at my age).  They brought me back 2 days later for repeat bloodwork.  In a healthy pregnancy, your HCG should double every 24-48 hours.  My HCG more than doubled to 399, so this was a very good sign that this pregnancy was moving in the right direction.  All in all, everything appeared to be right on track.  However, the cramps did not go away.  In fact, they got exponentially worse.
 
Thursday evening (two days after my BFP), I had fallen asleep on the couch when I woke up to a big cramp coming on.  Unlike a normal cramp, though, it did not subside after a few minutes.  It kept increasing in intensity until it felt like someone was trying to rip me in half, and then it stayed there.  I was moaning and writhing in pain on the couch, unable to stand or think and barely able to breathe.  Eventually I hobbled into the bathroom where I started pulling my clothes off since by then I was dripping with sweat from the pain.  I figured I had to be miscarrying so I curled up on the floor and braced myself for what was to come.  I texted Brian but he was working late and couldn't come to my aid.  I wanted to call my mom but I didn't want her to find out I was pregnant that way, or to be informed immediately after that I had lost it.  I tried calling my OB's after-hours number but the automated system informed me there would be a $50 charge to page the physician on call, so I hung up and decided I would just go to the emergency room as soon as Brian could get there to drive me.  After 20+ minutes of lying on the floor in gut-wrenching pain, it suddenly began to subside.  There was no sign of spotting or bleeding anywhere.  Just like that, it was over.  I told the nurse about it the next day when I went back for my repeat blood draw but she just said she would let the doctor know.  Unfortunately, this was only the beginning.  
 
The intense cramps continued happening randomly for the next several weeks.  Each time, they would come on slowly then peak for 20-30 minutes before subsiding.  And each one was absolutely excruciating.  But all I was allowed to take for the pain was Tylenol, which did absolutely nothing.  And each time, I was sure I was miscarrying but, again, nothing.  The worst part was there was no predictable pattern to when they would happen.  Sometimes they woke me up in the middle of the night, sometimes they hit while I was relaxing on the couch, or anytime I engaged my lower abdominal muscles in any way.  One week after they first started (Thursday, April 10), I got one while at work. I hadn't told anyone there I was pregnant yet so I hid under my desk, crouched in a fetal position, unable to do anything until it passed.  (I prayed the phones wouldn't ring until it was over because there was no way I would be able to hide the pain from my voice.)  As soon as it was over, I called my OB in tears and they told me to come in ASAP for a check.  Leaving work in the middle of the day was very difficult since I was the de facto receptionist for the time being due to pandemic furloughs.  Fortunately, my doctor had an opening during my lunch hour when I already had someone lined up to cover the phones for me, so I went then.  
 
At the appointment, the doctor did another physical exam and, again, said everything seemed normal.  She decided to do an ultrasound but advised me it was still extremely early so she was unlikely to see anything.  The ultrasound showed a small gestational sac but nothing visible inside.  However, it appeared to be in the right place, so we at least knew it wasn't ectopic, which had been one of my concerns.  Overall, there was no obvious reason for the intense cramping.  She asked me to come back in a week for a re-check and printed out a few ultrasound pictures for me as a keepsake.  I was still pretty sure I was going to lose this pregnancy so I thought of them as little more than a parting gift at the time.
 
One week later, I went back for my re-check.  I was now 6 weeks along so there was a small chance they might see something on the ultrasound, but my doctor said, "No promises!"  These images once again showed a small gestational sac but this time with a tiny yolk sac inside (the precursor to the placenta).  I asked rather matter-of-factly whether she felt this was an actual viable pregnancy and not just a blighted ovum.  My doctor very cautiously stated that she was "reassured" by the way things had progressed from the previous week.  She printed off a few more pictures for me and asked me to come back again in 2 weeks for another re-check.  However, she would be on maternity leave by then so I would be seeing my original doctor again, who would finally be resuming appointments at that location since being temporarily relocated to their other office.
 
Over the next 2 weeks, the intense cramps started to get fewer and farther between, and a couple of weeks after that, they stopped completely.  However, they were being replaced by something just as bad: nausea.  Something I learned about the term "morning sickness": it's the biggest lie on the planet. For one thing, it doesn't begin suddenly, like in the movies.  It comes on gradually, starting as a lack of interest in food and loss of appetite before progressing into a general feeling of queasiness, then mild dry heaving, and then full-on retching and vomiting.  Also, it's not just in the morning.  It's 24/7!  I couldn't stomach the thought of eating anything.  I'd spent the last 4 years being extremely committed to a healthy, balanced diet.  I'd cut out things like fast food, processed meats, and anything frozen or boxed in favor of fresh, home-cooked meals that were mostly plant-based with lean meats and whole grains.  Now, I couldn't even look at anything like that.  It was a hard thing for me to come to terms with since I had been determined to eat as healthy as possible throughout my pregnancy.  But I had to force-feed myself canned soup and ice cream just to have something to subsist on.  It was like I had the palate of a toddler!  I joked that my new 4 food groups were "frozen, canned, boxed, and bland."  The extra challenging part was that I had to find someone to cover the phones for me at work every time I needed to run to the bathroom to throw up.  Sometimes I didn't make it in time and ended up getting sick in the trash bin under my desk.  Even worse yet, I couldn't keep down my prenatal vitamins no matter what I did.  This baby seemed determined to wreak absolute havoc on my body in every way possible.  When I complained to my doctor about my nausea, her response was: "Congratulations, you have a healthy pregnancy!"  I asked about any anti-nausea meds she could prescribe me.  After trying every non-prescription item she told me to try first but to no avail, she finally called me in some Reglan.  For the next 6 weeks or so, I subsisted on that around the clock just to be able to function.  But nausea was only one of my problems.  The first trimester fatigue was quite debilitating.  I could barely keep my eyes open all day.  Sometimes, I lost the battle to stay awake at work and had to lay my head down on my desk (all while trying to remain awake enough to answer the phone when it rang).  I would come home at the end of the day, take care of Kirby, then immediately change into my pajamas and sleep for the rest of the evening.  It was just as well my gym was closed due to the pandemic because I didn't have the energy to work out anyway.  I still did my daily walks to work and back, but even that wiped me out.  It's exhausting growing a human!
 
On April 30, I went back to my OB's office for my next re-check.  At just 8 weeks along, I was still too early to be considered an official OB patient, so these appointments were all billed as problem visits and required a separate co-pay each time.  If all went well at this one, though, I would come back in a week or two for my "1st OB" appointment, then everything after would be billed under that same umbrella.  At my appointment, I filled my old doctor in about how we had conceived after just one month of trying (take that, Day 3 lab work!) but that I had been dealing with horrible cramping pretty much since the day of implantation with no obvious reason why.  She then hooked me up to the ultrasound machine.  (Most OB patients get 1 or 2 ultrasounds throughout their entire pregnancy.  I was only 8 weeks along and already on my third!  One of the perks of being high risk, I guess.)  This time, that empty gestational sac now had something inside it: a blurry little gummy bear next to the tiny yolk sac.  The doctor zoomed in on the middle of the gummy bear and clicked a button.  She asked me if I wanted to take a video.  I didn't know what was about to happen so the thought hadn't even occurred to me until she said something.  So I pulled my phone out and hit record.  Then I heard a sound that reminded me of the old Atari game "Space Invaders" only much faster.  Houston, we had a heartbeat!  A very strong 165 BPM.  "Sounds good!" the doctor said.  I asked her if she believed in the old wives' tale that a fast heartbeat meant it was a girl and a slow heartbeat meant it was a boy.  She shook her head no.  Not surprising since my own heartbeat while in utero had sounded like a boy's and my younger brother's had sounded like a girl.  But I wanted it to be a girl so badly, I still clung to every piece of hope I could get.  

Once a heartbeat is confirmed, the chances of miscarriage drop dramatically, so this was the moment it started to feel more "official."  However, I still felt like I needed to stay cautiously optimistic.  I wondered if I would finally believe this was really happening once I had an actual baby in my arms (if even that soon).  Now that we had confirmed viability, my next appointment would be my 1st OB in 2 weeks, which I set up for Tuesday, May 12, just 2 days after Mother's Day.  That was especially exciting because I had just booked a flight home to Ohio for that weekend when I planned to not only spend Mother's Day with my mom, but also tell her in person that she was going to be a grandma.  I'd been aching to tell her for the past month, ever since I got my positive test.  Now just 10 days away, it was so close, I could almost taste it!
 
I had planned the whole reveal very meticulously.  For her Mother's Day gift, I got a T-shirt in her favorite color that said "Great Moms Get Promoted To Grandma" and a picture frame with the caption "I am fearfully and wonderfully made" (a Bible verse she often quoted to me when I was growing up), which I planned to put one of my ultrasound pictures in.  I had also bought 3 Mother's Day cards: one to mom from daughter and 2 to grandmother from grandchild.  I would put the one from daughter and one of the grandmother ones on top of the box, knowing she would open the one addressed to Grandma and assume it was from Kirby.  Then she would open the box and see the T-shirt first, which may or may not tip her off right away.  The final confirmation would be the picture frame with the ultrasound photo underneath, and under that would be the other card to Grandma.  I even managed to add a little inside joke to the picture frame: It had 2 places for a photo in it; one for an ultrasound picture and one for a picture of the eventual baby.  Obviously I had none of those yet.  So rather than leave it blank, I printed off a meme from the episode of "Friends" where Rachel has her first ultrasound and is upset because she can't find the baby on the screen and tearfully exclaims, "I can't see it!" which I wrote in the caption.  (When that scene first aired, my mom nudged my dad and said, "Who does she remind you of?"  My dad grinned and pointed at me and they both laughed.  Twenty years later, I can proudly say that it ended up not being the case at all!)  I absolutely could not wait to give it to her.  I hadn't seen her laugh or smile since Dad died so I really hoped she would finally feel joy again once she found out there was a long-awaited grandbaby on the way.  She had already cried several times when talking about how hard Mother's Day was going to be without him here.  I wanted her to have something to look forward to again.  
 
My flight to Ohio left DC at 10:00 am on Saturday with a brief layover in Charlotte before landing in Toledo at 3:00.  My return flight took off just 24 hours later, so it was a very short trip.  The night before my flight out, I started feeling nervous, almost apprehensive.  Not about the flight, but about how Mom would react to the news.  I wasn't sure why since I knew she would be excited.  Actually, excited is an understatement.  Absolutely nothing could have prepared me for her reaction.
 
When I arrived at the airport on Saturday morning, it was nearly empty, almost none of the shops were open, and the people that were there were all masked up so it was a bizarre scene.  The plane was only about 1/4 full, too.  A lot of people I know were concerned about traveling during the pandemic but I never felt unsafe at any time.  Kirby is usually a good flyer and she did well this time, too, sleeping in her carrier the whole way.  Mom picked me up at the airport and didn't seem to suspect anything was going on.  The previous year, she had flown me home for Father's Day weekend to surprise my dad as his present.  It was serendipitous since it ended up being the last Father's Day we would ever have with him, so it was perfectly fitting that I was flying home for Mother's Day the following year.  Right after we got to her house, I casually asked her if she wanted to open her gift now or wait until tomorrow.  I'd been trying to decide if I should give her the whole weekend to enjoy it or if it would be more meaningful for her to find out on actual Mother's Day, so I decided to let her choose.  She said, "I can wait until tomorrow."  (For what it's worth, she said after the fact that she was glad she waited.)  
 
That evening, we all had dinner at my grandmother's house.  I had put in a special request for my grandma's English roast since something had jogged a memory of it recently and I'd been craving it ever since.  My family used to go to my grandparents' house every Sunday after church and have English roast with mashed potatoes and peas for lunch.  My brothers and I would watch WWF wrestling on TV while the adults prepared the feast.  I'd recently seen a post on Facebook about a classic WWF character and it was like a Pavlovian response.  Although I still wasn't completely past the nausea phase yet, it was under control enough by then that I thought I could safely satisfy this particular craving.  Later that night, my friends from my wine lovers group (the "wine tribe") had a "virtual happy hour" via Zoom.  I joined in drinking a sparkling grape juice varietal my dad and I used to love to drink together every Christmas.  My mom and brother both knew it was grape juice instead of wine but didn't bother to ask me why.  I figured if they asked, I would just say it was because the bottle had been in their fridge since Christmas so I needed to drink it up, which was true.  When my friends asked me what I was drinking, I said it was an Ohio-grown sparkling white Catawba, which was also true.

On Sunday morning, I made Mom a batch of French toast with mixed berry compote since she's always loved French toast and it was one of the few breakfast foods I thought I could keep down.  Mom was in a fairly somber mood, though.  She hadn't had much of an appetite since Dad passed, but seemed to enjoy what little bit of French toast she ate that day.  I asked her a few times if she was ready to open her present yet and she kept saying, "I will in a bit," without much excitement.  While I was preparing breakfast, my younger brother (who had recently remodeled the hallway bathroom for her) started talking about all the improvements he was planning on doing to the kitchen next.  Suddenly Mom got flustered and said, "Stop!  It's too much!  It's too much change!"  I told her, "But Mom, these are good changes."  She said, "I know but..."  Then she broke down in tears and sobbed, "These are things Dad and I were planning to do together!"  At that point, I said to myself, "OK, it's time to open the gifts now.  This woman needs nice things!"
 
After breakfast was over and the dishes had been cleared, I finally got her to sit down at the dining room table with me to exchange presents.  She had me open my gift first. (She always gets me little Mother's Day gifts and cards "from Kirby," also from Kia and Aria back when they were still around.) Then I presented her with her gift, wrapped in an ordinary rectangular clothing box with nonspecific wrapping paper.  As I'd predicted, she opened the cards first and read the one signed by "your grandbaby" to which she said, "Thank you, Kirby."  Then she slowly unwrapped the box, opened the top, and pulled back the first layer of tissue paper, revealing the T-shirt.
 
"Great moms get promoted to grandma?" she asked, looking confused.  "Keep digging," I urged her.  She reached under the shirt and lifted it up, then pulled back another layer of tissue paper, revealing the ultrasound picture frame.  Silence.  Suddenly, she gasped louder than I've ever heard anyone gasp before and looked up at me, her hand over her mouth and her eyes wide as saucers, as if awaiting verbal confirmation.  I smiled.  "I'm 9 weeks, 4 days..." I started to say, but then she let out this howl that sounded positively primeval, like a dying animal.  I wasn't sure at first if it was a howl of joy or of horror.  I tried cautioning her that it was still very early and we weren't announcing it yet, but then she started screaming "OH MY GOD!!!" over and over again.  She clearly wasn't hearing anything I said.  Finally, I gave up and decided to just sit back and let her process as the "Oh my Gods" continued to flow.
 
"WHEN ARE YOU DUE???" she squealed hysterically.  I told her December 9th.  "OH MY GOD!!" she screamed.  Her head collapsed onto the table as she sobbed.  She tried to stand up but her knees buckled, so she dropped back down onto her chair, all while howling and yelling, "OH MY GOD!", "THANK YOU, JESUS!!", and "I'VE BEEN WAITING FOR THIS FOR SO LONG!!!"  My younger brother was in the living room and must have asked what was wrong because she also managed to scream, "APRIL'S PREGNANT!!" at one point.  I tried filling her in on the events of the past 6 weeks, but every time I attempted to say something, I was interrupted by another iteration "Oh my God!" or "Thank you, Jesus!"  At some point during all of this, she took the ultrasound frame over to Dad's memorial picture on the stand next to the table and held it up to him, like she was showing it to him, and sobbed that she wished he were here to see this.  Once she appeared to have finally calmed down slightly, I filled her in on all the clinical stuff, like my quants and progesterone, and all of it she responded to with a howl and an increasingly tearful "Thank you, Jesus!!"  (Me: "I had my quants checked at 4 weeks and they were 178." Mom: *howl* "Thank you, Jesus!"  Me: "I went back 2 days later and they were 399."  Mom: *howl* "THANK YOU, JESUS!"  Me: "My progesterone was good, too.  It was in the 40s."  Mom: *howl* OH!!! THANK! YOU! JESUS!!!")  Finally, after about 20 minutes of this, I suddenly remembered there was still one last part to her gift.

"Here," I pulled out my phone and opened the video of my ultrasound with the heartbeat and hit play.  Mom grabbed my phone out of my hands, held it all the way up to her ear and listened intently.  "WHAT WAS THE RATE?! WHAT WAS THE RATE?! WHAT WAS THE RATE?!" she yelled, waving her arms frantically.  "165!" I told her.  She howled again and sobbed, "IT'S A GIRRRRRL!!!"  
 
"Not necessarily," I cautioned her.  She responded, "No, it is!  I had a dream a few months ago of a little baby girl.  This is it!  This is her!"  I told her not to get either of our hopes up yet.  Then I told her about all the horrible cramps and she waved her hand said, "Oh, that's just the uterus stretching.  That's normal."  To which I responded: "That's NORMAL?!?"  Then her face lit up with realization and she exclaimed, "This is why you asked for Grandma's roast!  You had a craving!"  
 
She asked if she could call a few family members to share the news.  I reminded her to make sure they knew not to tell anyone else since Brian hadn't told his kids or family yet so we didn't want the news leaked for at least another few weeks.  She assured me she would swear them to secrecy. Then she proceeded to call all my aunts and uncles to tell them about her Mother's Day present.  "I'm gonna be a grandma!" she would exclaim.  Some were in disbelief, but all were excited.  A few even shed a few tears with her.  She decided not to call her parents to tell them but to stop by and show them her gifts instead, since they were both fairly hard of hearing.  So she and I went over later that morning with the ultrasound picture and Mom proudly wearing her new t-shirt.  Grandma giggled when she read the shirt, thinking it was joke.  But then Mom showed her the ultrasound picture and she gasped "Oh!" in surprise. 

My older brother had been at work while Mom was opening her present and had missed her whole meltdown, so she got to tell him when he came home from work that afternoon.  He too laughed when Mom showed him the t-shirt, thinking it was a gag gift, so she showed him the picture.  He stared at it in confusion for a few seconds then went "Nooooo!" several times, as if in pure disbelief.  (I think Mom being able to tell people she was going to be a grandma and seeing their reactions to the news was almost as much fun for her as hearing it herself.)

My flight took off out of Toledo at 3:00 so Mom had to drive me back to the airport around 1:30.  Once there, she hugged me and Kirby goodbye and tearfully thanked me for the best Mother's Day present she's ever gotten.  All in all, it was a very quick trip but 100% worth it to be able to give her her gift in person and see her so happy for the first time since Dad died.  
 
I had another layover in Charlotte on the way back, then landed in DC at 10:00 pm that night.  Brian picked me up and I told him all about Mom's reaction to the news on the way home, although I couldn't adequately portray the true extent of her excitement myself.  I wish I'd gotten it on video but I wasn't sure how to do that without arousing suspicion.  Plus, neither of us had showered or even brushed our hair yet so we were far from camera-ready and I knew she wouldn't want to remember the moment that way.  I suppose it was better to be more physically present rather than behind a camera lens, but the whole thing was already such a blur, I wish I'd captured it somehow.
 
Now that the cat was out of the bag, I could send my mom real-time updates during my OB appointments and weekly baby size comparisons that I got via an app on my phone (usually with some sort of food or pop culture item as a reference point).  Since my gestational weeks always began on a Wednesday, I started referring to those days as "Humpday Bumpday."  She would text me first thing every Wednesday morning with whatever number of weeks along I was, and I'd usually respond "Happy Humpday Bumpday!" along with a picture of my baby bump and whatever important milestone was occurring that week.
 
My 1st OB appointment had been scheduled for the Tuesday after Mother's Day.  But the day of, my doctor's office made me reschedule it and the soonest I could get was 3 weeks later.  I was incredibly angry about that, not just because of pregnancy hormones running wild but because of all the issues I'd been having and being high-risk.  This meant I would be almost 13 weeks along before I'd even be considered an OB patient!  What was especially upsetting was that I'd been planning on requesting an order for an NIPT (Non-Invasive Prenatal Test) at this appointment.  NIPTs are something I often saw discussed in my pregnancy groups on Facebook and the first time I heard of them, I knew that I would want one as soon as I possibly could.  They're a blood test that checks for fragments of placental DNA in the mother's bloodstream and screens them for common chromosomal disorders and can also tell the baby's gender with 99% accuracy as early as 9 weeks!  I was extremely anxious to get this test done not just for my own peace of mind as an over-40 woman at an increased risk of having a child with a chromosomal disorder, but also to find out whether that little girl in my mother's dream would be coming true.  I didn't want to wait 3 more weeks to do that!  (This is where that whole "patience is not my forte" thing comes into play.)  Plus, I'd be 12 weeks and 5 days along by then which is dangerously close to the 13-week cutoff that the test can even be done.  So I called my OB's office later that same afternoon and had them email me an order for the test so I could get it done ASAP.  I called the lab to make my appointment as soon as I had the order in hand and scheduled it for Thursday, May 14 at 8:00 am.
 
Honestly, I was more nervous about learning the baby's gender than the genetic screenings.  I wanted it to be a girl so desperately that I couldn't stop obsessing over it and trying to mentally prepare myself for it to be a boy just so I wouldn't be too devastated if that were the case.  It took 8 long days for me to learn the results.  On Friday, May 22, my doctor called me herself while I was at work to discuss the test and immediately asked, "Do you have a minute?"  Uh oh, I thought. That phrase is never good!  My heart started pounding and I grabbed a pen and paper to write down whatever it was I was about to hear just in case I couldn't process it fully.  The good news, she said, was that the test was negative for all 3 of the major trisomy disorders (Down, Edwards, and Patau Syndromes).  Then she asked me if I had wanted to know the fetal sex.  My heart started pounding even faster and my mouth went completely dry as I told her yes, I did.  She said, "Good, because I have to tell you in order to give you the rest of the results."  (Say what?) The fetal sex was (as the test puts it) "consistent with female" meaning they didn't find any Y chromosomes in the DNA samples.  However, the lab's additional finding was a "decreased representation of the X chromosome" making it suspicious for a genetic disorder called Monosomy X, a.k.a. Turner Syndrome.  When she told me this, I remember feeling detached and numb, like a clinician viewing the results through a microscope lens.  Immediately after that, though, I felt relieved.  I actually personally know a few people with Monosomy X and they live completely normal lives.  It presents some challenges but it's not incompatible with life like some of the other disorders they tested me for.  Also, this meant the baby was almost definitely a girl!
 
It's important to note here that NIPTs aren't really tests so much as they are a screening, so they aren't meant to be a definitive diagnosis.  They're touted as being "99% accurate" but that just means that if there's a problem, the test will pick up on it 99% of the time.  The accuracy rate is much lower if you factor in all the times it picks up a problem that isn't actually there.  I'd seen many, many posts in my Facebook groups from people who had an NIPT done and ended up getting a false positive for something that was later ruled out by an amnio.  It's horrifying to think of all the perfectly healthy pregnancies that were terminated due to false positives simply because so many people don't realize the test isn't diagnostic.  I told my doctor about all the times I'd seen people post about false positives and that most of the time, the babies ended up being completely fine, so I wasn't terribly worried that the baby had Turner's.  She said soberly, "Well, it's a real possibility."  That phrase cast a huge shadow of doubt in my head.  The odds seemed good that the baby was just fine, but what if?  The not knowing was worse than if the test were a true positive.

My doctor then told me I was being referred to a perinatologist (a high-risk pregnancy doctor) at a Maternal Fetal Medicine (MFM) clinic for more invasive testing and that they would be in touch regarding my first appointment.  As soon as I hung up from my OB, I called Brian and told him the results.  I tried reassuring him that the test was not definitive, but he was still quite shaken by the results.  So much so that he still remembers exactly where he was when I called him and he even pointed that place out to me once when we drove past it.  Then I called my mom.  I'd always imagined that if I found out I was having a girl, I'd call her excitedly and she and I would share a wonderful happy moment together.  Instead, there was huge "but" casting a dark cloud over the news.  I will always resent the unbridled joy of that moment being stolen from me.  My mom was upset about that, too.  She said she knew in her heart that there was nothing wrong with the baby since she'd dreamed of a perfectly healthy little girl.  But she was angry that everything had to come with a struggle.  "Why can't we have just one good thing?  Why does something like this always have to happen?" she wondered.  I was already starting to regret having that test done.

The Maternal Fetal Medicine clinic called me later that day and my appointment was scheduled for the following Thursday, May 28 at 11:00 am.  Over the next 6 days, I dug deep into researching more about not just Turner Syndrome but also NIPTs and what all could cause a false positive.  I found a 2300-post-long thread on BabyCenter by people who'd gotten the exact same result I did and I read through the entire thing.  All but 1 or 2 cases ended up being false positives for Turner's and a few even learned they were actually having healthy baby BOYS!  So what's the reason behind all of these false positives?  There were several possible explanations, as I learned.
 
Monosomy X, as the name suggests, means that the baby only has one X chromosome instead of two. (Without the presence of any Y chromosomes, all monosomy X babies are female, which is why my doctor couldn't give me my test results without revealing the fetal sex.)  Since the NIPT only looks at fragments of DNA from the placenta found in my bloodstream, it's possible that the abnormality is confined to the placenta only (this is actually fairly common and referred to as "confined placental mosaicism").  However, since the test can't differentiate between placental DNA and my own, it's also possible the abnormality came from me.  Monosomy X can appear in varying degrees.  Either all of the person's genes are affected or only some of them are (a condition referred to as "mosaicism").  So it was possible that I had some low-level form of this condition without ever knowing it.  Another possibility: X chromosomes often start to disappear as a woman ages since the body no longer needs them after puberty.  Since I was already over 40, it was quite possible that was the case here.  Another possibility: the baby was actually a boy and the test had simply failed to pick up any of his Y chromosomes.  And of course, the final possibility was that the baby really did have Turner Syndrome.
 
On the day of my appointment with MFM, Brian was only allowed into the waiting room with me due to pandemic-induced restrictions.  (By the time of my next appointment, though, he wasn't even allowed that far.  In fact, every remaining appointment of my entire pregnancy--both with MFM and my OB--I had to attend alone.)  My appointment that day was a long one and included several components: First was a consultation with a geneticist, then a more detailed ultrasound with the ultrasound tech, and then I would finally see the perinatologist to discuss the plan.  The consultation with the geneticist was just a virtual talk in a small conference room with a table and a laptop in order for her to explain the test's findings and talk to me about what all it could mean.  First I had to answer all kinds of in-depth questions about both Brian's and my family histories.  I then let her know I was already very familiar with Turner Syndrome and told her about all of my findings regarding the possible explanations for the result.  She said, "Wow, you make my job really easy!"  She seemed much more optimistic than my OB was that it was a false positive.  In fact, she said the odds of the test being correct were actually around 40%.  That made me feel much better, but it was still a big enough "what if" to warrant further testing.
 
After our talk, I had my ultrasound (my 4th one so far and I was only 12 weeks along now).  The ultrasound room had a large flat-screen TV mounted on the wall in front of me where the images would be projected.  There were signs stating that absolutely no photos or videos were allowed, which was very disappointing.  But the tech told me any pictures she took would be posted to a special website where I could create an account and view them for up to 30 days.  Then she dimmed the lights, applied the gel to my midsection, and placed the probe over my uterus.  The second the images popped up on the screen, I gasped in shock. The little gummy bear with a tiny flicker of a heartbeat I'd seen in my 8-week ultrasound was now a full-on baby with arms, legs, fingers and toes, and was bouncing around like a pinball inside the womb.  I couldn't feel it of course, but the transformation was astounding.  I couldn't believe how much growth and development had taken place in just 4 weeks.  I wished so badly that Brian or my mom could be there with me to see it.  
 
The tech took a lot of measurements which all appeared on the TV screen after she was done.  As soon as she stepped out of the room to go over everything with the doctor, I pulled out my phone and snapped a picture of them.  Something I had learned via all my internet research and in the Facebook groups was that there are certain measurements they take which are indicative of genetic disorders.  One is the Nuchal Translucency (NT), which is a collection of fluid under the skin behind the baby's neck.  A measurement of 2.5 and above is typical of Turner Syndrome.  I held my breath while I scanned the screen for the NT and when I found it, I let all my breath out.  It was 1.28!  I knew an amnio would be the final determination but, to me, this was almost as good as negative.  The heart rate was also very strong again at 153 BPM.

The final part of the 2-hour-long appointment was my meeting with the perinatologist.  He first reviewed the tech's images and measurements then he joined me in the ultrasound room to discuss the next steps.  He stated that everything appeared to be normal, however Turner's is not always detectable on an ultrasound so he still couldn't rule it out.  He was recommending I undergo 1 of 2 different tests.  One was an amniocentesis, which many people are already familiar with, and involves taking a sample of the amniotic fluid for analysis.  The other was a CVS (Chorionic Villus Sampling) which is done by taking samples of tissue from the placenta.  Each test has its own pros and cons.  The main advantage of doing the CVS was that it can be done between 10 and 13 weeks gestation, so I could get it done right away since I was already 12 weeks.  Whereas I would have to wait until week 15 to get the amnio, which meant 3 more weeks of not knowing, plus however many additional weeks it would take to get the results back.  However, the amnio is a far more definitive, reliable, and all-encompassing test.  Plus, since the CVS is testing only tissue from the placenta, then the results would likely be the same as the NIPT if the reason for it was confined placental mosaicism.  The amnio is actually analyzing the fetus's own genes, so it would be a much more accurate result.  It also carries a slightly lower risk of miscarriage and detects certain things that a CVS doesn't.  I knew immediately which test I would rather do.  I just couldn't stand the idea of having to wait 3 additional weeks to do it.  Of course, there was always the option to forego any additional testing and just find out at the birth, but Brian and I both wanted to know for sure so we could be prepared in either scenario.
 
My amnio was scheduled for exactly 3 weeks later on June 18.  The doctor also ordered another blood test to check my risk for Down, Patau, and Edwards Syndromes, even though the NIPT hadn't detected any those.  He also did a blood test that checks to see if I'm a carrier for about 150 different inherited conditions, like cystic fibrosis.  All the conditions require both parents to be carriers in order for the baby to inherit them, so if I was negative, then the baby definitely didn't have any of them.  He also noted in my medical history that I'd been diagnosed with juvenile-onset type 2 diabetes.  Even though I had no symptoms and it played absolutely no part in my life anymore, I still always noted it in my history since there's no way to get "un-diagnosed."  So the doctor gave me an order for a Hemoglobin A1C to check my average blood sugar over the past 3 months or so.  He also recommended I get an early 1-hour glucose tolerance test at my OB's office since this put me at high risk for developing gestational diabetes.  And finally, he recommended I start taking baby aspirin every day to lower my risk for pre-eclampsia.  Since aspirin's a blood thinner, he said to start out with just one tablet a day until after my amnio, then switch to 2.  It felt good to finally be starting on these preventative measures my OB had discussed with me 6 weeks earlier.  I started on that later that same day.

As soon as I got back to work after my MFM appointment, I logged onto the website to download the ultrasound photos and immediately emailed them to my mom so she could see how much the baby had grown since the heartbeat video.  I texted her to check her email.  A few minutes later, she texted back, "AWESOME!!"  She said when she saw them, she gasped and screamed "Oh my God!" and cried, just like on Mother's Day.  I wished I could've heard it.  Despite the shadow of uncertainty cast over us by the NIPT, some joys just can't be contained.
 
The following Monday, June 1, was my official "1st OB" appointment (and not a moment too soon since I only had 2 more days left of my 1st trimester).  It was mostly a lot of blood work and questions.  The doctor also did yet another ultrasound, which I got a video of.  The baby wasn't quite as active as she was at MFM, but still bounced a little.  Heartbeat was good and everything was still measuring right on schedule, too.  I sent the video to my mom and asked her later if she cried again when she saw it.  She said she didn't but talked to it excitedly.  I asked what all she said and she replied (in a baby voice), "Ooh, look at you!  I see your nosey, your feeters, ooh, listen to your strong heart!  I love you!  I love you!  I love you!"  I told her next time I should call her before sending something pregnancy-related just so I could hear her wig out over it.

On Wednesday, June 3, I officially entered my 2nd trimester!  Most people wait until the 2nd trimester to announce their pregnancy since the risk of miscarriage is pretty low by then.  I had already told everyone at work but Brian still wanted to wait a little longer to announce it publicly since he hadn't yet told his kids or the rest of his family.  He assured me he would do so sometime in the next week, though.  It was very frustrating.  I felt like I was doing so much waiting and anticipating already between that, the NIPT, and now the amnio looming ahead.  I needed to get SOMETHING off my chest!  I did get the results of all my blood work from MFM back that day, though.  As usual, everything was normal.  So far, the whole pregnancy was progressing extremely smoothly.  It was all textbook perfect, aside from the NIPT.  There was just that one major test remaining and I still had 2 more weeks of limbo before I could get it done.  I would need to draw upon all my inner strength to get through those next few weeks without losing my mind.

With that, I will conclude Part 1.  Stay tuned for part 2: The Second Trimester.

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