The 2nd trimester is often thought of as "the good trimester" because by then, you're past a lot of the 1st trimester woes like fatigue and morning sickness, and you're also not yet bogged down by 3rd trimester things like swollen extremities and slogging around a giant boulder in your belly. Also, that's when a lot of the fun stuff happens like learning the baby's sex and feeling the first kicks. It's the honeymoon period of pregnancy! My second trimester was arguably the most pleasant, and by far the busiest.
Any pregnancy is eventful enough. To be doing it as part of a clinical trial is even more so. I knew what I was signing up for when I enrolled so I was OK with that. Towards the end of my first trimester, the research team at Georgetown scheduled me for a virtual visit with the oncologist. I did that on Monday, May 18, which just happened to be the 3-year anniversary of my cancer surgery, so it was quite fitting. It was also around that time that Brian and I finally began discussing the plans for our future. We'd both known early on in our relationship that we were in this for the long haul (hence him agreeing to me doing the study after only 2 months of dating). But we agreed to play everything by ear and see where things were when/if I got pregnant. Since it happened a lot more quickly than either of us anticipated, we didn't have a lot of concrete plans until around Memorial Day. He stated his goal was for us to be living together no later than October, so we felt we should start our housing search sometime in July or August. Meanwhile, I decided to rent out my condo rather than sell it so I set about refinancing at a lower interest rate to make it more economically feasible.
I've always made important life decisions based on how much of a "no-brainer" they felt like. Moving to DC was an absolute no-brainer, as was accepting my current job, buying my condo, and enrolling in the POSITIVE trial. If I ever had any hesitation about something being the right move, I held off until it felt right. I'd previously looked into refinancing but something about it just didn't feel like the right time. In June of 2020, the interest rates were at record lows and demand for housing was far exceeding the available inventory, driving up property values. My decision to refinance hinged solely on being able to do so without having to pay PMI, which I needed a loan-to-value ratio of no higher than 80% in order to do. I'd only owned my place for less than 3 years so I was crossing my fingers that the sudden rise in property values would be enough to generate the equity I needed. My appraisal came back with a LTV ratio of 74% so I took it as the green light I was waiting for to move forward.
Focusing on the fun stuff during those 3 weeks between my first appointment at MFM and my amnio helped make the wait slightly more bearable. On Wednesday, June 10, Brian and I made our official pregnancy announcement since he'd finally broken the news to the rest of his family the night before. I texted my mom that morning that she was now free to shout from the rooftops that she was going to be a grandma. She texted back, "Yeah!" There was a bit of a damper on the celebration, though, with the uncertainty of the NIPT results and the amnio looming ahead. Several people asked me if I knew what we were having and I honestly didn't know how to answer since there was still a chance it could be wrong. Although I didn't exactly want to keep what was happening a secret, it made me want to avoid the question altogether until we had more definitive answers.
My amnio was scheduled for Thursday, June 18 at 1:45 pm. It was another long appointment. I took the entire afternoon off work since the perinatologist advised me to take it easy for the rest of the day. Plus I was anxious about the procedure and potential complications, so I knew I likely wouldn't be very productive anyway. Brian drove me to work that morning so that he could drive me to MFM and back home after, but he wasn't allowed past the office's front door so he had to wait outside in the car while I texted him with updates.
The first part of the appointment was yet another ultrasound. The tech took a lot of the same measurements as last time and also did a detailed scan of the baby's heart to make sure it was developing normally. (A lot of aspects of my plan of care hinged on the results of that.) She also did a gender confirmation and declared it was "definitely a little Miss!" So I finally felt safe in rejoicing that I was for sure having a little girl! When the doctor came into the room after reviewing everything, he told me that all of the measurements and images looked good, as did the baby's heart. However, the scan had revealed that I had a condition called marginal
placenta previa, meaning the placenta was lying dangerously close to the
cervix. This can cause issues like bleeding and delivery
complications, depending how severe it is. The doctor said most cases of placenta previa resolve on their own and he felt mine would probably do the same by the time of my next appointment. So, I put that information into a little box in my head to worry about later. At the time, I was more focused on the needle they were getting ready to pierce me with.
I don't usually have a fear of needles, but I was extremely apprehensive about this one. The idea of being poked all the way down through my skin, muscles, and into my uterus made me squirm. The procedure was being guided by ultrasound so I decided to turn my head away from what they were doing and focus on the images of the baby on the screen instead. When they deployed the needle, it actually felt more like a cramp than a stab, so I was very relieved! The baby, however, was being very active again and kept moving around, making the doctor have to keep adjusting the needle so he wouldn't poke her with it. He seemed to be growing more and more exasperated every time it happened. Eventually, he was able to get the sample and withdraw the needle. He said my body would replace the fluid he'd removed by the end of the day and, in the meantime, to just go home and relax for the next 24 hours. He also felt confident enough to state that there was a "pretty good chance" the baby didn't have Turner's. He said the rapid results should be back within 24-48 hours and the full results should be available in 1-2 weeks. My next appointment there would be my Level 2 ultrasound at 20 weeks, when would they do a full anatomy profile. I scheduled that for Wednesday, July 22. I couldn't believe I was already approaching the halfway point!
In the past, most people had to wait several weeks after an amnio to get any kind of results. Nowadays, they can do a FISH test, or Fluorescence In Situ Hybridization test. This tests a small sample of the baby's genes for a limited number of chromosomal abnormalities (including Turner's) and is usually available in a day or 2, so it's kind of a preliminary result while waiting for the full karyotype to come back. I waited expectantly all day on Friday, hoping they would call with the results of the FISH test, but I didn't hear anything. The following Monday, I still hadn't heard anything by late morning, so I called the office to see if anything had come back yet. They said nothing was back yet but it should come in today, so they would call the lab to check and call me back. I waited all afternoon for a call back but still hadn't heard anything by 4:30 p.m. So I called the office again but they had just closed for the day. This was deeply concerning. I thought back to when I was waiting for the results of my first breast biopsy, thinking it would be back in 2 or 3 days, and wondering why it was taking so much longer. I was getting worried that, once again, no news was actually bad news.
On Tuesday morning, I got a call from a phone number I recognized as an Ohio area code, which I figured was spam so I didn't answer. However, they left a lengthy voicemail stating they were calling from someplace that I couldn't quite make out the name of but I thought I heard the word "laboratory." They asked me to call back referencing a couple of case numbers. I Googled the number they called me from and it came up as a genetic lab. However, the message they left was about billing and payment and I'd never received a call like that from any lab ever before, so I wasn't sure if it was legit. Something told me not to disregard the message, though. Hesitantly, I called them back, referencing the case numbers they left me. Long story short, it was the billing department for the lab that was processing my amnio. The person I spoke with said the results were ready, however they couldn't release them to me or my doctor until they conducted a "benefits analysis" of my insurance to find out how much of the test would be covered, and they needed my permission before they could do that. I was pretty miffed to learn that they were essentially holding my test results as collateral until they figured out how they would get paid for them. I didn't see how that was even ethical! I told them to please run whatever they needed and send the results to my doctor's office ASAP. I was willing to pay for the whole test out of my own pocket if I had to.
The next day, I got another call from that same lab. The person I spoke with that time told me my estimated out of pocket cost was $200 and asked me, based on that, if I wished to proceed with the test. I was quickly losing patience with them at that point and said "Yes, I'll pay whatever, let's just get this done!!" However, this person also told me the benefits analysis was actually run on Monday. If that's the case, why did they call me on Tuesday to ask me if they could run it?? Nothing about this was making sense and I was only growing more and more agitated by the delay. The rep I spoke with said they would go ahead and send the results to my doctor's office either today or tomorrow. I called my doctor's office a few hours later to see if they had come in yet. They said nothing was back yet so they would call the lab and ask them to fax the results over. It frustrated me to no end knowing that someone out there knew what the results were and wouldn't tell me. This test was supposed to have been back in 24-48 hours but it was now going on a week and I was still waiting! I just needed to know something!! It had been a full month of limbo since the NIPT came back.
The next day, I waited all morning for a phone call from MFM and finally called them again myself around 11:30. I was told the results were in but they were on the doctor's desk waiting to be reviewed and finalized so I should hear back by the end of the day. The waiting and the suspense were almost too much to bear. Finally, at 2:30 pm, my phone rang. It was the geneticist I'd spoken with at my first appointment. She told me, "I have some results for you. However, they're not the results you--" I let all my breath out and dropped my head to my chest, anticipating her next words to be "were hoping for."
"--Were waiting on." she continued. Huh? She explained that, instead of the FISH test, she had the results of the Fetal Alpha-Fetoprotein Test. This was a blood test they'd done the same day as the amnio that checks for congenital birth defects such as spina bifida, anencephaly, and all the major trisomy disorders (which I'd already been tested for twice and knew they were all negative!). Of course, it was all normal. I then told her about the runaround I'd been getting from the lab and she agreed that was not acceptable. She said she would call them herself and have them send over the FISH test ASAP.
A hour or so later, she called me back, this time with the FISH test results. She reiterated that the test only looks at 50-100 genes out of the entire sample in order to get a preliminary idea of what the amnio results would be, so it was still important to wait on the amnio for a definitive diagnosis. For my test, they had analyzed 100 of the baby's genes. Every single one of them had 2 X chromosomes!! Obviously, they still needed the full panel in order to rule out some form of mosaic Turner's and any other conditions they were testing for. But this was probably the best news I'd heard since week 8 when we confirmed the baby had a heartbeat. I hung up and immediately called Brian and then my mom to tell them the good news. It would be yet another week before I would receive the rest of the results.
On the evening of Wednesday, July 1, the geneticist called me again. It was already after hours so my mind immediately went to: "Uh oh, she can only be calling me this late because there's bad news." She explained she was calling after normal business hours because she knew how long I had been waiting and wanted to finally put an end to my limbo. She then proceeded to tell me that everything had come back 100% normal and healthy! I could physically feel the weight leaving my shoulders. After nearly 6 weeks of waiting and not knowing what lie ahead for us and our child, we finally had the answers we so desperately craved--and they were the answers we wanted to hear! The geneticist apologized for the runaround with the lab, saying it was a new lab they had just started using and nothing like that had ever happened with their old one. She said if it ever happened again to please let her know and she would deal with them herself. (Now she tells me!)
I had dinner plans that night with Brian and his mom, who had flown in from Michigan the day before for a 2-week visit. They both arrived at my door just as I was hanging up with the geneticist so I got to share the good news with them immediately. I later informed my mom, who by then was just like, "Yeah, I knew it all along." All in all, I
regretted ever getting the NIPT done. It was supposed to give me peace
of mind but instead, it just created even more stress and more trouble than
it was worth. If given the chance, I probably wouldn't do it again and I would caution any women who did do it to take any positive results with a grain of salt.
After the amnio came back normal, I figured I wouldn't have to see the perinatologist anymore. But, at my second OB appointment on Monday, June 29, I learned that wasn't the case. Since I was still considered high-risk, the plan was for me to continue seeing him every month until delivery, on top of my regular OB visits. This was also in addition to my periodic visits with my oncologist, breast surgeon, and the research team at Georgetown. Clearly it takes a village to monitor a post-cancer pregnancy conceived as part of a clinical trial!
One of the things I was at high risk for was developing gestational diabetes. Usually that develops in the second half of pregnancy so they typically test for it around 24 weeks. But because of my history, they were recommending I get tested earlier, at week 18. So I had that done the morning of Thursday, July 9. Despite this being my first pregnancy, this was not my first glucose tolerance test by a long shot. Since I'd been diagnosed with type 2 juvenile diabetes at age 10, and spent 3 years working in an OB/GYN office (plus my mom had been an OB/GYN nurse for 40 years), I was already very familiar with the test and how it was done. I'd shown no symptoms of diabetes myself since my early teens and my blood sugars had been completely normal for the last 20+ years. Regardless, they were testing me early anyway. I had to fast the morning of my test then drink the sugary drink 30 minutes before my appointment, and I had to finish drinking it within 5 minutes. Then I had to arrive at the office and have my blood drawn exactly 1 hour after finishing the drink so they could see how well my body was handling all the excess sugar. I
admit I was a bit nervous that I wouldn't pass. Although I was finally past the nausea and able to eat
normally again for the most part, my biggest pregnancy cravings were ice
cream and candy, and I'd been indulging my sweet tooth pretty regularly since I couldn't have coffee or wine. (Hey, we all gotta have a vice!) Five days later, I learned that I had passed the test with flying colors!
It was around the middle of July that Brian and I began our housing search, shortly after I'd closed on my mortgage refinance and began getting my condo ready to rent out. We also decided to plan a trip up to Ohio and Michigan to visit both of our families, which we scheduled for the first week in August. On Wednesday, July 22, I was officially at the halfway mark of my pregnancy. I also had my 20-week Level 2 ultrasound at MFM that day. The office had called me the day before to let me know my usual perinatologist wouldn't be in the office that day and asked if I'd be OK seeing someone else. I was anxious to get this scan done so I said yes. When I looked up that doctor's bio on their website, I discovered he'd gone to medical school in Toledo at the same hospital where I'd seen my pediatric endocrinologist after being diagnosed with juvenile diabetes. Small world, isn't it?
The morning of my 20-week scan, I brought a little box of orange juice to work with me to drink about an hour before the appointment. I wanted to give the baby a little sugar rush so she would be nice and active on screen. It worked very well. She bounced around so much in there, the tech had to chase her around with the probe like a cat chasing a laser pointer! The good news was that her head was now facing down and, as the doctor predicted, the placenta had moved far enough away from the cervix that placenta previa was no longer a concern.
It was around this same time that I began feeling the baby kick. I'd actually been feeling what resembled tiny gas bubbles popping for a couple of weeks but thought it was just that: gas bubbles popping. I didn't realize it was the baby kicking until around week 20, when the popping sensation started getting stronger and more frequent. I was beginning to wonder if it was a hostile takeover!
Something that had really bothered me about all the covid restrictions was that no one other than me was ever allowed at any of my doctor appointments. I really resented that Brian was missing out on being there to experience it all with me, especially the ultrasounds. Fortunately, my mom, given her current profession, had quite a few connections, including an ultrasound tech who owned her own little shop up in Northwest Ohio that did "for fun" 3D and 4D ultrasounds. Brian and I were planning on flying into the area on August 6th and visiting until the 10th, so Mom scheduled me an appointment there on Friday, August 7, when she and Brian could both be in the room with me and watch the baby live in action. My aunt and cousin also decided to throw me a small baby shower that weekend, mostly for family and a few local friends who couldn't come to my main baby shower that was being planned for the fall in Virginia. Brian was born and raised in the Detroit suburbs, about an hour and a half away from my hometown, so his family all lived close enough to attend, too. My shower was scheduled for Saturday, August 8, in an outdoor picnic area at the city park. It was shaping up to be a very full weekend. What I was most looking forward to, though, was the ultrasound. I'd longed for Brian and Mom to be able to attend one in real time with me. I wondered if Mom would react the same way she did when I first told her I was pregnant or sent her the pictures from my first scan at MFM.
On Tuesday, August 4, I had to drive up to Georgetown first thing in the morning for some second trimester blood work for the clinical trial. It was the first time I'd been there in person since early March, right before the pandemic hit. The research coordinator met me at the front desk and walked me over to the research lab for the draw. She and the phlebotomist both seemed very excited to see me and raved about my "cute little baby bump" the whole time. They explained they're used to seeing sick people so it was exciting to see someone healthy for a change. Afterwards, I was told I would need to come back sometime in my 3rd trimester to meet with the oncologist for an exam. I was lobbying for it to get scheduled on November 18 to commemorate the one-year anniversary of the day I enrolled in the trial, but it ended up getting scheduled for Monday, November 9th instead. (In hindsight, that was a very fortunate thing...)
Our flight to Michigan took off out of Reagan airport the morning of the 6th. While Brian and I were sitting at the airport waiting to board the plane, we signed the lease (electronically) for our new home together. The place where we would be bringing our baby home from the hospital was now locked in! It was everything we'd been looking for: 4 bedrooms, 3.5 baths, upper and lower level decks, wood burning fireplace, plenty of storage space, less than a mile from the local schools, and as an added bonus: it was right on the lake! Our soon-to-be new home had a waterfront view! I'd dreamed of living on the water ever since I was little. Although I wasn't looking forward to moving again so soon, I was very much looking forward to living there (and living under the same roof as Brian).
We landed in Detroit around 11:00 am. Brian's dad met us at the airport and drove us over to one of the cell phone parking lots, where my mom and aunt were waiting to take Kirby for the duration of our stay. (We were staying at Brian's grandmother's house so I thought it would be nice if Kirby got to stay with her grandma, too.) Brian's boys had flown up the previous week to stay with his sister and her family for a few weeks, so they were already there. Although I'd been to Detroit dozens of times while living in Northwest Ohio, I hadn't yet visited the suburbs. Most of the weekend was spent with Brian giving me the grand tour of his old stomping grounds and telling me every little historic detail and trivia tidbit about every single building and landmark. I lived in my hometown for 29 years and felt like I barely knew anything about it compared to his knowledge of his. (This was clearly the history buff/geography major/urban planner side of him geeking out.)
On Friday, my ultrasound appointment wasn't until 4:00 pm so we spent the day driving around and exploring Brian's hometown before heading down to Ohio. I'd scoped out the shop's website earlier in the week and saw they offered several packages starting with the most basic up to "the works." Mom was paying for it as my shower gift and was getting me the works, which included ultrasound pictures, a video, a gift bag full of goodies, and a stuffed animal that, when squeezed, plays an actual recording of the baby's heartbeat! Since she knew the owner, she was getting the friends and family discount, too.
On the way down to the appointment, I drank another 8 ounces of orange juice to make sure the baby would be energetic enough to perform for the camera. My mom and grandma both met us at the shop. My grandma had never seen a live ultrasound before, only pictures. She was absolutely captivated by everything she saw on the screen and kept cooing, "Isn't she special? Oh wow, she's so special!" I thought Mom might cry seeing live images of her grandchild in real time, but she held it together pretty well. Brian acted fairly ambivalent about the appointment, saying he'd already seen tons of pictures and videos so this was just "icing on the cake." But as soon as the tech started the scan, he had his phone out and was concentrating so hard on recording his own video, I couldn't get him to look up from it. The scan itself lasted just 15-20 minutes. The tech was able to switch back and forth between 2D and 3D so we could get plenty of images. It was hard to capture the baby's face, though, since she kept covering it up with her hands. The tech had me jostle my belly a few times to try to get her to move her hands down, but it wasn't long before they were right back up by her face again. Mom said that was a good indicator of what she would do outside of the womb. I joked that she was probably just practicing for her first wine tasting.
They processed the video and pictures right away and gave us the DVD and an album of the photos. I got to pick out the stuffed animal I wanted for the heartbeat recording and I chose a giraffe that reminded me of a musical giraffe toy I'd had as a baby. They told me to be careful with it because the recording device inside was able to be recorded over, so one false move could erase it forever. I decided to give it to Mom for safekeeping until she could drive it down to DC since I didn't want to risk the TSA mishandling it. I asked her to bring it with her to the shower the next day, though.
The day of my baby shower was a sunny and temperate 80 degrees. We were limited to 30 attendees so it was mostly Brian's and my family plus some longtime friends. Since it was small and somewhat last-minute, it was fairly informal but it ended up being a wonderful event! I was very impressed with how well my cousin and aunt had thrown it together so quickly and how nice everything turned out. The only problem was I couldn't take all the presents back home on the plane with me, so I had to leave most of them with Mom until she came down for my bigger baby shower in 2 months.
The rest of the weekend was spent mostly walking around suburban Detroit, spending time with Brian's family, and admiring all the classic cars that people were displaying up and down Woodward Avenue. On Sunday, we squeezed in a trip to the Detroit zoo with Brian's mom, his 2 boys, and 2 of his nieces. Afterward, he and I took a drive out to Frankenmuth to shop for the baby's first Christmas ornaments at Bronner's, with dinner afterward at the Bavarian Inn. Our flight home left Detroit on Monday morning. Mom met us at the same cell phone parking lot to return Kirby to me and hug us all goodbye. The next time I saw her would be at my 2nd baby shower.
For the rest of August, I focused mainly on finding a tenant for my condo and packing for the move. I also had a virtual visit with my oncologist on Monday the 17th for my biannual follow up. I'd been looking forward to that appointment ever since I found out I was pregnant since the last time I saw him was the day before my 3-month "wash-out" period ended after stopping Tamoxifen. I'd thought about how fun it would be to show up at my next appointment nearly 6 months pregnant. It just wasn't the same surprising him with the news virtually. We did discuss what my life would look like during the postpartum period, though, with regards to restarting hormone therapy. I'd been under the impression I would have to go back on Tamoxifen as soon as possible, which is 6 weeks after giving birth since you're at higher risk of developing blood clots during that time. Since you can't take Tamoxifen while nursing, I thought I wouldn't be able to nurse any longer than those 6 weeks (assuming I could at all). But, he told me that wasn't the case. Rather, he said he would defer to the protocol of the clinical trial. I emailed the research team about it later and they said there were no strict deadlines or parameters on that. I was free to nurse as long as I wanted! So, I decided that I would give myself 6 months to breastfeed before going back on Tamoxifen. Brian was very happy to hear that since he was a big proponent of the benefits of breast milk during the first 6 months of life. I was also excited to have that much more time off hormone suppression!
The following Friday, August 21, was my monthly check-up and ultrasound at MFM. Now that my amnio had come back completely normal, they were mostly just monitoring the baby's growth. She had measured exactly average at my 20-week scan and that was still the case 4 weeks later. My regular OB had also begun measuring my fundal height and it was always right on target, so the baby appeared to be growing perfectly. However, I was already having difficulty packing for the move with my ever-expanding belly in the way. The last time I moved was so easy and happened so quickly in comparison. Being near the end of my second trimester made me feel quite helpless since I couldn't lift anything heavy or do anything strenuous. It was frustrating wanting to be able to do everything normally like I did before while knowing I simply couldn't. Brian's and my new lease started on September 1 and we were planning on moving in over Labor Day weekend, on September 5 and 6. Meanwhile, I was still trying to secure a tenant and replace the carpets in my condo. Brian and I also decided to purchase a whole new bedroom suit for ourselves, so we spent many weekends and evenings furniture shopping. We finally settled on the very first set we'd looked at. But by the time we signed the purchase agreement, it was on back order and wouldn't get delivered until September 18--nearly two weeks after our moving day!
On Tuesday, August 25th, I met with my regular OB again for a check-up and we scheduled my next visit for exactly one month later on Friday, September 25th. That appointment would also include another 1-hour glucose tolerance test since I would be 29 weeks then, which was around the time they typically test for gestational diabetes. I had easily passed the first test but my affinity for sweet treats (and my inability to deny them) continued to plague me, so doing it again felt like tempting fate.
Brian and I picked up the keys to our new home on Monday, August 31. The rest of that week, we both spent our evenings taking boxes and small items over to the house a carload at a time. Our official moving day was Saturday, when the truck came to move our furniture and big ticket items. He had taken care of securing the moving company to move both of us that same day. They arrived at Brian's house first thing in the morning, loaded everything up, then unloaded it at the new house (which was less than a mile away from his old one). Then they continued on to my place just 2 miles away that afternoon to do the same. It was an absolutely backbreaking day that seemed to drag on forever. Combining two people's entire homes into one is an extremely onerous task, and with me being 26 weeks and visibly pregnant, I wasn't exactly operating at full capacity. We didn't even get everything moved out that day. We had to spend the next week or so removing all the last little things ourselves (with the help of some very generous friends, for whom I remain extremely appreciative!). And then there was the challenge of unpacking and finding places for everything, all while waiting for our new bedroom furniture to get delivered. I'd gotten rid of my old bedroom furniture before moving so I lived out of boxes of clothes stacked precariously on top of each other for those two weeks. The baby's nursery became a makeshift storage room while we slowly chipped away at everything that needed to get done. Fortunately, I had found a tenant for my condo who had signed a one-year lease beginning on September 14, so that was one major thing off my plate.
On Wednesday, September 16, I officially entered my 3rd trimester. My 2nd trimester had ended on a high (albeit busy) note, and I was anxious to find out what the final 12 weeks had in store for me. Well, just 6 weeks later, my fears would start to become a reality. I would be reminded once again that life doesn't give a shit about your plans. I was also about to come face to face with something every bit as intimidating as cancer.
Stay tuned for that in 2020 A.D., Part 3: The Third Trimester.
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