2020 A.D., Part 3: The Third Trimester

If I've learned anything over the past 40-some years, it's that life doesn't care about your plans.  I certainly didn't plan on being a cancer patient at age 38, having to move 4 times in one year, losing my dad before he had the chance to walk me down the aisle, being pregnant for the first time at age 41, or that I'd be going to all my appointments without my child's father there with me due to a global pandemic.  To that end, I never saw the point of writing up a Birth Plan.  I had enough experience in the field of obstetrics to know how unlikely it is that the baby would adhere to it, so it just seemed like an exercise in futility.  I'm a person who thrives on making plans and sticking to them, so I knew I'd be setting myself up for disappointment if I tried doing that for the birth of my child.  So my only birth "plan" was to be open to all possible scenarios and turns of events.  However, even I was unprepared for how the last few weeks of my pregnancy would play out.  

One of the games we'd played at my baby shower in Ohio was having everyone write down their predictions for the birth, e.g. the date/time, the baby's weight and length, etc.  Since my due date was December 9, most people picked a date within a day or 2 of that.  My mom, however, predicted it to happen a week early.  She said that at my age, they almost never let you go the full 40 weeks since the stakes are higher and the placenta is not as efficient, so the general school of thought is "Why prolong it?"  She said most likely they would induce me at 38 or 39 weeks.  I was fine with delivering early since I was hoping to keep my baby's birthday as far from Christmas as possible.  I even asked Brian how neat it would be if she ended up being born on November 11, since that was both his and my dad's birthday.  He vehemently disagreed, though, saying it was too early and that no child wants to share their birthday. 

I actually had a very vivid dream near the end of my 2nd trimester that I spontaneously went into labor and had the baby at 11:05 pm the night before Thanksgiving.  Since Thanksgiving was 2 weeks before I was due, it seemed entirely possible that dream could come true.  I'd been discussing with Mom her plans for coming down for the birth, but it was impossible to set anything in stone without knowing when or if I would be induced.  If it ended up happening on or around Thanksgiving, that would undoubtedly complicate matters. When I asked my doctor at my 29 week appointment whether she had any inkling when or if they would schedule me for induction, she said it was too early to know that yet. 

On Friday, September 25th, I woke up bright and early for my second 1-hour glucose tolerance test.  My first test had gone perfectly with a one-hour glucose of 106.  I was worried I might not pass the second time around, but I found out the following Monday that I had actually passed the second test even more handily.  That one was 92!  However, my blood work revealed that I was borderline anemic.  The nurse who called me with the results said that since it was borderline, they didn't recommend iron supplements just yet.  When I reported this finding to my mom later, she asked me what the number was, but I didn't know since I'd only spoken with the nurse and hadn't seen a copy of the lab report.  I'd been noticing that this office didn't give actual numbers or reference ranges unless I specifically asked.  They preferred to just say something was high, low, or normal.  (On both my glucose tests, the nurse had simply said they were "normal" so I had to ask her what the exact numbers were.)  I'm a numbers person and prefer a bit more transparency, so I decided I would ask for a copy of all my lab work from that point on since I was starting to feel like I was being kept out of the loop.

The next day, I had a rather upsetting incident.  I was getting ready to take my morning shower and was piling all my daily pills, vitamins, and supplements into my palm when I realized one of them was not supposed to be there.  It was one of my old blood pressure pills that I'd been told wasn't pregnancy-friendly!  Even though I hadn't taken it in a while since my blood pressure was perfectly fine and even below textbook average, I had pulled that bottle off the shelf of my "active" prescriptions and set it somewhere else.  I had no idea how it had gotten placed back into the daily lineup.  My guess was that it happened sometime during the move, but I didn't know for sure so I had no idea how long I had been taking it without realizing it.  I called my OB that morning to let her know and she just said there was nothing I could do about it now except to stop taking it.  The main reason it wasn't pregnancy-friendly was that it's a diuretic, so the primary complication would be low amniotic fluid.  She said to let MFM know at my next appointment there so they could check my fluid level if needed.  I was so upset and angry with myself, especially over not even knowing how long it had been going on.  But it hadn't even occurred to me to be paying attention!  Every morning before getting into the shower, I take one each of the pills on the bottom shelf of my bathroom vanity without much thought, as if on autopilot.  Thank God I just happened to notice one of them didn't belong in there or it could've gone on indefinitely.  Pregnancy brain is very real.  

Since I had a history of estrogen-induced hypertension, I'd been watching my blood pressure since the beginning of my pregnancy.  My OB recommended at my very first appointment to schedule a visit with my PCP to see about pregnancy-friendly blood pressure medications.  But my PCP had said that, since my BP was fine, we should wait until it went up before treating me for it.  So I'd just been monitoring it and taking preventative measures such as the baby aspirin, keeping physically active, avoiding caffeine (much to my own chagrin), and watching my sodium intake (much to the chagrin of the people I was now cooking dinner for).  I'd been expecting my BP to be at least slightly elevated by the time I hit my third trimester, but it remained steady throughout the beginning of October.  

That same month, Brian and I began working on the baby's room since we had finally emptied all the boxes from it.  Choosing a paint color felt like the most impossible task ever.  I suffered from extreme option paralysis and Brian refused to give any input, saying he wanted the choice to be mine.  I finally made the decision by asking him to pick a random number and then going with the lightest shade on that page number of the Sherwin-Williams color fan deck.  Once again, it was hard not being able to help him with priming and painting so I sat on my hands and put that creative energy towards the decorating process.  I was getting anxious to have it done since we were going to need the spare bed to put up my mom and aunt KoAnn when they came down for my baby shower on the 17th. 

The week of October 12, I saw both my OB and MFM for my 32-week visits.  At my OB, I asked again about the possibility of being induced and she said we would likely finalize an induction date in 3-4 weeks, but that it would likely be at 39 weeks.  Of course, a lot could happen in that amount of time that could change that, but that was what they were anticipating for now.  I was grateful to at least have a rough estimate of when I'd be able to let Mom know when to book her flight down.  At MFM, the tech did all the usual measurements and estimated the baby's weight to be 4 lbs 2 oz which was right in the 50th percentile (although it felt like she was now taking up my entire chest cavity!) and my amniotic fluid was actually maxed out, so it seemed the diuretic hadn't had any adverse effect on that.  The scan also showed that the baby had a full head of hair.  The tech pointed it out to me, explaining it was all the wispy lines on the screen by her head.  

That same week, I also decided to schedule a maternity shoot since I really wanted to have one done.  A photographer friend of mine had offered to do it for me as a gift but our schedules just wouldn't align. So I set about searching for a photographer and just happened to find one who lived in town and whose only available date for the next several months was Sunday, October 18th, the day after my baby shower.  It was too perfect!  

I'd wanted my shower to be held that weekend for a few reasons: 1. Victoria would be flying in from California for a wedding so she'd be able to attend; 2. The weather was still nice enough in mid-October to hold it outdoors, so more people would be able to come while still remaining within the county's covid-era gathering protocols; and 3. My parents' anniversary was the 18th so I figured it would help Mom to be away from home and focus on the impending birth of her grandchild.  She and KoAnn left Ohio bright and early on Friday.  I had just put the finishing touches on the baby's room the night before so it was perfect timing.  The shower was being held at a local park from 1:00-4:00 pm on Saturday, but we had rented the pavilion for the entire day.  I was mostly looking forward to just hanging out with my friends since it had been so long since I'd seen most of them.  The weather ended up being a little chillier than I was hoping but the event itself turned out absolutely perfect!  It felt so good just being around people again!

My photo shoot was at 4:30 the next day, just as the sun was beginning to set.  I'd wanted Mom to come to the shoot, but KoAnn had to be back home by Sunday night, so they left immediately after breakfast Sunday morning.  I'd managed to schedule a salon appointment at 1:30 that day to get my hair done.  It was the only available time they had so I prayed my ultra-stubborn hair would hold until after the shoot.  The entire photo session lasted less than an hour but it was perfect.  It was shot at a nature park just a couple miles from our house.  The photographer emailed me a few untouched pictures a few days later as a sneak preview and said the full prints would be ready in about 4 weeks.  I absolutely could not wait to see them.  

Less than one week later, my good luck started to run out.  I noticed my feet, ankles, and lower legs were starting to swell, as well as my hands and face, too.  I checked my blood pressure a couple of times and it was slightly above my average, but still within normal parameters.  However, something just didn't feel right.  Swelling is perfectly normal in the third trimester but something inside me just felt off.  It was a general feeling of unwell that I couldn't quite describe.  

Pre-eclampsia had been one of my biggest fears about pregnancy long before I even started trying to get pregnant.  Most of the symptoms are indistinguishable from normal pregnancy stuff, but the main hallmarks are elevated blood pressure and protein in the urine.  My blood pressure is usually in the low 100s/70s but it started creeping up around week 33, which is when symptoms of pre-eclampsia often begin.  My OB's office always did a urinalysis at the start of every visit and had said nothing to me about the presence of protein, so I figured I was in the clear unless told otherwise.  I saw them again on Monday, October 26th, and my BP there was 122/78, which was slightly higher than my usual but still perfectly normal.  I told my doctor it had gone up a few ticks recently and she told me to keep monitoring it and let her know if it got to 130/90 or higher.  My mom was starting to get nervous that they weren't being proactive enough as pre-eclampsia tends to flare quickly.  She urged me to call my PCP again to see about putting me on Labetalol (the go-to blood pressure drug for pregnant women) before it became a real problem.  So I contacted my PCP but was told that at this point, all medications would have to come from my OB. 

By that same weekend, my BP hit 130/90.  So on Monday, November 2, I called my OB's office and the nurse told me to come in that afternoon to get checked.  Of course, when I got to the office, it was back down to 120/80.  The doctor examined me and said she didn't see any evidence of pre-eclampsia but she decided to run some labs just to have something for comparison later.  She said to keep monitoring my BP twice a day and let them know if the top number got to 140 or higher and/or the bottom number got to 90 or higher.  The next morning, my BP was 142/87 and 137/91 (I checked it twice just to be sure).  So I called the office to let them know, as instructed.  This time, I was told to let them know if it got to 160/110.  I was getting pretty frustrated that they kept moving the goal posts on me.  How high was it going to have to climb before they finally decided to do something about it?  Later that afternoon, the nurse called to tell me my lab work from the previous day had all come back "normal."  I wasn't relieved, though.  I did not like that unwell feeling, like my entire body was in a compression garment.  The last time I'd felt that way was when my blood pressure was near stroke range.  I wished someone would call me in something to take for it just for my own peace of mind!  I didn't want to wait until it was suddenly critical. 

After I left work that day, I was walking back to my car and started thinking about the possibility of becoming pre-eclamptic and needing an emergency c-section, like my cousin's girlfriend just a few months before.  Then I wondered: What if I had to have an emergency c-section without any anesthesia?!  I actually know two people that had happened to.  I started wondering what I would do if faced with that.  I didn't think I could go through with it.  They would just have to kill me first.  As I was walking and thinking about it, I suddenly started to feel warm and queasy.  By the time I got into my car and started driving home, I was feeling shaky and my legs were so weak, I could barely press down on the pedals.  I thought about pulling over but I just wanted to get home so I could lie down.  I was sweating all over and it felt like someone was standing on my chest, so I rolled down the windows and cranked up the A/C, trying to catch my breath.  By the time I got home, I didn't think my legs could carry me to the front door.  I was gasping for air, panting, shaking, and dripping in sweat.  I managed to hobble inside and immediately collapsed on the couch, feeling like I was either going to throw up or lose consciousness, or both.  I thought about having Brian drive me to the hospital, but I was too weak and dizzy to even stand up.  After about 20 minutes of lying on the couch and feeling like I was going to pass out, I gradually started feeling better.  A few minutes later, I felt completely normal again.  I had no idea what had just happened.  

The next day, it dawned on me that what I'd had was a vasovagal syncope.  I'd had a handful of those in the past (most recently the evening after my first breast biopsy) and all of them in response to some sort of bodily trauma or injury (sometimes my own, sometimes another person's).  But this was the first time it had happened from just thinking about it without anyone actually being injured.  The next time I met with my OB, I told her about the incident and what had triggered it.  She reassured me that if I did end up needing to be sectioned and we didn't have time for the epidural to take effect, they would knock me out with general anesthesia first.  That came as a great relief.  

The rest of the week, I continued to monitor my blood pressure and it continued to hover around 140/90.  I was really hoping they would finally put me on Labetalol at my next visit, which was on Tuesday the 10th.  My mom didn't want me to wait, though.  She spoke with several of the OB's at her office and none of them agreed with the 160/110 parameter.  They all said that by then, you're considered quite sick.  I told her I was continuing to log my BP and would definitely plead my case at my appointment, but mt doctor didn't seem to want to do anything as long as I wasn't in stroke range.  Mom argued that in her experience, it can flip overnight and suddenly become critical.  I asked, "Even without protein in the urine or any other symptoms of pre-eclampsia?"  She responded, "Yes!"

The week of November 9th, I had 3 doctor's appointments lined up: The oncologist for the clinical trial at Georgetown on Monday the 9th, my OB on Tuesday the 10th, and MFM on Thursday the 12th.  At Georgetown, I told the oncologist what had been happening with my BP and asked what her opinion was.  She agreed the 160/110 threshold was too high but deferred to my OB to take further action.  The next day, my appointment with my OB was supposed to be in the morning, but my doctor had to run to the hospital for a delivery so they rescheduled me for 1:45 pm with one of the other doctors.  This was a bit frustrating since I was anticipating scheduling my induction at this appointment and the last thing I wanted to do was wait even longer to learn when it would be.  I also had brought my BP journal with me to show them how it had been trending upwards over the last few weeks.  

At my OB's office later that day, they checked my BP and it was 140/86.  I was glad that, finally, they could see it with their own eyes so maybe they'd be convinced to take some action.  However, the doctor still refused to call in any medication.  She said that if I was in fact developing gestational hypertension or pre-eclampsia, they don't treat that with medication.  They treat it with delivery.  So I asked when exactly that might happen.  She said that by the looks of things, I would be getting induced next week, most likely on Wednesday when I would be 37 weeks.  She decided to draw the same labs as last week in order to compare the numbers and said to come back in a day or two for a re-check with my usual doctor.  I asked her if I could have a copy of last week's lab report.  She said she'd have her medical assistant print it off for me, and would also have her make a copy of my BP journal to put in my chart.  After the phlebotomist came in and drew my blood, the medical assistant walked in with last week's lab report and laid it on my purse, then took my BP journal and went to make a copy it.  While she was doing that, I picked up my lab report and looked it over.  My stomach dropped.  There was protein in my urine!!  Not just a little either, but nearly 3 times the normal limit!

"Oh, shit!" I said out loud to myself.  How long had this been going on?  Why had no one told me? Why did the nurse say everything was normal?  Had the doctor even looked at this report?  Most importantly: Why wasn't anyone doing anything about it??  As soon as the medical assistant came back in with my notebook, I jumped on her, asking frantically, "Where's the doctor?  I need to talk to her!"  But the doctor was already in with another patient, so the MA said she would get the nurse for me.  While I waited for the nurse, I went up to the front desk and scheduled my follow-up appointment with my regular doctor for Thursday at 10:50.  (My appointment at MFM was at 11:30 that same day, so this way I could go straight from one to the other.)  The MA came back a few minutes later and said the nurse was at lunch so she would have her or the doctor call me later.  I waited all afternoon for a call but never heard from anyone.  

The next day (Wednesday, November 11), I was 36 weeks along.  It was also Brian's and my dad's birthdays although, under the circumstances, we didn't have anything special planned.  While I was at home eating lunch with Brian, my OB's office called.  It was the doctor I'd seen the day before calling to tell me, yet again, that all my labs were "normal."  I asked her about the protein in my urine. She answered that since the protein/creatinine ratio was normal, it wasn't a concern.  The reference range for the protein/creatinine ratio stated anything under .2 was considered normal and my labs from the previous week showed it was .1.  I asked what it was this time and she said it was .2.  Even though that was still normal, it had doubled from the previous week!  I didn't understand how that wasn't a red flag to anyone.  Brian was sitting next to me at the table and had overheard the conversation.  As soon as I hung up, he high-fived me and said "Yay!  Everything was normal!  See, I told you it would be OK!"  But I wasn't convinced.  This just did not seem "normal" to me.  I couldn't understand why no one was taking it seriously.  

The next morning, I left work at 10:30 to head over to my OB's office for my re-check.  They checked my vitals and, of course, my BP was still elevated.  Right away, I asked my doctor about the protein in my urine. She agreed with the other doctor that as long as the protein/creatinine ratio was normal, it was OK.  She asked when my next appointment at MFM was and I told her I was heading over there as soon as I left her office.  She said she'd call them that afternoon to make sure they were all on the same page, but it was looking all but certain I'd be getting induced next Wednesday.  Based on everything, she said she didn't recommend me staying pregnant past 37 weeks.  

Before leaving, I scheduled my next OB appointment for the following Tuesday, wondering if I would even last until then.  Then I walked across the street to the main hospital pavilion and rode the elevator up to MFM.  While waiting to get called back, I texted my mom that she might want to book her plane ticket ASAP.  The tech did my ultrasound, took all the usual growth measurements, and estimated the baby's weight to be 6 lbs 1 oz.  While she was putting all the measurements together and printing her report, she casually asked me how everything else had been going.  I told her, "Well, my blood pressure's been elevated lately."  She stopped dead in her tracks and said, "Wait, what?"  I wasn't scheduled to see the perinatologist that day but, in light of this information, the tech said she would have him come in to check me himself.  When the doctor came in, he asked me to elaborate on my blood pressure issues.  I told him about how I'd been keeping a log of it and had showed it to my OB, and they refused to call anything in for it, but were planning to induce me on Wednesday.  He decided to check my BP himself so he put the cuff on my arm, his stethoscope in his ears, and started squeezing the pump, then stopped and let it hissssssss as he watched the gauge and listened.  He paused.  He looked up at me, then he looked back down and started checking it again.  I recognized the look he gave me right away because it was the exact same one my mom had given me 15 years earlier when she checked my BP and it measured 160/100, right before immediately checking it again just to be sure it wasn't a mistake.  It was an eerie deja vu moment.

"What is it?" I asked, not sure I even wanted to know.  He gestured "up" with his thumb and said, "It's bad.  You're getting delivered."  Trying to suppress my waxing anxiety, I asked him, "How bad?"  The exact numbers escape me but he said both readings were around 160/100.  I was starting to feel like I was detaching from my body at this point.  I couldn't believe what I had feared all along was coming true right before my eyes.  He told me to lie down on the table to try to relax and he would check it again in a few minutes to see if it came down at all.  When he re-checked it a few minutes later, it was back down to the 140s/90s.  However, he wasn't reassured because this was while I was lying down in supine position.  He said the second I got up and started moving around again, it would just come back up.  I then told him I had a copy of my lab report from last week if he wanted to see it.  He did, so I pulled it out of my bag and handed it to him.  He looked at it for all of two seconds and said, "You're pre-eclamptic.  You're getting delivered.  Tonight!"  

 

After 3 weeks of being made to feel like this was all in my head, I wanted to hear him say it in no uncertain terms.  So I looked him dead in the eye and said, "You're officially diagnosing it, then?  Pre-eclampsia.  Just like that?"  He responded, "Yes!  I mean, there's protein in your urine!"  THANK YOU!!, I thought to myself.  I informed him that my OBs had both said that since the protein/creatinine ratio was normal, it was OK.  He shook his head and said, "I could see that if it were just a little protein.  But anything over 9 is high.  You're 25.5!  No, you have pre-eclampsia.  You need to deliver tonight, if not sooner.  Like, this afternoon!"  As scary as it was hearing all of this said out loud, I was so relieved someone was finally taking it seriously.  He said he would call my OB to tell them his thoughts but he did not recommend I stay pregnant a day longer.  The problem with pre-eclampsia, he explained, is that it's very unpredictable.  I could have a mild case today but 24 hours later become severe.  Even though the baby was still premature, her lungs were now fully developed and most babies born at 36 weeks tend to do just fine, so he didn't see any benefit in keeping me pregnant for a few extra days just to get me to full term.  He told me to go home and rest but that I should be getting a call to come back to the hospital for induction probably in the next hour or two.  I left there without even bothering to schedule another follow-up appointment.  As I hurriedly made my way back to work, I suddenly felt like there was a ticking time bomb inside my body that could explode any minute.  My mom texted me as I was leaving the perinatologist's office, asking "What day is induction?  Wednesday?"  I texted back, "Tonight!"

 

Back at work, I frantically tried to tie up as many loose ends as possible and get everything in order for my maternity leave.  I also tried searching for a flight for Mom, but there was nothing leaving Toledo, Detroit, or Columbus before 5 pm the next day.  So it appeared she would have to drive if she had any hope of making it in time for the birth.  But my brother Rob had borrowed her car to drive to a job in Indiana, was currently driving it back to Ohio, and wouldn't arrive until 8:30 pm.  It was decided that she would wait for him to get back, throw some things in a suitcase, and the two of them would immediately jump back into the car and drive all night to Virginia.  Rob had to be back in Ohio for another job on Sunday night, so he would drive himself back on Sunday morning and leave Mom here, then come back the following weekend to stay a few days then pick her up and take her home.  In the middle of all of this, the hospital called and told me to come to the labor & delivery ward at 4:00 pm to be induced.  I looked at the clock.  It was already after 2:00 and I hadn't even packed my hospital bag yet!  I'd been planning on doing that over the weekend.  This was all happening way too fast.  I didn't see how any of it was even possible.

I arrived home from work around 3:00 and went straight upstairs to throw some things together in a bag.  Brian was still working in the dining room (his makeshift home office) and trying to finish up his day, plus make sure the boys and dogs would be taken care of for the night, and he still had to pack his bag, too.  We clearly were not going to arrive at the hospital by 4:00 but, at that point, I no longer cared.  (What would they do?  Start without me?)  We arrived at the hospital just before 5:30 (me still in my work clothes) and found parking in the garage right outside the entrance in a spot marked "Expectant Mothers Only."  It was funny because I'd been waiting my whole pregnancy to be able to park in one of those spaces and only finally managed to do it on the day of my induction!  

After checking us in at the L&D ward and admitting me, they led us down a long hallway to my room where they had me change into a hospital gown, stuck me with an IV, and hooked me up to a fetal monitor and a blood pressure cuff.  I remember scanning the room and thinking, "This is where our baby will enter the world.  This room will be the first thing she sees."  It seemed like such an unceremonious locale for such a momentous event.  Several different nurses came in to do a battery of tests and ask me hundreds of questions.  Around 6:00 pm, they gave me a dose of Misoprostol to start contractions and "ripen" the cervix (as they put it).  Within 30 minutes or so, the cramps began, but they were little more than strong menstrual cramps rather than true labor contractions.  My doctor stopped in to do a quick check and said I was exactly 0 centimeters dilated and 0% effaced, but the Misoprostol would continue to work over the next 12 hours.  It was shaping up to be a long, uneventful night.  So Brian and I set up camp and basically just waited.  

Over the next several hours, the Misoprostol continued to do its thing.  However, the baby was not tolerating the stress very well.  Her heart rate kept decelerating and the fetal monitor would bleep ominously, so the nurse would race in and make me roll over onto my side to see if it came back up.  The hospital bed (if you can even call it that) was ridiculously uncomfortable no matter what position I was in, and having to change sides made it even worse.  It felt like I was sleeping on a lumpy cement block.  I couldn't see how something like that aided the process of bringing babies into the world.  Mom texted me updates on their progress throughout the night.  She and Rob arrived at our house around 4:30 am and Rob went straight upstairs to sleep, but Mom was too preoccupied.  I wanted her to come to the hospital but, once again, Covid restrictions prohibited anyone but me and Brian from being there at any time.  I hadn't bothered making an official birth plan, but the 2 things I always knew I wanted in the event I gave birth were 1. an epidural, and 2. my mom there with me.  One more thing Covid robbed me of.

The on-call doctor stopped in a couple times during the night to check my progress, but I remained no further along than I was when I first checked in.  Meanwhile, the baby's heart rate continued to decelerate during cramps.  Finally, around 5:00 am, they decided to try Cervidil instead to see if the baby handled it any better.  They said, if not, I might end up needing a C-section, an idea which did not appeal to me at all.  Putting the Cervidil in was pretty excruciating, but the baby seemed to tolerate it better, at least at first.  They said they would give it 12 hours to work before starting Pitocin to induce contractions.  So we seemed to be trending away from a C-section.  Around noon, my doctor stopped in to do another check.  Unfortunately, I had made absolutely zero progress.  She said she would stop in again around 5:00 after she was done seeing patients.  If I still wasn't at least a few centimeters dilated by then, we would probably try Misoprostol again and see how the baby tolerates it.  If not well, then we were most likely looking at a C-section.  I was in quite a bit of discomfort at that point.  I really, really didn't want to have a C-section but at the same time, I just wanted the pain to stop.  Absolutely every little thing that anyone did to me hurt.  The cramping, lying on that table, checking my cervix, putting the Cervidil in, taking it out, even checking my blood pressure hurt!  I was near tears as I thought, "Isn't there one thing anyone can do to me that doesn't hurt like hell??"  

Just after 5:00 pm, my doctor came back in to see how I had progressed since putting the Cervidil in.  I crossed my fingers, held my breath, and prayed for good news.  But I still wasn't dilated even a single centimeter.  She said everything was exactly the same as it had been in her office at my appointment the day before.  The baby was also back to not handling the contractions well.  The doctor decided to remove the Cervidil and give me another dose of Misoprostol as a last-ditch effort to avoid a C-section.  But almost immediately, the baby was handling it no better than she had the previous time.  At that point, the doctor said it was looking like the only way I was going to deliver a healthy baby was via caesarean, so that was her official recommendation.  She left to go prep for it while everyone around me began hustling and bustling to get me ready for surgery.  Brian had gone down to his car to attend a virtual work meeting so I texted him, "I need you!!" and he texted back, "I'm coming!"  At that point, everything became a blur and the room felt like it was spinning.  I started trembling with anxiety as I wondered whether the fears that had triggered my vasovagal syncope the week before would come true.  Someone asked me to slide over onto the gurney so they could wheel me down to the OR, and the thought that this was all really happening became too much.  No!!, I inwardly screamed.  I don't want to slide onto the gurney!  I don't want to go to the OR!  I don't want my baby to be born this way!  I don't want to get cut open!  I don't want to do this!  I don't want to do this!  I DON'T WANT TO DO THIS!!  

 

Just then, a scream emerged from the adjacent room that sounded like a woman being eaten alive by a wild animal and the whole room froze for a second.  "That's a natural delivery," one of the nurses said in response to the look of horror on my face.  Hmmmm, I thought.  Actually...a C-section is not so bad.
 

The nurses helped lift me from my bed onto the gurney as Brian emerged from the bathroom wearing a fresh set of OR scrubs.  Suddenly, the fetal monitor screamed to life as the baby's heart rate plummeted yet again.  They urged me to get on all fours and lower my head to relieve some of the pressure in case the baby was pressing on the umbilical cord.  My doctor then re-entered the room in full scrubs and announced that time was now of the essence if we wanted the baby to get out safely, so my C-section was now considered an urgent one.  

 

They hurriedly rolled me down several hallways and into a large elevator to take me down to OR.  I couldn't see where we were going since I was on all fours with my head hanging down, but I was too afraid to look up anyway.  I felt like I was being led to the executioner as I heard the OR doors burst open as they pushed me through.  The room was absolutely freezing, and I was insulated by nothing more than a thin hospital gown.  I was trembling uncontrollably as they helped me off the gurney and onto the operating table, partially from fear and partially from the cold.  I sat down on the edge of the table with my legs hanging over the side as they rubbed my back with alcohol and iodine, then administered the epidural in the base of my spine.  Gradually, I started going numb from the waist down.  A few seconds later, the baby's heart rate dropped yet again, setting all the monitors ablaze.  But this time, it didn't come back up.  At that moment, my urgent C-section graduated to an emergency one.  This baby needed to come out NOW!

I started panicking that the epidural hadn't had a chance to take full effect yet.  My doctor, remembering my fear, had them do several quick tests to make sure I was fully numb.  They nicked my belly with a scalpel and squeezed my thighs as hard as they could, assuring me that if I wasn't jumping off the table in pain, then we were good to go.  They draped a sheet up in front of my face to hide my view while Brian rolled up on a stool behind my head with his camera poised and ready.  They yelled out the time as they made the first incision: "6:07 pm."  Less than 60 seconds later, I heard someone say excitedly, "Happy birthday!"  I was trying to figure out who they were talking to when my doctor announced, "She's here!"  I didn't hear any crying, though.  They held her up over the sheet for a split second to show her to me before whisking her over to the table to try to stimulate her breathing.  I felt my brow furrow with surprise the first time I saw her.  She looked nothing like I'd pictured based on her 3D ultrasound!  I was incredulous how that could be the same baby they had just cut out of me.  I kept thinking, "Are you sure that's her?"  

 

Seeing her in person was such a shock to my system.  My brain couldn't quite process it at first that this was actually my baby.  However, I do remember that she looked exactly like the name Brian and I had agreed on for her: Avery Roberta.  We'd had an incredibly difficult time agreeing on a first name but I knew I wanted her middle name to be Roberta after my dad, Robert (and after Brian as that's also his middle name).  Avery was #3 on my list of potential first names and the only one of my suggestions Brian even liked.  I'd tentatively agreed on it with the caveat that I wanted to see her in person before setting it in stone.  When they held her up to me, I knew without a doubt that it was her name.  She just looked like an Avery!

 

As they continued working on her and stitching me up, they yelled out her weight (5 lbs, 7 oz) and length (18").  She was small but mighty.  Her first screams pierced through the air like a tiny tea kettle.  I was feeling rather battered and still in shock so I couldn't really absorb anything and don't remember much about her first moments.  Thankfully, Brian grabbed several pictures and videos of her, him holding her, me holding her, and the three of us together.  All I could do was lie on the table with my arms outstretched, too weak to even turn my head.  I remember someone saying while they were working on her, "You're being sassy, aren't you?"  I heard myself inform them that she'd been sassy since the day she implanted.  The room burst out laughing and my doctor responded, "I can attest to that!"

Eventually, they finished what they needed to do and wheeled me down to the recovery room, where it was only slightly less cold.  They put a couple of heated blankets over me, which helped.  The feeling was starting to come back in my legs and abdomen, though, and the pain was quite intense.  They gave me some pain meds but it still felt like I was being stabbed with a red hot knife.  My legs felt very heavy, too, like I was trying to push down a block of concrete with them.  Brian laid Avery down on my chest and I remember feeling the weight of what had just happened hit me like a ton of bricks.  I now had a whole other person I was responsible for who was completely dependent on me for everything and it was terrifying.  As small as she was, she was the most intimidating human I'd ever met.  I felt like a deer caught in the headlights as I thought, "What now?"  I knew a fair amount about pregnancy but I had no idea how to take care of a baby.  I was so grateful Brian was a 3-time veteran, because I had absolutely no clue what to do next.  I'd never felt so unprepared for anything in my life.

After a few hours of sitting in the recovery room and texting pictures to my mom and everyone else we know, they wheeled us up to the mother/baby ward.  My room number was 13, which I actually saw as a good omen since our daughter had just been born on Friday the 13th.  (She'd missed having to share her birthday with her dad and grandpa by just 2 days!)  I didn't get much sleep that night, but not because of Avery.  Every couple of hours, someone came in to give me different medications and check on us.  I was feeling OK aside from the pain and the fatigue, and Avery seemed to be doing well despite being a preemie.  However, within a few hours, she was developing a complication: She was having difficulty feeding.  We gave her several bottles of formula but she didn't seem to want any of it and all night long, she never cried to eat.  They checked her blood sugar several times during the night and, although it started out good, it was starting to go down.  They figured it was likely because she hadn't yet learned how to suck, which they said is a common thing for babies born at 36 weeks.  We tried having her suckle on my finger to stimulate the feeding reflex, but she would only suck 2 or 3 times then stop.  They were getting concerned that she wasn't getting enough nutrients, but they decided to let her keep trying for a little longer and to check her blood sugar that evening.  If it wasn't at least 50, they would probably have to take her to the NICU to give her a glucose drip and feed her through a tube. 

At 7:00 pm that night, they checked her blood sugar and it was 49.  However, rather than taking her to the NICU, they decided to try giving her a higher calorie formula and said they would test again in an hour.  She needed 2 blood sugars of at least 60 before she could be discharged from the hospital, they said.  One hour later, her sugar was back up to 52, which was close enough to 60 that they decided to give her one last chance to feed on her own before tubing her.  She had a few small feedings during the night, but again, she would suckle just a couple of times before tiring out.  The barely-drank bottles of formula were piling up on the stand next to my bed.  When they checked her blood sugar again at 6:00 that morning, it was back down to 42.  At that point, they took her down the hall to the NICU where they admitted her, hooked her up to an IV glucose drip, and put a feeding tube through her nose down into her stomach.  She was barely 36 hours old.  They estimated she would be in the NICU for up to a week, which meant we would likely have to go home from the hospital without her.  I was extremely bummed out about that as I mournfully packed her coming home outfit back into my hospital bag.  I tried to focus on the silver lining that at least she was being well cared for and that it was better for this to happen in the hospital than for us to struggle with it at home and risk her not getting the nutrition she needs for proper development.  I prayed she would be able to come home sooner than a week so my mom would at least have a chance to meet her grandchild before going back to Ohio for the holidays.

 

Little did I know we were only at the beginning of the most trying and frustrating road I've ever traveled to-date.  I thought giving birth would be the hard part.  But the hard part was just getting started.

To be concluded in 2020 A.D., Part 4: The Fourth Trimester...

2020 A.D., Part 2: The Second Trimester

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.

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!  It amazes me 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 emergency 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 begged them to fit me in their schedule.  They told me to come in ASAP to be checked.  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 getting fewer and farther between, and a couple of weeks after that, they stopped completely.  However, they were being replaced with 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 over a period of days to weeks, starting as a lack of interest in food and/or loss of appetite before progressing into a general feeling of queasiness, then mild dry heaving, and finally 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.  Instead, 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 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 Thursday, 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 realize what was about to happen, so the thought hadn't even occurred to me until she said something.  I pulled my phone out, opened the camera, 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 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.