Maternity Maths

June 17, 2010 at 2:05 am (Uncategorized)

Project ‘Our Little Friend’ is proceeding smoothly thus far, although that’s not how I’d describe the current state of my stomach… flat, smooth, these are words we won’t be seeing for a while. For the time being I’m still doggedly stuffing myself into my own clothes – something about suspecting that a move into maternity wear will act as an instant inflation device – but I’m not long for my magic jeans. Clearly. It’s interesting, though, because everything changes over the course of the day: I still look pretty normal in the morning, but by bedtime, I’m huge, hence my strong sense that it’s mainly a food rather than a baby thing. Still, it’s logically getting pretty crowded in there, what with the growing uterus and growing foetus and my growing appetite, so it makes sense that the more I consume, the less room there’s going to be.

We’re 13.5 weeks right now… and we had the 12-week scan on Tuesday, nearly a week later than originally booked due to a problem their end. There was a moment of real anxiety at the beginning because neither Llew nor I could detect anything that looked remotely like a heartbeat – I could feel my own starting to race as I peered at the monitor, and there was a tight panicked edge to my voice when I asked the imaging lady C where it was. “There,” she said. “See?”

“No. Where?”

There.”

Cue big sighs and nervous laughter from us.

Well, if you’re after a mind-blowing experience, I can recommend a 12-week ultrasound. Not only is there someone still in there, but that someone now has a brain and limbs and looks, well, kind of like an actual baby. While we were watching on the screen, he or she stretched out its little stick legs as far as they would go, clearly intent on getting comfortable (that could come from either of us…). We saw the hands groping around, and although it’s too soon to clearly count digits, I still gave it my best shot. She or he is an average size – currently about 7.5 cms long – and never has the idea of being “average” seemed more appealing. Average. Average in pregnancy is good, because average in pregnancy means “everything looks normal.”

“It’s got its whole life to be special,” added C, the imaging lady, and I couldn’t agree more.

The main purpose of Tuesday’s scan is the measuring of the nuchal transparency. This is the fluid at the back of the foetus’s neck, and the thicker the nuchal transparency, the higher the likelihood of Down’s Syndrome. That measurement is one part of an algorithm used to determine likelihood of Down’s occurring; its other components are my blood test results from last week, and my age. I think that’s all. It’s an anxious question, and an anxious wait, and I think I might as well get used to this constant low-level anxiety because parents tell me that’s what having children is: one long anxiety trip. Welcome to the rest of your life. Now, I’m going to focus as much as possible on all the other things parenthood offers – top tier tickets to Cuddle Town, for a start – but I can imagine this is just the start of a new, special kind of worry. It would be very nice if my hideous and graphic miscarriage dreams would stop, but they would probably only be replaced by others. One of my friends kept dreaming her babies were born without fingers. Another, that her baby was the Devil. It sounds like there’s a whole phenomenon of disturbing dreams induced by pregnancy, and at its core is the simple, real and perfectly understandable fear of something going horribly wrong.

A doctor from the imaging place called me several hours later with the results of the algorithm. He explained that my Down’s risk as a 37 year old was 1 in 150. YIKES. 1 in 150 – isn’t that kind of high…? But then he told me my risk assessment based on the nuchal transparency measurement, my blood results and my age: 1 in 2,670.

“Hey!” I said. “That sounds much better!”

He gave absolutely nothing away, just didn’t react, and I hung up already anxious again, trying to dissect his silence, his unwillingness to say the only thing I wanted to hear: “Yep, you have absolutely nothing to worry about!”

It’s hardly a million to one, is it? I’m seeing Dr F tomorrow, and I’m really, really glad, because I have nothing with which to compare my assessment. It’s just this vast world of probability, and I don’t have a clue where I sit on the spectrum of those dream terms, “average” and “normal.” What do other people score? And should we do the more definitive test, which brings with it certain risks, including miscarriage? I can’t seem to find anyone who’s done it, the amniocentesis test, but its accuracy is extremely high and it can test for other abnormalities beyond Down’s, so that’s a pretty compelling option… except of course for those pesky risk factors. So how high are they? And why do they seem to change so much depending on whom I ask? For instance, I’ve heard and/or read the risk of miscarriage as everything from 1 in 200 to 1 in 1,500 – which is it?? Once again I’m going to have to quieten the chatter and focus on what Dr F says – it’s ultimately a decision for Llew and me, but the opinion of someone knowledgeable whose expertise we trust is so important. Otherwise you could quite honestly drive yourself mad.

Anyway, I’ve been feeling really well and mellow and Our Little Friend is growing and moving, so I’m going to concentrate on that, and hush that nagging voice of anxiety, who really needs to learn its place in the pecking order.

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19 Comments

  1. Samantha said,

    Hello Di,

    Congratulations on reaching another one of the pregnancy Holy Grails. And what a result it is!

    Your risk of a down’s baby is incredibly low (even lower than that of a 16 year old!). I understand however the dilemma about whether to have the amnio or not. I believe the risk of a miscarriage is 1 in 200 but a lot depends on the experience of the doctor performing the procedure. The only friend I know who has had amnios did so for both her pregnancies conceived (naturally) in her early 40’s and everything was fine. She has two healthy boys.

    As you’ve heard from Jenny, we are continuing to have no luck as my eggs continue to resist being fertilized. We have just entered cycle #14 which our doctor has said should be our second last before ceasing treatment or seeking out an egg donor. As you know, my sister who is 21 months younger than me has tentatively offered me her eggs. It was an unexpected offer that completely and utterly overwhelmed me.

    My sister has two girls borne of IVF-ICSI technology. She underwent her first stim cycle at 31 and her third and last at 34. My nieces are now 5 and 3. The youngest looks and behaves like me and my sister has nicknamed her MiniSam. It’s bizarre how the genes are dished out (sister’s share 50% of the same genes.)

    My sister is now 38 so her fertility will also be diminished. I sent her off to have her AMH level tested, the results of which should be known this week. She doesn’t believe that her level will be as low as mine (at 1.5) and for whatever the reasons for my impending early menopause, she does not believe she shares it (and therefore hopefully she inherited the high fertility genes which bypassed me.)

    My counsellor says that many many pregnant women dream that their babies are not quite normal and that this is perfectly normal!

    Enjoy the second trimester; apparently it’s the best part of pregnancy.

    Warm regards,

    Sam

    • doctordi said,

      Thanks, Sam – yes, I am going to have to install a new trophy cabinet at this rate, what with all these Holy Grails so nicely stacking up!! It really does feel like a surprise win, each and every time another milestone is reached and passed. I’m so sorry to know that you are meanwhile still in the throes of these relentless-seeming IVF cycles. I wish I had the solution to offer. But I am *thrilled* about the possibility of a donor egg from your sister – this seems pretty exciting as a fall-back position. What was the result of the AMH test???? My fingers are crossed tight that she has a vast egg reserve waiting to share with you.

      A big hopeful thumbs-up, Sam – god knows you deserve one.
      xx

  2. litlove said,

    The stats sound absolutely fine to me. I think you can stop worrying, but you’ll feel better when a professional tells you so (bear in mind there are kinds of doctor – those who will NEVER say anything hopeful in case one day they get sued, and more humane ones). But don’t talk to me about parenting. My son’s been sitting end of year exams and hasn’t done very well – he’s gutted, although he didn’t actually do any work for them. Nor can he bear the thought of working for them on another occasion, despite his results. He had a total meltdown last night and i feel exhausted this morning from trying to comfort him in a place where he can’t take comfort. Be thankful you still have 15 years ahead before you hit this bit.

    • doctordi said,

      Oh dear, LL, that does NOT sound fun. I do recall being horribly lazy academically once I got to Pearson, aged 16 (being there seemed like my reward for any work I’d done prior and my deceleration was instant and total), and yet still being gutted when of course I started doing poorly. Perhaps at a certain age – adolescence – we feel invincible, and expect that therefore things will come easily – particularly if they have done in the past. How is he going? Don’t tell him this, but I’ve never really lost the sense of shame that followed my very bad IB results. It was a kick up the arse I have never forgotten – I veered perilously close to failure and might not have been awarded a university place. It was a very sobering experience and one that never dims in its horror. The good news is, I scraped in, and did well, and now have a PhD, so there’s hope for all of us and certainly for young Master Litlove!!!

  3. charlotteotter said,

    Hooray for Project Baby! Your stats sound good, but it’s natural to want to be reassured. Thrilled for you, Di.

    • doctordi said,

      Thanks, Charlotte!! Yes, it’s all getting quite exciting now!

  4. Lilian Nattel said,

    I’m so glad to hear about the progress of little friend. 🙂 Just think of the anxiety as practice. 😉 The odds are good–they’re just not absolute. That’s how it goes, as good as it can be. Personally, I’d rather have absolute protection for my kids. If you know where to find it without making them crazy, let me know!

    • doctordi said,

      Thanks, Lilian, me too!!! Yes, I am viewing the anxiety as the start of a long, intimate relationship we’ll have together!

  5. Norwichrocks said,

    Congratulations on the 12 week scan (at 13 weeks!) milestone. How completely exciting to see him or her for the first time. I’m getting goosebumps just imagining it. Hopefully the chat with the Doc will reassure you – if its any consolation, amnio tests seem much more common in the UK, I know that pretty much all of my friends had them when they were pregnant and none resulted in miscarriage. I think its fair to say that some of the amnio risk stats you’ll have seen will be fairly old, and that techniques improve every year.

    Just want to wish Sam the very best of luck, too.

    • doctordi said,

      It was pretty cool, Truce. And now we have PICTURES – they arrived in the mail a few days later, although they’re not nearly as good as the live event. Yes, I think you’re right. The other thing about the stats is that they don’t speak to the doctor’s individual experience conducting amnios, which is a massive part of the risk factor.

      I’m wishing Sam the same, and thanks, a combined effort hopefully brings twice the result.

  6. davidrochester said,

    So happy for you! And just think of all the worries you have to look forward to … if you think it’s bad now, just wait until that little womb-freeloader arrives in the world, and is continually on the lookout (or so it will seem) for ways to kill itself accidentally.

    • doctordi said,

      Thanks, David! Yes, I’ve watched fascinated as toddlers race toward the traffic with a determination that is bordering on psychotic. They just want to run onto the road. It’s evidently the place to be if you’re two.

  7. Pete said,

    Yay for the 13-week scan! I’ll have a word with Dr L about the stats but yours sound very reassuring (even if you didn’t get reassurance from the lawsuit-averse medical person on the phone). I still find the whole pregnancy thing miraculous. And that belly sounds very healthy. What better time to feed it than winter! Enjoy.

    • doctordi said,

      Pete, that makes me laugh because I am SO HAPPY it’s winter, it just seems so perfect for taking it easy and eating lots of comforting, nourishing things. Which I’m doing. A lot.

  8. Grad said,

    I am so happy for you and Llewie! Everything sounds thrilling! Enjoy the very good news and celebrate your expanding waistline. Feeling anxious and worrying is normal in every pregnancy, and the worrrying never stops – even when the “kids” are adults and on their own. I guess it’s the dues we pay for being granted such a special gift. Rock on.

    • doctordi said,

      Thanks, Graddikins – it’s been so abstract up until recently, but now with the expanding waistline and the scan, it does seem much more real. And yes, much more worrying!

  9. Pete said,

    Just wanted to add that I checked in with my resident gynae (Dr L) and she says:

    “I agree that with a nuchal lucency like that, the chances of her having a baby with trisomy 21 is low. She’ll have a fetal abnormality scan at about 22 weeks which should help to confirm that all is well. As her risk of miscarrying after an amnio is about the same as her background risk of T21, it may not be worth the risk, though does give a definite answer of the baby’s genetic make-up.”

    But you knew that already. Maybe I just wanted you to meet L in an indirect way 😉

    • doctordi said,

      Oh, what a lovely way to meet L – hello, L, and thanks! Please tell her, Pete, I really appreciate that. It’s interesting because Dr F said the exact same thing on the one hand – that the risk of miscarrying after an amnio is about the same as the baby having an abnormality – but his spin on that came down in favour of the amnio rather than against it. At about fifty/fifty odds between them, I’m personally inclined to agree, but I only want to do it if I can be assured of getting an experienced doctor who performs amnios all the time, and that’s the referral Dr F has said he’ll give me if we do decide to go ahead with it.

  10. piereth said,

    Hello girl – sounds like things go well, and I’m so glad!!

    I had the same sort of readings as you… I had the amnio and it was not a bad experience, and I also found out the sex of my lovely Roro at the same time, so I can say I didn’t regret it. However, 1 in 2700 is really really low. I hated the idea, at the time, that the baby’s life depended on borderline statistics, whichever option I chose, so I can relate to the dilemma.

    xxx

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