Thoughts on the First Trimester Screening

I have the option of doing this test if I want (all tests are optional really though) and I sort of always dreaded the thought of making a decision about it. Now, being here at almost 11 weeks, the decision is in front of me squarely -- and I find my instincts, my being, is telling me not to do it.

It's taken me four years to get this far -- which is why I'm now over 36. We've had two losses, early on, but both of them were drawn out over weeks, not to say months for the first one (July-October). I also had fibroid surgery -- and I've got a new fibroid growing.

I'll have a c-section either way, due to the fibroid surgery. I'm in a major city with an excellent hospital so it's not like labor is going to cause any complications. But none of that is my concern.

Having lived through my losses, I know the stress that waiting can bring when you already have the bad news. It's not something I want to bring on myself. It would be crushing for me, and I don't see any good that will come of it. I didn't ever due ART or hormones or anything, opting instead to find other means of healing my body enough to let it be able to carry (other than the needed surgery). I think even if I end up with a sick baby, I will feel more at peace with that than with knowing -- there's nothing to prepare for, what happens happen. I would rather let fate or God have a hand in it and just live with that outcome.

Come what may.

The Kid

The scan shows s/he's measuring 3.5 cm right now.

When the baby came up my partner's first reaction was "he looks just like me" LOL, what is he thinking. It's nice that he had such a strong sense of affiliation with his unborn.

The doc said that we're not out of the woods just yet, but that everything looks great.

Let's see what else, we met with a nurse first who gave us this booklet from the hospital and all these brochures to look at. Then she started asking questions and explaining things to us like we were going to have a baby. You have to imagine what it was like for us, as we were both sitting there thinking that maybe we would have a kid but then maybe the sky was about to fall again. In my head I was like "blah, blah, blah...yeah whatever if you want to pretend we are having a baby" It was very surreal as she just went on about this and that.

They asked about genetic defects and testing in several ways. I think we're going to do the first trimester screening where they look at a few measurements including primarily the nuchal translucency screening, plus some blood work to rule out big issues (hopefully). I've seen how women get online when they get results that put them in the possible range for an issue and it isn't pretty. That's my key hesitation. I'd have to do it in the next couple of weeks and they gave me all the codes to run it by my insurance company.

My doc started going on about appointment frequency and delivery and then I reminded him that I was a mandatory c-section -- unless of course he was feeling daring. He assured me that he was not. I gave him a copy of this article I read through an Ovusoft link this morning about a "natural c-section" and told him that I didn't know that I wanted to necessarily do something like that but perhaps he might find it interesting and we could discuss it later. We also brought up with the doc about how my partner didn't like being there for the d&c with the vacuum and not being on good drugs like I was -- he understood. At least this way we can address it as we get closer to delivery, about how we can make sure my partner is comfortable with the plan.

My next ob appt is in a month about. Sheesh, I would be in the second trimester then already.

Early Pregnancy Success Rates

Everyone online is always wondering when certain positives are linked with a reduction in the chance of pregnancy loss -- and a greater chance of having a baby. I've looked it up an found these references:

The loss rate after a normal scan was similar in symptomatic (10.6%) and asymptomatic patients (9.1%) and declined progressively with gestational age from 17.0% at 6 to 7.9 weeks to 4.3% at 12 to 13 weeks (P < 0.01, chi-squared).
From: Pregnancy outcome after a first trimester sonogram demonstrating fetal cardiac activity.

The pregnancy outcome of 347 patients with a confirmed, viable intrauterine pregnancy between 6.0 and 14.0 weeks, menstrual age, was determined. The miscarriage rate was 4.2% in a subgroup of patients without vaginal bleeding, as compared with 12.7% in a subgroup with bleeding
From: Fetal loss rate after ultrasonically documented cardiac activity between 6 and 14 weeks, menstrual age.

This one isn't an easy read, but it sort of looks like, in the absence of bleeding, the rate is around 4-5% chance of pregnancy failure after the detection of fetal heart activity. With bleeding it's a little more touch and go, with the miscarriage rates ranging from 11-16.5%.

There's a kid in there

My appointment went well this morning and I'll post my u/s pic later tonight. The kid looks perfect and measured exactly where it should 10w3d -- with a due date of February 17th, just like Ovusoft predicted.

More later. I've got to get some work done.

GTT/GDM Testing and alternatives

I've read so many times online about women throwing up from the GTT and it seemed to me that there had to be other alternatives (my friend Gato just went through that this week). I did a search and came across some interesting info that I thought might be helpful. Please feel free to add in any other options you may know about.

I have to take the glucose tolerance test and drink that awful sweet drink. I detoxed from sugar before pregnancy, are there any alternatives?

You may ask your doc to forgo the GTT unless you are actually spilling sugar into your urine. It does not have to be done routinely.

Here is another alternative from Helen.

At the beginning of December I wrote to you all asking about what I should do about the glucose test to see if I have gestational diabetes. I didn't want to drink the sugar drink because I know it would make me so sick. I mentioned it to my Doctor and he kind of murmured to bad but didn't give me any alternatives.

I decided to switch the midwifes at the office I go to so I can use the natural childbirth center. In the orientation they said all tests are up to me. So when I met with one of the midwifes I said I didn't want to take the glucose test that morning. She said instead of not taking it, she proposed a sugar sensitive friendly alternative. I'll pass it along in case it comes up with any of you.

She told me to fast starting at midnight. Go to the office first thing in the morning and have my fasting blood drawn. Then go out and have breakfast- protein and complex carb like I eat anyway. Then come back in 2 hours and have my blood taken again. She said that will tell her everything she needs to know. Now it is a bit of a pain because the test will take all morning instead of an hour, but I think it is worth it.

And one more suggestion from Julie

A few years ago (1999, I think) ACOG did a study that showed that 18 Brach's Jelly Beans (the small ones) had exactly 50 ml of glucose and was a valid alternative to the glucola for the gestation diabetes test. Women also tolerated the jelly beans much better with fewer side effects such as headache and nausea/vomiting. Maybe your care provider has heard of this and/or is willing to look into it to let you try it.
from: http://www.radiantrecovery.com/newsletter2/pregnancy.html

The American College of Obstetrics and Gynecologists (ACOG) said in a recent statement to the media that there is not one certain method to be used to effectively screen the pregnant population for gestational diabetes. They do not, however, know what screening is best or agree on when the screening should take place.

...

Testing for those women who have a positive screen for GDM can take many forms. The most common is a fasting glucose after a woman has been given a drink called glucola (concentrated sugar) and had her blood drawn. About four years ago some studies were done showing that ingesting 18 Brach's® jelly beans worked just as well as the glucola. The jelly bean test is a bit more pleasant and has few stomach side effects than the glucola for most women. It is also important to note that there is not one perfect time for testing for GDM and that this should be decided between the practitioner and the woman.

Jelly Bean Alternatives for Glucose Testing

Glucose Tolerance Testing

How, when, and why to test for gestational diabetes mellitus <-- great article

Some of my tips for controlling nausea in early pregnancy

These are some of the things I've been doing to help keep my nausea at bay:

* make sure I have protein a couple times a day -- typically meat, fish or cheese (not liking eggs right now) -- remember a serving of protein is the size of a casette tape

* carry snacks in my purse -- fruit leather works well, as did nuts for a while though I'm not digging the bitterness of walnuts right now

* tortilla chips have helped me out at work in the afternoon, just plain with a little salt on them

* keep the water going at all times, I carry bottles of water with me just about everywhere. I alternate between wanting plain water, water with lemon or lime in it, or wanting sparkling water.

* if you start to feel it kicking up on you go eat something right away, eat slowly while sitting down

* don't eat too much at once -- eating small amounts all the time will help prevent you from wanting to binge. Eating too much at one sitting will just cause you to have digestive problems including gas and constipation which is really, really not fun

* make sure you are getting your fruits and veggies in with your protein. Portioning out grapes into baggies I could grab on the way out the door helped, also cutting up a cantelope or pineapple and having it ready to go

* try ginger if you are having acid indigestion, it might just surprise you at how well it works -- freshly grated with hot or cold water, or even spice cookies with ginger in them can help.

* don't go for the simple sugars, they aren't going to make you feel better -- it's just empty calories and your body knows the difference

I also haven't been eating fried foods at all, and I normally eat a low fat diet that's pretty high in fiber. My mother told me that she didn't have any vomiting when she was pregnant so maybe it's partially a physiological thing that we share.

Also, the other day I just was feeling so nauseous. I left my acu appointment and thought I would be fine until dinner but obviously my body had other ideas. I dug in my purse for a fruit leather and ate that but my body was on a rampage. My partner called to let me know he was going out with a friend and as I walked along I had this dialogue in my head about whether or not I could make it home without eating something. My body decided no, so I went into Westlake Mall and ate dinner right then and there in the food court. I felt a bit silly about it, but then again not eating was not an option -- my body was starting to send those signals that something awful was going to happen if I didn't eat right then (if you have been pregnant you will know what I'm talking about). I had a mediterranean platter and felt so much better after that -- grilled chicken, hummous, salad, tabouleh, falafel, pita -- a nice well rounded meal. Be good to yourself.