Saturday, January 30, 2010

Boy, oh Boy...

It's a boy! Those of you that have done this before and are counting on your fingers are going, "Wait, she's only 16 weeks and the anatomical scan isn't done until 18, how does she know that it's a boy already?" Well, gentle readers, we recently had to make the first really difficult decision of this pregnancy -- not the decision about finding out the sex, not the decision about MD vs. midwife, not the decision of pickles with ice cream or just pickles.

We opted to have an amniocentesis.

As you may or may not know, I'm a genetics technologist by profession. At my place of work, that means I mainly do chromosome analysis, mainly on prenatal samples -- amniocentesis. Due to the large number of pregnant women in this world, and the time-sensitive nature of the test, amniocentesis is mainly offered when a pregnancy is "high risk" for chromosomal abnormalities -- something shows up on ultrasound, markers in the mother's blood screen positive, there's a family history of abnormalities (or previous pregnancies), or the mother is over 35 -- a condition called "Late Maternal Age".

Thankfully, we were none of these things.

I was not even considering the possibility of amniocentesis until BG mentioned it one day and thought it would be a good idea. This was around week 12, so we had a few weeks to make a decision. I thought about it. I spoke to coworkers and friends. I thought, and thought, and thought. One day a case came across my desk that made my mind up for me. Early pregnancy screens had been normal, but the baby had a chromosomal abnormality that was fatal. I thought, "I have to do the amnio." Both of us are planners by nature, me in particular. I don't even like surprise birthday parties; I had to know what was going on with my little baby.

I want to point out that even in high risk populations, chromosomal abnormalities are very rare. We test, as I said earlier, primarily high risk pregnancies, and the proportion of actual abnormalities is very small. Most women have a few weeks of anxiety between finding out they're high risk, and finding out that everything is fine. I still firmly believe that a woman having an amnio shouldn't fret too much (easier said than done) because the probability is that her baby is chromosomally normal.

So I asked my doctor to book an amnio. I had to go for a genetic counselling appointment, where we discussed the procedure and the risks and went through the family histories on both sides. I was relieved to hear that the risk of miscarriage after amnio, usually quoted as a 1/300 risk, is actually more like 1/900. I was relieved to find out that my age-related risk was something like 1/600 (I'm not 35 yet). I was relieved when the counsellor looked me straight in the eye and said, "It doesn't hurt." Only part of me believed her.

The morning of the procedure, I choked down my breakfast and tapped my feet nervously in the car, in the elevator, in the waiting room. I fidgeted nervously as BG tried to distract me with conversation, but I could not be drawn in and responded with curt, one-word answers. There was no reason to be nervous, I told myself. I had seen this done before as a student. I knew it was safe, I trusted the doctor, and no matter how much it hurt it was not going to be as bad as labour. Some friends from work came down to see me in the waiting room, and their presence was a relief.

Finally, I was called into the procedure room. I lay on the bed and was asked to pull the waistband of my pants down, further than I thought was decent. A quick flash of the ultrasound wand across my abdomen and we caught a precious glimpse of our baby's head and back. The doctor found a pocket of empty fluid, and said, "You will feel some pain now." Then he pushed the 7" needle through layers of tissue and started drawing out fluid. It felt so strange, but the counsellor had been right -- apart from the expected sting of the needle, it didn't hurt. I kept my eyes on the ultrasound monitor the whole time, seeing our baby and the needle next to it, so close, but not touching. At the end, the doctor showed me the tube of amniotic fluid he'd withdrawn, labelled with my name. The professional side of me noted the healthy quantity of clear yellow fluid and pronounced it a good specimen for testing. I could picture it being taken to my colleagues upstairs, and I knew it was in the best hands possible.

I spent the rest of the day resting -- really! I had a nap. I ate mashed potatoes. I had another nap, we watched a movie.

The next day, after my morning coffee, a preliminary screening result was waiting for me. I was relieved to see that our baby had no numerical abnormalities of chromosomes 13, 18, or 21 (the most common ones) and I was happy, choking back tears, to call BG at home and tell him that he was going to have a son.

Being on both sides of the process has been really interesting and educational for me. Sometimes, when you're processing 14 or 15 samples of amniotic fluid a day, you forget to see the human side. You forget that all of these samples came from a nervous pregnant woman that is desperate for her baby to be pronounced healthy. When you find an abnormality, it makes the day more interesting, in an academic kind of way. However, I find myself feeling a twinge of sadness when I think of how the lives of these couples is turned upside down in an instant. I will be thankful for every normal result that I see. I will not roll my eyes at the reason for referral, "Maternal Anxiety" (because, having fit no other criteria, this is what was written down for me). I believe that we made the right choice for ourselves and am so grateful that we had the opportunity to make this choice.

In the meantime, we're doing the usual things -- trying to choose a name, sifting through endless piles of baby gear to choose the things we'd like, and enjoying this new experience day by day.

1 comment:

Tamara said...

wow. That was really interesting to read! Congrats on having a son... boys are great :)