Just as long as it's healthy...

It was taking my usually efficient medical assistant a long time to room my patient. Not a good sign. The patient was a transfer from Kai.ser at 12 weeks and 4 days. This was her fifth pregnancy and will be her fifth baby. Finally, she emerged from the room. "The patient doesn't speak English, so I had to use the translator phones. The husband was annoyed as he offered to translate." [we're not allowed to have family or friends serve as translators] "I explained that we don't need to do an ultrasound today, as she's had two with Kai.ser and he is also annoyed as he thought they would get an ultrasound today and learn the gender. He was particularly focused on the gender." my medical assistant explained. It's always good to know what I'll be facing when I enter the room. The patient had a pretty complicated medical history and the translator was having a tough time keeping up. The husband started answering a lot of my questions, which I let pass, as he was pretty detailed. I could sense the frustration in his voice. Finally when I concluded with her intake, he brought up the fact that the call centre agent told them they would have an ultrasound today [as he or she probably didn't know they were a transfer] and he took the day off from work so he could find out the gender.

Perhaps I was a bit sympathetic, as I took an afternoon off for my most recent OB appointment which involved a 5 minute interaction with a doctor who hadn't looked at my chart and a lab tech who had to stick me twice as he didn't draw for my second trimester genetic screening in spite of the fact that the order was in my hand... How incompetent was this office? Let me count the ways... Anyway, I offered to the couple that I would do an ultrasound as courtesy, but I explained that 12 weeks is too early to accurately determine the gender. The baby was cooperative and I was able to get a good measurement and some nice photos. As I was finishing, the patient asked (in perfectly spoken English) "So, is it a boy or girl?" I reviewed again that it's too early to tell. "TRY." she commanded in a very demeaning tone. I was struck by the audacity of her request and the fact that she understood and spoke English after we spent her entire visit using the translator service. She then added, "My children will be very disappointed as they thought they would be finding out today." "Well." I replied as I prepared to leave the room "You can tell them that you're having a boy or a girl."

I figured she would go home and tell her kids that about the mean lady who wouldn't try to determine the baby's gender and was making them wait six more weeks. Maybe she'll look for another provider. I couldn't believe that after four prior pregnancies she expected to learn this early. I offered that they could do a gender scan at 14 weeks, but they weren't interested when they were informed that it wasn't covered by insurance and would be an out-of-pocket expense. This patient stuck in my head for the rest of the day, as I started to question if my own decision not to know our baby's gender makes me less sensitive. (Although two of my medical assistants who have children couldn't understand why they were so obsessed as she already had two boys and two girls.) I defend my bias by noting that I've seen enough tragic cases to understand that there is more at stake than determining if you'll be painting the nursery pink of blue. Noting the genitalia on an ultrasound is really an incidental finding (with the exception if a parent is a carrier of an X chromosome linked disorder) as the purpose of an anatomy scan is to assess the growth and development of the baby's vital organs. Determining gender doesn't affect the obstretical management. I recently discovered a blog where a woman left her anatomy scan disappointed that they didn't uncover the gender during their scan, only to find out how trivial such a disappointment was when her obstetrician called later that night with the horrible news that multiple deformities were found on her scan. Since we've started using the Pan.orama Non-Invasive Prenatal Test, we have been correcting patients who refer to it as 'The Gender Test'. Co-worker is not so subtle. "It's a genetic screening test, not a gender test. How would you feel if we called you with the news, 'Guess what! You're having a Boy! Snails, Pails and Puppy Dog Tails! Go Team Blue! Oh, by the way... he may have Trisomy 18...'"

Oh, we don't care... Just as long as it's healthy... Despite the fact that this statement embodies what I preach, I find this cliche rather annoying. 'Healthy' just seems like such a vague and generic term in this context. It's more than just a normal set of chromosomes. There is physical health, developmental health, emotional health, psychiatric health... we all want our babies to be perfect in every way. Maybe I still hold a little distain as I hear echos of Myrtle's smug words during her pregnancy, "I'm older than you and my baby is healthy..." as I expressed my intention to do an amniocentesis [this was prior to any fertility treatments and eventual CCS testing on our embryos]. No Myrtle, my proximity to you and your perfectly healthy baby does not offer me any reassurance. Speaking of Pregnant Women [who] Are Smug, I have to give props to Garfunkel and Oats who call attention to the fact that gender and health are not mutually exclusive. "I mean, it's not like you have to chose one or the other." It's okay to have a preference for a girl or a boy and to wish for him or her to be healthy. Although they challenge anyone to admit that she "doesn't care if it's brain dead, or limbless, just as long as it has a penis." (If you're confused, click on the link)

There is one more case that stays with me. When I was working in an inner city clinic in Connecticut, I saw a young patient in her third trimester. She was a bit immature and rather bratty. She requested to have another ultrasound to make sure the baby was actually a ________ (I can't remember what the gender was). I explained that our clinic doesn't perform scans just to determine gender and she didn't have any other indication for an ultrasound. "Well, if it's not a [whatever the gender was], then I'm going to be really MAD!" she threatened. I sighed. Earlier that week, I had helped deliver a full term stillborn baby girl. The patient was 41 years old and this was a surprise, but desired spontaneous conception. "No." I told her "You'd be mad if something horrible happened to your baby and you went home to an empty nursery." Although I had no basis of experience, I added, "As long as your baby is fed, warm and comfortable, he or she won't care what colour the walls are painted. Trust me, when you're getting up at three in the morning for a feeding, you won't care either."

"So we're still not going to find out the gender?" Husband asked as we drove to the anatomy scan. "I could go either way at this point." he quipped. I thought about how quickly we exclaimed 'NO' in unison when the French embryologist asked just after our transfer. How we double checked that the 'gender of baby' box wasn't ticked on the Pan.orama form, and I had Co-worker look at my results first just to be sure our request was honoured. "We've come this far without knowing, we might as well go all the way." I replied. Perhaps it's an obstetrical obligation; that if I talk the talk, I'd better walk the walk. Least, I come across as sounding noble, I do have to confess that once upon a time I viewed unveiling the gender at birth as a novelty. I thought people might be impressed with my restraint, given how easy it would be for me to determine. I was bitter when both Myrtle and Co-worker also held out until the end, as I feared I wouldn't be perceived as being original, or could be accused of copying. I've finally learned the lessons that I've preached over the years. It doesn't matter, just as long as he or she is healthy. Whatever that means.

I actually didn't watch most of my ultrasound, for fear of accidentally discovering the gender, but also so I could focus on the technician's face. She was very serious, but I didn't see a wrinkled brow or look of fear in her eyes. Jate's measurements are on target and no abnormalities were found. "Based on the American Institute of Ultrasound Medicine (AIUM) guidelines, this is a normal obstetrical study." my report will read. Of course, it will be followed by the legally mandated statement, "the presence of a normal anatomy survey does not rule out a genetic, structural or chromosomal abnormality," but I'll take it.  I can't smugly proclaim that my baby is healthy. I can only hope.