Wednesday 18 February 2015

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.

15 comments:

  1. I've always thought it was interesting that people really only mention gender when going to or leaving their anatomy scan. SO MUCH MORE is looked at and looked for during that scan- it's actually scary- I held my breath for the boys' and will do the same again on Friday for my little girl's. I sometimes think how nice it'd be to have gender as the only thing on my mind during that ultrasound... Or at any point during the beginning stages of a pregnancy. I guess though, that worry comes with years of infertility?

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  2. Hi Jane, I've been reading your blog for ages, since I was trying to conceive my son in early 2013. I've been meaning to delurk to congratulate you and I keep putting it off, but just after a perfect anatomy scan seems like a good time to do it. Congratulations! I'm so happy that this pregnancy is going so well after all you've been through. I'm impressed with your restraint in not finding out the sex! I couldn't wait to know (although I wasn't hassling anyone to tell me at 12 weeks!). That said, I agree people focus on it far too much. It's only one small aspect of who the baby is, after all.

    Also, I love that Garfunkel and Oates song!

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  3. Oh congratulations on the great news! I remember after my positive 20 week scan is when I really started to settle into the pregnancy.

    I think it's great to not find out the sex before delivery. If I'm able to have another child, I would definitely do the same thing. I can't believe you were able to not look during the ultrasound. Temptation would have gotten the best of me for sure. My best friend didn't find out the sex before delivery and we always had fun guessing according to old wives tales.

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  4. Oh congratulations on the great news! I remember after my positive 20 week scan is when I really started to settle into the pregnancy.

    I think it's great to not find out the sex before delivery. If I'm able to have another child, I would definitely do the same thing. I can't believe you were able to not look during the ultrasound. Temptation would have gotten the best of me for sure. My best friend didn't find out the sex before delivery and we always had fun guessing according to old wives tales.

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  5. Congratulations! We didn't find out the gender either, and honestly, it was so much more fun that way! I don't think the worry ever goes away, but after 20 weeks I know I felt a little bit better!

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  6. Congratulations on your healthy baby! Whenever I tell people we didn't find out at the scan, they're shocked and say they could never wait. It's not that hard. That was probably (hopefully!) our last ultrasound, so no big deal. Part of the reason I wanted to wait is because I know Bobby would prefer a boy. But I think if he hears "it's a girl" and then is handed his baby for the first time, there will be a lot less disappointment than just hearing a tech say "it's a girl" and see it on a screen. Just my thoughts.

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  7. Just don't put too much stock in either decision. Ultimately, I don't think it's a principle that's that important either way. We'd always said we'd probably wait to find out, but didn't feel that strongly about it. Once I got pregnant, I realized that I did want to know during the pregnancy, and it helped me bond with my babies before they were born (as bonding isn't exactly my strong suit and I was feeling a little unmoored with regards to my identity as a pregnant woman/mother). But it doesn't matter if everyone finds out the sex or nobody does, except, as you point out, for medical screening purposes. I think you'll have fun guessing and going back and forth before the big day, and maybe you'll feel an extra rush of bonding when you first hold little Jate and find out the sex in that moment as well. All I'm saying is, if you decide you've changed your mind, don't hold yourself to decisions you made before. Your plans for delivery and parenting and everything else are going to be fluid, as I know you're aware, and this is not something that anybody else is even really going to remember. Besides, if they do and they give you a hard time... fuck 'em. It's your damn baby. :.) (But yes, from what you've written so far, I think you're going to be very excited to find out when that little person is right in front of you, face-to-face!)

    Oh, and it's worth it not finding out just to annoy people at your baby shower. I actually had people complain that I "couldn't do that to [them]" not to tell them the baby's sex, because they didn't know what gender they should buy stuff for? I was like, "How about you calm the f*** down and get something with a duck on it?!"

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  8. Congratulations on a good scan!

    And this: '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...' I clench up a little every time I hear someone glibly rattle off that 'as long as it's healthy' sentiment, for all the reasons you so aptly outline. As the mother to a child who I guess many would consider to fall outside both the 'normal' and 'healthy' labels by virtue of the number of chromosomes she carries, I can't tell you how refreshing it is to hear a recognition of just how irrelevant that can prove to be, in light of all the unpredictables that can affect health and wellbeing over a lifetime. Thank you :) I sometimes feel like the desire to plan and predict that comes with (often confused diagnostic vs predictive) monitoring robs people of real joy.

    As for gender, I can only wonder at those people who seem to have had so few challenges in life that these are their primary concerns. Just call me Judgy McJudgerson! ;)

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  9. I have to admit, as much as we wanted to find out the sex at our anatomy scan, I paid a hell of a lot more attention to making sure that all of the other parts were in place and measuring correctly. I find it hard to believe that people would look at it as some kind of big gender reveal, but I guess that's the luxury of not having to struggle to get pregnant and being able to take it for granted that you'll have a healthy pregnancy.

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  10. I have to admit, I desperately want to know the gender of our baby (so much so that we paid out of pocket for a rather pricey blood test to determine gender...though not as expensive as PGS). I am hoping for a girl, but obviously gender is not the be-all end-all. Mostly I just hate surprises and am really impatient (and don't want to wait until the anatomy scan).

    I also agree with Emily's comment above, that being able to attach a gender to the baby will help me bond. We have names for both genders chosen, and I would like to be able to use one during pregnancy. Though I had no control of the gender, finding out early is now is one form of control I have over what has been a situation that has been entirely clinical and mostly out of my hands. I have great awe and respect for those who can wait. Can't do it!

    We also just had our nuchal translucency scan and the screen was facing away from me so all I could do was watch the tech and she kept furrowing her eyebrows and scrunching her face. It was driving me crazy, but the baby was not being cooperative for the measurements and I hope that was her only issue. U/S techs need to practice their poker faces.

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  11. We just had our anatomy scan--everything looked great--and the u/s tech had us turn away when she got to the part of the scan when we might have been able to figure it out. I was excited to see fingers and toes and the seeing the heart beating is always a thrill. Our u/s tech was all smiles and easy banter--if something had been wrong she should have won an oscar.

    I'm so excited to find out the gender, but I'm also excited to find out what this baby will look like, what its personality will be, how well we will (or won't) succeed at breastfeeding, how it'll get along with our animals. There's so much excitement and so many unknowns right now, that I feel like gender is just one more exciting thing in a long list of exciting things that will happen once we meet this baby. For us, there's no need to rush it. That, and, so much of getting pregnant was so carefully orchestrated and overseen by amazing technology, we're happy to find out the gender the old fashioned way.

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  12. It's crazy the things people worry about. And how demanding they can be. Your priorities are in the right place and that is all that matters. So happy to hear about the great news from the scan. I feel like time is going so fast and your baby (boy or girl) will be here before we know it!

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  13. i agree with you about the healthy baby being the most important. We had the Harmony test done (as i was 35 at the time of pregnancy) and for me that was the best option for us (over amnio or CVS) in making sure we were going to have a healthy baby. Since insurance covered us we did opt to find out the gender, but that definitely wasn't the most important part. Regardless of whether its a boy or a girl, you will love that child with every ounce of your heart and soul. And honestly if you were hoping for one over the other, every thought of that will go out the window once you see your baby for the first time!

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  14. Congrats on a great scan! We found out the sexes from the Maternity 21 test. As much as I wanted to find out the sex beforehand, I sort of wish it had been revealed at an ultrasound with my husband there instead of over the phone by some nurse while I was sitting at work. In the end, I don't think it matters when or how you find out. You just have to do what feels right for you. For me, it helped it to feel more real to know what was in there. For my BIL and SIL who had their kids after IVF, it was more fun for them to find out at the birth since they said all the "surprise" was taken away from them because of fertility treatments.

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  15. I always wanted to wait till birth to find out boy or girl, but with twins, I felt like I needed to have time to prepare ahead of time. Not that it really mattered because we really could have prepared anyway, but it helped me feel better. Besides that, my Hubby has a super hard time with surprises and can't wait for things like that! Haha. I admire anyone that does wait. I am so happy the scan went well and baby is looking good!

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