Week 8: Prenatal Visit Numero Uno

Contents: mention of miscarriage, mention of stillbirth, mention of disappearing twins

The "First" Visit

It was finally time for my first prenatal visit! It seems silly to call it that, given that I had been to see a medical professional multiple times at this point (the urgent care, the LDR triage unit, the pregnancy center, the midwife's sister office, and the main office), and I had already had two ultrasounds. For context, most typical pregnancies get two ultrasounds: the viability scan at eight weeks and the anatomy scan at twenty weeks. 

I had already had the same number of ultrasounds at my seventh week that most women have for the entire forty weeks of pregnancy. And we weren't done yet! 

Here's another thing, Dear Reader, that I have not told you: my mom worked on my postpartum unit for over a decade and on a labor and delivery unit for years before that. She worked with another fantastic nurse on the night shift who went on to obtain her master's in midwifery and became a certified nurse midwife (CNM) a few years ago. 

Ultimately, that's why I chose to go to a CNM office rather than an MD office. 

I know several people choose midwife practices based on their values around birth and pregnancy, but I just wanted to see my friend for my prenatal care. And I would also like to highlight that I was lucky to be a candidate to receive care from them! CNMs are not qualified to care for a certain level of care; medically complicated and high-risk pregnancies may demand MD care. And I think more people need to consider their candidacy for things. Someone with a history of shoulder dystocia, gestational diabetes, and large babies probably shouldn't attempt to free birth at home on a bed of moss and not a single medical provider, in my opinion. 

The way I see it is as a gamble. If you are trying to adhere to a low-intervention plan when you may not be a candidate, you are risking your life and the life of your baby. The entire ordeal is about risk management. And would I love to have an uncomplicated vaginal birth and have my sweet baby room in with me? Yes! But I've seen what happens when things go wrong. If I end up having a c-section under general anesthesia because the epidural won't work, and my baby has to go to the NICU for meconium aspiration syndrome, then that's what has to happen! The goal is for both of us to stay pink and breathing through the experience. 

And Dear Reader, I know most births are uncomplicated. I know that the chances of things going wrong are actually quite small, and my job has given me access to extreme situations that are not actually all that common. I understand that in my brain. But my heart has heard stories about moms coming in for decreased fetal movement and end up sending their babies to a funeral home. 

The other job I do at the postpartum unit is birth certificates, if you recall. This also includes completing reports for what we call in the business IUFDs (intrauterine fetal deaths). This occurs when a baby is considered deceased before birth. And during the week I found out I was pregnant, I had to complete three of these reports. 

I was reading through medical histories, entering the names of these babies, and preparing the report to send to the funeral homes. Two of these moms had full-term pregnancies. which would also be called a stillbirth. And often, the doctors aren't able to identify why this happens. For one, the umbilical cord had become knotted, but there was no cause of death for the other two. 

Suffice it to say that I am definitely biased by my experience! I fully admit and own that! 

Now that I've gotten that out of my system, let's talk about my third ultrasound. 

Hello, Peanut! 

Despite the fact that I had already been scanned twice, the office wanted its own scan in my medical records. And I was already in love with seeing our little Peanut, so I didn't mind for the most part. The only thing I didn't like was having to get Pooh-bear naked (top, no bottoms) and probed with my mom in the room. 

Joe and my mom came to see the baby, of course. Of course! 

The ultrasound tech took some measurements, let us see that sweet little jellyfish heart, and printed us some more photos. 

Afterwards, I got cleaned up, and we were taken to a different room to discuss the results. And we got to see our midwife, Meg! 

She told us that she had instructed the tech to look "from her tonsils to her kneecaps" to ensure that I didn't have an extra baby floating around in there that could explain my high hCG levels. And no, no multiples. Just one Peanut. 

An Extra Egg

But we did find out that I had a twin. 

In a healthy pregnancy, before the placenta forms, the pregnancy is maintained by a benign cyst that forms on the ovaries called a corpus luteum (Cleveland Clinic). The ultrasound showed us that Peanut came from my left ovary, but I had another cyst on my right ovary. 

She said that I just happened to release two eggs instead of just one during my ovulatory phase. 

For at least a few weeks, I had fraternal twins. 

By the time this ultrasound took place, there were no signs of a second baby. It was probably absorbed fairly early in the pregnancy, but it was...it was really something to think that I had had a second fertilized egg that just didn't keep developing. 

Now, I would never say I lost a twin, had a miscarriage, or lost a baby. And I certainly wouldn't say I had a twin disappear. Vanishing twin syndrome (Cleveland Clinic) technically would count me in—the Cleveland Clinic highlights that the prevalence of vanishing twin syndrome is unknown because of instances like mine—but in my heart, I wouldn't. I didn't get attached, start picking out two sets of names, or think about having two bassinets next to my bed. I didn't find out that I could have had twins until we already knew I just had one baby. I would never compare what I experienced to someone who had a loss. 

It feels disrespectful, I guess, to mothers who have lost more than an egg that they didn't even know about until it was long gone. 

But I would also be lying if I said it didn't bother me at all. 

At every ultrasound I had had so far, Joe and I joked about having them look for another baby, just in case, because of how sick I was. And we talked about how we hoped it wasn't twins because we didn't know how we could adequately support two babies. 

Looking back, those jokes felt awful. I know that, jokes or not, the second egg would've been reabsorbed. But when we talked about not being ready for twins, we didn't ever think that we'd have just one baby as a result of having something taken away; we assumed we just had one the whole time. And thinking about how we talked so much about not wanting twins made me feel extraordinarily guilty that day. 

Talking about it now doesn't bother either one of us, but that first day, between the pregnancy hormones and guilt, I did cry. I didn't want to have one baby by losing one; I just wanted one from the start. And the end result is the same, but it was a strange feeling. 

I texted my mom afterwards to tell her that I felt ridiculous, crying over a disappeared egg. And she told me that it wasn't ridiculous. When Meg told us, even she felt "a little twinge", as she put it, for that little fertilized egg. 

Dear Reader, you may be thinking to yourself, Well, this explains why your hormone levels were so high! Mystery solved! And you would be wrong. 

The hCG levels of a twin pregnancy can be measured. And the midwife's office has cared for twin pregnancies before. My levels were incalculably high, the highest that the other midwife we had seen, Sydney, and the lab tech had ever seen. 

Meg told us that we may never find out why my levels were so jacked, and maybe I would experience it again with another pregnancy, maybe not. 

But if one thing is for sure, it is that I will be looking very closely at my postpartum birth control options, given that I may release an extra egg at any given ovulatory phase. Next time I get pregnant, even if I have triplets, I want to be prepared to give my babies everything they need.