Hello again, friends! I think it’s time to wrap this story up; a nice three-act structure works well and also I’m tired of trying to remember what the heck I’ve been doing all this time. This chapter is all about PREGNANCY and BABY STUFF and PICTURES FROM INSIDE MY UTERUS so if that’s not your jam you might want to tune out now.
Not long after I got home from visiting my dad in California, I had an OB appointment to confirm my pregnancy and meet my new doctor. Why a new doctor? Well, that’s a fun story. When I was pregnant with Ben, my old OB diagnosed me with acquired hypothyroidism and put me on medication to regulate it. After I gave birth, I never had any sort of follow up with the OB or an endocrinologist, but at the time I didn’t think anything of it. Cut to two years later and nearly a year of trying to get pregnant, and I wondered if thyroid issues were the culprit. I booked an appointment with my then-OB and ordered an independent “fertility panel” test I had seen on advertised on Instagram. I figured knowing my baseline levels would be a handy thing to have when I asked the doctor about it and felt good about taking my health into my own hands.
Several weeks later I got the test results back and met with my OB. It did not go well.
Not only did he completely dismiss my concerns and ignore the test results I had brought, but his assistant also voiced her opinion of me loudly enough that if I could hear her through the closed door at the opposite end of the hall, then the rest of the patients in the office could hear her too. Apparently, she thought I was “so dumb” to have bought this test, and that I was “still young enough that a year of trying isn’t that long.” I was livid. The panel I ordered was the same exact panel my OB had ordered during my pregnancy, drawn at a Quest Diagnostics, and reviewed by a licensed doctor before the results were sent to me. I wanted to know what my thyroid levels were independent of a doctor’s appointment, in the event that the aforementioned doctor didn’t take my concerns seriously. I may not have been considered advanced in terms of maternal age, but my husband was nearing 40 and wanted to have our last child before he was much older.
That sealed my disgust with that OB’s office, and when I got home, I immediately looked up endocrinologists in the area. I found one with excellent reviews, called, and made an appointment. A couple of months later I had my first appointment with Dr. Alan Cleland and was praised for having ordered the independent fertility panel. He was happy to see a patient being so proactive with their health, and upon reviewing my test results, immediately ordered another blood test and a thyroid ultrasound. He then confirmed what I had suspected all along: hypothyroidism that was likely interfering with my ability to get pregnant. He started me on 50 mg of levothyroxine* and speculated that it wouldn’t be too long before I was able to get pregnant.
That was July 5th, 2018. Not even 6 months later, I found out I was pregnant. Thank you, Dr. Cleland!
Which brings us back to my new doctor! I specifically wanted a doctor who had experience with reproductive endocrinology, and my search led me to Dr. Amy Wrennick with Women’s Physicians of Jacksonville. So far we love their office and staff, and I’m so much more comfortable there. I don’t feel judged or ignored, and I feel like I’ve been given much more information about my pregnancy.
So, my first pregnancy appointment landed around 7 weeks gestation. The first checkup is always a fun one: pee in a cup, weigh in, blood pressure check, then hop up onto the exam bed and wait for the doctor to come and stick an ultrasound wand up your hoohah to see what’s going on in there. I had been feeling pretty sick already, so Peter was convinced I had twins in there. Thankfully, he was wrong!
It was still early, but this pregnancy was already pretty different from my first. Mainly, I felt sick constantly. Perpetual nausea, food aversions, and general malaise every day up until week 15 or so. I never actually threw up (hallelujah), but I certainly came close. Every morning I choked down my thyroid meds, and every evening I took my prenatal vitamin and felt awful for hours**. My health record noted that I had a “threatened miscarriage” early in my first pregnancy, so I had another ultrasound and more bloodwork around week 11 to make sure everything was progressing smoothly.
I had really wanted to take more weekly bump photos, but I felt so awful I only managed to get one during week 12. I should probably start taking more now that I’m feeling better!
In mid-February, I had my first-trimester screen, where they check for abnormalities, like trisomy of chromosomes 13, 18, and 21. My results for these came back well above normal, so no worries about Downs, Patau, or Edwards Syndromes. They also check the levels of Pappalysin-A, also known as pregnancy-associated plasma protein A, commonly abbreviated as PAPP-A. Results for this protein are typically expressed in Multiple of Median, or MoM, and normal values are 0.5 or greater. My value? 0.31.
When my doctor called to tell me about the results, she emphasized that it was nothing to be concerned about, but that they would be referring me for a high-risk ultrasound specialist for the remainder of my pregnancy. Being the worrier that I am, however, I immediately googled what low levels of PAPP-A meant and found this article and this other article and this OTHER article on the NIH database. I really should not have read those.
In late March, after returning from our cruise, we went to the first of our high-risk ultrasound appointments. These folks are not messing around: I laid there with (thankfully warm) goop slathered on my belly for close to an hour as the technician checked everything on that little peanut. Arm and leg length, head circumference, every chamber and valve of the heart, the major blood vessels, kidneys, brain, and the placenta and umbilical cord. I hadn’t been able to feel any kicking yet, so it was nice to see them wiggling around in there, even if I was nervous about what the doctor was going to tell us. We also verified that we are having boy #2!
After the ultrasound tech got all of the measurements and images she needed, the doctor came in to talk to us. He explained that so far, everything looks good! Baby boy is growing as he should, and development looks normal…but something is off with the umbilical cord. Normally, an umbilical cord has three blood vessels: two arteries and one vein. Mine only has two vessels; one artery and one vein, a condition known as Single Umbilical Artery, or SUA. It only affects 1% of singleton pregnancies, and usually has a good outcome…but the not-so-good outcomes can include heart, brain, or kidney defects. Not what I wanted to hear. The doctor tried to reassure me that it’s likely not an issue and based on how the baby is growing so far, we won’t have any problems. They just want to see me once a month for more ultrasounds to track his growth and make sure he’s sticking to the curve. I try to look at the bright side and get excited about seeing the little wiggler more often, even if inside I’m super worried and trying not to have a panic attack.
We’re almost back to the present! Home stretch!
On April 23rd we had our second high-risk ultrasound, and the tech repeated all of those measurements and checked all of those important bits again. This time, however, little Mr. Eliot Owen had about doubled in size and I could feel him punching and kicking away in there as she checked him over. I wasn’t quite as nervous as the first appointment, so when the doctor came in to chat I didn’t have my fingernails digging into my palms. He seemed very pleased with Eliot’s growth and didn’t see any issues with the important bits (heart, brain, kidneys). So far, it seems like we’ve just got a wonky cord, and little man is baking away just fine! As I write this, he’s rolling around and punching me in the cervix. Apparently he’s already gotten pretty cozy in a head-down position facing my back, with his little butt stuck over on my right side. I’m sure he’ll move around a bit as he gets bigger, which will be nice…the way he’s positioned makes anything with a waistband uncomfortable and when I sit down he shoves his feet up into my guts.
So, here we are. It’ll be 24 weeks tomorrow, I’ve definitely “popped,” pregnancy cravings are in full swing (gimme all the apples and peanut butter, please) and we’ll soon have (gulp) three boys. I am so outnumbered. My next big prenatal event is my second one-hour glucose tolerance test. Lucky me, I get to do it twice since I had gestational diabetes with Ben!
Well, that about covers all of what’s been going on for the last six months. Now I have to figure out what else to write about!
*My dose has since increased gradually to 112 mg of levothyroxine daily, partially due to pregnancy. Endocrinologists like to keep a tighter rein on thyroid levels than an OB/GYN, and so in addition to my numerous prenatal visits, I have blood drawn monthly to track my TSH and Free T4 levels.
**Turns out, the iron in my prenatal was making me sick. It’s unusual, but not uncommon. I switched to a gummy prenatal with no iron and felt a million times better.