Tuesday, March 5, 2013

Little Black Dot

I had my first appointment today with my OB. I am still a whirlwind of thoughts and feelings and so I am going to try to sort it all out here "on paper." I'll start with my first impressions of the office. When we walked in, there was a very harried receptionist and a very busy waiting room. I immediately didn't like how busy the place felt - just rushed. Next thing I noticed was the practice doesn't seem to be purely obstetrics/gynecological, because there were a few old men there making appointments, getting blood drawn, whatever. I had pictured women and husbands and pictures of babies, etc. Oh well. None of that. Just a busy doctor's office. As my husband pointed out, "You're in LA, what do you want?" Ok. So I sat trying to ignore my first impression. And I sat. And I sat. We finally went back 30 minutes late. The nurse didn't believe me that I wasn't 7 weeks along, based on my LMP, but I expected that. The positive was that the nurse was warm, friendly and sweet. She also deducted 2 lbs off of my weight for my tall boots I was wearing. Bonus for her!

Then we went in the exam room and I stripped to the waist and we started to wait again. Now, I've been in some really nice exam rooms for my pap smears and some really not so nice ones (think Planned Parenthood in high school). The nicer ones have nice blankets to put over your waist, a warming lamp, pretty pictures.... This office was right in the middle. Nothing special, nothing that stood out either way. I'm not going to lie. I would have been excited about a nice, cushy room or even a few pretty touches. All I noticed was a weird little wind chime thing hanging from the ceiling. I guess you're supposed to look at it to feel calm?

At this point my husband was noticing that I was keyed up and tense (really quick on the uptake there). He asked me why I was so nervous and I couldn't really explain. I hadn't been nervous before about this appointment. I think I was just feeling the importance of the moment, not to mention feeling excited about the whole thing.

Then the doctor walked in. I had been telling myself I could put up with all of the other stuff about the office, as long as I really liked the doctor. Well, I liked her right away. She came in with a huge smile and immediately started by apologizing over and over for keeping us waiting. As my husband later pointed out, that is the first time either of us has ever had a doctor apologize for keeping anyone waiting. She is a young, pretty, African American woman with a beautiful smile and a warm voice. After apologizing for the wait, she congratulated us hugely. Again, I liked that. After she started asking questions, we did the little dance again that goes like this:
Her: "When was your last menstrual period?"
Me: "January 16th, but you see, I ovulate late and so..."
Her: "Hmm. How do you know that?"
Me: *babbling about temperatures, charting, opks*
Her: *laughing* Oooookay, well good for you I guess *insert disbelief*, let's just see what the ultrasound shows ok? According to your LMP you should be about 7 weeks along..."
Me: *sigh*

So, proceed to the Ultrasound. Now, I am 5 weeks, 5 days along. I knew there was a very good chance we wouldn't see the heartbeat. Or, much of anything really. But you know I'm an overachiever. So, I was secretly hoping... My doctor grabs the skinny dildo ultrasound wand, lubes it up, covers it with a condom, lubes it up again, and then BOOM...there's my uterus. Yep. My uterus and a...Little Black Dot. The sac. Exactly what I was expecting to see. My doctor couldn't keep the surprise out of her voice. "Ohhhh, well, ok...so your uterus looks great..." (thanks lady, I'd rather hear about the baby) "...and it's definitely not ectopic..." (yes, okay, good) "...and there's your sac, right where it should be...and, well, yes, it looks like you are right about five weeks along." (I TOLD YOU SO!).

So that was that. It was neat to see what we saw, but I'm not going to lie that I'm not a little disappointed about not seeing more. An egg sac, fetal pole, heartbeat? She scheduled us to come back in next week to try again so we can "see the heartbeat." I think this doctor is more obsessed with ultrasounds than most of the women on fertility forums. She really wants to see that heartbeat.

After the ultrasound, she interviewed me about family history, etc, and gave me the lecture on what to eat/what not to eat. Major plus here - for those of you familiar with the westside of LA, she did clarify that, although I cannot eat lunch meats that may not have been handled properly, Bay Cities Italian Deli is perfectly fine - they know how to handle their meat (hooray!). There were some things I didn't love her answers to, and that I would have probably preferred a midwife's answer, as in her answers to my questions about acupuncture (she says - not unless there's a clear purpose, and even then, who knows if it really works) and when she asked me if I was "willing" to do an epidural (but it's totally up to me either way). The things I did like is that she only sees her OWN patients and has only one other doctor who covers her in case of an emergency and that she was done EVERY SINGLE one of her own patients' deliveries since starting this practice in the last two years. She said, "I want to deliver my own patients. We develop a relationship and we get close and become friends." The whole interview was filled with laughter. And, even though I could tell she was rushed, she felt present.

And then, that was it. Appointment over. Now what? Now I'm left feeling....weirdly anxious. I know this is why people say do NOT do early ultrasounds. Prior to this, I wasn't nervous at all. Even in the room, when she seemed to be trying to reassure me that everything was perfectly normal and healthy, I said "Oh, don't worry, I'm not nervous at all." But now? The appointment just feels...well, like a jumble. First of all, I suddenly and fully feel pregnant. I mean, I saw my uterus. How cool is that? Not to mention, our little black dot is the coolest Dot I've seen on anyone's ultrasound photo. And, I am officially a prenatal patient, a mommy-to-be. Wow. But, also, I feel like I didn't pass some type of test. After we left, all of the nurses were asking "Did you see the heartbeat? How do you feel?" and I was like "uhhh, well no, it's too early...", only to be met with "Huh. Okay." And now I feel like the pressure is on for next week. (relax, relax, relax, relax....)

After I left I called my friend and was trying to describe this to her and I said, "You know, I guess this is what it feels to suddenly start feeling worried about my baby. Stepping into the shoes of concerned mother, or whatever." But then again, maybe it's just overachiever-me, hoping I have an overachiever baby.



According to AmericanPregnancy.org:
The gestational sac is often the first thing that most transvaginal ultrasounds can detect at about 5 weeks. This is seen before a recognizable embryo can be seen. Within this week, at about week 5 ½ to the beginning of the 6th week, a yolk sac can be seen inside the gestational sac. 5 ½ to 6 ½ weeks is usually a very good time to detect either a fetal pole or even a fetal heart beat by vaginal ultrasound. The fetal pole is the first visible sign of a developing embryo. This pole structure actually has some curve to it with the embryo’s head at one end and what looks like a tail at the other end. Generally from 6 ½ -7 weeks is the time when a heartbeat can be detected and viability can be assessed.

Yep. It's true. I did it. I googled my appointment. Ooops. Anyhow, my husband would read this and say, "Great, so you're right where you should be! You have a sac, and then next week there will be a heartbeat." Overachiever-me reads it and thinks, huh, but I didn't see a yolk sac, did I? And was that little squiggle that showed up in the dot when she moved the wand around a fetal pole? was I seeing things? If it was there, why didn't she say anything? If it wasn't, why the hell wasn't it? Annnnnd....stop. Just stop. The baby is fine. My doctor says we're both fine.

This is just me, doing my new, foreign job of being a mom, amplified by my own hyperanxiety and ambition to "do things right." So that's it. That's my update. My doctor is good. Not perfect, but good. I am good. The baby is good. Everything is just "good."

17 comments:

  1. I'm so glad your appointment went well!! It's great to hear that everything is going along as it should!

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  2. Good is great! I have no doubt that it was a super cool little black dot and that the heartbeat next week will be even cooler!

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  3. I'm glad you like your Dr. That is so important!! Especially for something as monumental as becoming a Mom. Are you considering a midwife too? I would totally have the same reaction as you... if my IVF works you've just inspired me to hold off on my ultrasound until I can see more!! if I could wait that long... hehe

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    1. I don't think an OB and a Midwife is an option. I looked and looked for that option, but couldn't find it. I was going to go with the hospital-based midwife program at UCLA, but they only see patients on certain days, and it didn't work for my schedule :( I AM thinking of going with a doula though.

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  4. I am so so happy for you and glad to hear your doctor is nice!
    I am not sure, but the yolk sac, which is rudimentary in us mammals, eventually regresses (totally normal) and is full of fluid anyway. This means : if there is fluid, you see it black. So we can assume it is there, you just can not distinguish from the rest.
    I am curious... why didnt you like her asking you about the epidural? (Feel free not to answer if I am prying too much). Here medicine is very conservative, I believe we have the highest percentage of home births, and a priori they would not use it (unless the patient asks specifically for it).

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    1. Well, I don't really understand either, but I know for sure it was "a sac," but is there a difference between a gestational sac and a yolk sac? (Now I feel like we're talking about eggs for breakfast...)

      I didn't mind her asking me about the epidural, but I just got the vibe from her in general that she is not gung-ho about natural or alternative medicine. It felt like, when she asked, that she was basically saying "You're not one of those crazy ladies who won't do an epidural, are you?"

      In answer to her question, I really don't want an epidural(partially because I think a natural birth would be ideal for a lot of reasons but also because I am terrified of a needle in my spine), but I am not opposed to one if it were necessary for some reason or I couldn't tolerate the pain at all.

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    2. I never really heard the term gestational sac (and I don't know if they mean "amnios" by it. You should look into the 3rd diagram from the top on this website:

      http://faculty.southwest.tn.edu/rburkett/human_development.htm

      You will see there are 2 fluid filled cavities supporting the embryo: the amnios, which really acts like a cushion, in blue, and the yolk sac (which nourishes the embryo in chicken for the whole development processs, but in mammals just during an early stage and then disappears, as the placenta takes over and continues to nourish the baby in yellow). As fluid, in echography is always seen as "black" (anechoic) and since both of this cavities are filled with fluid you would not be able to distinguish from each other.

      It's funny. I am in general opposed to using an excess of medications (hence I did not want / strongly fought against having to go through fertility treatments), and well open to alternative medicine, I am SO afraid of pain (after really bad period cramps) that regardless of the fact that needles through my spine also scare me, I just want the drugs. Anyhow who knows what will happen and what decisions we'll make at that moment.

      Oh actually I just found out this image in the wikipedia which clarifies it. A gestational sac is "the whole thing", it includes both the amnios and the yolk sac (which is real small). But since it's all fluid you don't really distinguish structures.

      http://en.wikipedia.org/wiki/File:Gestational_sac.svg

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    3. Thank you for the websites and info! Based on these pictures, all we saw was the gestational sac aka the absence of anything. Just the nice little home for a baby. Looking forward to seeing more next week (fingers crossed).

      I totally agree with you that we have no idea what we will do until we are faced with the pain in the moment. I could see myself crumpling and completely losing it and not even caring if they accidentally paralyze me with the epidural as long as they stop the pain. But, I can also see myself going to a quiet, strong place and just baring through it. I really don't know. I know my mom gave birth twice unmedicated and I always say, if she did it, I can do it. Ha. we'll see!

      Oh, and I wanted to thank you for the recommendation for Lauren's blog. I just finished reading through all of her entries during the pregnancy up to current date. Great writing and good reading. I'm waiting to see what happens next!

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    4. Lauren is the best! And I am sure you will do great, you already are!

      And you see, everything was fine with baby (it's just that at the beginning they are little balls of fluid (well it's a lot more complicated than that, but for echographists, that's all there is... it's only when they start to take form you see them).

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  5. First, CONGRATULATIONS!! I somehow missed this and am SO happy to hear you're pregnant and happily coming along! :D

    Matt and I had to go in for an emergency scan at 7 weeks (I wasn't initially scheduled for one until 13 weeks, I think, but I started bleeding -- so word to the wise, if you bleed, DON'T PANIC, just call your care provider; apparently, this happens much more often than we're led to believe), and we were able to see the heartbeat. It was uh-ma-zing, absolutely amazing. You're right in your research that you won't really see too much before 6.5 weeks, but once you're around 7, you can start to really see stuff. I hope they give you pictures! Kit looked like a gummy bear. ;) I can't wait to see what yours looks like!

    I'd definitely look into getting a doula, and into taking childbirth classes. We hired a doula for ours and took her classes, and while I thought I knew a lot from my own research and anecdotes from friends and family, we still learned a LOT in those classes. They were invaluable to Matt, too, as he's not a reader. ;) And the doula is just great!! It'll be awesome to have an extra advocate for you, especially since you'll be with doctors and so forth. (FWIW, though, I still feel the need for one, despite going to a birth center and having midwives.)

    And as for going natural, I hope you can and do, if that's what you want! Having the support will DEFINITELY help with that. And I'm exactly like you... my mom gave birth to three children, completely unmedicated, and SHE has said that if she can do it, I can, too. I totally believe in you and your body's ability to birth your baby. :)

    Congratulations again!!

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    1. Oh yeah, duh, this is Stephanie from TCC is TTC. Posting under my main blog, sorry about that. :)

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    2. Thanks for all of the good advice! I definitely want to do a childbirth class. I think my husband would love it and would feel more involved. I think he will do amazing in the role of coach. I mean, he kinda already has that role in my life, anyhow ;) That's actually my only concern about getting a doula. He has expressed concern that our own connection and teamwork would be undermined by having someone else involved. I think we'll have to interview a doula and see. Also, I think we have some more talking to do.

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    3. If it helps, if you do consider a doula, his/her job will be to be an *extra* support person, definitely not at the exclusion of your husband! In fact, doulas should be encouraging the partner to help the laboring mama along, not the opposite. But there will be times when he wants a breather, needs to pee, gets something to eat, whatever... and that's when the doula will take over. S/He should also help advise your partner on pain management tips ("Here are some ways you can massage her that will feel great!") and be an advocate for the both of you.

      Just thought I'd mention that, as yeah, it might appear that a doula is going to be more intrusive than not! But nah, they're in the background and help when needed, not to replace a helpful and supportive partner. :)

      BUT... this is all your decision! If you don't feel comfortable with it, don't do it. We ended up going with it because, as supportive as my husband is, he can tire out quickly and can sometimes let his emotions take too much control. I need a bit more stability than that. ;) And he doesn't mind that there's someone to rub my back while he strokes my hair and whispers encouraging words!

      AAAAH, good luck, and congratulations again!!

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    4. Oh thank you! That is all so helpful to know! I will read all of this to my husband so he can hear :) I'm still undecided, but I love how you described it.

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  6. I'm glad that everything is "good" and can't wait to hear after your next ultrasound that everything is GREAT!

    Praying for you to have peace in the waiting!

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  7. The whole doctor appointments thing makes pregnancy feel anticlimactic... and that I do not like because this is a HUGE FREAKING DEAL, PPL!!! I'm having a BABY.
    Unless it is a woman's appointment-only office there won't be many pretty things like floral photos in macro or upholstered seats in the room... which stinks. That dangly on the ceiling is for when you are... ahem, in stirrups and need to go to your happy place. LOL

    I am so glad you saw ANYTHING! That in itself is great! You just wait for the coming weeks. That baby grows fast. Next week you'll be all "OMG! The black dot looks like an alien already!!!" And then before you know it you'll be feeling little jabs and bubbles. It's great.
    SO happy for you; I think this journey will quell your anxiety as you realize how things are "just so" and bombastically amazing all at once. :o)

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  8. Congratulations on finding an awesome doctor. My first OB always had me waiting at least an hour, and she never smiled at us or apologized for making us wait.

    I've already read your next post, so I know things turn out okay and you see the heartbeat, but it's true what they say about Google and early pregnancy. You'll really just drive yourself crazy Googling everything that could be wrong this early. There's pretty much zero that you can do to stop it if something does go wrong (assuming you're not smoking, getting hit in the stomach repeatedly, etc.), so there's not much point in worrying about it.

    Really happy for you that things are going so well!

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