29.5 Week Appointment and description of a typical doctor visit

On Wednesday, I had my regular weekly appointment at the Center for Maternal and Fetal Care.


When we arrive, I have the exact same conversation with the friendly receptionist about co-pays - CMFC charges $25 fee, I don't pay it, they call the insurance company which says they won't pay it, then I call the insurance company and they tell me not to pay it because it is covered. What a run around!



After that somewhat awkward conversation, we are escorted into the main waiting room. It is filled with the most relaxing and comfortable chairs EVER. Enya is playing in the background to soothe nerves. There are very few, if any, other patients in the room because we arrive for the first 7:30 am appointment or the very last 4 pm appointment. No crying toddlers. No coughing, grumpy people. Nothing stressful AT ALL.



Within five minutes, the ultrasound professional calls for me. We walk through the maze of tan colored walls filled with more spa-theme decor, until we come to the bathroom with the pass-through-urine-cup window. Each time, the sonographer asks the same questions, "Do you need to leave your sample now or after you drink a bottle of water? Do you remember how to put your sample in the pass-through door?". Yes, yes.



Dan is taken back into room 7 or 8, which is a small ultrasound room. He is usually waiting for me in a chair nearby the large exam table I sit on. The sonographer always comments about the temperature of the room and politely asks me to lift my shirt above my belly. Then she tucks a beige towel into the top of my pants and squirts warmed ultrasound gel onto my belly. Each week the amount of gel increases as my surface area increases.



As she begins to rub the ultrasound wand device on my abdomen, a black and white image of my uterus appears on the large, HD television mounted just in front of my exam table. The baby's image is fairly large on this large screen TV - probably the size of a toddler! I always have to ask where the baby is in relation to my abdomen, because it seems like the angle she is pointing the ultrasound wand and the position the baby is in on the screen don't mesh. The sonographer not-so-patiently explains that I am looking at a 2D image, and that she is only able to get a small slice of the baby's total appearance. I say, "Yeah, but where is the baby at in me?" I always feel dumb when she has to physically point. The little moves and pokes I feel don't feel as if they are coming from feet or elbows ... I can't tell a difference between the baby's backside pushing on me and his skull. The sonographer apparently thinks this is uncommon.



Usually she begins the scan locating the baby's face. This is a nice pleasant way to start the ultrasound! During the first trimester, they skipped over the baby entirely and began measuring my ovaries and position of other internal organs. In the second trimester, the fetal sac was much smaller, and so I could usually see the entire baby, placenta, and fluid in one screen shot. They would quickly located the heart, listen to the heart sounds and take measurements of the baby's body size. Now, the baby doesn't fit into the entire picture area. She begins locating the baby's front side, then switches to a top down view of the head. Every time she says, "I'm measuring his hat size". Then she begins to find the abdomen and says, "I'm measuring his belt size." Usually they measure his femur, too.



During this ultrasound, the baby's foot was prominent. I asked her to measure his foot so I could have some sort of scale to reference how big he is now. His foot is 6 cm long! The doctor has told me that the Internet sites that compare baby's size to vegetables or offer approximate lengths or weights are totally off most of the time. (ex- My baby weights 3 pounds, 9 oz right now, but the websites have said he should be just under 3 pounds. The baby is in the 80th percentile for weight, so if I listened to the website, I'd feel freaked that I have a huge baby.)



During this week's ultrasound, the baby was lying head down, facing to my left hip bone and forward at an angle. He had his elbows above his head, just like how Dan was reclining with elbows behind head while watching the exam! I think that is neat.



Here is his profile. I've seen a few pictures of Dan when he was very young, and I think that the forehead and nose look more similar from the side than my physical features. He is very cute here!


The black area around the baby's face is amniotic fluid. There is a nice, comfortable amount to cushion him and give him liquid to drink. Yes, babies DRINK the amniotic fluid and then urinate it out! How odd is that??


We spent some time looking at the baby's face. I asked the sonographer if all fetuses look the same, or if they are distinct. She told me that this baby is unique, and that I may recognize him after he is born since we can see so many physical features.



Then she started to comment on how he was SMILING. We could see his chubby cheeks lifting at the edges of the mouth and the lips curling up! His eyes were open for most of the time, and we could see the eyelids closing occasionally.








Can you see the smile? The image on the live TV was much clearer than this still that is scanned. I still can see the lips and cheek bones!



I hope he has Dan's thicker lips and my higher cheek bones. He could model.

And here is another profile.

He kicked up one leg and propped it on his knee. This was an ultra cute pose! I like seeing all the bones in his foot. He also had his hand in a fist near his chin. The bottom of my uterus is up at the top of the photo where the lighter band where the word FOOT is located. You can see he is in cramped quarters!

And here is another VERY sweet picture. He has his fist near his mouth and was putting it in or on his mouth, too.

This is very similar to Rodin's famous statue, The Thinker.

The ultrasound time always ends abruptly. Usually too quickly, too! I appreciate time to look at him and get to know him. We usually get four to ten "memento" photographs printed out while we are still in the ultrasound room. I wipe off the water-based gel, which I swear does stain my clothes, and try to feel clean.

Then I go across the hall to an exam room, where my blood pressure is taken each time. The Nurse usually has to take my blood pressure manually, instead of in the auto-cuff because it is low and the cuff doesn't get very accurate results. She goes over recent blood work I've had, such as the glucose test I had last week (passed with flying colors!) and discusses fetal-kick counts I've done as well as other symptoms. Usually my report on the frequency and predictability of contractions gets her attention, and I have to promise to sit down, drink more water, and stop being stressed out. I assure her that the contractions are long and not the quick, rapidly progressing type and that I have no other signs of preterm labor. She gives me the same information card and demands that I call or go to OB Triage if I have more than 4 contractions per hour for three hours in a row. I agree.

Then comes the worst part of the entire experience - the scale. I have an arrangement that I am never told my weight and that it is not commented on in detail, EVER. This is to help my mental health. However, I've been more stressed about my body lately and have started to panic at this point in the exam. I asked if I could refuse weight, and she told me it is my right. But of course, this lead to a question about my eating habits, mental state, and mood. Which was merited. I am not doing well. I am stressed and my coping mechanisms aren't healthy. Instead of getting a lecture, I get support. Nurse Mary arranges for medications, therapy appointments with a pregnancy ED specialist, and asks kind questions.

I typically spend the next ten minutes asking my own questions... here are the sample ones from this week: My top three right ribs really hurt. Is it possible they are popped out? Can I see a chiropractor? Is it safe for me to take a Calcium BiCarbonate heart burn medicine such as Alkaseltzer, rather than a Calcium Carbonate such as Tums? Can I get a refill on the Nexium medication? Will my acid reflux get to a more normal place after pregnancy, or does the relaxin hormone have lasting effects on the esophageal sphincter? How much bigger will the baby get this week? How much longer do you think I have? Do you think I should try to meet some of the doctors who work at the facility I will go for delivery? Is there any reason why I might need a c-section at this point? Does drinking a lot of water lead to fluid retention?

Yes, I have lots of questions! And I'd rather ask them and be informed, thanks.

Then I go across the way to another testing area, which is also decorated in beige and white and reminiscent of a spa. This is the Fetal Non-Stress Test monitoring area. There are four different curtained areas, each with a leather Lazy Boy recliner and an uncomfortable looking chair for the dad to sit in. I sit down and the technician reclines me back and puts two elastic bands around my waist, like a belly belt. One of the bands holds a fetal heart rate monitor, which is about as big as a stethoscope. The other band holds a similar looking monitor, which is used to measure contractions of the uterus. I am given a small "clicker" to click when I notice the baby moving. All three pieces of equipment are used to monitor the health of the pregnancy and will be used every week until I deliver him. The monitors are connected to a small machine that I can see. Its interesting to see the fetal heart rate change so quickly - from 135 to 160 to 140 - in a matter of seconds as he moves and gets exercise. Usually the "clicks" I make noting movement coincide with the increase in heart rate. The doctors are looking for at least two accelerations in 20 minutes.

When 20 minutes has passed, Dr. G comes in to see the test results. He always has my file - which is a white binder - and has seen the other notes from my previous care providers. He always shakes our hand to welcome, and then says:

"Your baby's size is perfect. Baby's weight gain is perfect. Amniotic fluid is perfect. Muscle tone and reactions are perfect. Heart rate is perfect. The contractions we measured are very small. Your pregnancy is progressing perfectly."

We have a five to ten minute discussion of follow up questions from the previous week and from Nurse Mary's patient notes. By this time, it is nearly 5:30 pm and I am tired, starving, and ready to bolt out of the office! I bet Dr. G is ready to be home, too. I try to wrap up the appointment as quickly as possible.

As we walk out, I note that the cleaning staff has already arrived and we are just about the last patients in the building!

Dan clutches the ultrasound pictures, I make conversation with a different receptionist about next week's appointment and our bill (unpaid, pending insurance figuring out!) and we ride the elevator three floors down to the parking lot.

Every week I think about how long it seems its been since I was there last, but how quickly the time passes when we are in there for an appointment.

Our next appointment is next Friday, May 24, which is my LAST day of work for the school district! I hope we have a very pleasant experience that morning!