The Last Word On Nothing

When you’re carrying a child, you make certain sacrifices. I knew I’d have to give up Tanqueray and the occasional guilty cigarette. I was even prepared to forgo sushi. But I soon learned that the list was far longer than I imagined. No hot tubs, the experts advised. No queso fresco. No Advil. No deli meat. Limit the caffeine. These losses, so numerous and unexpected, were harder to bear. Still, I knew I could handle them. But then the doctor took away something even more precious: my autonomy.

I have lived my life largely outside the medical system. Sure, I’ve been to the clinic for pap smears and the occasional physical. But I’ve never had any serious illnesses or accidents. I’ve been lucky. On December 23^rd, however, when I had my first ultrasound, it seemed like my luck had run out. I expected to see the flutter of a heartbeat, but the grainy screen revealed no movement. Everything was still and black. The technician couldn’t even find the embryo.  

Doctors calculate a how far along a woman is in her pregnancy using the first day of her last period. I don’t religiously keep track of my menstrual cycle, but miraculously I had a date written in my planner — October 28^th. Based on that date, the nurse calculated that I was eight weeks pregnant.

Eight weeks pregnant doesn’t mean you’re carrying an eight-week-old embryo, however. Because obviously conception doesn’t happen on the day a woman begins menstruating. It occurs after ovulation, a couple weeks later. So a woman who is eight weeks pregnant is actually carrying an embryo that is roughly six weeks old. This is what’s known as the embryonic age. Using a woman’s period as surrogate for the beginning of pregnancy may seem idiotic (at least it does to me), but there is a rationale. Most women can make a rough guess at when they last had their period. It’s not so easy to pinpoint conception.

But this system has a major flaw. Not every woman has a regular 28-day cycle. In one 1968 study, researchers examined the cycles of 2,300 women. They found that their cycles lasted, on average, 28 days. However, some women had 15-day cycles. Others had cycles that lasted 45 days. The time between menstruation and ovulation can also vary. However, none of this gets factored into the doctors’ calculations. My own cycle seems to be on the long side, about 40 days. Perhaps that is why my first ultrasound revealed a lifeless yolk sac instead of a 6-week-old embryo with a beating heart.

At the time, of course, I had no rational explanation for what I was seeing, and the technician couldn’t tell us much. But it seemed clear something was wrong. When the nurse finally called, she offered two possibilities: either I was mistaken about the date of my last period or something had gone very wrong in my womb. “Are you absolutely sure about the date?” she asked. I wasn’t. But how far off base could I be, I wondered. Why would I have written down the wrong date in my planner?

The nurse asked me to return to the clinic for a blood draw. If the hormone levels in my blood matched what we had observed in the ultrasound, that would be a good sign. It would simply mean I wasn’t as far along as they thought I was. The next day was Christmas Eve, and we’d planned to tell our parents about the pregnancy. But she advised us to keep quiet. “I wouldn’t tell anyone unless you need the moral support,” she said tersely.

For three tense days, we waited for the lab results. To keep my parents from asking questions, I poured myself a glass of wine with Christmas dinner and then dumped it down the sink. The nurse had promised she would call with the results first thing Friday morning, but she never did. When I finally reached her that afternoon, she sounded cautiously optimistic. The hormone levels seemed to match, but the doctor wanted to make sure the levels were climbing. So she sent me to the lab to get my blood drawn again.

A week later we had another ultrasound and saw the flicker of the baby’s heart. Everything seemed normal, and I was looking forward to a reprieve. But the doctor wanted another ultrasound to make sure that the baby’s heart rate had reached 150 beats per minute. The nurse had already scheduled it, she told me when she called. “Why?” I asked. A third ultrasound seemed like overkill. “What would you do if the heart rate hadn’t reached 150 beats?” The nurse didn’t have an answer. She mumbled something incoherent that ended with the words “fetal demise,” jargon for a dead baby. “That doesn’t make any sense,” I told her, perplexed. “What good would an ultrasound do if the fetus is dead?”

But the nurse wasn’t done delivering bad news. She also informed me that my doctor — a doctor I’d never met and wouldn’t meet for another month and a half — had taken the liberty of writing me a prescription for thyroid medication. The lab results seemed to suggest that I wasn’t making enough of the hormone. No one had told me they planned to test my thyroid levels. “Is this because I’m pregnant?” I asked. She didn’t know.

I felt frantic. Everything seemed to be slipping out of my control. My medical care was in the hands of a despot I’d never met who would only communicate her orders via an irritable nurse who didn’t seem willing to explain anything. In early December I’d been healthy. Now I had a thyroid problem that would require lifelong medication and a fetus in my womb that seemed intent on demise. I’d had enough. I decided to switch doctors.

What frustrates me most is that all of this anguish was probably unnecessary. The age mismatch highlighted in that first ultrasound was almost certainly due to my longer-than-average menstrual cycle. Instead of conceiving two weeks after my period began, it was probably closer to three or four. But the discrepancy raised red flags that would no doubt have stayed stubbornly flapping in the wind no matter how many tests my doctor ran, no matter how many ultrasounds she ordered.

Being pregnant requires certain sacrifices. But it isn’t the lack of alcohol that gets to me. It’s the pervasive idea that I — a healthy, 36-year-old pregnant woman — am one step away from calamity, that I must be poked and prodded and pricked and bled, that the baby must be constantly monitored. I’m only 16 weeks into my pregnancy, and already I’ve had four blood draws and three ultrasounds. I’ve met with a genetic counselor and peed into a cup — twice. I’m not sick, but with so many medical interventions, how could I possibly feel healthy?

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Image credit: Jerry Lai via Flickr