Friday, June 3, 2016

Week 11: Maternal-Fetal Specialist

I think in some places it's called a maternal-fetal specialist, and in some places it's called a perinatologist. Anyway, this week, I went to see one.

I am somewhat wary of highly-specialized doctors. They jump into your care mid-stream, they know very little about your history except what's on paper (and there's no guarantee that they've read it), and they really, really, really love tests. So much. It doesn't always matter how invasive or painful it may be for you. They just want to know. It doesn't matter how expensive it is, because they always just figure insurance will pay for it. It also doesn't always matter whether the information it will give you will affect the way you care for yourself. They just want to know. Because...knowledge and information. No matter what. I'm beginning to see why the tree of the "knowledge of good and evil" was even a thing. Some people just want to know, whether anyone needs to and no matter the consequences. I feel like I'm outing myself as an ostrich burying my head in the sand on this one, but perhaps ignorance actually is bliss sometimes?

All that to say, I have found maternal-fetal specialists to be of this sort. I am working on making peace with them, out of necessity, because I think if I asked my OB to let me go without the extra testing, I would probably be rejected as a patient. (This has happened to me when I refused to come in for visits which seemed not to have much purpose, though that time it was an endocrinologist.) It's not that I always reject testing, but sometimes it feels like a non-stress test every other week, rather than once a week, is adequate. Or sometimes an ultrasound isn't necessary, and maybe we'll just see how things play out. I was burned by a maternal-fetal specialist in my first pregnancy when they told me that my son's growth was in the third percentile and I would have to go on bed rest for three weeks. As it turned out, their measurements were simply incorrect and a different clinic gave a different reading. I was also burned by a maternal-fetal specialist in my third pregnancy when they told me that my son might die before he was born, and the only prenatal "treatment" offered for his condition would be abortion.

Therefore, it was with another sigh and some more trepidation that I went to visit the maternal-fetal specialist this week. I explained that I would decline first-trimester genetic testing because it has something of a false positive and false negative rate, and there is no prenatal treatment for the baby if something bad does show up. "But, knowledge..." they said, and I said in reply, "But, knowledge will be more certain and actionable at a later date." I asked him if there was anything I could do for the baby if I found out at this point in the pregnancy rather than later, and he confessed that "stopping" the pregnancy is the only reason one would want to know sooner rather than later.

I was very pleased to see that they seem to trust me completely with my blood sugars. I was surprised that the nurse who assists diabetics during their pregnancies in the new office didn't seem to have a plan for following up with me about my blood sugars other than "as needed." Perfect. The only thing I need for my diabetes is a fortune-teller, and I haven't found a reliable one of those. So it's back to observation of recent patterns plus some intuition and guesswork, and that's going OK for me.

They did tell me two things that left me wondering how much I needed to know them. One was that I have complete placenta previa, but this situation almost always resolves by the third trimester. (I do know one woman for whom it did not, and that's a situation which requires a c-section. Peggy Vincent writes an especially riveting birth story about a case of placenta previa in her book, Chronicle of a Modern Midwife.) I guess I'm glad that I know about it, given the impact that it does have on delivery, but it does sort of feel like I could have gone in for an ultrasound at 28 weeks probably found out that it had resolved entirely if the doctor is so sure that it will resolve...

The other is that I have arterial knotting to the uterus. This is NOT a knot in the umbilical cord, which can cause miscarriage (before 20 weeks) or stillbirth (after 20 weeks). Blood flow to the baby is fine. It's just blood flow to my uterus which is lacking. I wonder how this developed? Was it there in my last pregnancies and they just never mentioned it or didn't notice? Will it go away? What kind of effect will it have on labor and delivery? Will it make my uterus work less efficiently during labor? I have a feeling I'm never going to get answers to these questions. You can try to Google it for me, but Google has turned up with nothing on the topic whatsoever. I have no idea what the relevance of this issue is. The maternal-fetal specialist told me to take some baby aspirin.

Do you like going to the maternal-fetal specialist? Am I missing something here that will make me more grateful for and less wary of their care? Does anyone know about uterine arterial knotting?


  1. I also declined the forst trimester screenings. Granted this is my first time going through this so I don't really know what I am doing but I feel that a lot of it is unnecessary simply because of the "high risk" label and am trying to take as much of a "hands off" approach as possible. (I actually wrote about my first trimester experience on my blog today)... I haven't heard about knotting of the uterine artery, but I am guessing they suggested the aspirin to minimize blood clot risk which could reduce blood flow further. Hopefullt it won't pose any issues!

    1. Yeah, I understand the baby aspirin. My bigger questions are how does it happen? How normal is it? How does it resolve? How does it affect delivery or recovery? Do they have any statistics on how it affects blood flow to the baby or is the risk to the baby a theoretical one? I guess I'm happy taking aspirin for now, although I know that NSAIDs are not usually recommended late in pregnancy because of the risk of hemorrhage for the mother. My doctors were a tad bit worried about my postpartum bleeding after my fourth, so I wouldn't want to put myself at any greater risk when it comes to the birth.