We went up to Providence this morning for the first appointment with the maternal fetal medicine specialist, aka MFM, aka high-risk OB: Dr. D. We liked her a lot. We will be seeing Dr. D for most of our regular appointments from now on.
First of all, I know you’re all holding your collective breath. No, we didn’t find out the sexes today. I did get a quick ultrasound, but it was a low resolution mobile machine and was only a couple of minutes of checking to make sure all heartbeats were accounted for.
The appointment was long and there was a lot of information, both given and received. A lot of it was repeat of things covered between Dr. G, the various books, and the internet. Dr. D talked to us about different complications, especially preeclampsia (more on that in a minute). She talked about realistic timelines and kind of echoed the milestones I posted recently. She is not concerned about me working for now, so that’s good.
We met with several staff members other than Dr. D, including a social worker, a nutritionist, and Nurse N who’s the one we call in case of problems. Everyone was really really nice, though the social worker was, uh, a little spacey. The nutritionist knew exactly which book I’d read as soon as I started to open my mouth, and said not to make myself sick or over-stress myself worrying about Dr. Luke’s weight gain schedule and calorie counts. The nutritionist gave me a sheet of daily serving suggestions that doesn’t include any calorie estimates or goals as far as grams of protein. She will be keeping track of my weight gain, and said that 45 to 50 lbs total is usually plenty and instead of 36 by 24 weeks, 20 by 20 is what she tends to look for.
There were a couple of major important things that did come out of this morning. One, my blood pressure was the highest it’s been, ever. So now I have a prescription for Labetalol. This makes me unhappy.
Second, for the first time the possibility that two of the fetuses are sharing a placenta was raised. Apparently during the NT scan, the sonographer wasn’t able to tell for sure, but she didn’t mention it – just wrote it in the notes for Dr. D to bring up with us. If they share a placenta, that means they are identical (#3, which I believe is Baby A, is clearly fraternal). Identical means a riskier pregnancy, particularly with the chance of something called Twin to Twin Transfusion Syndrome in which one of the two starts to take over the blood supply for both, putting both in jeopardy. So if they do share a placenta, then the way in which we’re all monitored changes somewhat. This Wednesday afternoon, I go back to the clinic (adjacent to the Providence hospital) where we had the NT scan and they will try to get it figured out for sure.
The next MFM appointment will be April 12. I mentioned that I’d get back to the preeclampsia thing? Well, I’m at greater risk for that because of the blood pressure issue, and protein in the urine is one indicator of preeclampsia. So they want to get a baseline for the amount of protein in my urine somewhat early on. This is not done with a single ordinary pee-in-a-cup-at-the-doctors-office scenario, either. I will be collecting all of my urine on April 11. ALL of it. In a three liter jug.
I find the prospect pretty hilarious, honestly. There are a couple of things that add to the awesomeness, other than the doctor calling the second item a “hat.” One, is that April 11 is a Monday. They didn’t have any appointments available that Monday, which would have allowed me to collect my three liters of urine discreetly on a Sunday. Instead, I have to take my pee-hat and pee-jug to work. Two, is that it’s someone’s job to inspect my three liters of urine, and that person has one of those no-nonsense Massachusetts accents. Three, is that this is the bag in which they gave me these devices: