A Bright Spot

I'm finally ready to tell about our visit to the fetal medicine specialist in Louisville. Let's start at the end so that the suspense doesn't kill you. The blood test showed Emmie is at low risk for the three most common genetic trisomies. Hurray!

Back to the beginning. We see a fetal medicine specialist because they have the really good ultrasound equipment and can scan thoroughly to let you know if there are any problems or possible complications. The ultrasound takes an hour. That's how thorough they are. They document and measure arm bones and leg bones, several organs, and even several parts of the brain. And they can even examine the placenta and umbilical cord, which are what concerns me most after Neil.

Emmie made things difficult for the ultrasound tech, but the scans looked good except for a bright spot in her heart called an echogenic intracardiac focus (EIF). According to Wikipedia (and our doctor), EIF "is thought to represent mineralization, or small deposits of calcium, in the muscle of the heart. EIFs are found in about 3-5% of normal pregnancies and cause no health problems. EIFs themselves have no impact on health or heart function. Often the EIF is gone by the third trimester. If there are no problems or chromosome abnormalities, EIFs are considered normal changes, or variants." Emmie's heart looked perfectly fine except for the calcium deposit, so her heart is fine.

The problem is that EIFs are a "soft marker" for Down syndrome. Up to 25% of Down syndrome babies have this condition. Having the condition doesn't mean that you have Down syndrome, but babies with Down syndrome have the condition more often than other babies do. And my "advanced maternal age" is also a risk factor for chromosomal anomalies. The ultrasound showed no other indicators of Down syndrome, so the likelihood of her having it were low; however, the main rule of obstetrics is "better safe than sorry,"although sometimes is feels like the rule is "panic at every opportunity." 

The doctor gave us options for testing if we wanted to prepare ourselves in case Emmie did have Down syndrome. She didn't recommend an amniocentesis because of the risk of miscarriage, which might have been higher than Emmie's risk of having Down syndrome. We chose to do the Harmony test, a cell-free fetal DNA test which just required a blood draw from me. The test looks for fetal DNA floating in my blood and determines high or low risk for Trisomy 21 (Down syndrome), Trisomy 18 (Edwards syndrome), and Trisomy 13 (Patau syndrome). Trisomy means an extra copy of a chromosome, giving you three instead of just the two you're supposed to have. None of these trisomies are good, but Down syndrome is the least life threatening.

We got the results today that Emmie is at a low risk. It's a screening test rather than a diagnostic test, so it's not 100% conclusive, but it's very accurate. According to the testing website, "Harmony delivers exceptional accuracy with detection rate greater than 99% and a low false positive rate of less than 0.1%." That's good enough to put our minds at ease.

We have a follow up appointment for another ultrasound in Louisville in five weeks. The calcium deposit should take care of itself eventually. They just want to make sure that nothing else develops. If that scan is OK, they'll let our regular OB take it from there. Hopefully, everything is OK. We've had enough excitement.

The Mongolian Covenant

Let's review the rules of "going Mongolian."

1. You are free to talk to anyone EXCEPT me.
2. If you tell someone, you must update them with bad news.
3. I will keep you updated via this blog.

If you don't recognize the phrase "going Mongolian," you can check out this post to explain it.

If you remember the phrase "going Mongolian," you've probably guessed I'm pregnant. Now that you know, you are bound by the rules of Mongolianism. I don't want your congratulations or questions. I assume that you're happy and praying for me. I appreciate it and don't want to hear about it. I really, really don't want to talk about being pregnant. You may tell other people (it's not a secret anymore), but they will also be bound by the rules of Mongolianism, and you are responsible for telling them if something goes wrong and we don't get a happy ending. I don't want congratulatory messages from distant relatives in June if I don't have a live baby. "Going Mongolian" worked really well last time. It saved me a lot of emotional wear and tear, and I'm hoping it will do the same thing this time.

Now to uphold my end of this Mongolian covenant. Here's what we know.

• I'm expecting a baby girl in May. The due date is June 1, but a c-section is planned for at least a week before that. 
• We're calling this baby Emmie until she's born. Matt and I have had multiple girls' names picked out for years. However, previous experience has made us reluctant to give unborn children names that we want our children to carry all their lives. So we are not giving our daughter a name until she's born. Until then, we are calling her Emmie. Let me repeat, HER NAME IS NOT EMMIE. That's just what we're calling her until she gets her permanent name. (Yeah, I just updated that paragraph from last time. I don't have a better way to say it.) We did this last time with Elsie/Lucy, and it worked really well. It took me a few days to make the switch after she was born, but it gave us a name to use during the pregnancy, which made her feel more real than if she had just been "baby."
• We've had two ultrasounds recently, and all of the baby's measurements were right on track. She seems to have all her parts. During one ultrasound, she was sleeping with her hands by her face, and her ankles were crossed. At the other she was uncooperative. She kept covering her body with her hands so that the ultrasound tech couldn't see anything. If the tech was trying to look at her heart, she put her hands on her chest. If she wanted to scan the face, Emmie put her hands on her face. She also used her legs to keep the tech  from being able to see. Some of the time he feet were over her head like Lucy used to do in ultrasounds. We may have to start a circus with our acrobatic daughters. However, Emmie didn't keep her feet over her head. When the tech tried to look at her genitals, she tucked her legs under her and crossed her ankles. She was pretty determined, but eventually we saw all we needed to. She is healthy, well formed, and a normal size.
• So far I am healthy. My blood pressure has not been a problem. I'm supposed to watch my sugar intake and my weight. Neither has been a problem yet, but family history and my starting weight make them possible concerns. I've gained more weight than I'd like, but I find that inevitable in winter. It's easy to lose or maintain weight in the summer with gardening for exercise and plenty of fresh produce just outside my door. However, the swimming pool opens again next week, and I'm making more of an effort to eat vegetables and fruit. Despite the weight gain, I just switched to my "fat pants," the next size up from normal, in the last few weeks. I hate maternity pants, so I'll try to get by without them as long as possible.
• We are also seeing a fetal medicine specialist in Louisville. I'll give an update about that in a separate post. 
• We've got a lot of appointments in the next few months: two in February and two in March already. About the time we get past those, we'll be having weekly appointments for BPPs.
• Lucy is unaware that she is getting a little sister. I asked her a couple of months ago if she would like a baby to live at our house, and she said yes. Of course, she didn't know what she was agreeing to, but at least she was agreeable. She has been present for one of the ultrasounds, and we've mentioned her sister to her. She doesn't care. We'll figure out eventually how to get her on board with this big sister/little sister thing.
• I've felt Emmie move a little. She wiggled nonstop during one of the ultrasounds. She didn't flail or kick, but she wiggled and shifted her hands and feet in the way. She's a busy girl. I look forward to getting to know her. 

Feelings

Emotional intelligence and self-awareness are important to me, and they are important for me to teach Lucy. Matt and I have been talking to her and naming her feelings most of her life. When she tries to do something and fails and gets mad, I tell her it's frustrating when you can't do things and encourage her to try again and eventually offer assistance if she doesn't succeed on her own. When she wants something but can't have it and feels sad, I tell her it's disappointing to not get what you want and suggest something else that might make her happy. Those are two of her biggest feelings. Most of her anger and sadness fall into those two categories. The goal of all this naming of feelings has always been for her to recognize her feelings and name them so that she can react appropriately. Frustration doesn't mean that you throw things, it means that you try again or ask for help. We hoped that she could eventually tell us how she feels so that we can help her.

I was expecting her naming of feelings to take a long time, but she started telling me that she was sad while we were traveling for Christmas. Drew and Katie go to bed earlier than Lucy, and losing her playmates made her very unhappy. One night she told me, "Drew oo-ee-oo-ee-oo. Me sad." She realized what she felt and told me about it. I told her that I understood that she felt sad because she couldn't play with Drew and offered her a hug and a story instead. Eventually, I'll start asking her how she could respond to her feelings and give her suggestions. And ultimately, she should be able to figure out how to appropriately react on her own. That's what mature adults should do. (Notice I say they SHOULD do it. The number of adults who lack self awareness and emotional intelligence frustrates and disappoints me.)

Lucy has told me that she is sad several times since then. Almost every time, she tells me what is making her sad, and by sad she typically means disappointed. If she was just telling me she was sad all the time, I'd pay attention to that, too. I don't know that two year olds experience depression, but with my mental health history, I'm prepared to keep an eye on her to look for symptoms. If she ever does seem depressed, we'll help her name it and respond to it, too, and get her help if she needs it. For now I'm just really impressed that she can recognize and name one thing that she feels. And it makes me feel good as a parent. There are all sorts of things I'm doing wrong, but this seems like one thing I'm doing right.

Naming Names

We had a lovely Christmas and nice visits with family. Lucy seems to learn something every time we visit family. This time her big leap was realizing that people have names. We've been trying to get her to say her name for months, and she just wouldn't do it. We weren't sure if she understood the concept of naming. She doesn't know that "mommy" and "daddy" are not what everyone calls us. She thinks of herself as "me." She's never referred to herself in third person. She has never named any of her dolls or stuffed animals.

The first glimmer than she might be understanding names happened at church in December. She became fascinated with the nativity scene and would point at the figures and say "daddy" (Joseph), "mommy" (Mary), and "Lucy" (baby Jesus). It was the first time she said her name, and it seems like a good thing for her to identify with Jesus.

While we were visiting family, she looked at pictures of herself, and I told her that the person in the photo was her, that was "baby Lucy." Near Lucy's photos are Audrey's photos, so I pointed out the other baby on the wall and said, "That baby is Audrey." "Audrey," she repeated. Wow. She said a name. And she called Audrey by her name while they were together. I don't remember if she every said Aiden or Alton. I know she said Ash and Gram (which sounded more like Dram).

She really figured out names when we went to Springfield. She woke up every morning looking for Drew and calling for him. By the end of the week she was calling Katie "Dee." But the best was what she called Cathy. Lucy loves their dog, and so when the dog followed Cathy to the bathroom and sat outside the door, Lucy talked to him to keep him company. I noticed that she kept saying "mama," so I answered her, but she didn't seems to want my attention. Then I asked her if she was talking to me or talking to the dog about the dog's mama. She said, "Dog mama. Dog mama peepee." And Dog Mama was Cathy's name for the rest of the week. Toward the end of the week, it was sometimes Mama Dog. Cathy didn't mind. She was thrilled that she had a name.

After we got home, we went to dinner with our friend Susie. As we left the restaurant, Lucy called her Shooshie. Susie's heart melted. I look forward to seeing who or what else she names.