22 February 2013
My 8 Week Postpartum Visit: Achieving Emotional Stability
Today I had a postpartum check up with the doctor who delivered baby Luke. Mostly he was just checking my incision to make sure it was healing okay (according to him it is "looking really good") and also to complete an evaluation of my mental state. Getting the Baby Blues or a more severe case of postpartum depression is relatively common after welcoming a child so it's part of the normal routine to screen for it. Although after receiving our prenatal diagnosis, I had envisioned myself on a high dose of antidepressants following baby’s delivery, I’m happy to report that I’m not on anything and am feeling really good from an emotional perspective. That said, I have a hypothesis of why I'm feeling so positive right now and since I feel strongly about it - I'd like to share.
The Backstory: We chose to complete a routine screening test called the Quad Marker early on in our pregnancy with Luke. It’s a blood test that is drawn at 12 weeks and again at 18 weeks gestation. We didn’t really think much about getting the test. It was recommended by my OB doctor and we had completed it with Matthew, only because it was recommended by our doctor then too. Honestly, I’m not even sure I was 100% positive what it was screening for at the time. The blood work came back normal following the 12 week draw, so we went on our merry way, looking forward to the anatomy scan at 18 weeks to learn if we would be having a boy or a girl. They call the ultrasound an “anatomy scan” because they are looking for all of the anatomy to be present and normal, but really all anyone thinks about before the ultrasound is that they will be able to find out the sex of the child. During that ultrasound, we found out that we were having a boy and the ultrasound tech mentioned that he was having a hard time viewing the heart so he wanted us to come back in a week… he explained that the baby was measuring a little small and that it could be normal for the heart to not present well if our dates were off and baby was actually younger than 18 weeks so by coming back the next week, we’d probably see what we needed to and things would be okay. I stopped at the lab before going home to complete the 18 week blood draw for the Quad Marker follow up and called it a day. That was a Friday and we spent the weekend relishing in the fact that Matthew would have a brother just a grade below him since they were only going to be 16 months apart… they’d play on the same sports teams at our small rural school, would go to prom together and would hopefully become best friends. (We know now those things could still happen for our boys and their relationship, but it took us a while to come to that understanding). On Monday I got a phone call from my regular OB doctor letting me know that the 18 week Quad Marker screening had come back “abnormal” with a 1/85 chance for Down syndrome and that she’d like for me to have a follow up ultrasound with their high risk doctor later in the week. I was a bit scared, but since I’m a glass-half-full kind of girl, thought, “well that means we have a 84/85 chance that our baby doesn’t have Down syndrome so we’ll just go to the appointment on Thursday, find out that things are likely okay and that will be that”. Life doesn’t always go the way you expect….
Present Day: During the conversation today with my doctor this afternoon (a Perinatologist with the Cleveland Clinic who works with “high risk” pregnancies within their Maternal Fetal Medicine Department), we referred back to that moment on Thursday, August 16th, 2012 when following the ultrasound (in a room just down the hall...), our lives were completely changed as he shared his belief that the fetus I was carrying had a congenital heart defect and Down syndrome. The heart hadn’t presented well the week before, not because it wasn’t mature enough, but rather because it was defective and had two holes, one between the atrial and another between the ventricular chambers. A week later, we had already met with a cardiologist to complete a fetal echocardiogram (which would become a routine appointment for me during the pregnancy to monitor baby’s heart development) and had completed a non-invasive maternal blood serum test called “Verifi”, which is 99.9% accurate in detecting whether or not baby has Down syndrome. We also had plans for a scheduled delivery at the Cleveland Clinic's Main Campus so we'd had access to their Level III NICU and cardiac facilities if necessary.
What this has to do with the "Baby Blues": I feel very strongly that part of why I’m doing so well at two months postpartum is because we knew what to expect after Luke was born. We were able to deal with the shock of the news and had time to accept it before we met him…. Allowing us to celebrate his arrival after birth instead of grieving what might have been. I still ask Dustin pretty regularly “can you believe we really have a child with Down syndrome?”, but it’s more out of disbelief since the odds were relatively slim for us, only 1/650 for us since I was only 30 when he was conceived. Since the Quad Marker Screening is optional (and has been known to have a high instance of false positives), lots of couples choose not to do it. Our ultrasound tech likely would have found the heart defect if we had gone back for the follow-up (which was replaced by the visit with the high risk doctor), but maybe he would have missed it… Dealing with the shock of the news while adjusting to the stresses that accompany a new child would have really been a lot to handle at once. I would whole-heartedly recommend the Quad Marker Screening to anyone who has just learned they are expecting a child… chances are your baby is what the common world calls “normal”, but in that off chance that things aren’t quite right, it’s wonderful to have time to accept the path that your future will take….
Regardless of a medical or developmental diagnosis with your baby…. if you or someone you know seems overwhelmed after giving birth, please be sure to discuss with your physician... it’s okay to need help. They can prescribe medicine to help to even out your emotions and help you to cope until your body has regulated itself and your hormones are back in order!