What Came Before

The ultrasound -- the anatomy scan -- was last Tuesday. It was supposed to be today. We moved it up a week because a scary test result told us to. I guess this was our clue.

At my 16-week OB visit, just two short weeks ago, I waited an hour for a five-minute visit with the doctor. She told me to stop worrying about miscarriage. We scheduled a c-section. She listened to the galloping heartbeat. It was the last time we'd hear it.

She asked me if my MFM was doing an AFP (alpha feto-protein) test. Since this was a PGD embryo, we'd decided not to do the chromosomal testing. But the AFP was for neural tube defects. So I agreed to it, and although I always welcome something new to google, I didn't think a single thing of it. Until I got a call, late Friday afternoon, from my MFM.

The call was odd because the OB had run the test, but it turned out my OB had called my MFM about the result -- which didn't seem like a good sign. She told me my AFP was high. How high, I said. She launched into some explanation about medians and multiples, that mine was 3.6 and they want to see below 2.5, and I wanted to scream that I am an English major and I do not speak Math. By then, I was shivering like a small dog, which is my body's natural response to hearing possibly scary news about my baby at 4:30 p.m. on a Friday afternoon, when there is nothing to do but google and worry all weekend.

I was told it could be a neural tube defect, like Spina Bifida, or another anatomical defect. Or a placenta issue. Or absolutely nothing. I researched the heck out of it. Learned about Multiples of Median. Read medical journal articles and MFM texts. I found out that early bleeding from a subchorionic hematoma or placental lakes, both of which I had, could contribute to a high AFP. That felt hopeful, but also a little too easy. I chose to ignore the part about high AFP pointing to fetal demise.

I couldn't sleep Monday night. By the time I walked into the ultrasound on Tuesday, I thought we'd hear some kind of news. Maybe some correctable stomach issue, or a minor form of Spina Bifida (which seemed incredibly unlikely given my religious folic acid consumption). Maybe, and this seemed much more likely given my history, a placental issue that could be scary but somehow manageable. Here's the paradox: Although I always, always expected, every time I walked into any appointment, that they might tell me the worst had happened, the truth is that last Tuesday, no heartbeat was the last thing I thought we'd hear.

The doctors seemed surprised that I was so anxious about the high AFP. It was confusing, because they told me it was probably nothing, even as they felt the need to alert me before the weekend, when we couldn't verify anything until the following week. Maybe they didn't get it because these doctors are new to me and my story -- they haven't previously been along for the tough slog, when too many times I have fallen squarely on the wrong side of the odds in my favor.