Tag Archives: prenatal clinic

The Second Ultrasound: A Scary Proposition

In Sweden you have one ultrasound, typically around week 18 to 19 (see my previous post about that experience here). We were told that you only have more than one ultrasound if there are potential complications.

Yesterday we received news that our baby did not appear to be growing, although our midwife said that it was possible the baby had just shifted position; thus resulting in the uterus appearing like it wasn’t growing (read that story here). We were scared, I cried, Lisa comforted me, and off we went to see what the hell was going on.

Screen Shot 2015-12-29 at 10.22.13 PM

Quick Background on Uppsala:
Thankfully, we live in a city with a hospital. Also, we live in Sweden–where health care for pregnancy is completely free. So we didn’t need to ask ourselves if it was worth the money to get the check up. We didn’t need to consider the expense of another ultrasound. We could totally focus on our family’s health.

That was more than enough to focus on.

Even though we had time to walk to the hospital (20 minutes), we were too anxious, and called a taxi to drive us there (5 minutes).

The Visit:
Once we arrived and checked-in, there were two main tests that would be performed: 1) check the baby’s heartbeat over a period of time and 2) get an ultrasound.

Lisa was in the bathroom when they called for us. I sauntered over to let them know.

“Hi, she’s currently in the bathroom,” I politely and semi-quietly said. “Oh wait, here she is.”

The midwife popped out of her chair, walked immediately passed me and greeted Lisa.

Checking the Heart Rate:
She then said, “come this way Lisa” and led the way to a private room complete with a bed and a heart rate machine. It had two circular sensors that would be strapped onto Lisa: one to monitor the baby’s heartbeat and the other to monitor the number of contractions. Lisa also had a joystick-like object, where she should press the top button with her thumb whenever she felt the baby move.

Lisa was all strapped in, and I sat on a chair next to her bed.

Screen Shot 2015-12-29 at 11.15.02 PM

“Oh, I forgot to introduce myself,” the midwife said. We shook hands and quickly exchanged names (my name was never spoken again).

I miss my prenatal midwife! I thought.

“How long will the heartbeat be monitored for” I asked. After all, we had just heard the baby’s heartbeat at the prenatal clinic, where they said everything was fine.

“It’s different. It could take 10, 15, 20+ minutes. Just look for a check box to be on the machine, and then you’re done,” the midwife reluctantly replied.

“You said the number of contractions will be counted. Is there a number or range that’s good?”

“Everyone’s different.”

I prodded her more to get more specifics. “So should we expect to see 5?”

“Yes, that’s possible. It’s also possible to have 0. Anything is possible.”

“So we could have 100,” I asked, looking for a limit to the number of contractions.

“No, not 100. That would be too high.”

No more was discussed on this or any other topic, since she decided to leave the room. The language that the midwife used was always non-helpful, even with multiple questions.

Lisa and I continued to talk, hold each other’s hands, and tried to relax. Meanwhile, I sent out texts to different parents letting them know what was happening–I always need a support network.

I buzzed for the midwife to come back after the “check-mark” was on the screen. She then informed us that the doctor would look at the output and then determine if an ultrasound was needed. She failed to ever mention how our output looked. I still have no clue if Lisa had any or several contractions while the baby’s heartbeat was monitored.

Thoughts on the Support the Midwife (Didn’t) Give:
It was clear that the midwife made no decisions and could provide few answers, as she placed the results on the doctor the way a guy places his results on his wife–“aw guys, I want to come play poker tonight, but I’ll have to check with my wife first.”

There was clearly no accountability to be had via the midwife. She was there to perform the tasks instructed and to not provide us with advice or support or results.

She could however explain what different machines do or what she’s currently doing–although these responses often left more questions than answers.

Nevertheless, we figured the baby’s heartbeat was good, since we had just had that test completed, and we knew how to interpret the results (this time, the baby’s heartbeat was often around 140-150 compared to the slower 130 heartbeat 30 minutes earlier).

The Second Ultrasound:
We were then taken to the ultrasound room.

“Lisa, please come this way,” the midwife said walking us down the hallway.

“I’m not going to measure the baby,” the midwife said after laying on a thick layer of jelly on Lisa’s belly. “Are you ready Lisa,” she asked.

Screen Shot 2015-12-29 at 11.14.49 PM

She then studied the baby, mainly measuring the baby’s head, stomach, and femur. She was silent, clearly focused on her work. This ultrasound was a lot different than the first. The first time we felt a great joy in seeing our baby on the screen. This time, we felt overly anxious, concerned, and in constant wonder of what was being found as the midwife measured these areas.

Brief side note: The stomach was measured twice, from NW to SE and NE to SW, making an X pattern on the screen.

“Did you also check the umbilical cord?” Lisa asked.

The midwife then checked the flow (of blood or nutrients???–this was never explained, but the answer was simple–after hearing a few beeps and seeing wave-like formations show up on the screen, the midwife announced–“looks good.”

The midwife seemed to remeasure the head, stomach, and femur two or three times, and then called in a second midwife to assess her assessment (although leading questions were asked).

“I measured from here to here and I got a normal number. Do you see that?” she said to the second midwife.

We were then abruptly told that everything was normal. No pomp, no circumstance. It was just black-and-white with no explanation.

I prodded.

“How do you know?”

The midwife then when into a litany of how numbers are calculated based off of the mean size for a baby in the week you’re in (e.g. week 36) compared to the size our baby is.

After the ultrasound, we found out that our baby was -6 on their head size and -3 + -3 on their tummy = -12 overall. Of course these numbers meant nothing to me, so I inquired further.

I can’t remember how long the femur was except that whatever the average was for a 36 week baby, ours was one (cm, mm???) longer.

Turns out that there is a scale for the average head, stomach, and femur (for some reason the femur length isn’t calculated, but is still measured. This was never fully explained to me).

Great, the one part that’s above average isn’t calculated into the proper growth of our baby’s size, I thought.

Then they take how long our baby’s head and stomach are, and those numbers are subtracted from the average baby at our week.

You’re considered “normal” or “healthy” if you’re between +22 to -22.

Screen Shot 2015-12-29 at 11.20.58 PM

Meeting the Doctor
We then met the doctor. She had only one agenda–to reassure us in as many different ways as she could that there was no problem. Again, without going into as many (apparently needless) medical details as possible.

“Do you know why you’re here?” she asked as an opening statement.

“To check on the growth or lack of growth of our baby,” Lisa quickly responded.

“Yes, that’s right. Well, this is as perfect as it gets. You’re great. You fall within the normal range. Everything is fine. You have nothing to worry about,” she said.

“You can go home and enjoy your New Years,” she continued.

Again–I had lots of questions, but clearly could see that those were not welcomed. In fact, at one point I even called her out saying “Yes, I get the point that you clearly have one job–to make us feel calm and safe, but…” and then I continued asking several questions of things to look out for or how to prepare ourselves should this arise again, and what to do at our next prenatal meeting.

Conclusion: The doctor could only guess like our original prenatal midwife–that the baby had just shifted position in the body, making the uterus appear as though it’s not growing.

I told her I was quite interested in what was happening with our baby, which is why I had so many questions.

Rather than finding it beneficial to have involved parents seeking answers from a professional, her response to me stating my interests was simple, but dumbfounding.

“Google it,” she said.

“Really? We come to the hospital seeking answers from a professional and your response it ‘Google it’?”

She then argued why Googling was a good method, but that people can’t interpret the results well.

Well no shit! That’s why we’re talking with you right now. We want to be informed parents and understand the potential situation our baby may or may not be going through. Plus it just doesn’t hurt to know more, in case this same thing happens again in the future with another child, I thought.

We left the hospital feeling glad that nothing was wrong with the baby (as far as they could tell). The first baby scare was over. For now.

But I also left the hospital with a pain in my stomach, knowing that I could have a midwife as inattentive, unsupportive, and unwelcoming as her when we give birth.

Fingers crossed that we have one like our prenatal midwife!

Screen Shot 2015-12-29 at 11.17.47 PM
Tried to go into town to enjoy the Christmas lights.

PS–Interesting side-note, the midwife said it wasn’t a problem to take pictures during the ultrasound, despite the first ultrasound midwife saying that we weren’t allowed to take pictures. Of course, no explanation was given on why it could or could not be ok to take pictures during the ultrasound.

PPS–This has so far been our fifth midwife, and we haven’t even given birth! Talk about a lack of continuity of care, as well as trying to develop trustful, stable relationships! Not ideal, Sweden!

First Parenting Scare at the Prenatal Clinic

Yesterday I had my first real parenting scare. I cried. Several times…

Side-note 1: I say “real” because twice now Lisa has felt quite dizzy, with a palpitating heart, forcing us to quit our dinner outings and take a taxi home–presumably due to low blood sugar (or so thinks the midwives who answer the phone at the hospital).

Screen Shot 2015-12-29 at 9.42.50 PM
Laying on the couch after a bad dizzy, racing heart, low blood pressure, spell.

Side-note 2: We’re in week 36. At this point, several people have already gone through miscarriages, pre-term births, or know that they are awaiting various birthing complications. This has not been our case, so far. Despite the fact that we’re currently in the norm, we still feel quite lucky and thankful that no major problems have arisen.

Side-note 3: Our biggest pregnancy problem thus far has been acid that continuously disrupts Lisa’s sleep, often starting in the evening and continuing throughout the night. Even though she stays away from acidic foods, like apples and oranges, especially late at night, she still routinely gets acid, causing her to miss out on plenty of sleep, and subsequently myself as well. A prelude of things to come.

Screen Shot 2015-12-29 at 9.48.38 PM
Helpful acid relief that’s supposed to reduce acid, since the medicine that should hold the acid back didn’t help much.

My schedule for the day: The day started out normal–I was to clean out my old desk, since I will start a new job in the new year. Then I should get a new haircut; a courtesy for the new job. Then I should meet Lisa at the prenatal clinic for our normal two-three week check-up. Then after-Christmas shopping should ensue 🙂

Routine Prenatal Visits: The visit to the midwife was standard and routine. Read my previous posts about these visits here and also here. Therefore, I have not continued documenting every visit (although currently, including the present visit, we have gone to the prenatal clinic post ultrasound 6 times, with two more times scheduled before the birth [since we had two visits pre-ultrasound, we will have a total of 10 visits to the prenatal clinic + 1 ultrasound)–every two weeks, we arrive, the midwife greets us, we swap slightly personal stories about the goings-on in our lives (aka small talk), we ask semi-anxious prenatal questions, and then proceed with checking the blood pressure, occasionally checking the iron levels via a finger prick, and measuring the size of the uterus (a subjective measuring, but still, fun to see the results charted out on a graph). Overall, it’s a fun time, because we like our midwife’s personality and get along well with her (aka–she laughs at my jokes 😉

IMG_5732

In fact, the last four visits to the midwife have been so mundane, that I, a fatherhood researcher of child health care, have questioned if I even need to show up. I figure everything will be normal and if not, then my partner will inform me if anything is abnormal (e.g. iron levels are low; solution = take an iron pill more frequently). So, unless I have specific pregnancy questions, there’s little reason for me to attend–accept that most of our visits have, so far, corresponded with the prenatal parent education classes–and since those go over different information at each meeting, I may as well come 20 minutes earlier and still participate in the routine meetings with the midwife. Plus it’s fun!

Back to the prenatal parenting scare: Yesterday’s visit was not completely routine. Beyond the trivial routine measurements and tests, we were to also talk about how we wanted to give birth. The midwife would then notify the hospital of our requirements–epidurals, laughing gas, sterile water, etc. Do we want things in succession? Do we want a completely natural birth? Do we want a midwife who’s good in English? Yes, that last one is a definite yes! Do we have any special needs, especially dietary?

Lisa was already at the clinic when I called her from the elevator asking where she was. I hadn’t worn a hat, despite the Swedish winter in bitter December.

“Oh, I love your new haircut,” Lisa responded when she first saw me. “She does such a great job, and great job styling it. You need to buy whatever product she puts in your hair. You look so good!”

That felt amazing. I can’t wait to get another haircut! I have the best girlfriend, I thought.

We hadn’t really discussed this at home to any great extent. So we went into the prenatal visit saying “we don’t know, what we don’t know,” and sought out a few more answers–why get laughing gas over the epidural and vice versa? What are the pros and cons of both? And what point are you beyond the point of no return when it comes to getting these?

Prior to having the birthing discussion though, we decide we would go through the normal routine. Lisa’s blood pressure was perfect. Her finger was then pricked, and her iron count was 130; a very healthy iron level, just like every other visit.

Then she went to lay on the bed so that her uterus could be measured and the baby’s heart rate could be measured. Knowing Lisa loves video of the baby’s heart rate, I started video recording with my phone. While the last few times we had visited the baby’s heart rate was always around 150-160 (dropping below 150 and occasionally going above 160), this time the heart rate was around 130.

Screen Shot 2015-12-29 at 9.29.10 PM

“A perfectly normal heart rate” the midwife responded.

I replied back, “ya, but normally it’s around 150-160, because [the midwife] is pressing so hard on Lisa’s belly, forcing the baby to stress out and move around; so maybe the resting heart rate is closer to 115 or 120?”

No one seemed to care about answering that question, including myself. It was just an automatic statement that blurted out, since we had always seen the baby’s heart rate rise (to 160-170) and then drop after thirty seconds to two minutes (to 140-160).

The uterus was then checked. I was so excited. Since the start of the pregnancy, the uterus has been about one standard deviation below the mean, but over the weeks, had been inching itself closer to the mean. I was hopeful that we would be directly on or even just above the mean line this time.

“There is no growth since the last time you were here,” the midwife said in a slightly urgent and bewildered tone.

She appeared confused and re-examined the size. Then she called in another midwife to confirm her findings.

The room wasn’t filled with jokes. The cheery feeling had left. Silence took it’s place, as Lisa and I wondered what all this meant. Especially having just seen a “perfectly normal heart rate.”

The second midwife came up with similar results. Lisa then reannounced that the baby had, starting a day or two earlier, started to move a lot less. This  fact was stated at the beginning of the meeting but was quickly dismissed as “normal” and “anything can happen during pregnancy”. The sentence was not dismissed this time. This time, it was taken seriously.

“The baby not moving much, coupled with no uterus growth–I recommend you to go to the hospital and get another ultrasound,” the midwife strongly urged us.

Thoughts rushed through our heads. What does this mean? How bad is this? Will we give birth today via a C-section? Can something bad happen to our baby? Can we lose our baby!? I want answers, and I want them now!

She then immediately called the hospital to arrange our visit. We found out we could go as soon as our routine prenatal visit ended.

The new chart was created. We weren’t near the average growth anymore. We were on the second standard deviation line below the mean.

Screen Shot 2015-12-29 at 10.22.13 PM

Joking time was over. I didn’t give a shit about my new haircut. I was, for perhaps the first time of my baby’s life, completely focused on whatever might be happening in Lisa’s belly.

Lisa and I didn’t speak to each other, but it was clear that we both just wanted the meeting to end at that moment. We wanted to know what was wrong with the baby’s growth. Answers were needed; were needed quickly; and we were quite done at this meeting.

“Do you want to talk about how to give birth,” the midwife inquired.

Lisa didn’t immediately talk. I spoke up.

“Honestly, I don’t really care. I don’t know if we should reschedule or if we should just decide quickly. Lisa, maybe you have some quick thoughts and then we can go to the hospital,” I said.

“I agree,” Lisa responded.

Even still, we continued on, and made some decisions, asked a few more questions related to the birth….and took a few more deep breadths. Lisa and I were clearly more worried than the midwife was about our situation, but even still, she made sure to know she cared.

“I’ll be off the rest of the week, but I may still check my email. In fact, I will try to check everything before I leave today to see how it went at the hospital. If anything comes up, please let me know. And feel free to email me the results and any questions you have,” she said while we were shaking hands goodbye.

As we walked down the stairs, scared and filled with questions, we easily decided we would take a taxi (5 minutes) rather than walk to the hospital (20 minutes). We wanted answers, and we wanted to make sure we did everything we could to be seen sooner.

Off we went!

The exciting conclusion can be found here.

 

Prenatal Visits: Every Two to Three Weeks

A few weeks after our ultrasound, we visited the prenatal clinic.

We walked in and took a seat, genuinely interested in what the next steps were. After all, the pregnancy was all real now! The belly is growing. The baby is moving! We’ve seen the baby!

IMG_5623

 

Now what?

While we waited, our midwife popped from around the corner.

“Hey! How are you guys doing?” she said.

“Fantastic. Looking forward to the visit,” I replied without missing a beat.

“I’ll be with you in just a minute.”

Looking over at Lisa I said, “Wow! Can you believe she remembered us? And remembered that I’d prefer English?”

“Ya, she has a great memory,” Lisa replied.

#impressed

Sure as the morning star, a minute passed, and she whisked us back to her office. We could then ask any and all questions on our minds, while she had a few topics up her sleeve.

She showed us the “chart” that would be used every three weeks from here until the baby is born to measure things like the amount of iron in Lisa’s blood (via a simple blood test), measuring her blood pressure, measuring the size of her belly, and checking the baby’s heart beat.

Screen Shot 2015-12-01 at 9.48.35 AM
Inquisitive as I am, I had to ask how she found the uterus–the place where they measure from. I couldn’t feel it with my hands, but clearly she felt something and the measurement took place.

 

Then we waited and listened for the heart beat. That was almost as cool as the ultrasound. Hearing your child’s heartbeat was a great and euphoric feeling, especially for Lisa.

Screen Shot 2015-12-01 at 9.48.09 AM

 

Meanwhile, I started asking questions: What’s the heart rate? What’s a normal heart rate? What do we do if the baby’s heart rate is too fast?

IMG_5542
Answers: Around 142, 130-150, if it’s above 150, then they would make us wait and remeasure to see if the baby’s heart rate calms down. If it doesn’t then they would send us to the hospital to monitor the heartbeat for a longer time period to see if the baby’s stress level can go down or not.

She then took Lisa’s blood pressure and did a blood test to check for the iron levels. Her iron was right in the middle, which apparently meant that she should take one iron pill every second day from now on.

 

Screen Shot 2015-12-01 at 9.54.01 AM

The midwife then reminded us about the prenatal parent education classes that would be starting soon, and we started booking all of our prenatal visits between now and our baby’s due date (25th of January 2016). We will visit the midwife every three weeks (the normal routine for all parents in Sweden).

All of the midwives at the location we visit
All of the midwives at the location we visit

All in all, a great visit and great information.

First Antenatal Visit: Gender issues, limited office hours, and language problems

Prior to the first visit, Lisa called to make an appointment at a prenatal clinic close to our home. Since we wouldn’t meet them for two more weeks, she asked them about what types of food she can and can’t eat while pregnant.

They responded by saying to visit Livsmedelsverket to see the latest food recommendations.

Screen Shot 2015-10-13 at 7.07.44 PM

As a fatherhood researcher that focuses on child health, you might be surprised to learn that I never thought about my research when my girlfriend and I went to our first antenatal visit.

All I could think about was how nervous I was, how nervous she was, and what information we might glean from attending.

So, pure usual, I nervously coughed, hacking out a lung, before entering the building and climbing the stairs.

We had picked a prenatal clinic close to our home, figuring that would be the best option–convenience always has its rewards. It happened to be a public clinic, although I’m not so sure how important that is?

We walked in and patiently waiting in the lounge area for our names to be called. Within minutes, we heard the beckoning sounds of an older, albeit experienced, midwife: “Lisa,” she announced.

We sprung up. She exchanged some quick words with Lisa while shaking her hand. No eye contact was exchanged in my direction, so I hopped in and held out my hand. She shook it, while turning her head, preparing to walk back to her office.

She didn’t even ask my name, I thought. My research came flooding into my mind. It was certainly one thing to read about the misfortune of others, and quite another to experience gender discrimination. My first encounter with a medical profession about my changing role from man and partner to father, and I’m met with an abrupt non-introduction. Shit!

I can’t ever be too judgmental though. After all, I don’t speak much Swedish, so perhaps I need to be more engaged in the conversation in order to garner more attention. Fair enough.

We meandered back to her office, and took two seats opposite the midwife. We asked if it was ok to speak in English, but that Swedish was fine, especially for more complicated questions. The midwife happily agreed, and in shyness, excused her “bad” English. It wasn’t bad at all. In fact, I would call it quite good, and so we both reassured her.

She began typing on her computer before asking “Lisa, can you please tell me your email? I’d like to send you some parenting information and information about your upcoming visits.”

Lisa did so. After a couple of other short exchanges with Lisa, such as, what do you do for a living and other small talk, the midwife looked over at me and asked “And what is your name? And can you give me your contact information?”

“Do you want my email address too,” I asked.

“No, I just need your phone number in case we can’t reach Lisa,” she replied.

What the hell! I thought. Why can’t I also be emailed the same information? Oh well, Lisa will just forward the email to me. I gave her my phone number.

Then she proceeded to ask Lisa several questions about her drinking and smoking habits via completing some survey forms.

While Lisa completed the forms I asked, “what are these forms for?”

“Oh, to see if there are any drinking or smoking problems. If so, then we like to recommend places where people can see support, since it’s not healthy to smoke or drink when you’re pregnant,” the midwife politely replied.

So many thoughts went through my head. So my drinking and smoking habits don’t matter for the health of the baby? What if I was an alcoholic–would it benefit my child and the mother, as well as myself, if I also got some support for my habits? Isn’t second-hand smoke not ideal? Can’t I get support if I need it?

It was hard to raise these issues though, since I don’t smoke and only occasionally drink.

“How much is too much drinking during early pregnancy?,” I asked questioningly. I was actually interested in this answer, because I have heard some conflicting reports on if drinking during the first 6 weeks of pregnancy can hurt the baby (plus I had time to kill while Lisa completed the forms).

“Oh, Lisa’s amount is fine,” she said looking at Lisa’s drinking record (side note–the survey asks how much you drink, on average, over the past year–not specifically on how much you’ve been drinking while pregnant).

Her immediate and thoughtless answer really upset me. She clearly hadn’t listened to what my question was, and instead was just trying to calm me from being worried about drinking while pregnant by giving me a non-descript answer. Now I need to inquire more.

I lied (but she doesn’t know that). “Lisa has been doing a lot of drinking since she’s been pregnant. Way more than before being pregnant because of different end of the year parties. So I’m wondering if she has been having too much.”

“No, no, she’s fine,” the midwife answered back quickly.

What the fuck! You didn’t even ask me how much she’d been drinking while pregnant, and yet you can still give an answer basically saying there is no limit to how much she could have drank? I thought, while also simultaneously thinking Oh crap, now Lisa is mad because I just made her sound like she drinks a lot. Maybe I should only stick to issues that actually matter to us, because I’m clearly not getting medical answers.

The visit continued, discussing various issues, like how often we’d come, what week we were in, and other topics we had questions about–like parenting classes in English and their hours of operation.

Around 40 minutes into the meeting, and after me asking several questions to show that I’m engaged in the conversation, the midwife finally asks me “what do you do for a living?”

Now I’m a bit embarrassed. “I research father involvement in the child health field.”

“Oh that’s interesting,” she responded hesitantly. “I have two thoughts about fathers coming here, but maybe it’s because I’m old. Either they need to work and so they can’t come here, or they come here because they are controlling of their partner.”

Wait. What the hell? Did I just hear what I thought I heard? Was she accusing me of being controlling, or just men in general? I can’t be here because I’m interested in my pregnancy? I can’t be here because I want to learn and be involved?  I can’t be here to support my partner in pregnancy? I can’t be here because I want to experience my work first hand? I don’t believe it. Quick, look at Lisa and see if she heard the same thing…..She did, she heard the same thing. 

Well that shut me up. I am no longer engaged in the conversation. I’m not upset, outwardly, but I’ll just want her finish up the visit, so we can get out of there.

The rest of the conversation was pleasant, and we finished about 15-20 minutes later, after talking the ultrasound visit, the various types of tests you could get at that visit, and the prenatal parenting classes.

To their credit, she stated that I could get an interpreter for the parenting classes and that they were going to start up their first fathers’ group class ever, even if she said that reluctantly.

On the way home Lisa started the conversation, “did you hear what she said about fathers?”

“How could I not?,” I replied with disgust.

After a short conversation at home, we decided the closest antenatal clinic isn’t necessarily the best. Not only were there obvious gender issues (especially since both Lisa and me want both of us to be there as often as we can), but there were other problems too–for example, not having parenting classes in English and having limited office hours. Office hours definitely matter for commuting expectant parents, because we need early morning or evening hours. 3pm doesn’t work when you work in another city.

Luckily, this hasn’t deterred me from being involved with my partners and my pregnancy. But it certainly didn’t encourage me to be involved with the child health field. For the record, Lisa didn’t have any problems, and felt ok continuing to go there for her sake, but not for mine. Luckily I have a very supportive partner (plus she would also like a place with longer opening hours).