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Too Early To Tell

Too Early To Tell

I always thought I would have three children. Growing up there were three in my family, so it felt natural. It wasn’t something I aspired to, but I felt like I was always asking myself, “Should I go for that third?” At 42, my husband and I decided this could be our last chance.
 
When the news came I was pregnant, we were ecstatic. This one took awhile to happen, so I thought it was a lost cause. Getting those positive results was definitely surreal. And, immediately I felt the morning sickness. And oh, how I felt it: morning, noon, and night.
 
I was especially sick when I went in for my first pregnancy appointment. I didn’t know exactly how many weeks I was, but I could guess. I was probably a little over six, maybe more. The ultrasound would know.
 
“There it is!” I’ve heard those words before with my other two children’s ultrasounds. That tiny little dot on a large black and white screen pulsing a resounding “pound, pound, pound,” is so much more than the sum of its parts. It’s a little spec of an idea that’s bigger than all of us. It represents yearning, growth, and hope. For anyone who has ever been blessed to conceive, from the moment you find out you are pregnant, you start planning for birth and beyond. Every prospective parent does this. It doesn’t even matter how many children you already have.
 
I waited to hear those words as I lay there on the table staring at the monitor, fixed on this huge idea of who and what my baby would become. And I waited… and waited some more. “I just don’t see it,” said the ultrasound technician, her face grimacing as she continued to search. She kept shaking her head, “It’s not there.” Finally she stopped. She was so sorry, she said.
 
Immediately I went into a fog. I still felt all the pregnancy symptoms, but I did have a miscarriage years prior. The thing with miscarriages is you go from the highest of highs to the lowest of lows in less than a millisecond. From then on, until you hear your baby’s first heartbeat, you expect that every pregnancy will be followed with those same words: I’m sorry. I’m so sorry.
 
There was one difference this time. My last miscarriage was an obvious loss. I still felt pregnant with this one. Maybe it was just the high progesterone levels that made me feel this way? I’ve read a miscarriage can mimic signs of pregnancy. Blame it on the hormones, right?
 
The doctor didn’t come to look at my ultrasound, but was available the next day to clean out my uterus. I saw so many people in the office that day—from the technician and doctor to the midwife and scheduling nurse. Everyone had a story about miscarriage, as if it was as natural as breathing. Statistics show that one in four women actually experience a miscarriage, so in this profession, it must seem normal. As if a loss could ever feel normal. My husband and I were devastated.
 
I had one last weapon: instinct. Something inside me told me to wait through the weekend and have that procedure the following week. It was Thursday; I scheduled it for Tuesday.
 
“No, you are NOT getting that procedure,” said my coworker, when I called to explain why I wasn’t coming to work that morning. I could barely get the words out about being told my fetus was not viable, when she immediately told me to get a second opinion. I would never have thought about it otherwise. She was pregnant at the time too, and her instincts told her I should get another ultrasound. It took time to wrap my head around it. Who would I even call? I don’t know any other doctors. I’ve been with the same practice since I was 18. Those midwives delivered my other two girls. I trusted them—how could they be wrong?
 
Through the weekend we tried to put the procedure out of our minds and kept busy. It wasn’t hard: there were swimming lessons and play dates, errands and laundry to do to get ready for the workweek ahead. Yet, it was there and the less I tried to think about it, the more I did. My coworker was right, I thought. What would it hurt to have another ultrasound? Maybe I’ll just call my practice and tell them I want a follow-up, just to be sure. But no one called me back. When I called again to cancel my scheduled procedure altogether, I was made to feel like I was crazy. “So, wait, you don’t want to come in Tuesday?” said the receptionist. It was inconceivable to me what was happening. Weren’t they in the business of saving lives? There must be more women in my situation. I couldn’t help but wonder.
 
This has a happy ending. I am lucky. I found a new doctor’s office to perform a follow-up ultrasound, coincidentally on the same day as my scheduled procedure. The entire office knew of the news I was anxiously waiting to hear—and were also on edge. And there it was…a beautiful, strong, healthy heartbeat at exactly six and a half weeks. It turns out it was too soon to hear it the first time and getting another ultrasound was critical. Everyone in the office practically cried with me when they learned of the news. It was a powerful moment I will never forget.
 
My baby is over a year old now and, of course, I couldn’t imagine life without her. But my experience is something I could live without. It cast a shadow on my entire pregnancy. I didn’t actually become fully attached to the idea of something growing inside of me until we went through the genetic testing process. At that ultrasound, all the technicians wanted to know why I couldn’t stop crying; I was petrified I would get bad news. When I saw the baby’s progress, had them identify the sex, and received her excellent results, I knew she was going to be okay.
 
There isn’t a day that goes by I don’t think about what might have happened had I not listened to my coworker and went through with the procedure. For a long time I couldn’t talk about this. It was too emotional, and it still is. But as my daughter Nora grows and my family marvels at her milestones, I feel like it’s important I do. And here’s why: The ultrasound technician who gave me my wonderful news had some incredible news of her own. The very same thing happened to her. Someone performed her ultrasound and gave her negative results and right before the procedure she decided to have another one. And I bet you can guess the rest—there are more women like me.
 
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The presence of a heartbeat is a very assuring sign of the viability of your pregnancy. However, when an ultrasound is performed too early, a heartbeat may not be detected, according to Jessica Bienstock, M.D., M.P.H. professor of Gynecology and Obstetrics at Johns Hopkins. That’s because the crown rump length of the fetal sac that measures from the baby’s head to its bottom needs to be a certain size to find it—about 5 MM. This typically happens when the fetus is about six-and-a half-weeks. “After seven weeks it’s very unusual to misdiagnose a fetus as being non viable,” she said. “But before that, it’s very easy.” It’s simply too small. While there is no industry standard, the American College of Radiology practice guidelines recommends a follow-up examination may be appropriate to re-evaluate the fetal size. “Sometimes you have to tell the patient you have to wait,” said Dr. Bienstock, who is also director of the Gynecology and Obstetrics residency program at Johns Hopkins. “It’s cautious optimism.” 
 
Other reasons for a misdiagnosis may include:
  • Late ovulation, making your body seem more pregnant than it is
  • A tilted (retroverted) uterus, making it difficult to see the sac and find the heartbeat
  • Outdated ultrasound equipment
  • Wrong conception dates

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