Why the perinatologist?

I guess there are some portions of this pregnancy thing that I've skipped over because it was happening when we still weren't talking about it (when it was only the worst kept secret in the world). Here's the scoop on the perinatologist.

Some background to begin--in November 2003, I went in for my annual gynecological exam and afterwards, I had a call from the doctor that the Pap smear was abnormal and that I'd need to schedule a follow-up procedure. I think she told me there was a chance of cervical dysplasia and the follow up procedure, a colposcopy, was needed to confirm the diagnosis and determine the severity of the dysplasia as well as how many spots there were. Since the dysplasia was caught early enough (a definite benefit to having annual Pap smears), all that was needed was a LEEP procedure which occurred in January 2004. It was an in-office treatment and Paul came with me. I probably would have been fine to go by myself but the moral support was definitely necessary. It was a pretty uneventful procedure, everything went well, and I relaxed the rest of the day, acutely aware for the first time of where my cervix was actually located.

At the follow-up, the doctor said that it had been a smallish spot and the edges had been clear so all that would be needed would be Pap smears every three months for the first year, every six months the second year, and annually afterwards. Except that after the first year, I was still getting abnormal Paps back so I had to continue the every three months thing for longer--maybe 18 months. I don't really remember. Just when we were thinking things were going to be OK, during the summer of 2006, a Pap smear revealed abnormal cells from my uterus and I got to have an intrauterine swab.

I cannot say how excruciatingly painful this procedure was. The doctor said that I'd probably only need about four Advil beforehand to give me a little relaxer but it was a quick procedure--less than 10 minutes--so he wouldn't give me anything else. Short but he didn't mention the B-A-D bad part. Basically, the doctor takes a swab and runs it up through the cervix, all the way up into the lower part of uterus and starts scraping. You know how a normal Pap feels--a little pinching? That but MUCH worse. My uterus pretty much revolted and started cramping, HARD and sharply, pretty much immediately. It was 10 of 10 pain and I was crying almost immediately because of it. I know my discomfort was really bothering Paul. I think even Paul was ready to tell the doctor to stop it, it's not worth this. The doctor and nurse were both telling me to lie still, just breathe through it, Paul was doing his best to keep me still and calm, and all I wanted to do was get out of there. The doctor said he didn't know if he had gotten enough cells but if we had to do it again, he'd give me anesthesia. I think I'd requested Valium or some such drug beforehand and I think he thought I was joking. Paul told me afterwards that the next time the doctor told me it was going to be something a few Advil would work for, to ram my head into the wall repeatedly until I knocked myself out. Thankfully there were enough cells and the test came back negative. Subsequent Pap smears also came back clear and finally, the past two years have had clear Pap smears. (That's really not part of the story; I just wanted a little sympathy for what I went through.)

So, the perinatologist--

At the doctor's visit in July for the pregnancy confirmation, the doctor gave us a few minutes together before he came in with all the rest of the information for us. I don't know if that is his standard practice but it was appreciated since we were jet-lagged and emotional. Then all the bucket-loads of information came at us. He recommends no caffeine the first trimester, limit cold cuts and soft cheeses, sushi is out in his opinion. He's a single practitioner so we'll need to see someone else, here's the name of the doctor and practice he's referring OB patients to. Oh, yeah, you had the LEEP and you'll be 35 when Baby is born so you're of advanced maternal age, we'll schedule an appointment with the perinatologist for genetic screening and monitoring. Keep taking vitamins. And, oh yeah, congratulations. Let us know when Baby is born.

The perinatologist visit was three weeks later and we met with a genetic counselor. Paul and I have very few, if any, indicators of genetic anomalies that we needed to worry about and since we're pretty much the last people having children in our families, we knew that there had been nothing for anyone earlier. Neither of our mothers could remember any incidences that might be cause for concern. We opted for the level 2 screening which requires two blood draws to rule out the possibility of chromosomal abnormalities, a spinal abnormality, and cystic fibrosis. There was also a sonogram to take measurements of Baby, who was being most uncooperative, including the nuchal fold at the base of the neck which can be an indicator of chromosomal abnormalities. So far, everything looks good (except for an already stubborn child). That was the perinatologist visit for the advanced maternal age side of things.

Because of the LEEP procedure and the fact that I have scar tissue on my cervix, there is a *slight* chance that my cervix could become compromised. I'll continue to see the perinatologist every month until at least 20 or 24 weeks to monitor the condition of my cervix. I'll alternate visits every two weeks with the perinatologist and the OB/GYN. The OB/GYN said that he'd "spring" me from the perinatologist's office after my last screening work was done (I can't remember if that is 20 or 24 weeks) because he's seen very little that indicates the cervix will compromise after 20 weeks. While it's a pain to go to a doctor's office that much, it is fun to get to see pictures of Baby all the time (I've had three sonograms already). I don't know what we're going to do yet--we've got at least 6 weeks to decide. In the meantime, I'm glad that I've got people watching this to make certain things stay like they should.