Tuesday, April 5, 2011

Reassurance (Part Two): The BPP

I went in for my first biophysical profile (BPP) today. The BPP combines a non-stress test (where they hook me up to monitors for both the baby’s heartbeat and any possible contractions and then observe how his heart rate corresponds to his movements or contractions) with an ultrasound to check the amniotic fluid index. As I wrote before, these weekly checks are now recommended for all women over 35 once they’ve reached 36 weeks. My doctors were kind enough to let me start them at 33 weeks simply for the extra peace of mind they might provide.

I was not disappointed. With one small exception (something that was totally unrelated to the test itself), the entire experience was wonderful and I came away feeling completely and totally reassured and so very glad that I had asked for the early weekly monitoring.

The room where they do the test is dimly lit and contains three very comfortable reclining chairs, each one having its own testing equipment so three women can be monitored at once. When I first got there, I was the only person in the room, which ended up being a good thing. The technician put a blood pressure cuff on me and started it, and then, as she was working to get me hooked up to the monitors, she asked, “Is this the first baby for you?” I could certainly have guessed this was coming but hadn’t really thought about it in advance.

“No, my second.” And I started preparing for what I would say when the next inevitable questions came.

“And how old is your older child?”

“She actually passed away last year.” Tears start. There goes that “actually” again. “That’s why I’m here at 33 weeks—it’s more like the doctor is letting me come than making me come, because I have been so anxious during this pregnancy. Even though it wasn’t pregnancy-related. She got meningitis at 17 months old.” Tears really coming now. The tech, so very sympathetic, brought me some tissue and knelt back down in front of me.

“That must have been a terrible shock for you.”

“It was.”

“What was her name?” I was floored by this question. Not a single person with whom I’ve had this very difficult conversation has yet asked her name. I couldn’t believe what a difference it made and how warm it made me feel toward this person I didn’t even know.

“Hudson.” I fingered my necklace with her name on it, as I so often do (thank you again to my friend Andrea for such a lovely gift). “Thank you for asking. No one ever asks that. That’s really kind of you.” I can’t even remember what else we said, because I was still so surprised that she’d asked about Hudson’s name.

Then she looked at my blood pressure. 132/82. High, especially for me. “Well, we’ll hook you up again at the end and see what it says then.” I agreed this was a good idea since that reading had come right in the middle of my minor meltdown.

After all the monitors were hooked up, she gave me a little button to push whenever I perceived any movement. I could hear Jackson’s heartbeat pounding away out of the machine right next to my chair, which is always comforting, and I could see his heart rate accelerating every time he moved, which is really comforting. But the really incredible thing, the real takeaway from the day, was that I kept hearing him move even though I couldn’t feel him move. I’d read about other women’s experiences with this, but it was still amazing to witness it myself. It tells me two things—one, that he could be moving a lot more often than I ever realize, so I probably don’t need to worry quite so much when I don’t feel him move in the exact same patterns every day (although I’ll still keep doing my kick counts all day and calling if anything seems really significantly off), and two, that I probably don’t need to worry during those times when I can actually feel him moving like crazy, because he may be doing that a lot more often without me knowing it, too.

Like my friend Andrea suggested, though, the monitoring does come with a little bit of test anxiety. I thought it was so strange that I couldn’t always feel him moving, so I found that I was almost willing myself to feel the movements. It was much like what happens when I have to endure hearing tests as my hearing loss gets worse and worse. I sit in a stupid soundproof booth with headphones playing tones in my ears. They tell me to raise my hand whenever I hear something, so I end up practically straining my neck trying to hear things that I can’t and often raise my hand just because I think I should. I had to fight that impulse today, knowing that the monitor was picking up the movements even if I wasn’t.

Once the non-stress test was over, and I had been sitting there calmly for about 30 minutes, she checked my blood pressure again. “Wow. What a difference,” she said. “92/57. You can see why people have strokes when they get upset.” I was momentarily bothered by the possibility that my blood pressure has been rocketing up like that every single time over the last year that I have gotten really emotional (which is often several times a day, you know), but I got over that quickly. She showed me the test strip (a long piece of graphing paper that traced Jackson’s heartbeat above dark boxes that indicated his movements) and explained that everything looked good. There were hash marks at every spot where I had pressed the button indicating I had felt him move, and again, it was unreal to see how many more black boxes (actual movements) there were than hash marks (my perception of movements). It’s hard to describe how reassuring this was for me.

Then she did an ultrasound to check on the amniotic fluid again. It’s now around 15 cm, so down a little more from last week, but still plenty enough and well within normal range. And she gave me another picture in case anyone ever questions that I’m having a boy. Definitely a boy.

The only dark moment of the whole experience was when another woman, very pregnant, joined me in the monitoring room. She was 45 minutes late for her appointment, so the tech had to fit her in (and having to do things like that is one of the reasons I had to WAIT 45 minutes for my own appointment, for which I had arrived on time). But even worse, she reeked of cigarette smoke—I could smell it as soon as she walked in the room. I thought I should give her the benefit of the doubt—maybe she was a smoker before she got pregnant and her clothes were still stinky, or maybe she lived with a smoker, which isn’t great for her baby, but is not as bad as her smoking enough herself to smell that way. But then the tech asked her when she had last had a cigarette, because it could affect the readings, and she replied, “About seven this morning.” I gritted my teeth thinking about the unfairness of it all, thinking about all the women I know who have struggled so long and so hard to get pregnant at all, let alone carry a baby to term, who have restricted their diets and their activities and done any number of other extraordinary things in order to have a healthy child, and this woman is still smoking. I was thinking about all the women I know who have suffered devastating pregnancy losses, despite having done everything “right” from beginning to end, and this woman is still smoking. I thought about all the worrying I have done throughout this pregnancy with my sweet little boy for no real reason at all, and this woman is still smoking. I thought about all the organic food I fed Hudson, all the research about the safest car seats and other baby gear, all the vaccinations we made sure she got, the year’s worth of breastfeeding and pumping I did, the constant watch I kept, all just to have her die in the end of a rare aggressive bacterial infection that I could not prevent, and THIS WOMAN IS STILL SMOKING?!?!? As much as I hate myself for being so judgmental in situations like that, it was just too much. Of the many things I will never understand about the world and what happened to us, this has to be one of the worst. It’s a good thing the tech didn’t recheck my blood pressure at that moment, either.

But that’s not what I’m taking away from the day.  What I’m taking away is some satisfaction for having advocated for myself to get this extra reassurance, continued awe at the compassion of perfect strangers, and at least one more good night’s sleep.


  1. Yay for you and Jackson, Mandy. Your writing delights me always - your humor, self-awareness and perceptiveness. Thanks once again for your gift to your readers.

    And remember: You are not the only judgmental one about "this woman is still smoking"!!!

    Love, Rebecca

  2. It's amazing to me that such comfort could come from the simple act of a perfect stranger asking Hudson's name. It's even more amazing to me that no one asked you before now. Thinking of you all every day...

  3. That's so very kind that the tech asked Hudson's name...I can see how that would make it seem more personal and caring, v/s trying to change the subject as quickly as possible. How thoughtful that this person took the time to delve a little deeper and reach out to you ~ and to Hudson's sweet memory!

    I'm so glad the test went well and provided you with some concrete reassurance. You are doing an extraordinary job taking care of yourself, and in turn taking care of Jackson...so to get a healthy "grade" on the test is just proof that you are a phenomenal mommy. Terrific job!

    As for the smoking mommy.....well, she fails.


  4. So glad you're feeling more relaxed.
    The tech sounds awesome. I too have had only ONE person ask me Veronica's name when I've mentioned that my daughter died.
    And I will be forever grateful to that woman.
    Amazing, isn't it?

    And with regards to the smoker...she'll probably have a totally healthy child who will outlive her without her ever losing a night's sleep over its well-being. It does seem that that's the way the world works. On the flip side, it has taught me that there's really no point in worrying...never changes the outcome. Not that I've been able to put that belief into practice.


  5. Mandy, I'm so glad the test gave you some much needed reassurance. Hopefully you get the same tech next week (anyway you can request her?). As to the smoking mommy, I would have felt the exact same way, and I haven't experienced the awful loss you have. I was (still am, to some extent) TERRIFIED of SIDS and did everything I could think of to prevent it, even buying one of those movement monitors. And then my cousin (who is 17, by the way) had a baby, the baby had breathing problems and was in the NICU for a week or so and she started smoking again (inside) immediately after he was born. At least she didn't smoke while pregnant, but I just want to smack her every time I think of her sleeping baby. So--you aren't the only one who has trouble remaining non-judgmental in this area.

    Only seven more weeks until you'll get to see little Jackson's sweet face.


  6. Go, Jackson! So happy that you're reassured. Try not to think about the less than stellar parenting that goes on out there-there is no rhyme or reason to the randomness of life. I try not to frustrate myself. When my daughter struggled so with her past horrors, when I worked so hard to make her happy and seemingly couldn't, I always saw parents who were hideous to their kids and their kids seemed fine. I always wondered why...and there was never an answer.

    Big Hugs.

  7. So glad you asked for extra monitoring. We also had a page in the front of our other children's medical records saying that their sibling had "expired" (don't love medical terminology!) from meningitis. It helped when we saw other docs in the practice to know that we all needed a little extra attention and reassurance.

  8. In the months of reading your blog, I've tried to think of how I could best react should someone share such tragic news with me. And now I feel like I have a good idea - asking the name. It seems so simple and yet it validates that person's existence in a very concrete way. Thanks for sharing this positive experience.

    As for the smoking-while-pregnant patient... oh my. I remember as I was struggling to get pregnant, several cousins who were teens and/or unmarried, one of them smoked (during pregnancy!), etc, etc, all got "knocked up" with great ease. I just had to come to the conclusion that life isn't fair, and we can only do so much about it. sending hugs your way, Kate Z.

  9. I'm so glad you got this reassurance. Yay for Jackson!

    I was surprised to read that that was the first time somebody has asked about Hudson's name. Among many other things, reading your blog is so helpful in knowing how to speak compassionately and sensitively to those that have lost a child. Thank you for sharing...

    Finally, I try really hard not to judge other moms, but that's something I would have a hard time not being judgmental about. I know addiction is a hard monster to kick though, for some more so than for others...so there's compassion to be had there too.

  10. I'm so glad you felt comfort today! As for not feeling all of Jackson's kicks (and worrying yourself sick!) I also was crazy with kick counts because I also lost my baby to stillbirth. He was my fourth. I went on to have 3 more and was very nervous/anxious with the next pregnancy because I was convinced he wasn't alive when I couldn't feel him. My doctor explained that with every pregnancy - especially if they're close together -- the womb expands, then gets small and starts to look like a blown up balloon with the air let out (kind of misshaped, with lots of stretched out spots). Those stretched out parts have less feeling in them and that's why I couldn't feel as much action. It really helped my to relax after he told me that. Hope it helps and my prayers go out to your family.

  11. That tech was awesome. I'm glad she was a comfort to you, and that you got some data that will help comfort you as well.


  12. I speak your name! A simple act of compassion does so much. Loving you Big...Renee P.

  13. One more thing...I'm on call this weekend for work and I get a call about a domestic violence incident where the mother is being arrested and the father is too intoxicated to care for the child, and there are no other responsible adults in the home. The mother provided two names of relatives who reside in Richmond, who we called at 2am, but they haven't responded. Perhaps it's due to the early morning hour. Now, this precious 2-year-old will be wisked off by a stanger (friendly, warm and compassionate of course) and placed in a strange home to the world of foster care. Life is so not fair! What I know for sure is that Hudson was loved and cared for every second of her precious life and only knew pure joy. Renee P.

  14. If someone ever grants me the privilege of telling me about his or her child that died, I'm going to remember to ask the child's name. Thank you for teaching me that.