The Quad Screen AKA "The Eff You Test For Anxious Pregnant Ladies"

Approximately two weeks ago, during my high risk meeting with a doctor about this pregnancy, they recommended I stop by my regular doctor for blood work for a quad screen since I'm of "Advanced Maternal Age". Without thinking too much about it and because my fear of getting blood drawn is now down to normal fear levels, I agreed and hopped over to do it. I knew my regular odds for Down Syndrome and I knew other stuff could occur, but like all people who don't have any results, I assumed my baby was healthy and comfortable and perfect.

Monday of last week came around and I got a call from my doctor. "Are you meeting with a genetic counselor?" I replied happily, "Yep, tomorrow." She paused and said, "Good, because your quad screen results came back and your Down Syndrome chance is 1 in 110 as opposed to most people your age. And there is something called trisomy 18 which I want her to discuss with you. The odds for that have been increased also, though not by as much. I'd suggest an amnio." I paused and said, "Okay." Then I came home and was anxious, but not as anxious as I was during my meeting with my genetic counselor.

Joann, a sweet lady of roughly my own age, attempted to calm me down when we met. "The odds are still low for both, but not as low as they should be. You've been flagged as a positive for further testing." I tried not to throw up on her as she showed me a drawing of what would occur with the amnio. "Do you want me to move away from this page?" I teared up and nodded at her. She further tried to calm me down. "Your ultrasound looks good, so I can't say that your odds for either are exactly what they say on this form. In fact, doctors catch trisomy 18 a lot of the time and Down Syndrome 60% of the time just looking at an ultrasound. I can't give you official odds, but try to take a deep breath." Little does this lady know that I'm the most anxious person in the office today and that she is my own personal demon. She has basically told me that my baby is going to die weeks after its birth and it's all because I did something wrong with the chemicals in my body. I refuse to listen to reason which states that this baby is most likely (over a 99% chance) just fine.

Again, I tried not to be sick. This pregnancy has already been an anxious one for me, and now here was another thing to be anxious about. I schedule the amnio for two days later, even though getting a gigantic shot into my stomach was not on my personal bucket list.

My husband, a darling but somewhat busy man at work nowadays, asks me if I need or want company at the amnio. Somewhat sick over my baby's health, I'm barely able to concentrate on the idea of a giant needle in my stomach and I tell him that I'll be just fine. It also crosses my mind that I'm going to embarrass myself and I do not want him with me if I do so. Helen offers similarly when I see her for potted duck and macarons. This one is slightly harder to turn down. I know Helen has a fear of needles much like my own and I suspect that I could use the support. However, I am still much too anxious about my baby to believe I'm that worried about the needle and I still don't want to cry in front of someone else.

I get to the doctor's office a little early, unlike my normal self, but I'm made to wait for my amnio for an extra hour for some reason. During this time, the lack of sleep (due to my worry and general pregnancy insomnia) and anxiety I feel begin to take their toll. Randomly, in the office, I tear up, but manage to keep it down. The worry about the needle finally begin to overcome my anxiety about my child's health and I keep imagining the needle hitting me and causing a miscarriage. (One in 500 chance I tell myself silently over and over.) When they finally tell me to get into the office and get undressed, I ask, in tears, some questions and the nurse talking to me pauses. She asks me if I'm okay and I tell her about my fear of needles and the amnio and my general lack of sleep and my high dose of anxiety. She attempts to calm me, but I start sobbing giant tears. This does not go over well. I get changed, but it appears that a conversation has popped up behind the closed door.

When the doctor comes in, she looks around and asks, "Where is your husband?" Through my raging tears, I reply, "I told him not to come with me because I didn't think I'd be too bad." I can barely say the last part of the sentence because I'm shaking so badly. The nurse from before tells me that she will be holding my hands the whole time and that I can feel free to squeeze her hands. I ask them if other people in the office cry about this, and both the nurse and the ultrasound tech assure me that they do. The doctor looks peeved.

After they start, the doctor plunged the needle in, but did warn me. I did not look and nearly kicked up my legs, until they begged me to lay flat. The nurse holds my hand and chats with me, or attempts to. She reminds me to breathe like I did while in labor with my other son. Though nearly hysterical, I tell her that I was never in labor. I went straight to c-section and it was beautiful. She appears stymied before asking me more about my son, but I beg her to tell me that it is over. After a full minute of flipping out on my part, she asks me if I want to see the screen. I ask if the needle is out and when she tells me that it is not, I nearly scream no at her. They quickly remove the needle and tell me to look at the screen. Tired, anxious, crying, I do, and I ask if the heartbeat is strong and okay. They assure me it is. I ask when the prelim results will come in, and the doctor says, "Seven days." I nearly fall apart at the idea of seven more days of anxiety like the days I've already faced and as she walks out, she adds, "Hopefully we call with good news." I immediately wonder if she saw something that leads her to believe the news will be awful.

After she walks out, the nurse starts to carefully tend to me. As I cry a little more gently now, she tells me to call after three days because the results will more likely be in by then. She points out that my other ultrasound was good. She tells me a lot of people weep at this office. It is the high risk office. She tells me the odds are in my favor and the only thing I can think of is The Hunger Games ("May the odds be always in your favor.")

I head home convinced that my baby will be dying soon, that my pregnancy is miserable, that my husband will leave me, that the world is ending. After a long fretful weekend doing tons of internet searches, I manage to get back into a somewhat normal state of mind, one that allows me to do things like take a shower without weeping. I do not miscarry from the amnio, and then assume all my luck has been used up in not miscarrying. The rational part of my brain that is able to do math and calculate odds is beaten down by the part of my brain that wants my baby to be healthy when it is born.

Then, today. I'm at work, waiting for a call, because it has been three days. I'm able to concentrate because I like being in the office, but as the hours go on, it weighs on my mind. I can barely breathe by eleven and I say to my phone out loud, "Ring, damn you! Where are you?"

A minute later, the phone rings and it is the genetic counselor. She starts with "Good news! Just verify your identity!" They are no fools, these genetic counselors. I nearly fall apart with gratitude and relief as I try to verify. I ask them the reliability of the prelim test results and they assure me that it is ninety to ninety-five percent assured. I immediately call P, who seems unfazed (as usual) and cheerful.

When he asks if I'm happy I've had the amnio, I say, "HECK NO. If I had never had the stupid quad screen, I wouldn't have had the amnio and I would have spent my whole damned pregnancy believing everything was fine!" He asks me what the quad screen is and how it factors into anything.

I think he might block out half of what I say when I'm anxious.

So, when it comes down to it, what I'm saying is that if I ever got pregnant again (most likely not) I would skip the damned quad screen and go right to amnio even though it made me fearful and weepy. At least then I'd skip the two weeks of crazy anxiety too. If you think this tale of fear and anxiety is nuts, by the way, do a search on "quad screen false positive" and read the forums out there. Clearly other people out there are experiencing the same thing I am.


Helen said...

You know I'm always available if you need someone who understands the deathly terror of needles. And who thinks that crying any time, anywhere, is the right of every pregnant woman. But, hopefully, the next 4 months will be less stressful for you than the last 5 have been. You deserve a few months of smooth sailing.

CraftyAngie said...

I'm so, so, so glad that it was good news.

When I started reading I started feeling dizzy and started remembering our stupid genetic counseling session and about all the stupid things doctors told me about the risks related to twins.

I just kept on telling them "if my great-grandmother did back in 1900 (multiple times), I CAN do it".

I'm crossing my fingers you only hear good news from now on. As if pregnancy wasn't stressful enough!

Unknown said...

After a questionable first ultra sound for Ethan, I learned a very important lesson: you never go out and read what the internet has to say about what can go wrong with your baby. EVER. In my case, I had to wait almost 5 weeks before they'd do another ultra sound to see if further testing was needed. It may have been the worst month of my life.

Here's to smooth sailing the rest of this pregnancy!

Kitten said...

Angie -- Oh man. Twins pretty much eff up EVERY test out there. I swear that half the posts out there are like, "But it turns out that my twins were screwing up the test." And you have to get TWO amnios for twins. SHUDDER. My grandma had healthy twins AND delivered them naturally, so it must have occurred in the past. :)

Kitten said...

Ms. Knitpicky -- I'm the worst with internet research. I love to research things that could go wrong. P has threatened removal of my internet!

CraftyAngie said...

I'm glad I didn't find those blogs! (instead I was looking at real estate websites crying because we couldn't find something we could afford).

I think the one thing I did hate was at the genetic counceling session: "If one of them has a defect, we can inject blah blah blah stop heart blah blah blah blah...the second twin can probably be delivered safely"

Yeah, I blocked a LOT of that conversation off. As a scientist, I knew what they were saying, as a pregnant woman I kept on saying "go away!!! DO NOT get near MY babies!"