And A Follow-Up Appointment

A week or so after the December ultrasound, we had our regular, every-four-weeks appointment with the OB's office. I say the OB's "office" because the OB herself was on vacation; we saw the office's Nurse Midwife in her place. NM has, shall, we say, a somewhat less refined sense of the value of her time than does the OB. We've seen her once before, and found both times now that she's much more interested in talking to us than OB usually seems to be.

We took advantage of her chattiness to ask her a number of questions about our visit to the perinatologist and this whole single umbilical artery (SUA) thing. She read us the perinatolgists report, which said nothing at all about Down syndrome and focused exclusively on the low birth weight issue.

At this point I told her that, as far as I could tell, the perinatologists considered it an important part of their job to find some reason we'd have to come back and see them every month. In October there was the placenta previa issue; in November that had resolved, so there was this concern about the fluid "lake" in the placenta. By December that lake had completely disappeared, so there was (is) this SUA thing. I have no doubt, I told NM, that if in February they manage to locate the right side UA they will nonetheless find some other reason that we simply must return for yet another ultrasound in March.

I've had this theory for a long time that doctors are purveyors of a commodity (medical treatment) and that they will happily sell you more of it than you need. Most medical professionals vehemently deny this, and claim they would never order any test or procedure that wasn't neccessary. So I expected NM to scold me for my cynicism, and to tell me that the perinatologists would never, ever order additional ultrasounds without good cause.

To my surprise, NM did no such thing. Rather, she more or less agreed with my thesis. Some relevant facts, passed on to me by a CNM that's been proacticing for 25 years:

1. As recently as 10 years ago, there were three perinatologists in all of Utah: one at the U, one at LDS, and one in Provo.
2. Today there are five perinatologists in the office we visit for our ultrasound work. This is not the only practice in the building, let alone in town.
3. Diagnostic technology is improving faster than the ability to understand the results of the tests.
4. The proliferation of perinatologists and the explosion of pre-birth diagnostic technology feed back on each other and lead to an awful lot of unneccesary stress for a large number of expectant parents.

The Doppler ultrasound machine, for instance, is relatively new technology. Never mind what was available when your mother was pregnant with you; we're talking here about what diagnostic test that were unavailable when your older sister was pregnant with your six-year-old neice. Put it all together and you realize that untold thousands (millions, even) of babies have been carried to term, born, and grown up with conditions like SUA that no one ever knew about.

In this context, it seems kind of silly to get your knickers in a twist over a condition that is, in the end, damn near impossible to detect. Miss Ainsleigh is right smack in the middle of the "normal" range in every ordinary measure. To find fault with her, they've got to look down inside her belly with a Doppler ultrasound machine.

Which doesn't sound like such a bad deal to me. We've all got problems; that hers are limited to an absent umbilical artery (which is in any case invisible and completely useless after birth) seems, to my malformed and mismatched ears, like good news.