Sunday, August 9, 2009

Communications during the pregnancy

Although with several bumps, our surrogate’s pregnancy seems to be progressing well. It is difficult being so far away from our baby in many ways. The most anxiety-provoking is trying to understand the results of each pregnancy check-up and steps that will be taken to mitigate any irregularities identified.

Doctors in the U.S. have figured out and resigned themselves to the fact that people do research on the Internet and come in informed (sometimes misinformed, but most doctors say overall much more informed) and ask many questions. In the late '90s when patients first started visiting doctors with their Internet research, some doctors found it helpful (patients were more knowledgeable) and some found it annoying (the patients were more questioning, questioning their knowledge and authority). With lower Internet penetration, India is still in the earlier phases of this transition and some of the doctors do lean toward finding it more annoying.

Surrogacy complicates the situation. If it’s your own pregnancy, you talk to the doctor when you have your check-up. With surrogacy, the doctor has to communicate with both the surrogate and the remotely located intended parents. We are emailed reports of the check-ups, often with very short updates. More often than not, we have to chase to receive these in a timely manner. And chase to see whether the surrogate went to her scheduled appointment (monsoons sometimes cause cancellations, kind of like a snow day). And chase to understand the results of the reports. The level of initiative in proactively providing intended parents updates and interpretations of the reports is just at the lower threshold of acceptable. The emails we receive are typically short. This, of course, means we need to review and interpret the reports ourselves.

In reviewing the reports, it seems that our pregnancy is having it’s share of irregularities, but nothing terribly severe. What is frustrating is that we seem to discover these issues, rather than being told about them. Some of the irregularities include:

Amniotic fluid levels. An early June test indicated an amniotic fluid level of 20 and had “mildly high” written next to it. The amniotic fluid is the nourishing and protecting liquid that surrounds the unborn baby during pregnancy. Since the doctors didn’t mention anything to us, we asked them about this. As a result of our asking, the surrogate was scheduled for a followup check. No asking...probably no follow-up check. Interestingly, some Internet research shows that 25 is actually the cut-off for mildly high amniotic fluid. So, 20 probably is okay. It seems that the cause of high AFI levels is usually unknown, although since the baby swallows amniotic fluid, high levels can be indicative of swallowing or digestive problems.

Gestational diabetes. Because of the high amniotic fluid, we had the extra doctor visit. During this visit in mid-June, gestational diabetes was discovered, which resulted in the visit becoming a 2 week hospital stay. This basically means there is high blood glucose (sugar) in the surrogate’s blood. It’s apparently getting more common (3 to 10% of pregnancies according to Wikipedia) for women to have gestational diabetes which puts the baby at increased risk of being large for its gestational age (which can cause delivery complications), having low blood sugar and even jaundice. We seem to have caught this reasonably early and our surrogate was immediately put on insulin.

T4. At the same time we got the bill for the above stay, we got more reports and tests that were done during the stay. One late June report showed low T4 levels. HELLO! Was anyone going to tell us? The thyroid creates T3 (serum tri-iodothyronine), T4 (thyroxine) and TSH (thyroid stimulating hormone). T3 is a reservoir for T4, so my non-medical assessment is that T3 may be more important. But the available literature seems a bit fuzzy. T3/T4 seems important for brain development. By reading the invoice, we see that our surrogate was given/prescribed Thyronorm 25mcg tablets, which are Thyroxine. So, it seems that action is being taken to address the low T4 levels. Good on the action side, bad on the communication side.

Our mid-July updates showed blood sugar within normal ranges and T3/T4/TSH levels in normal ranges also (although T4 is still at the low end of normal). These were the first follow-up tests we received after the late June diabetes and T4 discoveries. The email content was:

Please find attached the blood reports of [surrogate name] for your reference.
Please note that these have already been checked by Dr. [doctor name].

Yup, no mention of whether levels were high, low, or whether they need to continue to be monitored. Follow-up phone calls are mandatory.

Our early August updates show AFI levels still mildly high at 25. Research seems to indicate there really isn’t much one can do.

Well, we’re focusing on identifying everything we need to bring with us to India in order to bring our baby home. Mid September is the due date! And hoping none of the above issues cause major complications...

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