Pregnancy: The Italian Edition - Part 2
Continued from Part 1 - Click here to skip ahead to Part 3
Pregnancy: The Italian Edition - Part 2, the Second Trimester
Chapter 9: 4th month checkup
After more than half a dozen appointments and tests in less than two weeks, things finally settled down into a less hectic groove with just once a month midwife appointments and blood work. If I remember correctly, blood work for a whole skew of things is done once in the first trimester including for toxoplasmosis plus a urine test, then the toxotest is done about once a month through the second and third trimesters. I told you they’re serious over here about toxoplasmosis! On the other hand, in the States you’re likely to have your urine checked at each visit, where here in Italy there is a urine test only once per trimester.
Now in the midst of the lockdown in Italy, only I could enter the building for my appointments, with a mask now required everywhere. They would ask what I’m there for, check my temperature, and send me on my way with a pump of hand sanitizer. Midwife now not only had on a mask, but also plastic glasses, shower cap, and full medical cape. She told me once again not to fret over the coronavirus and said that all the medical staff in the building had been tested for Covid-19 in recent days and were all negative.
So the 4 month checkup passed uneventfully, midwife each time gathering a bit more history, checking blood pressure and weight. This was the first appointment we listened to baby’s heartbeat! The third month appointment she elected not to since I had just had my ultrasound days before, didn’t want to “disturb baby more.” Boo. I wanted to hear the heartbeat! She wanted to know how much I weighed when I was born (didn’t know in kilo!), if I was breastfed and for how long, what kind of birth my mom had with me, and all the same stuff for my husband. He was born in rural Tunisia in the 80’s at home, so uh, no, he has no idea about any of that nor would there be any records!
We discussed birth options. I think it would be neat to have a home birth, but my apartment wasn’t very comfortable and didn’t have space to blow up a birthing tub, plus I’d have to pay a midwife in private to come to my home for the birth, which would be about €3.000-€3.500 my midwife told me. Come June she said to remind her and she would book some hospital tours for me at Ponte a Niccheri and Careggi’s Margherita Center, depending on the Covid situation. She told me right away that the hospital for me would be Ponte a Niccheri, they’re very naturally inclined (as I desired) and she said the birth ward is midwife run and they would “coddle me.”
Chapter 10: Second trimester ultrasound
Off to the Palagi hospital once again for my 20 week ultrasound. Having been here twice before for the anatomy screening stuff, we knew where to go. Or so we thought. A phrase including “I know” in Italy will almost always have you eating your words. We started walking up the hill towards the “women’s center.” Halfway up some man yells at us, “hey, you’re not supposed to be up here, didn’t you see the barricade? You have to pass through the main entrance.” Oh sorry, actually no, we walked right past because the barricade was open and not closed…
We go back to the main entrance where only I am allowed in. They take my temperature, pump of hand gel, and indicate where I can walk along the taped designated walkway. I then take the inside route to the women’s center, up six flights of stairs, down the narrow hall, long hall, anddddd nobody around? Hello? Where do I go? I finally see another pregnant lady and we find mutual comfort in both being lost. At that moment a doctor comes out of a room and we ask for help. She asks if we’ve already checked-in? The other lady had, so she was told to go one place, while I was told I needed to go to check-in first. Which is where? She indicates that I need to go back down the long hall, narrow hall, down to the third floor. Ahhhh ok. I still had time before my appointment (always give yourself extra time, peoples) so I wasn’t worried. I make it to the third floor and find another strange wing of the hospital that I tentatively start to traverse. X rays? No. Oncology? No. No no no. Ultrasounds, yes! I turn down that hall. Ok now where is the reception? I see a little office on the corner, but there is a sign saying “accettazione” is —->. I walk down the whole hall, no reception. I try to stop a passing nurse but she just brushes me off. So I turn back to the little office to inquire and realize that this really is the reception. That arrow on the wall indicating down the hall? It really just meant you needed to turn the corner to talk to the reception from that side, not the other side. A+ for clarity, guys! There are two nurses studying something on a computer. They ignore me. Finally I ask if this is where I can check in? They tell me to wait for someone else to come help me. A doctor walks past me, she asks if she can help me? I tell her I just need to check in…? Ah, someone else will help me with that. While I continue to wait by the reception, the doctor instructs some other women where they are supposed to wait. Maximum 3 in the waiting room, one out in the chairs in the hall, the rest down another hall. Another nurse shows up and I tell her I need to check-in. “What? Oh you don’t need to do that! Just go sit in the waiting room.” Oh. Ok. I poke my head in the waiting room, but there are already the max of 3 women in there. So I just stand in the hall, as it seemed the easiest spot to stay socially distanced. A nurse passes by and says I can’t stay there, I have to wait in the waiting room. Right then. The only seat at least 1m/3ft from another woman is one of the “don’t sit here, please respect social distancing measures” but I sit there anyway.
My appointment time comes and goes, every single woman is called back except for me, including women who had appointments at least half an hour after mine. Finally after more than an hour of waiting I asked a doctor (who had come to call back a woman who wasn’t there) if I would be called soon? She asked my name and brusquely told me I’m not on her list. But she seemed to pause in her tracks…”you’ve been here an hour waiting for an ultrasound? Well your doctor has already moved on to later appointments!” She leaves. Cool. I wait to ask at reception what the deal is. While I’m waiting another woman comes in and asks me if she needs to check-in? I apologetically tell her that I’m really not the one to be asking, I was told yes, no, and am a currently forgotten patient. At that moment another doctor appears, looking for a patient. The woman who had just asked me about check-in is the patient the doctor is looking for. The doctor starts loudly scolding her saying she couldn’t find her and she needs to stay in one place, etc. The lady responds that she was waiting where she had been told to for over half an hour and just came to check if she needed to do anything! They yell at each other back and forth a bit, then go on to the appointment. Mmm lovely energy in that room. Love the bedside manners here.
I ask at reception about my appointment. After the usual struggle of “what?!” When I give my name, which apparently comes from outer space, she says I’m on the list and they will call me. She suggests maybe it’s better to wait in the now empty hall seats just in case, so I’m more visible. After a total of 2 hours waiting, I finally get called back!
This doctor was much kinder than my first experience. Ultrasound went well, baby is healthy, got some good mid-kick images, even if those cute, whole baby side-profile images don’t seem to be a thing here? Ah well, got some great feet pictures and spine pictures and other things I have no idea what they are. Nothing like having a completely opposite experience from the first ultrasound, even down to the paper towels. This doctor only gave me maybe two pieces that wasn’t enough for the copious amount of gel she used. As things were going well, I didn’t want to risk her wrath by asking for more paper towel. But I’ll take a kind doctor with my shirt adhering to a sticky belly over an irritable doctor any day!
Chapter 11: 5th month checkup
Once again more Covid security measures were in place. My chair was now placed so far from the midwife’s desk that it was resting against the exam table, and there was a plexiglass screen on her desk between us.
The 5th month check-up was not as enjoyable, for the main reason that I was chided on my weight and thereafter thoroughly quizzed on my diet to find the weak link. I had arrived early that morning to do the routine toxotest blood work (done in 15 minutes!! So fast! On the down side, I now had to wait over an hour for my appointment but…hey pastry and cappuccino!), and ate breakfast just before my appointment since the blood work is supposed to be done while fasting.
Per usual at the beginning of the checkup midwife asked me to step on the scale, always with shoes and jacket on. As she adjusted the scale she asked if I had eaten a lot. “Why yes, actually I just ate breakfast before coming in.” “No, no, I mean in general.” Oh…I head to sit down but she stops me and asks me to turn a circle so she can “look at me.” “No, the tummy is about right,” she says to herself. Now feeling like an elephant on display I tell her I don’t think I have been eating a lot. I would say I’m normally a healthy eater, and have been even more attentive recently. She wanted to know what I’ve been eating, because I had gained too much weight in the 5 weeks since I last saw her (3 kg/6.5lbs instead of 2kg/4.5lbs). I eat a little bit of everything but mostly vegetable based meals and fruits…”Ah, fruit you say? Too much fruit can make you gain weight…” I certainly haven’t been eating THAT much fruit…”Do you eat bread?” Yes, but not excessively…”How about pasta and rice?” A couple times a week I eat pasta (hello, Italy) but not rice often…not to be discouraged by my lack of confession, she kept trying…”ah, you like your sweets, don’t you?” This is true, but again, I have been mindful of what I’m feeding baby.
Midwife still doesn’t seem to be giving in, so she takes my chart and pushes it towards me, to show me my weight gain. She shows me where I had gained a bit extra after the first trimester but didn’t say anything because, as she figured, I had been sick in the first trimester and needed to gain a little extra. At this point I’m starting to get a little irritated and was thankful that my mask covered most of my face; the only hint she would have that I’m not happy are my eyebrows getting incrementally higher with each question. Finally I try and tell her that I feel GOOD, I don’t feel like I’ve been excessively gaining weight nor eating poorly, so when I gained more than is recommended in ONE week without eating differently, I wasn’t overly worried. This in and of itself should be a good sign, coming from a former ballerina who has spent most her life being very weight-conscious and staring at her reflection in the studio mirror. I know my body and I know what my diet has been. She seemed pleasantly surprised to hear I had a scale at home and had been keeping track, and confirmed that I too, had seen the weight gain? YES, can we please stop talking about this now?! I kept my tone civil, but inside my thoughts were more akin to: “I feel awful” - “don’t cry” - “if she keeps on like this, maybe I should just get up and walk out?” - “just smile and nod” - “should I come up with some ridiculous story, like I’ve been eating McDonald’s every day, sometimes I even order a salad with my big mac, fries, and shake? I don’t always get the shake, but if I do, sometimes I’ll skip my daily gelato!” :D
We finally agreed that maybe it wasn’t my diet, but the exercise. Ya know, I’ve been stuck at home during a world pandemic for two months and not supposed to leave my residence, not even to go for a walk? Since the exercise restriction had been lifted the week before, we concluded I will go for not one walk a day, but two. I didn’t bother bringing up the fact that they never weighed me in the beginning, just asked me what my pre-pregnancy weight was. I knew what it was, and so I told them. I never thought to clarify that that’s my morning weight, no shoes, no coat, and before breakfast because that’s the most consistent way to weigh yourself?
Real life: Eating a gelato
Midwife was about to let it go and move on to other subjects when she lets out an “aha! You like your potatoes, don’t you?” Inwardly sighing, no, nope. “No, I don’t care for potatoes that much.” She just would NOT let it go. She never thought that, all things considered, gaining 1 or 2lbs outside the “clinical” range, during a world pandemic is maybe not a big deal? That maybe not every single woman should gain 25lb-35lbs because every body is different? That people gain weight differently, vary in height, babies’ weights vary, and a woman’s water weight during pregnancy can vary? I’m no doctor and not here to suggest throwing out the clinical weight guidance, but a woman who is 5’1” and gains 35lbs probably wouldn’t be given a hard time, and yet a woman who is 5’11” and gains 40lbs might be shamed because she gained 5lbs too much? Maybe you can tell that this bothers me, but I didn’t appreciate being quizzed and feeling like midwife didn’t believe me. And despite reassurances from both my husband and mom that I shouldn’t worry, I couldn’t help but have this little midwife on my shoulder every time I went to eat something for the next few days. Shouldn’t eat that. Maybe I should skip the olive oil on my salad? Aw man, I want a cookie, what would midwife say? Then I would constantly have to talk myself out of it and not feel guilt anytime anything entered my mouth. I’m not implying that I don’t think a medical professional should be able to discuss weight concerns with a patient, but there is a way to go about that, and it certainly doesn’t involve quizzing, guilt-tripping, or not believing the patient.
At the end of the appointment midwife said I would have to do the glucose test for gestational diabetes if I gained 3kg again by the next visit, instead of 2kg. Despite the fact that I have 0 risk factors for gestational diabetes aside from this 1 week weight gain. But I think all women in America get this done regardless, so there’s that. I’ve heard it’s not a fun test but it wasn’t the test itself I dreaded, it was the next weigh in.
Chapter 12: 6th month checkup
The fateful day when the midwife would weigh me had arrived. Silly that that was the thing weighing most on my mind, no?
By now I had gotten into a pretty good rhythm of doing any blood work on the same day as my midwife appointment. The way it works to get blood work done, is waiting. Lots of waiting. Namely, sitting in a large, cold, grungy room while staring at a screen waiting for your number to be called. During Covid they would leave the doors and windows open often, so dress warm! This particular place had a malfunctioning number system, the same numbers would be called repeatedly, creating confusion. The first time your number is called, you go back for the “accettazione,” or handing over your tessera sanitaria and slip with the tests you need done. Then you go back to the waiting room and wait again, until your same number is called a second time, at which point you go back to one of the other rooms and they draw your blood. Then you’re done and you can either come back and pick up your results in a week (depending on the tests done, of course ) or have them mailed to you.
Knowing it could take anywhere between 20 minutes (as it did the second time I did bloodwork) to over 2 hours (as it did the first time), I arrived with a bit more than an hour to go before my midwife appointment, hoping that would be enough time. Being pregnant, I fortunately did not have to make an appointment to do blood work during Covid times, I could just show up and not only would they let me in, but the people taking temperatures and verifying why you’re there would also give me a priority number. Which I personally find a bit strange, as the vast majority of people waiting to get blood work done at any given time appear to be 60 and older, and although pregnant, I still think most of them should get priority over the youngest person waiting (usually me). As the time for my 11:00 appointment neared I despaired of getting the tests done that day. It is a bummer that these tests need to be done while fasting and I would have walked, taken a train, walked some more, and waited an hour without eating all for nought. At 10:50, just as I was thinking I would need to head upstairs for my appointment so as not to be late, my number was called to go back to accettazione. After handing over my tessera sanitaria I asked the lady what my chances were of being called back to get blood drawn within the next ten minutes? She replied not to worry, I could come back down after my appointment without having to wait with a new number, as long as I was back by 12:00 when they close. That should work, my midwife appointments are generally 30-45 minutes, so that should get me back down here just in time!
I scurried up to the waiting room, arriving at 11:05, to wait for my midwife to call me back. I waited, and waited. 11:15. 11:25. 11:30. Where is she? I won’t be able to make it back down now to do the blood tests! Urgh. Did she come looking for me at 11:00, and I wasn’t here yet? I am normally early, and she often calls me a bit early, so maybe she thought I wasn’t coming today?? Finally at 11:35 she appears and apologizes for being late today. She sees my folder out with the test papers and asks if I have more test results for her to look at? No, these are ones I was supposed to do today but ran out of time. She suggests I run down and do the blood work and then return to her. I felt bad about that, since I’d be making her wait. She then suggests we do the appointment really quick, so I can get back down by 12:00. That works! I had no burning issues to discuss with her, so she made photocopies of my most recent tests, weighed me, took my blood pressure, made sure I was feeling ok in general, and then off I was! Fastest appointment ever, only 15 minutes! Didn’t even have time to chide me on my weight, aha! She did have to take my blood pressure twice since the first time was higher than usual. The second was better, if still a bit high, but she said it was her fault since she had stressed me trying to figure out how to fit everything in.
Now 11:50, I hurried back down and was able to get my blood work done, hurray! No wait, either. Now, where’s my pastry???
Thus marked the end of the second trimester appointments.