OB GYN needed about stress-related question

Patient

Q: I am 18wks pregnant.I'm surprised that I read this article when I did, because I misplaced my DH's keys to his car when I went out to look for something.He missed work the next day and was almost fired from his job.I forgot where I put them and that sent me into a fully blown panic attack that lasted a solid 5 hours.That was two days ago,and I haven't felt movement since,whereas I had felt it off and on every day.I'm unable to get to an ob because of a very expensive spend-down to be insured. There has been so much stress lately,and I think I might be carrying a dead baby at this point.I'm ashamed, yet my load at home hasn't lessened,nor will it.I spend 95% of my waking hours in tears,and I feel that if this baby has died,I'm going to have my tubes tied.All I have wanted in life was to be a mom,and now I just don't think I can go through this pain again.The stress of a big $ loss and being overwhelmed has left me feeling hopeless and sad.I have no support here(family or friends) I guess my question is what should I do?I don't have an option of calling a nurse on call.

Symptoms:  Menstrual cramps, depression, anxiety
Doctor

A:   I understand you are really really stressed out and anxious at the moment. Pregnancy hormones sometimes give you the blues and it is perfectly normal to feel low during this period.
As regards to not feeling any movement at 18 weeks, again I urge you to not imagine the worst just as yet. Firstly fetal movements are properly perceived only after 20 -24 weeks. Until then it is mostly a light flutter like feeling that you may have ignored because of your hectic schedule or even slept through. The full somersault like movement or kick or a nudge are not felt so early in pregnancy because of the lack of enough water around the baby.
In any case, if you feel something is amiss with you or your baby and you cannot see an OB just as yet, maybe you could visit an emergency room with complaints of absent fetal movements. Or if you are due for an ultrasound appointment that would also reliably tell you all is well with the baby.
I feel you and your baby should be fine as sttistically sudden intrauterine fetal death is seen in less than 3 in 100 pregnancies. Even if we were to assume the worst were true, although it would be devastating and you would be very aggrieved, it is really not the end of your dreams. If you want to be a mom, you must take another chance. In low-risk women such as you with unexplained stillbirth, the risk of recurrence is 7.8 to 10.5 per 1000 births.
Please do not let the pregnancy hormones and your stressful life get the better of you. Think clearly and stay positive.

Comments / Follow Ups

Patient: I had read an article on "pregnancy brain" on the "Baby Center" website. I commented on the article, and just copied and pasted that question onto the question block on here. It's in depth enough, but I forgot to take away the part in the very beginning saying something about commenting on an article. I apologize for any confusion, if there is any.

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