Tag Archives: OBGYNs

Another confusing OB appointment…

So I just went ahead with the check thing again today. I’m way too curious about what is going on to not let it happen. Kind of weird I’m sure. The only change this week is that I’m now 2 cm dilated. Only 8 more to go! Haha.

Of course, like the others since we hired our midwife and decided to home birth, this appointment was full of contradictory and confusing things from my OB…

“Any chance I could still convince you to have the baby here at the hospital?”
No. Not unless there is something wrong. My baby is healthy, I’m healthy, birth is a natural process.

“We’re about a week behind in growth.”
OK… last week he was telling me the baby was getting too big. What the?

“You better make sure your midwife is prepared for tearing. You are definitely going to tear. Your perineum is really small for a vaginal birth.”
Way to build up my confidence there, buddy.

“Your due date is the 13th, right? That’s a Saturday not a Friday. Hmm.”
Sorry my body’s timing didn’t work out to your Monday-Friday work schedule.

“We really don’t know what the baby’s capacity is for labor because of everything you’ve been through during this pregnancy. So I want to start non-stress tests twice a week on the 12th. Based on those results we may need to evaluate whether a vaginal birth would be the best option. I’m not really sure after the pregnancy you’ve had that we want to go beyond your due date either.”
Everything in here bothers me. Every indication thus far has been that my baby is totally healthy and fine. I don’t see why NSTs are needed twice a week starting before my due date. Most OBs don’t start doing NSTs until you are overdue or if you have something like pre-eclampsia. Then there is the not so subtle reference to the fact that he thinks I should have a c-section. And that he’s basically already hinting at trying to take some sort of action to induce me should I go a day beyond my due date.

I want to be flexible and what not, but I also don’t want to be forced into unnecessary procedures. I would take Stephen with me to these next appointments to help advocate, but he always winds up getting drawn into my OB’s scare tactics.

I feel like skipping out on the rest of the appointments altogether. I think I’m definitely switching OBs after this is over.

Leave a comment

Filed under Pregnancy and Birth

Next day feelings and findings…

Well first of all I was able to talk to my midwife.

I don’t want to completely throw my OB’s opinion out the window at this point, but some of the things he said yesterday were just so erroneous that it is hard to take the other things as seriously. It doesn’t completely discredit what he had to say, but it does call his credibility into question.

The sterile thing is just a big load of crap, obviously. This is for a lot of reasons. First of all L&D wards are not by any means sterile. You have people coming in and out (like dads, family and friends), eating snacks, going to the bathroom, etc. Nurses and OBs do wash their hands, but not like they do when prepping for a surgery. Also, Stephen’s point about super-bugs was very valid. The antibacterial soap they use to wash their hands is what causes the super-bugs because it doesn’t kill everything and what stays alive is stronger and resistent to the soap, etc. And what else is in hospitals? Sick people and diseases. Furthermore, if doctors were really concerned about home environments being sterile enough they wouldn’t let you bring your baby home 24 hours after the birth (sometimes less), or maybe not ever. We would all raise our kids in hospitals, wouldn’t that be fun?

Then the fact that he just went into the general homebirth is unsafe thing until we actually prodded him makes me think that he was just going to say anything he could to make me think I was making a dangerous decision. Plus the research at this point does not support the statistics he tried to throw at me. If that was the case the UK’s ACOG equivalent wouldn’t be trying to increase the number of homebirths. Countries where homebirths are something like 30% of the population wouldn’t be doing better than us as far as infant/maternal mortality is concerned.

As far as pre-eclampsia/eclampsia and stressed out heart rate concerns… those things don’t just show up suddenly in labor. Yes, hyperthyroidism does put me at a higher risk for them (if left uncontrolled), but we would know through monitoring whether that was an issue before the birth. Also part of the reason my midwife has me continuing my care with my OB is to have these things monitored if something serious does come up. And she assured me that if anything with either my heart rate or the baby’s heart rate was abnormal that would be immediate cause for transfer. She’s not going to ignore the signs of something going wrong. Plus, something I think I haven’t mentioned on here is that she’s also worked it out with one of the other licensed midwives in town to have her attend my homebirth as well. So I will have two trained women at my birth monitoring me and making the situation as safe as possible.

Baby breathing difficulties… my midwife was able to find one study last night that dealt with this issue. It was a really small study though. Out of 248 births, two babies had breathing difficulties. One was exposed to high levels radio-active iodine (one of the drugs used to treat hyperthyroidism, but you’re not supposed to take it in pregnancy) and had a goiter so big it caused the collapse of the baby’s esophagus. The other baby’s mom was treated with PTU and had some difficulty breathing upon birth, but there isn’t much information given about this case including the dosage of PTU that the mother was on. We could have a late ultrasound to see if the baby is doing things that are helping it to practice breathing too like swallowing amniotic fluid (something I’ve witnessed on our previous ultrasounds). Also the fact that she gets the hiccups all the time is another good sign that she’s getting prepared to breathe.

So after she found this study my midwife called me again and told me about it. Then she said that she was going to call my OB and talk to him about his reasoning for declaring my pregnancy high risk. She also wants to know what information/studies he is basing his opinions on.

I’ve also gotten several responses to a post I put on a message board about this and everyone from midwives to those with the same condition as me have said that thyroid issues do not risk you out of homebirth as long as your TSH levels are closely monitored throughout the pregnancy (which mine have been). Also hyperthyroidism is more of an issue if it is something you’ve had for many years rather than something that developed as a result of pregnancy. My midwife said if the former had been the case she would have told me that I needed to have my baby in a hospital.

It was very nice of my doctor to make the offer that he did as far as attending my birth. That has not gone unnoticed in my mind because that was actually a concern of mine. To go from a 1 in 10 chance to 95% is pretty good.

Also he did say that he wouldn’t run from caring for me even if I did decide to ultimately go ahead and homebirth. My midwife has had many patients with OBs that have refused to see them anymore for making this decision.

Stephen said he’d still support me in my decision, but he also thinks that based on what the doctor said the best of both worlds for me would be to go to the hospital and have our midwife as our doula.

At this point I’d say things are more up in the air. I’m just really anxious to see if my OB is going to be willing to talk to my midwife and what will come of that conversation. I’ll probably know more tomorrow. I just didn’t want to leave things hanging like I did yesterday. I covet your prayers and even little tidbits of information/research you come across (thanks Ruth!). I definitely have a lot to think about.

Leave a comment

Filed under Family, Parenting, Pregnancy and Birth

This is how the appointment went…

OB: So, how’s it going? Any contractions or issues lately?
Me: No.
OB: Well what about the morning sickness?
Me: I haven’t thrown up in awhile. I think the last time was 30 weeks. I have had a lot of heartburn lately. I still had some Pepcid you prescribed, but that didn’t really work. Tums seems to be the only thing that helps.
OB: Well we could prescribe something else if you are having a lot of reflux. Probably Reglan would be what I’d recommend, but only if you think it is bad enough that it warrants a prescription.
Me: I think I’ll just stick with the Tums for now. I don’t want to take something more serious unless I have to.
OB: OK then I’ll leave that up to you. Any other questions for me?
Stephen: Well yes, actually there was something else we wanted to bring up with you. I don’t know, Lisa do you want to do the talking or do you want me?
Me: Well, I know I had told you before that we were thinking about this and you gave me ACOG’s stance which I was aware of already, but I wanted to let you know that we’ve decided we do want to go ahead and birth at home with a midwife unless there are some things specific to my case that would put me at a higher risk.
OB: Well, first there’s just the risk of homebirth in general. Death is a real risk in about 2-3 percent of homebirths. There have been cases where the midwife didn’t monitor things closely enough and when signs of distress occured they were ignored. There is also a higher risk of cerebral palsey if interventions do not happen when they need to.
Stephen: Right, well we are aware that there are risks with homebirth just like there are risks with hospital births and even driving in our cars. I’ve gone through all the information with her and we discussed with the midwife what the risks were, I was very concerned about that. Ultimately though I’m not the one having the baby, so it is her decision and I want to support her. What we want to know is if there are reasons specific to Lisa that would make a homebirth more risky for her.
OB: Well you have not had a low risk pregnancy by any means. You have to remember that you have had hyperemesis gravidarum and hyperthyroidism. The PTU that you are on does cross the placenta and could have an effect on the baby. She could have problems breathing, latching on and even have a goiter upon birth that would need to be treated seriously and right away. Plus the stress of labor could cause your thyroid to get out of control. It could increase your heart rate. With hyperthyroidism you are at an increased risk for eclampsia and pre-eclampsia.
Stephen: We also want you to know that this is by no means a statement against you or your abilities. We think you’ve done a fabulous job with Lisa’s care and we’re happy with you. It’s more about her and her being in a comfortable environment.
OB: Oh yeah, I know that. I’d never think anything like that. I completely understand you wanting to be someplace that you are accustomed to. Another concern I would have is the home conditions. Homes are not sterile and babies are very susceptable to viruses and other things. Now I’m not saying that you don’t clean your house, but with a home birth one of the things you have to be concerned with is e-coli, among other things. In a hospital everything is sterilized and the baby is welcomed into that environment.
Stephen: Well doesn’t that increase the chances of the baby being exposed to a super-bug like MRSA?
OB: Super-bugs happen when doctors and nurses don’t wash their hands. We’re very diligent about that around here.
Stephen: Well I know some of the things she was concerned about was being able to move around in labor and have that bonding moment with the baby right afterwards. How likely is that?
OB: Those are all fine. You have to remember to that I’m not your typical OB. I was actually trained by and have worked with many midwives over the years both in the Indian Medical Service and when I did my residency at KMC. I don’t do routine episiotomies, if you want to labor your own way I will let you. I encourage you to have as natural a birth as possible because the more interventions you add into the mix the higher the risk of complications. However, there are just too many times I have written high risk on your chart that I cannot from a medical standpoint endorse this decision. I wish it was different for you. I wish you were a low risk pregnancy.
Stephen: And what are our chances of us actually getting you as our doctor at the birth and you being the one on call?
OB: Let’s see your due date is Sept. 13, the chance is very good. Actually, I’ll even make sure that I don’t go out of town during that time and make myself available to you guys at nights and on weekends. So I’d say your chance is about 95% that I’ll be the one attending your birth.
Stephen: Well thank you for that offer. You’ve given us a lot of information to consider. I know the midwife also tries to rule out as many things as possible ahead of time and wouldn’t take us on as candidates if it was beyond her scope of abilities.
OB: Well you see that’s what baffles me. Does this midwife you’re seeing know about your hyperthyroidism?
Me: Yes. She said she consulted with the other midwives in town and her overseeing OB and they said that it doesn’t rule me out from having a homebirth.
OB: Hmm. I just don’t understand that or agree with that assessment at all.

I measured at 33cm and the baby’s HR was 156. My TSH levels from my last blood test were normal.

I just… I don’t know where to go from here. I feel like my dream of my perfect birth story is already been ripped to shreds. I came home and cried. I left a message for our midwife to see what she has to say, but she hasn’t called me back yet. And now I’m afraid I might have put her in a sticky situation because my OB asked who her backup OB was that told her it was OK for me to have a homebirth. They work at the same practice and my OB said he was going to consult with him about his advice to my midwife.

It just feels so ruined. I wanted this so badly after 8 months of crap. I feel like I’ve been placed in this giant dichotomy of life or death though and if I go with what I really want I’m chosing death.

I also feel like the biggest dork for crying over this and being so upset. I mean I’m lucky to have made it this far in the pregnancy. I’m lucky that I’m affluent enough that I can even make a choice between these two forms of care. I can hear the responses now, “Just remember that the most important thing is the health of you and the baby.” Or maybe even a few “I told you so” things like, “Duh, Lisa anyone who’s watched you go through this pregnancy or read your blog could have told you that you were high risk and this was a crazy decision.” Or maybe a few along the lines of, “We told you not to get your heart set on an elaborate birth plan. You can’t plan birth.”

It just sucks at this point. That’s all I have to say.

Leave a comment

Filed under Pregnancy and Birth

It really is a business

I was annoyed by it at the car wash. Frustrated with it at Albertson’s.

But this is over the line.

As if the posters, stirrup covers and diaramas of the female anatomy sponsored by or advertising various forms of birth control, osteoperosis medications, STD prevention vaccines, PAP tests and fetal doppler monitor rentals at my OB’s office were not enough… now they’ve installed these HD flat panel TV screens in each “pod” with a constant stream of advertising and sporadic short “news” (I use that term very, very loosely as I have HIGH standards for what should be considered news) stories from CNN and Discovery Health. At least with the posters and other forms of advertising I could just choose not to look at it by reading a book or knitting while waiting.

Well anyway, other than that nothing really exciting to report about the visit. My labs were all normal except the anemia thing and my OB wants me to find a pediatrician before the next visit.

After this appointment I started to feel more like I want to switch to my midwife’s backup OB. Even after our last appointment it seems pretty clear that my current OB assumes I took his “warning” and I’m going to go through with a hospital birth. I don’t want to deal with the confrontation and I don’t want to lie either. Plus, he seemed annoyed that I was asking about the actual levels from my last lab results.

Leave a comment

Filed under Pregnancy and Birth