Confusion Has Set In And I Need Help

As many of you know, my visits to the high risk ob have been less than I assumed they would be. After Ronny called the doctors out on my perceived lack of care, we were given the information that I wanted (really just test results) and the doctors promised to be better at passing along information. I also spoke to the head nurse that works with my chronic pelvic pain doctor. We have had a pretty good relationship for the past 4 years. When I expressed my concerns with the level of care I was getting she immediately set to work. After consulting with Dr. W, and speaking with some higher ups she was able to finagle my pregnancy being co-managed by high risk ob and the nurse midwives if I wanted to.

Here is the part that has left me confused and not quite sure what to do: I am high risk for a reason. I have had multiple miscarriages, a bleeding disorder, asthma, a concave chest and spina bifida occulta. For this reason, the midwives referred me over to the high risk clinic for more monitoring and care. Aside from one extra blood test, I haven’t really felt like I am getting much “extra” care.

The entire visit is very clinical. I arrive on time or a little early, sit around for about 10 minutes, am taken to the back by a nurse where they take my weight and blood pressure and then send me to the room to wait. I usually wait about 10 minutes for someone to come in. So far I have only seen residents and have yet to see an actual licensed doctor in a white lab coat (I really want to see that happen). We spend a few minutes, 10 at most, talking about how the vomiting is going and if I have any concerns. They listen to my heart and lungs, presumably due to the asthma and chest wall issues, and then spend 30 seconds or so listening to baby’s heart on the doppler. Overall the appointment from start to finish is only about 20-25 minutes. The timing is fine, but I do not really feel like they are taking the time to explain to me what is happening in the pregnancy, or what to expect next. I have solely to rely on family pregnancies and the women online who I converse with. The other thing is that every time I tell them something that concerns me, like the chest pains I’ve been getting and the dizzy spells (to which I was told to drink more water…..fainted 2 days later), they brush it off as if it’s no big deal. If I was worried enough to bring it up to you, you better believe it might actually be something. I am notorious for not giving doctors all the details due to years of doctors calling me a liar.

I am told that the midwives take a more personal approach to the whole baby making thing. They take time to listen to your concerns and teach you about pregnancy rather than just push you through the system. I’m also told you see the same midwife each appointment rather than the “doc of the day” approach in the high risk clinic.To be honest the one midwife appointment I did have I didn’t much care for either.

I don’t know what to do. I don’t know if I have this glorified fantasy of what should be occurring in a prenatal appointment, and then feel let down when reality isn’t as good as the fantasy…..OR I’m really not getting the care that I should be. I’m reaching out to the community right now and asking for help.

Do you see an OB, midwife or high risk OB and what happens in your appointments?

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28 thoughts on “Confusion Has Set In And I Need Help

  1. This all seems pretty standard to me. I too have RPL and needed to have surgery and have medical intervention in order to have a successful pregnancy (I have hormone imbalances and a clotting issue treated with aspirin in the 1st trimester). I saw my RE for the first ten weeks and then was transferred to regular OB care. Everything has been standard since.

    As long as your asthma is under control, I doubt the pregnancy would affect you much. I have no idea about the chest or spina bifida stuff, but that might be more something your PCP should monitor, not the OB office? From what I understand, high-risk comes into play when something with either the mother or baby could severely affect the safety of either or both. Have you had any reason throughout your pregnancy so far to concern you other than the chest pain and dizziness? (If the chest pain is something you’ve had in the past, that might be why they aren’t concerned. Dizziness, unfortunately, is a symptom of pregnancy.)

    I think in general OB appointments are over-fantasized. After all the special care I had with my RE, I was thrown for a loop when my visits became 15-20 minutes, some Q&As, listen to the Doppler, measure the belly, give me a handout for that month, and see you in 4 weeks. But just because I was surprised doesn’t mean I was undertreated. I think I just wasn’t expecting it to be so casual. I don’t think it is really their responsibility to talk you through every element of the pregnancy…they are there to answer questions, tell you what’s normal or not, and make sure everything is going to plan.

    So all in all, I’m not sure if you’re expecting too much or not getting enough. If there’s literature you’ve read that says one of your conditions could affect pregnancy, then I would bring it up…but otherwise…I don’t know. 😦

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    • Thank you for your comments. The high risk ob is monitoring the asthma and other issues with my chest wall due to the fact that my lungs and heart are being squished by my uterus. If I were to have an asthma attack it could very definitely impact the baby. If I can’t breathe, baby can’t breathe. The asthma itself is being monitored by my doctor, but the ob is keeping an eye on what effects it has on the pregnancy.

      The bleeding disorder that I have is very rare and is known to cause hemorrhage during the pregnancy and delivery, which is what they are most concerned with monitoring. The chest pain is not something I have experienced in the past and is concerning as I feel as if I have a semi parked on my chest. Dizzyness may be a symptom of pregnancy, but telling me drink more water and then fainting 2 days later is a bit concerning. Perhaps if they had taken me more seriously in the first place it would not have led to where it went.

      I agree that “walking me through the pregnancy” is not what they are there for…..however I would expect for them to say at some point this is what you should and should not expect and watch out for these signs of something needing more attention.

      Thank you for your input though. Its good to hear how prenatal appointments go for others.
      \

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  2. Hi, I’ve been silently following you for awhile. I found you through somedaymama (who is a member of the family). I hope you don’t mind me commenting! Unfortunately, I’ve lost a lot of respect for the medical world. Rarely do they take you seriously until something bad actually happens. I had one nurse tell me I wasn’t having bad contractions only to check me and find I was dilated to a nine. I was upset that she wasn’t listening to me. I’m not a wimp, and I was indeed in pain (to say the least). I have had an actual midwife and had a child at home before with her because I was so sick of being treated so carelessly and non-chalantely. I’m afraid that she was the only one who has ever really tried to know me. Her visits were never shorter than an hour. It was marvelous. Even the so called midwife at the hospital I went to told me to get on pitocin, an epidural, and just hurry and have that baby. That is not a true midwife if you ask me and I’m concerned that the midwives that are in the medical field with doctors are somewhat influenced by the doctors office rather than what their name should stand for. Because of all of your health issues, obviously a home birth would not be wise, however what I would do in your situation would be to ask around and find the most compassionate doctor and midwife there is available there. Most just run pregnant woman through like a herd of cattle and lump all of our bodies into one giant “normal range of symptoms” and only pay attention when they are in the mood or when someone is indeed in deaths way, but I have found that there seems to always be a gem out there who does care and who does listen and then once you’ve found them, request to only see them so they can schedule future appointments for you according to the doctors schedule. You may not be able to see them every time, but more than you would’ve. I’ve got kaiser and they act the same way. You tend to only see who’s there, but I finally found one I liked and was able to request him for most of my appointments. It’s so dang frustrating to not be taken seriously. More than anything, trust your heart, because you know your body more than anyone. Again, I hope you don’t mind me commenting, and sorry for writing so much! It’s so great your husband spoke up for you!

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    • First and foremost: thank you for commenting and reaching out to me. I love to talk to others and am so grateful for everyone who follows me. I am so glad that you decided to comment, and I hope to get to know you better 🙂

      Also, thank you for your suggestion. This whole pregnancy thing is terrifying and it’s even more scary when there are so many things that could go wrong. Perhaps I need to advocate more for myself and be more assertive. I will definitely be writing a birth plan so that everyone’s ducks are in a row. I will certainly take your advice and request the same person every time I go in for an appointment.

      Thank you again for commenting 🙂

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      • Thank you for your kindness! And truly, with everything you’re having to worry about, one of them definitely should not be your care. I’ll be praying for you and your little one’s safety. ❤️ You are doing the right things for your baby! You’re already a great mom!

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  3. I saw a high risk OB and my appoints consisted of an ultrasound to measure my cervix, measure baby and amniotic fluids. Check baby’s heart rate.
    My OB checked my blood pressure, asked me how I was doing and if I had any questions. My weight was noted and check if I had sugar or protein in my urine. It was through for baby and cervix and typical for me.

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      • High Risk here at my hospital meant every woman had ultrasound and measurements at appointment until around 30 weeks.
        My cervix was measured as a precaution. I went into early labor w my daughter. It’s all relative as to what they look for but you should be going least biweekly and having ultrasound. What’s their protocol for high risk? How is it different w your doctor than if you weren’t HR?

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      • I have no idea to be honest. No one can seem to give me a straight answer. I would think with the high risk of hemmorage they would be a bit more proactive in scanning to make sure nothing fishy is going on (even if I’m not spotting), but they don’t seem concerned. I have the anatomy scan in 2 weeks so that’s fine, but after that I think I might request more reassurance scans.

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  4. When I was pregnant and going to my OB, they definitely took their time with me. It’s a small office with 1 Dr and 1 NP. The NP is great, and will just sit and talk to you until you’re both sure that you understand what’s happening and what to expect. The Dr sees you in a room, then takes you to his office to talk, which I love. My RE is also just as personable, and comes to get us from the waiting room himself, not a nurse. I think it totally depends on the office and Dr/Drs who work there. It’s so very hard to find a good Dr. I feel like if you don’t think you’re getting the proper care, maybe try to find another Dr, or get a second opinion? I don’t know what kind of options you have in your area, but I hope that you either start to get better results from your Drs and midwives, or find a practice that can give you the attention that you want and deserve. (I know that’s probably not overly helpful, but I just wanted to put in my 2 cents!)

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      • Maybe for your next appointment you request that a real Dr see you, not an intern or a nurse. And maybe request a different midwife as well. I truly hope things get better for you…you’ve been through so much already, you just deserve so much better!

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  5. Well, I only see Maternal Fetal Medicine every couple of months or so. It’s out of town. We drive there, check-in at the hospital, check-in at the office, and generally get taken into a room right away, although we might have to wait for the ultrasound tech. They do a 3D ultrasound. Then, the doctor comes in and does some more looking via ultrasound, looks at the photos, tells me what’s up, and asks me what questions/concerns I have. The nurse has told me about eating habits and how to look for pre-labor symptoms.

    My regular OBGYN is someone I have seen for regular check-ups for quite a long time. I have always known her to be thoughtful and thorough. If I don’t have an ultrasound, I check-in, wait a short period of time, get weighed and my urine sample is checked from protein and what-not, get taken to a room, get my blood pressure taken and a nurse talks to me, wait a little while, and the doctor comes in. The doctor has recently been measuring my stomach, listening to the baby’s heart on doppler, and asks me if I have any questions or concerns. She has been known to talk to us for a decent amount of time, but if I had no questions or concerns, she would tell us what to expect next and when to make our next appointment (i.e. next time I have the GD test).

    I don’t think either of these doctors really tell me much about the process of pregnancy except for the little bit that I shared with you. If I asked, they might give me resources. I did get a chunk of papers and such to read during my first appointment with the OBGYN that I still have including a sheet of symptoms I may have and how to deal with them (which I found helpful).

    I guess that my advice would be to ask for what you want. I, too, get a lot of information from women here in the blogosphere. I often bring it to my OB and ask her about it. I don’t know that any of this is helpful, but I’m thinking of you and hope things work out so you feel more comfortable! ❤

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  6. I am so sorry, I have no idea how you feel, but I believe I would be upset too. I sure hope you get the answers you are looking for soon.

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  7. Ok, first, let me say that I didn’t read the other comments you have received. So, I don’t know if I am reiterating something someone else said. If so, feel free to ignore me.

    I see a regular ob/gyn as I did with my daughter. My appointments are pretty much the same with this pregnancy compared to my pregnancy with my daughter. Let me do a quick outline for you:
    1. Pee in a cup then the nurse checks it for protein (and I think glucose and ketones)
    2. Weight and blood pressure
    3. The nurse then asks if I have been having any spotting/cramping/contractions (because if the answer is yes then she knows to get me a drape so I can take bottoms off because the doc will want to do a pelvic exam to check my cervix)
    4. I sit and I wait for the doc.
    5. Doc comes in and chit chats.
    6. She uses the doppler to listen to my son’s heartbeat.
    7. She measures fundal height.
    8. She then tells me if she has any concerns.

    This all takes maybe 15-20 minutes. The appointment is completely what I make it, though. If I have questions, she happily answers and discusses each with me in depth. If she is short on time and I have too many questions, she tells me to save them for next time or suggests we talk on the phone at the end of the day.

    The most important part of this appointment, though, is that I see her every single time. She was sick once so she was out and her nurse called me several hours ahead of my appointment to see if I wanted to see the nurse practitioner instead that day or if I would like to reschedule. I feel like I have gotten to know her and I have built a relationship and rapport with her. I really, really feel like this is vital to surviving the scariness of being pregnant. You have to know and trust the person supervising your care!

    Neither ob really outlined what’s up for me or what to expect without being asked to do such a thing. Start reading books (I can suggest some that are bent more to the natural birth side of things if you want) and researching and you will suddenly have a ton of questions. Once you start asking the questions, things will get to be more clear and little less scary.

    Now, with my daughter, I had a very capable and intelligent ob, but she was like a cold fish. Her bedside manner sucked. I never got to know her. I never knew whether to trust her judgement but I also didn’t know enough to know if she was deciding for unnecessary medical interventions. So, I had to trust her judgement implicitly because I didn’t do the appropriate homework.

    I would strongly suggest you switch to an ob that you can get to know and see consistently if not exclusively. Also, I have spina bifida occulta. No big deal apparently. No real risks associated with it and pregnancy. Another thing, how often were you having asthma attacks prior to pregnancy? I also have asthma, but it was very well-controlled prior to pregnancy. No issues since, thank God, even though I quit taking my daily allergy medications (Allegra and Singulair). My point is that maybe you don’t HAVE to see a high risk ob.

    Also, as for higher risk pregnancy in general I don’t have much experience. I am currently considered high risk because of my gestational diabetes. So for me that means I have to see my ob more often, get an ultrasound every 2-4 weeks, and at 32 weeks she started with nonstress tests every week. She monitors my blood glucose readings (which I take 4x daily and give to her at our appointments, with orders to call if I have more than one off day with the numbers).

    Sorry this is a book! Those are my experiences and my two cents. Best wishes to you!

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    • Thank you. The major reason I’m high risk is because of the bleeding disorder. I have a very high risk of hemmorage both during pregnancy and child birth. The asthma was pretty well under control pre-pregnancy, but with the compression of my lungs from my uterus it kind of got out of control. They mostly just want to make sure I’m getting enough oxygen to supply myself and tiny tot. I do have books and Google to steer me through but I would like the doctor to clue me in as well.

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      • Currently I only see the high risk Ob as I was passed off to them by the midwives. My pelvic pain doc pulled some strings and I can be seen by both the midwife and high risk Ob which is where the confusion lies. I don’t know what the midwife does that’s so different than high risk, or why I’m seeing high risk if I’m receiving the same level of care. Does that make sense or am I just rambling?

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      • I don’t think any of the docs I see now will be there. I think whatever doctor is on call in the actual labor and delivery ward is who will be on the case (hence the need for a birth plan now). I suppose I should find that out. Thanks for the question.

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      • Good luck to you. I would definitely get the question of who is delivering your baby nailed down because that will affect your birth plan as well. Some docs are comfortable with certain things that other docs won’t be. Best wishes!

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  8. i’ve been seeing an OB every 4 weeks since 6 weeks – my OB is the type that will pretty much ultrasound every visit, at least briefly to check on how baby looks and to listen to the heartbeat. blood pressure, urine – the usual. we chat about how i feel, he warns me about common aches/pains to expect, etc. it’s a really quick visit but i feel it’s thorough enough. i just started with the high-risk MFM doc for gestational diabetes, and he did a very thorough ultrasound check, along with going over where my blood sugars need to be to avoid complications.

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  9. I see a midwife and honestly from reading these other comments, I think the level of care is pretty standard regardless of who your provider is. My visit looks like this
    1.) Pee in a cup
    2.) Vitals
    3.) Midwife comes and reviews weight gain and symptoms with me.
    4.) Listen to the FHR on doppler for less than 1 min.
    5.) Answer any questions I have
    This would be what a routine visit looks like. No in depth breakdown of where I am in pregnancy I guess…
    However, my first visit was pretty amazing as we sat down in her office and went through what I expect from pregnancy. She loaned me a book on the Bradley method and talked to me about how to have a successful natural birth ( Because that is what I am Currently shooting for ….lol). Overall, she answers my questions very thoroughly when I have them….. She told me I need to write down more questions to bring to her!! However between being a nurse practitioner and struggling with infertility for 2 years, I feel like I already have a pretty good grasp on things;)

    What I love most about seeing the midwife is just the person aspect of things. I feel like I am going to see my aunt……..not some high and mighty MD who doesn’t want to just sit and chat with me. We talked about baby names and ideas for exercise.
    The whole visit probably takes about 30minutes.
    I love my midwife and I would never trade her in for an OB if I could help it!

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  10. I also saw a midwife, and like Melanie (poster above me) said, it seems that the mechanics of the visits are generally the same no matter where you go.

    What I think you might be lacking and is worrying you (rightfully so!) is the lack of personal attention. You see a different resident each visit. You don’t know which doctor will be there to deliver– if they will even tell you beforehand. You might end up with sort of a doctor lottery, whoever is on call.

    I just found your blog (hi!) but from what I have read so far, you seem very uncomfortable with this situation. That is not how you want to feel throughout your pregnancy, no matter if it is smooth or high risk.

    I can’t speak for being high risk, since technically my pregnancy went well with Annabelle (delivery was another story!) But if you think that there could be other options available, there’s nothing wrong with looking! You might find that you would rather stay right where you are, or you might find someone else that takes a personal interest in you.

    Even though most of our prenatal visits were probably 30 minutes on average, it was so comforting to be greeted by name by the staff and our midwife. We were all on a first name basis. We drove almost an hour to get there– this level of care was that important to me.

    I’m sure that being high risk, you’ll have to be in a hospital for delivery. Having ended up with a c-section, I will too IF we try again. That doesn’t mean that you have to feel like a number and not a person when you go. You might also look into a doula, which is someone who will be with you and advocate for you during birth. That might allow you to stay with this hospital that equipped to deal with any situation that might arise, but still you would have someone that KNOWS you and is looking out for you.

    Nice to meet you and I’d be happy to answer any questions I can from my experiences 🙂

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  11. Pingback: Update on the OB Issue | Eventual Momma

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