Can my OB refuse to take me on as a patient?

[Belia]

My caregivers during my last (only) pregnancy was an OB / MW group that I joined at 34 weeks (due to circumstances beyond my control).  I gave birth at 36 weeks.  It was a horrible pregnancy- I had hyperemesis and lost 35 pounds, plus I developed a blood clot at 9 weeks and had to be on injectable bloodthinners for the duration of the pg.

DH and I may try to become pg again this fall.  My hematologist has said that in his opinion, I should start the injectable bloodthinners again the minute I find out that I am pg. While I think that the main reason the blood clot formed was because I was dehydrated and immobile from being so sick, the hematologist said that I do have one, possible two, genetic markers that indicate a clotting problem.

Here's the thing, though.  I have already decided that I will NOT do the bloodthinners if I get pregnant again.  (If I develop another blood clot, then I won't have a choice.  I will have to do the injections or terminate.)  But I will NOT take the bloodthinners for purely preventative reasons.

Can my OB/MW practice refuse to take me on for a second pregnancy if I make this choice????

Thanks for reading all this.

[AlexisT]

An OB is under no obligation to take on any patient. There are rules about firing patients (notice times, access to other care) but they don't have to take you on, no. You'd have to find out what your OB thinks.

[scottishmommy]

Why don't you want to take the blood thinners? Are there specific side effects that are particularly troublesome? Could you talk to your hemotologist about possibly taking aspirin instead unless something happens?

[annettemarie]

Yes, they can refuse to take you on if they consider you to be too high risk/outside their area of expertise. A lot of moms who had the same heart issue as me and choose to go on to have another baby have reported having trouble finding an ob who will take them as patients.

[Lisa1970]

If you have genetic markers not sure which one, and you refuse to take any blood thinners, the blood clot might be found only after the baby dies. You should research whatever findings he had before making the final decision on using blood thinners. I am bothered he said one, maybe 2...because if he had really run blood tests for this, he would know if you have 1 or two. So I would wonder if he is just making a guess. You can ask your OB to run tests for this to find out for sure.

[kwilki8]

Do you know what markers your hematologist was referring to? If you need to have any testing redone it should be before you are pregnant because some of the tests are inaccurate during pregnancy. I would expect an ob to be reluctant to work with someone with a clotting disorder who refuses bloodthinners, because clots can be so dangerous and unpredictable. It may be helpful to look at why you object to the medication--if your concerns are with management of your pregnancy/birth, you might be able to work out compromises that would be acceptable to both you and your doctor. I know that pregnancy and birth with Lovenox can really stink (I've been through two), but to me it was much better than the risk of having another baby develop IUGR (and I know I was lucky it was only that bad) because of clots in the placenta.