need help in deciding when to start seeing my OB, and need some pointers

[CherryBombMama]

is that what its called - OB? or do i say Dr? i get so confused with those titles. anyways, im 16 weeks pregnant, third baby, my only choice is a Kaiser birth, i dream of a home birth, but it isnt an option so im stuck with Kaiser. first birth, i did everything they asked, got induced, had a fairly ok birth. second birth i had a wonderful natural labor, but a horrible, traumatic birth due to the horrible doctor/nursing staff. 

i am basically terrified of going to the doctor and i want to keep it at a minimum. i dont want to get an ultrasound, it always hurts and i want to avoid the pain. when can they hear the heartbeat from that handheld thing? what if they try to say that the hand held thing is not sufficient or whatever? i dont want to go to the doctor too early, but i dont want to wait too long. 

this is my last baby. i dont want people touching me. i dont want any vaginal exams. i feel like im going to have to fight tooth and nail for this. im so scarred from the doctor refusing to listen to me about the pain he was causing, i have flashbacks! 

if you are familiar with kaiser, or even if youre not, can you please help me with a dialog. how can i tell them/explain to them that i dont want ultrasounds/vaginal exams? i need to be assertive. 

i know there are lots of outspoken mamas on here, PLEASE help me :)

[1love4ever]

As a patient you have the right to refuse any medical treatment that you choose.  You are paying them for their services, remember that.  I dont know what Kaiser birth is.  Have you considered an unassisted childbirth?  Why is home birth not an option?

The handheld thing that they listen to the heartbeat with is called a Dopplar.  I dont see why they would say it is not good enough to hear the heartbeat.  And an ultrasound should not hurt, it should be the same thing as the Dopplar.   Just go and interview different doctors (an OB is an obstetrician, specifically trained for childbirth.  There are also family practice Drs who are trained in childbirth, I prefer family practice because IME they tend to be less intervention happy), ask about their practices, tell them what you want and ask how they feel about it.  Find one that believes in a womans bodys ability to give birth without interventions, and find one who will listen to you and respect you.  Usually a Dr wants to see you before you are 13 weeks pregnant, so you should probably start looking for someone.  I also spaced out my appts with my Dr, I only went in ever 6 weeks and then every 3, then every week for the last 3 weeks.  I also asked not to be checked for dilation at some of my last appts.  they probaby will want to do a pap at the beginning of your pregnancy unless you've had a fairly recent one, but again thats up to you.

[CherryBombMama]

im sorry, i should have been more specific. when i say Kaiser, i mean like Kaiser Permanente, the insurance/hospital. They are great when it comes to needed urgent care and other specialty things, but for pregnancy, the only option is their hospital. and whoever my care provider would be, there is only 15% chance they will be there at the birth, they go by a schedule. ive asked. the one by my house does have maybe two midwives but they are not allowed to accept patients, they either fill in for the doctors or are one of the random people on the delivery rotation list. 

as far as ultrasounds, the pressure has always hurt me. its like they want to dig in to get a good look. 

i have considered unassisted childbirth, i tried it with my 2nd ds and it made my dh and family very uncomfortable. my very long labor was stressing everyone out, which stressed me out, which is why i decided to go to the hospital. i couldnt block out everyones stress. 

home birth is not an option because the cheapest i have seen is $4400 and i would be wary to go with the "cheapest" option because the average seemed to be 5-6 thousand. this baby was very unplanned, and the 4400 option wanted the money before week 38, which is completely out of reach for us.

im just scared the hospital wont listen to me. does anyone know if the HAVE to do vaginal exams? i dont want them. when i go to the doctors, its this HUGE building with a million people moving about. i feel so lost and little. its not like i can go to a smaller, more personal Kaiser, they are all huge!

Originally Posted by 1love4ever 

As a patient you have the right to refuse any medical treatment that you choose.  You are paying them for their services, remember that.  I dont know what Kaiser birth is.  Have you considered an unassisted childbirth?  Why is home birth not an option?

The handheld thing that they listen to the heartbeat with is called a Dopplar.  I dont see why they would say it is not good enough to hear the heartbeat.  And an ultrasound should not hurt, it should be the same thing as the Dopplar.   Just go and interview different doctors (an OB is an obstetrician, specifically trained for childbirth.  There are also family practice Drs who are trained in childbirth, I prefer family practice because IME they tend to be less intervention happy), ask about their practices, tell them what you want and ask how they feel about it.  Find one that believes in a womans bodys ability to give birth without interventions, and find one who will listen to you and respect you.  Usually a Dr wants to see you before you are 13 weeks pregnant, so you should probably start looking for someone.  I also spaced out my appts with my Dr, I only went in ever 6 weeks and then every 3, then every week for the last 3 weeks.  I also asked not to be checked for dilation at some of my last appts.  they probaby will want to do a pap at the beginning of your pregnancy unless you've had a fairly recent one, but again thats up to you.

[cameragirl]

I feel you on the Kaiser birth situation. Until recently, they packed four women per recovery room at one of the local Kaiser hospitals. My sister checked out less than 24 hours after a c-section because it was so crowded that she was only getting meds every 9 hours or so, and she couldn't sleep at all with the noise.

How are the facilities in your area? They are more accommodating and willing to deal with natural births at the newer facilities. As far as prenatal care, I would go through the list of available doctors and pick the best one. Some of their care providers are great, some not so much. I don't see any issue with no vaginal checks, especially during prenatal care. There isn't much use for them except in very specific cases. Just be honest and tell them that you don't want the vaginal exams because ________. At this point it would be an external ultrasound, but if you are really against them, I would explain that as well. If the doctor scoffs, I would schedule the next appointment with someone else. I know it sucks. I had Kaiser for most of my life, and didn't particularly like it. You need to stand up for yourself, and keep telling them NO if you don't want a procedure. They'll eventually stop asking.

[tnrose]

If you don't want vaginal exams, or ultrasounds, etc., just tell them no - repeatedly.  If it's easier for you, you could make up something, like that you can't emotionally handle a stranger touching you so personally?  Or it's against your religious standards (no matter what, I don't think they can refute you spiritual beliefs)?  I have a really great OB, but the nurses on the other hand are ridiculous - I refused my last internal exam - had to tell two nurses 4 times "no."  And when the doc finally came in, he was fine with it.  I have a hard time arguing with people like that, seems like you might be the same way, but as long as your insurance isn't going to drop you due to refusing something in particular (you can call them and ask to be sure), you have nothing to worry about.

I'm not familiar with Kaiser, but in general, you don't have to explain yourself - just refuse anything you're not comfortable with.  Tell them you will sign a waiver if needed.  Threaten them with a lawyer if they try to force something on you against your wishes - medical establishments DO NOT want to deal with a lawsuit.  Eventually, they will stop asking.  If they get the feeling you're not going to budge, they will be less likely to pester you.  If they feel like they can talk you into it, they will try thier best, so stand strong.  Be rude (I always feel like I end up having to be rude, but I feel like THEY are being rude pushing things on me I don't want) - you'll likely never see these people again after this, so don't worry about making a bad impression of yourself - pregnant women are hormonal anyway, so they should be used to it lol  If you have a very outspoken friend or someone who will stick up for you, bring them to your appts with you to give you the extra courage.

Good luck!

[Just1More]

I find that stall tactics work great in those situations.  Since it's likely you'll be seeing someone else the next appoinment anyway, just say things like, "Interesting.  Could you tell me more about that procedure and why it's necessary?"  "Great, thank you for your time explaining that.  Let's table that until my next appointment while I think it over."  It is possible to sound agreeable and reasonable; you don't have to go in guns blazing.

Then, the next appointment, when it comes up again, say, "My dh and I discussed it, and we'd just be more comfortable waiting until x weeks to do that (or not at all).  What else do you have for me today?"  If they back to it, just say, "I appreciate your concern, but I've made my decision."

And...if you really start having issues, just skip appointments.  :)  I did that with my first one at 39 weeks because I knew that they would want to induce right at 40, AND I knew they had my dates wrong.  So, I just didn't go.  They were arguing and mad at each other in the hallway about "How that woman got past 40 weeks."  Then they came in wanting to push me, and so I said, "Well, let's just wait another week and go from there."  And she consented.  Whew. 

You CAN do this. :)

[llwr]

Are they the only place you can go with your insurance?  Any possibility of switching insurance?  If it's through a workplace you might have some options and an open season or life-changing event reason to change. 

Actually, my first baby was born in a military hospital, so I guess I was in the same type of situation.  They didn't even have the same staff for prenatals and for delivery.  It was the biggest relief to find a midwife I loved for my 2nd. 

I know you said you've researched the cost of a home birth.  I wonder what your out of pocket cost would be with the current situation.  Is it something like $5k vs $0, or is the difference less?

Do you think a doula would help you during labor?  You may be able to find someone in training that wouldn't be so expensive. 

[cameragirl]

Kaiser won't pay anything for outside midwife care, but a doula might be a good idea for the birth. It would allow you someone constant that you know, and she would be able to help you stand up for what you're looking for in the birth.

[ameliabedelia]

If I am reading your post right, OP..you are most concerned about vaginal ultrasounds and vaginal exams.  I believe they only do vaginal ultrasounds in early pregnancy...by 12 weeks, usually you can hear the heartbeat on the doppler and I think from 2nd trimester on, all ultrasounds are done on the abdomen.  Personally, (unless you have a history of m/c or low progesterone or blood clotting issues or other health issue). , I would wait until the 2nd trimester to see the OB (which would put you past the time of vaginal u/s).   I think the main reason for the early pregnancy u/s is to check dates or if there is a concern about m/c (ie spotting or bleeding).

Then you would just have the vaginal exams in later pregnancy to contend with and I think everyone else gave good advice on that.

[hildare]

i've not had a vaginal exam ultrasound with either pregnancy, and i have EARLY ultrasounds b/c of a previous ectopic. 

i've always seen the ob by 6 - 7 weeks for a non-vaginal u/s.  i've also declined vaginal exams until after 38 weeks so i would know what was happening.

and fwiw, you can absolutely refuse anything you like.  it's YOUR health care.  you are paying for it (or your employer/dh's employer, etc) so you are the one to decide what you will test for and what not to test for.

[CherryBombMama]

Originally Posted by cameragirl 

I feel you on the Kaiser birth situation. Until recently, they packed four women per recovery room at one of the local Kaiser hospitals. My sister checked out less than 24 hours after a c-section because it was so crowded that she was only getting meds every 9 hours or so, and she couldn't sleep at all with the noise.
How are the facilities in your area? They are more accommodating and willing to deal with natural births at the newer facilities. As far as prenatal care, I would go through the list of available doctors and pick the best one. Some of their care providers are great, some not so much. I don't see any issue with no vaginal checks, especially during prenatal care. There isn't much use for them except in very specific cases. Just be honest and tell them that you don't want the vaginal exams because ________. At this point it would be an external ultrasound, but if you are really against them, I would explain that as well. If the doctor scoffs, I would schedule the next appointment with someone else. I know it sucks. I had Kaiser for most of my life, and didn't particularly like it. You need to stand up for yourself, and keep telling them NO if you don't want a procedure. They'll eventually stop asking.

eek! really?! im glad i missed that! quick question - how did your sister check out early? they were ok with it?! last time they told me it was mandatory to stay 2 days, and i was ready to leave asap.

the kaiser hospitals in my area are much newer, the one of the older ones is right by my house but is overcrowded and not accepting new patients. that might be a good thing if the newer ones are more lenient.

Originally Posted by tnrose 

If you don't want vaginal exams, or ultrasounds, etc., just tell them no - repeatedly.  If it's easier for you, you could make up something, like that you can't emotionally handle a stranger touching you so personally?  

to tell you the truth, thats one major reason i dont want vaginal exams. you just gave me the exact sentence that i needed to find, thank you! i really CANT emotionally handle a stranger touching me so personally after such a traumatic last birth. thats exactly the truth. 

Originally Posted by Just1More 

I find that stall tactics work great in those situations.  Since it's likely you'll be seeing someone else the next appoinment anyway, just say things like, "Interesting.  Could you tell me more about that procedure and why it's necessary?"  "Great, thank you for your time explaining that.  Let's table that until my next appointment while I think it over."  It is possible to sound agreeable and reasonable; you don't have to go in guns blazing.

Then, the next appointment, when it comes up again, say, "My dh and I discussed it, and we'd just be more comfortable waiting until x weeks to do that (or not at all).  What else do you have for me today?"  If they back to it, just say, "I appreciate your concern, but I've made my decision."

And...if you really start having issues, just skip appointments.  :)  I did that with my first one at 39 weeks because I knew that they would want to induce right at 40, AND I knew they had my dates wrong.  So, I just didn't go.  They were arguing and mad at each other in the hallway about "How that woman got past 40 weeks."  Then they came in wanting to push me, and so I said, "Well, let's just wait another week and go from there."  And she consented.  Whew. 

You CAN do this. :)

i will remember these! thank you

and thank you for saying that i can do this. i think im just really needing some support. my dh really tries, but does not understand how the last birth affected me so much. other family members just roll their eyes :\

im glad you were able to birth on your own time :)

Originally Posted by llwr 

Are they the only place you can go with your insurance?  Any possibility of switching insurance?  If it's through a workplace you might have some options and an open season or life-changing event reason to change. 

Actually, my first baby was born in a military hospital, so I guess I was in the same type of situation.  They didn't even have the same staff for prenatals and for delivery.  It was the biggest relief to find a midwife I loved for my 2nd. 

I know you said you've researched the cost of a home birth.  I wonder what your out of pocket cost would be with the current situation.  Is it something like $5k vs $0, or is the difference less?

Do you think a doula would help you during labor?  You may be able to find someone in training that wouldn't be so expensive. 

This is my absolute only choice. pretty much set in stone. i have Pacificare as my other insurance option (through my dhs union) but the rules are we are only allowed to switch insurances once a year, and we just switched back to kaiser after having Pacificare =\ bah! ive called and asked if i can switch, it was a "birth emergency!!!" (my own words lol) and they said no.

any midwife fee would be 100% out of pocket for us. im actually meeting a doula tomorrow! and she is in training, so its WAY less. this is as much as we can spare

Originally Posted by hildare 

i've not had a vaginal exam ultrasound with either pregnancy, and i have EARLY ultrasounds b/c of a previous ectopic. 

i've always seen the ob by 6 - 7 weeks for a non-vaginal u/s.  i've also declined vaginal exams until after 38 weeks so i would know what was happening.

and fwiw, you can absolutely refuse anything you like.  it's YOUR health care.  you are paying for it (or your employer/dh's employer, etc) so you are the one to decide what you will test for and what not to test for.

you are so right! i need to remember this

[CherryBombMama]

Originally Posted by ameliabedelia 

If I am reading your post right, OP..you are most concerned about vaginal ultrasounds and vaginal exams.  I believe they only do vaginal ultrasounds in early pregnancy...by 12 weeks, usually you can hear the heartbeat on the doppler and I think from 2nd trimester on, all ultrasounds are done on the abdomen.  Personally, (unless you have a history of m/c or low progesterone or blood clotting issues or other health issue). , I would wait until the 2nd trimester to see the OB (which would put you past the time of vaginal u/s).   I think the main reason for the early pregnancy u/s is to check dates or if there is a concern about m/c (ie spotting or bleeding).

Then you would just have the vaginal exams in later pregnancy to contend with and I think everyone else gave good advice on that.

yes, and i just entered the 2nd trimester so i need to call up and make an appointment. i only have had completely normal pregnancies, no m/c, no anything really. 

i had vaginal ultrasounds with both my pregnancies so im glad that wont be a factor in this one, if im so far along already. im still wary of an abdomen ultrasound too.  but, its not so much because of the lack of research done on them, its more of me not wanting to be touched beyond what is minimally necessary (is that correct english? haha! it doesnt sound right to me but its not being spell checked, at least its spelled right so im leaving it there :D )

again, thanks everyone. im feeling a little more confident 

[cameragirl]

@ OP - My sister checked out against medical advice. Her OB was fine with it, especially since they weren't managing her pain. She healed better once she got home and got pain killers back into her system.

[zinemama]

My Kaiser hospital/clinic had a great group of nurse-midwives, who I saw throughout my pregnancies. (I could have chosen an OB, too). I had a great experience with them during my pregnancy, especially my primary midwife, who was wonderful. During labor the midwives and nurses followed my birth plan to the letter. Didn't mention drugs, I labored in a tub, in the shower, etc. The hospital was certified "baby friendly" and never questioned my not circing or declining Hep B, and staff was totally supportive of breastfeeding. You may be stressing yourself unnecessarily.

Personally, I would ask around about who's the best OB or midwife in the group, go with that person and be very honest about your past and what you want from this birth.