First appointments? - Page 3 « Back to Group Discussions

[nstewart]

Just came from my first appointment with my family doctor.  They did a pregnancy test and she gave me a requisition for the first trimester screen (nuchal translucensy ultrasound plus bloodwork), 18 week anatomy screen, and the routine blood work (HgC level, but not doubling time just a one time check, iron levels, cbc, screening for rubella immunity, etc.).  Lenny, perhaps these are the same tests your OBs office was talking about?  I had all these done last time as well.  I declined the earlier ultrasound for dates and to check for HB as I know what my dates are and while I believe in testing, I don't think that one is necessary.

It's interesting how many of you are going to OB practices.  I wonder if this is a US/Canada difference?  Any other Canadians?  Where I live, it is normal to go to your family doctor until 18 weeks, and they then transfer care to either a low risk maternity clinic (which is made up of MDs who just focus their practise on labour and delivery but don't have specialized training), or to an OB if you are high risk.  And midwives see you from the start.  I live in a large city too (well, by Canadian standards!), so it's not like it's due to there being no OBs in town which would be the case in a rural area. 

Anyway, I just find it interesting, and I do think it can impact care/outcomes because an OB is likely to lean more towards interventions, inductions, c-sections and the like than an MD, just on the basis of their background and training.I'm interested in other's experiences and perspectives on this.  Perhaps many just prefer an OB because they are then seeing a specialist.

[snozzberry]

Originally Posted by nstewart 

It's interesting how many of you are going to OB practices.  I wonder if this is a US/Canada difference?  Any other Canadians?  Where I live, it is normal to go to your family doctor until 18 weeks, and they then transfer care to either a low risk maternity clinic (which is made up of MDs who just focus their practise on labour and delivery but don't have specialized training), or to an OB if you are high risk.  And midwives see you from the start.  I live in a large city too (well, by Canadian standards!), so it's not like it's due to there being no OBs in town which would be the case in a rural area. 

Anyway, I just find it interesting, and I do think it can impact care/outcomes because an OB is likely to lean more towards interventions, inductions, c-sections and the like than an MD, just on the basis of their background and training.I'm interested in other's experiences and perspectives on this.  Perhaps many just prefer an OB because they are then seeing a specialist.

Yep, you hit the nail on the head! Going to an OB's office is the norm in the US, unfortunately. I'm in a relatively big city, and I know from talking to other moms in other big US cities that's the case for them too. Midwives are definitely not the norm.

[Paceman]

Originally Posted by nstewart 

Just came from my first appointment with my family doctor.  They did a pregnancy test and she gave me a requisition for the first trimester screen (nuchal translucensy ultrasound plus bloodwork), 18 week anatomy screen, and the routine blood work (HgC level, but not doubling time just a one time check, iron levels, cbc, screening for rubella immunity, etc.).  Lenny, perhaps these are the same tests your OBs office was talking about?  I had all these done last time as well.  I declined the earlier ultrasound for dates and to check for HB as I know what my dates are and while I believe in testing, I don't think that one is necessary.

It's interesting how many of you are going to OB practices.  I wonder if this is a US/Canada difference?  Any other Canadians?  Where I live, it is normal to go to your family doctor until 18 weeks, and they then transfer care to either a low risk maternity clinic (which is made up of MDs who just focus their practise on labour and delivery but don't have specialized training), or to an OB if you are high risk.  And midwives see you from the start.  I live in a large city too (well, by Canadian standards!), so it's not like it's due to there being no OBs in town which would be the case in a rural area. 

Anyway, I just find it interesting, and I do think it can impact care/outcomes because an OB is likely to lean more towards interventions, inductions, c-sections and the like than an MD, just on the basis of their background and training.I'm interested in other's experiences and perspectives on this.  Perhaps many just prefer an OB because they are then seeing a specialist.

I am in a Canadian city as well.  It is common here to have your family dr follow you until later on then refer you out.  Last pregnancy I was referred to another family dr that did deliveries instead of an ob.  This time around we have midwives in our province and so am using one.  I am happy to have this option although I love our family dr so would have also been happy with him as well. 

[tbarnett]

@Porcelina...  YES! It is wonderfully normal.  the corpus luteal cyst originates from the follicle that you ovulated from and should be visible on the ovary and present throughout the 1st trimester.  It is a good sign!  So, your right ovary was the side you ovulated from

[Mamma Mia]

Seconding tbarnett, the corpus luteum is the place in your ovary where you are making progesterone to nourish your endometrium and maintain this pregnancy, too!

[Lynann]

I don't get why its normal for OBs to care for pregnant women either and I'm in the USA, but grew up in the UK where normal prenatal care AND L&D is in the hands of midwives and only extremely high risk women ever see an OB before delivery, and only c/s births are handled by OBs too.

I've had 2 different experiences with OB care and I won't choose to ever go near one now unless I absolutely have to.

I will use a CNM again as I plan to home birth again this time. The level of care with a midwife is just not comparable to seeing an OB. Both the midwives I've previously used have become very good friends. The first was direct entry LM and since that birth ended up as a transfer for timing out after my waters broke before labor, and eventual c/s I had to find a CNM for DS2 as my LM couldn't do a 1st HBAC. I'd keep my CNM if I could but we moved too far away when DS2 was 2 months old, so now I have to find another CNM. But I'm not in any hurry as I don't plan to start prenatal visits until 12-16 weeks. I would go unassisted but DH isn't comfortable with that, so I'm happy as long as we find a CNM that will be as hands off as our last one.

[amyknits1076]

Originally Posted by Lynann 

I don't get why its normal for OBs to care for pregnant women either and I'm in the USA, but grew up in the UK where normal prenatal care AND L&D is in the hands of midwives and only extremely high risk women ever see an OB before delivery, and only c/s births are handled by OBs too.

I've had 2 different experiences with OB care and I won't choose to ever go near one now unless I absolutely have to.

I will use a CNM again as I plan to home birth again this time. The level of care with a midwife is just not comparable to seeing an OB. Both the midwives I've previously used have become very good friends. The first was direct entry LM and since that birth ended up as a transfer for timing out after my waters broke before labor, and eventual c/s I had to find a CNM for DS2 as my LM couldn't do a 1st HBAC. I'd keep my CNM if I could but we moved too far away when DS2 was 2 months old, so now I have to find another CNM. But I'm not in any hurry as I don't plan to start prenatal visits until 12-16 weeks. I would go unassisted but DH isn't comfortable with that, so I'm happy as long as we find a CNM that will be as hands off as our last one.

I have a friend that did an unassisted VBA2C and everything went great for her. But I totally get if your DH isn't comfortable with it not doing it. My DH isn't either, and I was high risk last time, so I'll be happy going to a CNM at a free standing birth center.

[BeagleMommy]

I won't be seeing my midwife until 12 weeks or so, but I can't think of a reason this shouldn't be homebirth number three. Nurse midwives don't do homebirths here. No matter, I love my midwife!

[tbarnett]

to those outside of the US questioning the involvement of OBs in our regular low risk pregnancy care... it is a cultural difference and while many OBs practice the CYA approach and are very quick to suggest interventions out of their ignorance... I have to also say something in their defense...(please no gasping)  Because OBs are the norm for handling healthy, low risk pregnancies in the US, many do go into practice with a very different approach from the OBs you are describing in your area.  For instance, most OB practices include large midwifery practices allowing their patients a choice between the approaches to birth without prejudice.  while the OBs in the practice focus their care on higher risk pregnancies or those opting for epidural and c/s birth, the midwives in the practice offer the more natural and holistic approach.  Their are many OBs, though, that have a very holistic approach many who have contributed to some of the books we natural mamas read and suggest.  

I was with a typical OB practice in my area and while I did deliver in a hospital, my OB was VERY supportive of my birth plan to have a medication and intervention free birth.  He was very supportive of my doula being present and I had also requested that my baby be "caught" by my hubby, which was exactly how it ended up.  He guided my husband and he helped me deliver our son and was very laid back letting me call the shots and just let me know if I needed him... he was just a quick call away.   Not all OBs are created equal... i know. 

Now, the US has a long way to go to get back to the basics when it comes to childbirth.  I know as a country statistically we love our interventions.  However, ... in a non-single payer system (consumer based healthcare for now), we have options from the get go as to who we can choose for our healthcare providers.  There are no restrictions as to who and how we see (unless specified by our particular type of insurance)... so if we want to see the specialist, ie our OB, from the very first appointment we can.  However, we always have the option at the same time to be cared for by a family doctor or midwife, as well.  Hope that helps make a little more sense of it.  

[BeagleMommy]

Fortunately, insurance doesn't come into play with my birth decisions at all. My insurance does not cover ANY pregnancy or birth related expenses. So we pay the real cost for whatever we choose.
That part doesn't pother me, but the fact that my insurance doesn't cover chiropractic care either does irritate me.

[Quinalla]

Haven't called the OB/GYN to schedule a first appointment yet as I just found out, will probably call next week. I won't go in until they want me in, not usually until 10 weeks IIRC, unless there is a problem. Home pregnancy tests are very accurate, I don't need them to do one in the office to confirm it for me, especially since this is the 2nd time around and I know I'm pregnant. I am looking forward to some BTDT respect this time instead of having to prove myself about certain things

And yes, OB care is the standard here in the USA. I do think it is weird too and did look for midwives that are covered under my insurance, but the closest are an hour away and that's too far for me when I was able to find an OB practice that is very chill and not intervention-happy. There will still things that were routine for my now-retired OB that I did the research on an ended up declining or having her not do, but again she was totally fine with that and was impressed with how much I knew. I have a new OB at the same practice this time around, I have no reason to think she will be much different (I'm hoping a little better on the whole IV thing as I'm not doing it this time without a reason), but I will just switch if she is. I think an OB works fine IF you are willing and able to self-educate about pregnancy and childbirth. For those that can't or won't, its blind luck with what kind of OB they may get and an OB, unlike most midwifery care, doesn't do much in the way of educating their patients about the process. Their practices just aren't set up to have that kind of one-on-one time.

[crunchybroccoli]

I have been following this thread with a lot of interest.  In my first successful pregnancy, I did not have the option of a midwife unless I was willing to do a homebirth (and the midwife would not be recognized by the state).  Because my first pregnancy ended in early m/c, I was nervous and went with my OB, with whom I had developed a relationship with over about 5 years.  He was a lovely, jolly, sweet man who could recite my birth plan from memory and always made DH and I comfortable.  I educated myself throughout pregnancy, tried to remain as low-risk as I could (although I caved to eating meat after pressure from family, friends, and docs, and gained too much weight in the 2nd and 3rd trimesters -- I don't think it's a bad thing to eat meat when pregnant, but when you start off as a pregnant vegan and end up eating meat after a few months, I think your body goes a little haywire...), and I finished a Hypnobabies course.  At 37 weeks, I was told I would be "induced" for a big baby (on the u/s screen, 11+ pound estimate).  This was after an "early" labor at 36 weeks was shut down medically by my doctor using Procardia, despite my pleas not to do so.  (I always thought that I had ovulated early and that DD was further along than the u/s suspected...hence why I am not sure if the labor was early or not.)

Fast-forward to my induction at 38 1/2 weeks, with no signs of labor (all shut down by Procardia): I go in in the evening, was told I could sleep, eat, and relax while they attempted Cervadil overnight.  As soon as I arrived I was immediately put on Pitocin, with no dinner, or sleep.  I labored into the next evening with no meds, until I was starving and exhausted.  I was also constantly being monitored and not allowed to walk around or use any of my birthing techniques (despite the baby doing beautifully).  The whole time there was a lot of pressure put on me to have a c/s, and my doctor's demeanor completely changed.  He was much more forceful and pushy, and I felt very much out of control.  After much pressure and threats about massive tearing, bleeding, etc. I caved to a c/s, mainly because my DH was really, really scared for me.  I will always regret that! 

DD is beautiful, healthy, and came out at exactly 10 pounds.  She wasn't small, but I am a tall gal and my husband is also tall.  She was skinny but loooooong.  We were very VERY fortunate to have no problems with breastfeeding, and my recovery was so quick that I was able to convince the hospital to let me go home after only 2 1/2 days.  In my mind, the fact that I recovered so quickly meant that I really didn't need any of the interventions that I was presented with, which is why I have chosen a midwife this time around.

I am not saying this to scare anyone or upset anyone, but I think who you choose for your care provider is the single most important decision you can make related to your birth.  You can educate yourself extensively, and should!, but the moment you let another person take over some of the control, you are having to put an implicit trust in that person.  Looking back, there were many warning signs that my OB was surgery-happy, and that he was just indulging me with my silly "birth plan."  But I was too trusting and too naive to see them.  Also -- educate your partner.  DH and I read a *lot* of stuff after that experience and discussed wishes and complications together.  Now he will advocate for me instead of falling victim to the hype that was created around me.

Just my two cents.    Hope this helps someone.
 

[porcelina]

Thanks, crunchy, I am sure your story will help some new mommies on here! It is so true that you really do put your care in their hands, and ultimately, doctors are looking to fix any little thing that could be wrong while midwives are assuming a healthy and normal pregnancy unless proven otherwise. Very different perspectives. I'm sorry you had to go through that, and I'm glad you have found what works best for you this time!
 

[AmandaLynnH]

I have my first appointment on the 27th for an u/s to help determine how far along I am.  Since I got knocked up on my first cycle off birth control there's two possible times I could have ovulated which puts me anywhere from 4-6 wks along.  

This is my first and I have no idea what to expect and know nothing about all the different tests and procedures and whatnot.  DH and I are both 30 and healthy.  

As luck would have it my regular women's doctor is a midwife (they were the first place that could get me in back in the day when I needed my bc prescription renewed and had new insurance) so I'll likely go with them as I'm happy with the care I've received when not pregnant.  I assume since my insurance covers their other services it would be covered for birth as well but I have no idea how billing goes.  In theory, wouldn't they be cheaper than a traditional OB doc since you're generally getting less in the way of interventions?  They contract with an OB just in case and I do have to meet her but I believe that as long as everything is moving along fine and dandy that they handle the whole shebang so they'd be billing my insurance rather than the doc, right?

All of this is super confusing and I did at one point tell DH we just couldn't have kids because I couldn't figure the insurance stuff out.

[OtherMother]

Since I know the exact date of conception, I won't need a dating u/s ... I probably won't schedule an appt until close to 12 wks. There's not really a point, since I'm not going to be doing any early testing (thought that could change.) That way if a m/c were to happen, I wouldn't have an appt to cancel  :(

Not sure where I'll be going to deliver- there is a freestanding, awesome little birth center, but it's an hour drive. Birth was less than 12 hrs after 12+ hrs of prelabor, but I think I'd have plenty of time to get there- I drove an hour w/ my first to the hospital, but left after laboring for about 12-16 hrs at home. This time I'd just grab our stuff and go at the first sign, so I'm sure I'd be fine.

For now I'll probably begin care w/ the midwife practice I used for my first pregnancy, and switch to the birth center for care after my 18/20 wk ultrasound.

Make things simple  :)

[kimble]

The other week I went to an open house at the midwife practice associated with one of my top two hospital choices, which was AWESOME. It was just a meet and greet, not a medical appointment, and there was another couple there (I went alone since DH was out of town). We talked with one of their midwives, asked her a lot of questions, and heard a lot from her about things we would not have thought to ask about. I have total respect for their approach, which tends to be hands-off, and the MW who was there definitely bends the rules a bit when it comes to "necessary" medical interventions if the mama is against them. I love her attitude and something clicked between us. Theirs is a group practice, but if she enjoys working there and gets no grief, the others must be flexible and supportive too.

The MW practice at my other hospital of choice doesn't do meet and greets or phone chats, so I scheduled my first appt there to get a feel for the way they do things. Honestly it will take a lot to impress me at this point. While their website implies a similar philosophy (pro-natural birth, minimal interventions, etc), the receptionist told me they would do an US at the first appointment. I'll be 8 weeks and plan to deny it - I was charting and have regular cycles, so we don't need to confirm a date. Seeing something bad would freak me out, and seeing something good is no insurance policy. I'd rather just do the quad test and 20 week anatomy scan and call it a day. With that in mind I'm looking forward to seeing their reaction to my requests at the visit.

We'll also be touring both birthing units to see what to expect, but I'm not sure if this will be a deciding factor. Hospital #1 with the rocking MWs is about 5 minutes from where I work and 30 min from home, and has a very good reputation in our area. Most of the mamas I work with gave birth there. Hospital #2 is 10 min from home and 20 min from work, is a smaller community hospital, but recently updated the delivery wing and I've heard good things. I don't think either will be bad, so it will come down to the practice I am most comfortable with.

Good luck to all of you as we take new steps on this journey together!
 

[Janadoe810]

I had my first appointment with my OB today.  All they really did was confirm the pregnancy, give me the paperwork for the blood tests and scheduled an ultrasound for the 28th.  My OB does not do VBACs, and since I had a c-section with my daughter, I will have another one for this baby.  I am really ok with it.  I love my OB and trust her to  know what is best.  I was 8 days overdue with my daughter when I was induced.  She must have been pretty comfortable in there, because I just never progressed past 3 cm.  My OB came in and gave us the choice, no pressure.  After discussing it with my husband we decided to go ahead and get her out.  It turns out that her cord was tied in a knot, and if we had continued to try for a vaginal birth, the knot would have tightened, cutting off her supply and it probably would have ended in an emergency c-section anyway.  In my OB's words...sometimes babies just know.  The delivery was really calm and absolutely wonderful.  I recovered quickly and wouldn't have changed it for the world.
 

[jacquelinej]

We were actually about to begin fertility treatments when we got our BFP 2 days before the fertility appointment.  So they did a urine and a vaginal U/S to make sure it was not ectopic.  We saw the sack, that was all.  Measuring 3.5 mm (small), but I am 4 weeks almost exactly so I didn't expect any more.  And then told me to come back in 2 weeks for a heartbeat check.  I would so love to forego all of these tests.  But I am not sure my anxiety will let me!  I don't have an appointment for the h/b check, so I may just skip it.  Unfortunately I am still trying to figure out how this process works in Japan.  I am regularly seeing an acupuncturist for my chronic RA pain, and she now knows I am pregnant so I suspect she will guide me in what to do next.  

If I were in the US, I would probably skip a lot of it, find a midwife with a lot of experience and stick with her.  I really do not want another c-section, would love a VBAC, but I don't know for sure what my options will be.  Seems like a birth center is the best option for me.  I was preparing myself for several months of fertility treatments so I am not prepared for this although very happy it has happened.  I was really planning that we would not get pregnant until we were closer to returning to the US.  But I'll take what I can get, which at the moment is a pregnancy!

So I have a list of research to do on birth centers in 4 different locations.  We will have to decide, at least have a plan, about where to deliver by the end of this month.

[crunchyruchie]

Thanks for chiming in, Lynann and Porcelina! I completely understand how and why having a close friend be your midwife wouldn't necessarily be a big deal. For me, I think it has to do with the person to whom she is married--my advisor! Since birth is such a primitive, right brained kind of thing, and the sphincter law is a pretty real issue, I would rather not have to think about the connections between my academic life and the process of birthing.

So, I found a really great midwife who works on a sliding scale, is around my age, and just has a perfect vibe. Dh and I couldn't feel more fortunate. I have my first "real" appointment with her planned for early October. Yay!!!

[Quinalla]

Just called and got my first appointment scheduled for October 24th at 8am. My OB will still be on maternity leave then, so it will be with a different OB in the practice, but that's fine and I'll be 9.5 weeks by then. Talked to DH and he'll be able to come, so that's cool as we'll get to hear the heartbeat! I don't drag him along for every appointment, but I like for him to get to a few as it really helps make it more real for him.