How long would you put off going to the doctor?

[CoBabyMaker]

We just started TTC our third.  First pregnancy I saw hospital midwives all throughout (my c/s was not planned).  Second I started to see an OB then switched to a homebirth midwife  ( I ended up transferring after pushing for a few hours due to fetal distress).  This time I am not going to try a VBAC so I will just see an OB, there are no hospital midwives in my area.  I have selected my OB and he was fine and respectful and all that at my last visit.  It's just that I can't stand doctors in general.  Their whole attitude and pushing stuff...they drive me nuts.  My pregnancies have been fine, healthy and without complication.  Given that, how far into the pregnancy would you feel comfortable putting off going to see the doctor.  I want him to know me enough to respect my requests but I don't really want to have to deal with all the medically minded stuff that comes with the doctor.  

Unless there is any cause for concern I am thinking maybe 14 or 15 weeks.  It seems long enough that I get to skip a couple appointments but early enough that I won't be viewed as neglectful.  Thoughts?

[MeepyCat]

I can totally see wanting to limit ob visits.

If I were looking at a planned c/s though, which it kind of sounds like you are, I would want to be sure my dates were solid, which means early ultrasound, between 6 and 8 weeks probably. So i'd call the ob as soon as possible, but at the initial appointment, I would discuss the idea of a reduced schedule of prenatal visit - the plan my obs and midwives were willing to go for last time I was pregnant was once every 6 weeks until 24 weeks (and then the plan got scrapped for complications, I forget what we'd agreed for the third trimester). I think you can reasonably make the case that this is not your first rodeo, and you know what to be concerned about and have heard the patient education stuff before, so as long as everything seems to be normal, there's not really a need for you to be in all that often, and you have a decent sense of what is normal, so if anything seems odd, you'll call.

[CoBabyMaker]

Going longer between visits is a good idea!  I hadn't thought of that!  Although I did try to schedule my appts as far apart as I could the first time, especially toward the end.  So if I had an appt on a Monday I would try to make the next one for a Friday.
 

[MamaBookworm]

I am pregnant with my second and I didn't see anyone until I was 16 weeks. I had a c-section with my first and will try a vaginal delivery this time, but the prior c-section didn't seem to bother them.  They said my uterus felt about the right size for my dates, so we just went with the LMP way of calculating the due date, no need for an ultrasound. I'm seeing hospital midwives, but I'll also meet their consulting OB one time just in case there are complications with my delivery this time.

I'm on a budget and have to pay out of pocket for this, and when I brought that up they said it was totally fine to come in every 5-6 weeks until 30 weeks or so, I think?

[fayebond]

Now I wish we could have been patient a little longer and waited until 15 weeks, since man did they bug us about those tests. I went in at 10 weeks for that first ultrasound, having done all th tests last time and decided they gave me nothing of value.  Its not like its my first kid, people, but no, every single nurse, OB, and secretary had to remind me about what the tests are, and ask if I want them.   I got really tired of it.  They even called to cancel my first appointment because they realized I hadn't had my bloodwork done and needed to make me an appointment for that before I could see the OB.  Blood work that the nurse couldn't even explain what it was for when I did go in, so I couldn't make even an educated decision as to which blood things I wanted done or not.  I did all the blood tests because I was tired of arguing by then, but next time, I wouldn't even do that.  (If you read some irritation with the way all this was handled, you read correctly: nothing came out of all this hassle except making that day longer and more tiring.  I get that they have to cover themselves against litigation, but its not "informed consent" when you have been trying to say no for an hour and a half and finally cave).

My first several appointments were 7 weeks apart because the hospital slipped up and forgot one of the appoinmtnets then it took forever to get back in.  My midwife is now cool with 6 weeks between appointments, and I am too.  I figure we can see each other as much as we need to or not.  Also, those last few appointments, all they really seem to add to the list is to offer to check dilation, so unless I go over 42 weeks, I don't get anything out of that addition.

[MeepyCat]

I get that it's really easy to be irritated with all this bureaucracy, and the constant appointments.

The reason I strongly in favor of a dating ultrasound in the OP's case is that her situation seems like one in which a planned c-section, possibly without trial of labor, will be on the table from the beginning. I know that TOL has some benefits to the baby, but it can also make recovery much harder, and complicate logistics for the family - if it were me in this situation, I'm not sure i'd be willing to do it.

That means that c/s will be scheduled for the best available estimate of the 39th week of pregnancy. Standard LMP dating is known to have limited accuracy - are your cycles exactly 28 days every time? What if you didn't ovulate when you thought you did? LMP dating can give you a due date that's seriously off. However, embryonic development moves pretty much in lockstep, so an ultrasound before the embryo transitions to fetus can give you a much more accurate estimate of gestational age, and hence, a better due date.

If you're planning to labor, a little uncertainty on the due date mostly means you have more NSTs, if your practitioners are into that (they're really not a bad idea for postdates, again, IMO).

If you're planning a c/s, this info can make all the difference between taking your healthy baby home right away, and spending some time in the NICU for iatrogenic prematurity, if at 39 weeks by LMP, your baby was actually more like 36 weeks. An accurate due date can also mean the difference between an uneventful surgery done by the doctor and anesthesiologist you choose, while your kids are happily ensconced with grandma; and a mad midnight scramble to get a sitter and get to the hospital so that whoever is on that night can get you into the OR as soon as possible. This is not as big a deal to me as avoiding the NICU, but having done that mad midnight scramble (by ambulance, DH had to wait for the sitter), I feel pretty strongly that it's not a thing to dismiss.

My dd spent a month in the NICU for unavoidable prematurity and the experience sucked, contributed hugely to PPD, and left us, as a family, more than slightly traumatized. I am grateful that we got a healthy daughter out of it. I will, however, always give advice that I think likely to help avoid the NICU.

[fayebond]

meepycat, that's a good point about avoiding the NICU and getting accurate datess from the US.  I think I had one too many appointments the day I responded to this.  

Cobabymaker, since you want a planned C/s, you can always go in, make an appointment, then call and rescheduale it for however far out you are cool with.  Or just don't scheduale one and wait for them to call you, by the time they do it'll be too late to get in on time probably.  If you aren't comfortable telling them you want it spread out, there's always pregnancy brain, I say.

[CoBabyMaker]

Thanks for all the replies.  You all have some good points.  It gives me somethings to think about for sure.

I am not sure how important a dating ultrasound would be for me since my cycles are very regular and I know when I ovulate.  On the other hand, I am not entirely opposed to an early ultrasound, I just don't want to get roped into 800 other stupid tests. 

I am planning a c/s in part because I don't believe that my body can actually push out a baby  (or rather the baby can't fit through my pelvis).  I don't actually have any personal concern over TOL.  Out hospital  doesn't allow VBACs so I would have to plan a homebirth (again) and since I don't have faith in my body I just can't go there emotionally.  Honestly, if our hospital allowed VBACs I would totally try, I just can't go through the whole trying/not happening/transferring thing again emotionally, physically or financially. 

On the other hand, while I find some of the things annoying I don't think they are all terribly harmful. 

I do like that at least this time I can request that things be done a certain way ahead of time.  The past two times have been emergency C/S so it was all a little crazy.  I don't really want to jeopardize that either. 

Soo, I guess I have some more thinking to do.
 

[suchende]

I did my prenatal visits on a modified schedule (fewer visits with more time between) per negotiations with my OB. The nurses and schedulers were having none of it but my OB was great about it. Good luck!