Wow talk about OB arrogance!

[TrishWSU]

I haven't really posted much here, but I am 33 weeks and have been UP this whole pregnancy. Recently I started having some symptons of Obstetric Cholestais so I want to get the blood tests done to find out if I actually have it. So I have called two OB offices to see if I can get an appointment and used the story that I have been seeing an unlicensed mw (technically true-I'm not a licensed mw ) and she thinks I need these tests. Well both offices said that their obs will not see me unless I start receiving all my care from them and plan to deliver in the hospital. Yeah freaking right, like that's going to happen! Some much for "choice" when its either their way or no way! If I don't have it there's no way in hell I'm changing my plans, and if I do the only thing it changes is I will try to induce labor around 37 weeks.

These people must really think they're hot stuff. It just reinforces so many reasons why I avoid the medical establishment in the first place!

[Naomi]

Why don't you start by telling them what they want to hear and getting the tests? If they're negative, you can fire them and go back to your original plans. If they're positive, you're going to need medical care. Cholestasis is really a big deal. I believe that it's not just a matter of inducing at 37 weeks -- I think that normally, it is treated by using steroid shots to speed lung development and then inducing preterm, at 35 weeks or so, because otherwise, the buildup of toxins will probably kill the baby. This is a really serious, extremely dangerous condition and even when the mother is being closely monitored for an early delivery, the babies still sometimes die.

A healthy pregnancy and a normal birth -- these are natural processes where the best care is to stay out of the way. But cholestasis is an actual sickness -- something going wrong, seriously wrong, with your liver. If you would seek a doctor's care for kidney failure or heart failure or lung failure (during or outside of pregnancy) you should seek a doctor's care for this.

[accountclosed3]

try a pregnancy-related free clinic (planned parenthood, etc).

and if that's not possible, like naomi said, say "yes, ok" get the tests and the results, and say "see ya!" and that's that.

what, they're going to FORCE you to continue care? they can't.

[Romana]

Originally Posted by Naomi

Why don't you start by telling them what they want to hear and getting the tests? If they're negative, you can fire them and go back to your original plans. If they're positive, you're going to need medical care. Cholestasis is really a big deal. I believe that it's not just a matter of inducing at 37 weeks -- I think that normally, it is treated by using steroid shots to speed lung development and then inducing preterm, at 35 weeks or so, because otherwise, the buildup of toxins will probably kill the baby. This is a really serious, extremely dangerous condition and even when the mother is being closely monitored for an early delivery, the babies still sometimes die.

A healthy pregnancy and a normal birth -- these are natural processes where the best care is to stay out of the way. But cholestasis is an actual sickness -- something going wrong, seriously wrong, with your liver. If you would seek a doctor's care for kidney failure or heart failure or lung failure (during or outside of pregnancy) you should seek a doctor's care for this.

Just wanted to point out that this is not necessarily the standard of care. Many pregnant women with cholestasis of pregnancy are induced at 38 weeks. I'm not sure what ACOG recommends at this time, but there are more and less conservative approaches to everything. Definitely something worth researching (out of curiosity I was doing a little research on it myself recently).

OP, I would go with zoe's rec, though I doubt you can get the testing you need or the proper analysis of the results without an OB. So I think saying "sure!" is the way to go at least until you have test results. It's definitely something I would want to know about. Good luck . . . it's unfortunate you can't just get what you need, but the OBs are concerned with liability issues (if they see you and do the test, you're a "patient" and could sue them if you wander off and then later say you were expecting care from them).

[accountclosed3]

the local PP clinic here has obs on staff. a nurse prac. does the gyn exams and the physician's assistants can do the basic intake stuff and get a script for blood work.

and if you have a problem, you can get OB care, or utilize their care with their OBs.

[pampered_mom]

Romana9+2 mentioned the ACOG guidelines. I don't know if they're of interest to you and I don't necessarily have all that much confidence in them, but perhaps it might be helpful just in an informative kind of way. You can find their guideline on it at guideline.gov. Or maybe the RCOG's guidline document would be more helpful? At the very least it would help prepare you for the OBs mindset if/when you do go in - so you'll be even better prepared if/when they start lying about the guidelines (yes, I am a bit jaded on this since it happened when I was seeing an OB when pg with ds).

I'm not surprised at their response, unfortunately, but I'd certainly second zoebird's suggestions.

[Romana]

Just want to clarify that I'm also not saying the ACOG guidelines are necessarily what you would want to do, but I think it helps if you're going to be seen by an OB that you be armed with that information. At least then you could say, "Well, the ACOG doesn't recommend induction for cholestasis of pregnancy until 37 weeks" or whatever it is. Never hurts to be informed.

ETA: Just looked at the link - now this is the RCOG - it says:

Should Women with Obstetric Cholestasis be Offered Elective Early Delivery?

B - Obstetricians should be aware that there are insufficient data to support or refute the popular practice of "early" (37 weeks of gestation) induction of labour aimed at reducing late stillbirth.

Interesting.

[khaoskat]

I had an OB's office actually tell me that unless I consented to some sort of pain relief during labor that they wouldn't take me as a patient. That they would not allow me to have a natural L&D from the get go of the last pregnancy - I quickly hung up, after saying 1) I am allergic to some of the stuff you use; 2) Epidurals don't work on me; 3) I prefer to labor and deliver w/o medication and intervention.

Good luck - could your regular family doc (if you have one) refer you. We have family docs but we maybe go to them like 1-2 times a year and they know if we are there then we have tried all the home stuff and need something more.

[amberskyfire]

When I was 12 weeks pregnant, I needed a doctor's note in order to get out of work for my extreme nausea. My OB wouldn't give me the note until I signed paperwork saying that I would receive all of my care from him and no one else and that I would deliver only at the hospital of his choice. SCREW THAT! I signed the darn note and was then given a pre-bill to sign stating that I would pay x amount out of pocket for a list of procedures and prices if he told me I needed them. Of course, the C-section was at the top of the list. I signed them, got my note, and then cancelled with him. They were really scary to me over the phone and I was sure that I would have the police knocking on my door or something the way he was treating me afterward. I ended up just telling them I had to cancel with him because I was moving out of state the next week. :nana:

[Jane]

I know of someone in a similar situation - she actually developed cholestasis and was risked out of homebirth with her midwife - but the OBs wouldn't take her b/c she was "too late" - and a few other issues. She ended up getting her blood tests from a family practice doctor. I believe she was doing tests weekly and then every 48 hours after awhile.
She carefully monitored her baby's movements, and went in for care when her baby's movements were below any normal amount for 2 days. At that point, she didn't have any trouble getting care in the ER.
I don't say this to scare you - I'm almost thinking I shouldn't have posted it, but I thought both the information about the FP doing the tests and the part about doing fetal movement "checks" was interesting.

A naturopath could also order those tests. If all else fails, the ER can too, if you want them.

[TrishWSU]

After about 2 hours on the phone I finally found a family practice doc who would see me AND take my state insurance-in a small poe-dunk town 30 minutes from me! Amazing that where I live has over 100,000 people and none of the offices here (and I called at least 15) would take the TN Medicaid-what good does that do?! But the doctor was very helpful-he didn't even ask about my prenantal care or why my MW didn't have a back-up ob or anything like that. He just asked me my symptons and ordered the blood tests plus a liver & gallbladder u/s to make sure everything was ok. And luckily it is!! I guess I just freaked out and over reacted when I started reading about the complications of cholestatis. I have spent the last 2 days researching and reading everything I could about the condition so I could make the best choices for me with the info available.

I had already told on ob office that yes I would transfer my care over, then they were like "We'll have to check if our docs will see you since you are already so far along." Um, WTF?! So I'm just SOL if I develop a complication late in pregnancy?

About a month ago I went to the person who was assigned as my PCP to get a pregnancy verification form signed and he outright refused because he hadn't been providing me prenatal care. And it was just a verification...I was like, "Well, what do you need to verify that I'm pregnant? A urine test, blood test?" and he kept going back to the reasoning of he hadn't provided me prenatal care so he can't provide pregnancy verification Then he basically kicked me out of office when I refused to give him the name of my midwife.

I know they are concerned about lawsuits. It's just so irritating and just plain sad that you can't get the tests and healthcare you need because doctors have to be worried about covering their own butts. Grrr! I'm just glad I found the MD I did, even if I do have to drive 30 minutes to see him. He was very helpful and informative about the condition, plus other things that may be causing my "symptons."

[Intertwined]

There is a major breakdown in maternity care in this country. It's sad, scary, and just wrong.

[Naomi]

I'm glad to hear it isn't cholestasis.

If it's itching that made you think cholestasis in the first place, it might be PUPPP. I maintain a website of information about PUPPP, including a long list of remedies that might give you some relief -- many of which you don't need a doctor to get. http://www.tcinternet.net/users/krit...aomi/PUPPP.htm

[SublimeBirthGirl]

They are more like insecure children, bullying people into being their "friends" because they are so unlikeable, they can't get them any other way.

[mum2conor]

Originally Posted by SublimeBirthGirl

They are more like insecure children, bullying people into being their "friends" because they are so unlikeable, they can't get them any other way.

This made me laugh!

OP I am so glad you found a great MD and that you are doing ok.

[maxmama]

Originally Posted by TrishWSU

These people must really think they're hot stuff.

No, it's not jsut that. It's that if they order tests for you, they become your provider. That is a risk for them if the ONLY contact they have is to basically do your bidding, especially when they don't know you and you are, in fact, if not actually lying to them, then not being entirely honest. Legally, it's their asses, not yours. Especially since you're asking for LFTs, which is not a "normal pregnancy" lab to request.

[SublimeBirthGirl]

Originally Posted by maxmama

No, it's not jsut that. It's that if they order tests for you, they become your provider. That is a risk for them if the ONLY contact they have is to basically do your bidding, especially when they don't know you and you are, in fact, if not actually lying to them, then not being entirely honest. Legally, it's their asses, not yours. Especially since you're asking for LFTs, which is not a "normal pregnancy" lab to request.

I believe this to be a frequently used, convenient, but untrue excuse doctors use for bullying people into doing what they want. Oh, I'm sure even the MDs believe it to be true. But adults are capable of making their own, grown-up decisions and if MDs would recognize that and treat us like adults, they would be less likely to get sued in the first place.

[pampered_mom]

*sigh* Gotta love the convenient excuses. Women deserve the right to informed choice w/out having to go through all this hagling. The state of maternity care in this country truly is abysmal!! OP - glad that you found someone who could help you and that things turned out no to be as bad as you originally suspected!

[mama in the forest]

That is a risk for them if the ONLY contact they have is to basically do your bidding, especially when they don't know you and you are, in fact, if not actually lying to them, then not being entirely honest.

Physicians put themselves at risk anytime they see or treat a patient. It's part of the job. OB issues or not, if I'm paying a doc I am asking them for their opinion and actually would expect them to "do my bidding" in the end. It's my body, my choice.

[Unoppressed MAMA Q]

Originally Posted by maxmama

No, it's not jsut that. It's that if they order tests for you, they become your provider. That is a risk for them if the ONLY contact they have is to basically do your bidding, especially when they don't know you and you are, in fact, if not actually lying to them, then not being entirely honest. Legally, it's their asses, not yours. Especially since you're asking for LFTs, which is not a "normal pregnancy" lab to request.

What you're rationalizing/excusing...in my house, we call 'medical facism'.