RE wants to do pevic exam- I'm 4 weeks pg. Huh?

[Katielady]

Background: I'm a doula and like to keep things as natural as possible. I also have PCOS and have been seeing an RE to try to conceive my second child. I got a positive pregnancy test this morning. I called them, thinking they'd want to do bloodwork. They do, but they also said to come in for "an exam." I said, "He does ultrasounds this early in pregnancy?" and she said, "No, just an exam. He probably wouldn't do an ultrasound til a few weeks from now."

"I'm sorry, I'm confused. What is the purpose of doing a pelvic exam at this stage?"

"Just to see if everything's OK."

I stalled and told her I need to see if I can line up childcare, which is also true. But I just feel like this is unecessary. Can any midwives or other professionals out there tell me what he might be looking for? This guy likes to do a LOT of tests, which has been hard on me. My cynical side wonders if he just wants to make some extra cash.

I'm thinking of refusing the exam, which makes me so nervous! Which is funny because as a doula I'm always encouraging my clients to feel like it's their body, their pregnancy, and their decision. Easier said than done!

Anyway, any insights would be helpful. I hate vague answers like "just to see if everything's OK." Stay away from my cervix unless you have something concrete you're looking for!

[JunipersMom]

Just tell him that you arent comfortable with a pelvic seeing as though you worked this hard to get pregnant you dont want to take any chances. He will probably be fine with it. FIRST thing I would do is not undress for your appointment, that way it will be clear that you are not comfortable and will not be having a pelvic. If he has a problem with it, then you can decide if you want to leave right then or undress and let him do it.
Just remember you dont owe him anything and it is still your body and your baby, even if you needed help getting to this point. Stay strong momma and trust your intuition.

[MidwifeErika]

Congrats on the pregnancy!

Often they do pelvics just because they do. Sometimes women are coming into care with no papsmear on file, no std tests, etc. So, some doctors choose to make that the first appointment to make sure they have test results for each and every person on file that are current. Also, they might be looking for signs of pregnancy and trying to get sort of a baseline exam to guestimate size of uterus and such to back up dating results that will come from an ultrasound and that sort of thing. You can always ask the doc exactly what it is that he is looking for and then decide based on his answer if you agree or not.

[3daughters]

I was told that the initial pelvic was to make sure that the cervix is closed.

[gretasmommy]

Nah. The pelvic is basically because they have you there, and it's an opportunity to do the routine stuff.

I declined the first trimester exam, and told our MW that I really didn't see the need (I have had them in the past 2 years) and that I honestly couldn't handle any spotting, emotionally. She was understanding, and said we would do one at our 6 wk PP check and not think about it again until then.

It's fine to decline it - you are not putting yourself or the babe at risk by doing so.

Congratulations!

[Katielady]

Thanks, everyone. I went to my local lab for bloodwork. When I call the RE's office this afternoon to get the results, I'm going to talk to them some more about the pelvic. I just don't feel like it's necessary and I don't like the idea of it. It's tough dealing with doc's fragile egos, so I'll just keep it to "I don't feel comfortable with that" if I decide to refuse it.

Originally Posted by JunipersMom

Just remember you dont owe him anything and it is still your body and your baby, even if you needed help getting to this point. Stay strong momma and trust your intuition.

This is exactly how I feel! Thank you for putting it into words so well. One of the things I hate about going to REs (which I did for my son as well) is that they act it's like it's their pregnancy. I have a hard time not buying into that and just submitting to whatever they want to do....I mean I've already submitted to a million tests, drugs, transvaginal ultrasounds...what's one more speculum? But it's good to remind myself that I do have a choice every time. Anyway, thanks.

I just hope this pregnancy sticks, so that I can switch to my home birth midwife as soon as possible and start working with someone who understands me. St Patty's day luck --->

[ZoeyZoo]

Originally Posted by 3daughters

I was told that the initial pelvic was to make sure that the cervix is closed.

This is what my MW told me. Many OBs/MWs like to do a pap smear on the initial exam too.

I declined the initial exam without any issues. I told my MW I would check my own cervix and report back the results if she was worried about it being closed.

[Katielady]

Update: I got my beta results (45, not so great, but hopefully it will double nicely). So I spoke with the doc over the phone and asked him why he wants to do a pelvic exam. He said, "We like to do an initial exam, and then we have you come in every week for a pelvic exam and an ultrasound until you reach 10 weeks." I asked what they're checking for, and he said, "Just to see if everything is OK, that there aren't any large cysts or unusual masses." I explained that I'm uncomfortable having a pelvic exam and getting my cervix messed with at this fragile stage in pregnancy. He suggested I could come in for an ultrasound instead. Great.

This whole thing just sounds fishy to me. He basically told me they do these weekly exams because that's what they do. (like, "Because I said so!") I don't know if he's overly meticulous, or if this is a way to generate extra money for his business, but the whole thing just seems excessive to me. At my last RE, when I got pregnant with my son I came in for a few ultrasound appointments until they found a fetal heartbeat and then he graduated me to an OB- done.

DH, who is great to talk to when you want advice about not letting someone push you around, thinks I should just blow him off. Either make appointments and then cancel them, or just tell them I can't come in because it's too difficult to get childcare or whatever, and make an appointment later for when I want to come in. I want to be assertive and just tell them flat out that I'm uncomfortable with such aggressive monitoring. I mean, what is it going to accomplish? I'm not going to develop a massive cyst in the space of a few weeks. And if he sees something that indicates impending miscarriage, what is he going to do about it? He can't make the embryo stay in there if it's not meant to be. A couple of y'all have mentioned checking to see if the cervix is open- to me it's like, "OK, so what if it is?" And as someone said, I can always check it myself.

Anyway, what I'd like is to go in for one or two ultrasounds until they find a fetal heartbeat, and then switch to my midwife from there. I'm just not sure how to get them to agree to that. I'm worried I'll tick him off and then if I need further fertility treatments down the line, he won't treat me.

I'm so upset. I feel really out of control, like I've gotten onto this fertility train and I can't get off.

[DoulaAlicia]

Katie,

I think you are complicating this. You KNOW what is right here. You don't want this mans hands all over you right now unless there is a good medical reason. And he has admitted there's not much of one. Do you have history of large cysts? I may have missed that. If not what is the good reason? And you've said that you know that if miscarriage is pending that there isn't much to do about it. I know you want to confirm heartbeat and get the ultrasounds. But trust your body here. If you are still pregnant in a few weeks go see your midwife and get along with this pregnancy in a peaceful way.

All my best,

Alicia

[Jane]

Have you seen the movie "Knocked Up"? How she keeps trying to find a good OB and they all do pelvics? Your guy reminds me of that.

Can your homebirth midwife order ultrasounds? If so, switch now! She can order the viability ultrasound you want.

[MamaVolpe]

My MW did a pelvic exam for my first check up, mostly to measure the size of my pelvic bones and to check if my tailbone was fused or not. (their was a possibility of that) I have not had a pelvic exam since. I think she just wanted it as a baseline. Once the relaxin kicks in your measurements won't give you an accurate before baseline. I did not have any spotting, she just felt up, down and side to side to see where everything was located. Everything else was measured from the outside, ie uterus size etc...

[JessicaE]

Alicia, I believe the cyst check would be because she used technology to conceive. That does increase her risk of large ovarian cysts.

Katie, your beta results are just fine! I will send you doubling vibes. I think that your instincts are spot on here. I understand how hard it is to be on the assisted reproductive technology train... But you CAN get off. Both my babies were conceived by IVF. My advocacy started with refusing certain procedures during my ART cycles if I thought they were unnecessary. I just got bolder as I went, lol. Anyhow, my RE doesn't routinely do a pelvic exam after a positive beta. My first appointment both times was at 6w, for an ultrasound, during which they checked for cysts. Between 4w and 6w I was on "pelvic rest," (no sex, no heavy exercising, no heavy lifting) because of the possibility of cysts, but that was it. I'm not sure if you did IVF or something "lighter," but there's nothing like an IVF cycle to weigh those ovaries down and heighten the risk of cysts.

I think you're on solid ground to say no to the pelvic exam, especially if that's what your instincts are telling you. Tune in, mama.

[Katielady]

More background: I have PCOS, and conceived on metformin and clomid. No superovulation or IUI or anything; just took some pills, did fertility charting, went on a PCOS diet, and did the deed. I've never had a large cyst or any other complications, just the usual small PCOS cysts. Had a totally normal healthy pregnancy with DS.

Anyway, here's my update!

I talked to my regular midwife yesterday and it was so great because we are completely on the same page about this. I told her everything he wanted to do and she was like, "But if he sees something that indicates you might miscarry, there's nothing he can do about it," and I was all, "I KNOW!" I love her, it's like talking to a friend.

She agreed that it seems like this is just his standard protocol and not necessarily appropriate for me, especially given that I don't want it. She said she'd be happy to take over my care whenever I'm ready. Her practice does an initial pelvic and pap smear, and then that's it until it's time to start listening with a doppler. She said she could order other tests (like an US to see heartbeat) if I want them, but I said I probably wouldn't. If I work with her I'm OK with the pelvic to check my uterus (since it's one time, and not every week!) but I will refuse the pap smear- I've never had an abnormal one, and I had one less than a year ago. But I'll probably switch to a homebirth midwife- my well-care midwife catches babies at a hospital, and while it has a great rep, it's pretty restrictive on VBACs. If I want my VBAC I think my best bet is at home.

So I called the RE's office and told the receptionist that I was cancelling my appointment. She asked when I'd like to reschedule it for, and I said I'm switching care to my midwife and don't need another appointment. Aghast, she asked, "Did you talk to the DOCTOR about this???"

"No," I said, "But I'm just more comfortable with the midwifery model of care. I don't want all the tests. Please tell him there are no hard feelings- I'm just ready to move on sooner rather than later."

She asked for my cell number so the doc could call me. But then she called a few hours later to say she'd spoken with him, and that he said good luck and to "let them know when I deliver." I think I'll send them a picture of me giving birth in my bedroom, they'll all faint.

SO...thanks so much for all the support and advice, ladies. This has been really emotional for me. I think I am more resentful and conflicted about having seen a doctor to help me conceive, and this thing brought all that out. I feel so much better having taken matters back into my own hands, and just letting nature take its course. I hope this pregnancy sticks; if not, I might try something different next time. My PCOS is mild and my nutritionist said she's gotten people's cycles back with diet alone.

Anyway, thanks again everyone.

[Charmie981]

Originally Posted by Katielady

But then she called a few hours later to say she'd spoken with him, and that he said good luck and to "let them know when I deliver." I think I'll send them a picture of me giving birth in my bedroom, they'll all faint.

AWESOME! I love it. It seems that when push comes to shove, he knows he provides different care than you're wanting and he's okay with it, but wants to know that you do get a healthy baby out of it. And I'd totally send a "born at home" birth announcement!

[WeasleyMum]

Nice reaction from your doctor! So many OBs seem to think that there's no other true option besides them, and that if you leave their care you're asking for trouble. I like the implied assumption that you'll be fine either way-- "when you deliver".

[Katielady]

Yes, I was pleasantly surprised at his reaction. I thought it was really respectful and positive. Next time I won't be so nervous to speak up for myself.

[mommydancer]

I think you did a great job feeling out your own reaction and figuring out what was the right thing to do. It is possible that because this doc deals with fragile pregnancies, he thinks close monitoring gives them the opportunity to catch something going wrong as quick as possible. That does not, as you mentioned, give the chance to "do " anything about it, but it does provide a chance to gather info...clues that could help figure out what happened and when, which might be useful for some moms' situations. That being said, I thought your refusing was totally appropriate, and I loved that you were straight with the nurse about why. (The nurses are sometimes much less respectful than the doctors, I've found. What IS that about?) If we stand up for ourselves and communicate, then medical folks will catch on sooner that we aren't all going to be sheep for them.

You're doing your thing, momma, and it's beautiful! Wishing you good vibes!

[Belia]

Originally Posted by Katielady

Yes, I was pleasantly surprised at his reaction. I thought it was really respectful and positive. Next time I won't be so nervous to speak up for myself.

That's exactly what I was thinking! Way to go, mama!

[Katielady]

Update

I thought I'd post a brief update, since y'all were so helpful in making that decision about my R.E.

I found a home birth midwife who I'm very happy with. If all goes well this will be an HBAC for me. I feel like the choice not to go in for what I felt was unnecessary testing with my R.E. was an important first step towards a successful VBAC for me. It made me feel so empowered. So far I haven't had any testing aside from the initial bloodwork. I'm seeing the midwife when I'm about 12 weeks to hear the heartbeat and check everything out. I feel so at peace about all of this. It's so different from my first pregnancy, when I had had 3 ultrasounds by this time. My belly is popping out, my boobs are huge, and I'm sick as a dog, so I'm pretty sure the little bean is making itself at home.

Anyway, thanks y'all!

[Jane]

Congrats on your sticky little one! I'm so glad that you found your path.