argh- my first (ever) prenatal visit with an OB

[BethSLP]

I went two weeks ago, but am just now getting around to writing about it. To preface, even though this is my second pregnancy, I had a midwife and planned a HB last time. Because of pre-eclampsia, I had to induce at a hospital. In the end, I found myself really comfortable with the notion of a hospital birth. It really surprised me, but even though I know all that monitoring equipment and such is unecessary statistically, it still made me feel secure. I also found that I liked messing up someone else's sheets, having nurses bring me stuff, etc. Maybe that sounds ignorant, but I found the hospital experience (at my particular crunch friendly hospital) to be actually a good experience. It was also financially WAY cheaper for us (because of insurance) and our midwife was very expensive (we had to pay both of course). Because of that experience, I decided this time around to go the traditional route. That said, I have never experienced traditional prenatal care. With Milena, I had no ultrasounds, one doppler late in the pregnancy, etc.

My OB is really cool and supportive of the midwife I had. He does talks on VBAC in town. So as far as OBs, he's pretty rad. He does my well woman visits and I feel very comfortable with him. But this first prenatal visit was...weird.

I had discussed with him ahead of time (before I was pregnant at a well woman visit) my preference to avoid u/s unless absolutely medically indicated etc. He was fine with it, but of course gives the disclaimer "you can do pretty much anything you want. I might think its stupid, but its a free country." You may have cringed when you read that, but I like the guy's honesty and I feel I can trust him because he doesn't ever keep a secret agenda and he tells me the straight stuff.

Anyhow, the nurse took me back and when she realized it was a pregnancy appt., she said "oh, we'll take you to the u/s room." I said "I don't want any u/s" and her reply was "oh, he'll just do a little one." WTF???

When he came in, he was ready to go for the u/s and I told him I didn't want it. He looked baffled. Is it standard practice to do a u/s at 8 weeks??

I thought early trimester u/s were somewhat uncommon?

When I said I didn't want the u/s, he said "umm. well what do you want me to do exactly?" I just laughed.

We also had the whole "how late do you let someone go" conversation, because I was a week overdue with Milena with a totally hard and closed cervix when we induced because of the pre-e. His reply was "or your dates were wrong."

WHY oh WHY is it so hard to believe that someone's dates could be RIGHT? I charted my cycle with Milena and I knew it to the date I ovulated. And this time around, I know the date of my LMP. So seriously, is a u/s the only way I could convincingly know my dates? The end result is that I think he's pretty hands off (as his record seems to indicate as well) so I'm not worried about it, but I'm annoyed that no one ever trusts dates without an early (and
IMO risky) u/s.

I don't mean to bitch too hard. I know many of you probably think "well just have a homebirth." But I know I'm not a homebirther deep down. Its just not for me. However, I really really wish I could have the midwife prenatal care and then a hospital birth. I know I'm gonna be that weird chick that comes in each time and says "no I don't want to do the AFP. no no doppler. no no u/s." I'm up for it, cuz I guess I'm used to being the weird one. but I just wish things weren't so either/or.

The OB I like and I trust him at my birth, but that prenatal visit scene is SO not me. Anyone else feel too crunchy for the traditional route but not enough for a homebirth?

XOXO
B

[mischievium]

Are there no midwives that deliver in the hospital in your area? (Not that that is necessarily a solution-- there are interventionalist midwives, too.)

It's too bad that he didn't seem to look at your chart before coming in to see you-- otherwise he may have remembered that you didn't want routine u/s.

As far as your question: "I thought early trimester u/s were somewhat uncommon?"

I don't know what the stats are, but it *seems* like a good chunk of women have early u/s, usually for dates, but many women who have had multiple m/c or women undergoing fertility treatments have them to check for a heartbeat or to see how many babies there are.

And, yeah, it amazing how OBs don't seem to trust your ability to actually know things like when you ovulated, etc .

[Peony]

Originally Posted by mischievium

As far as your question: "I thought early trimester u/s were somewhat uncommon?"

I don't know what the stats are, but it *seems* like a good chunk of women have early u/s, usually for dates, but many women who have had multiple m/c or women undergoing fertility treatments have them to check for a heartbeat or to see how many babies there are.

.

They are becoming so common. Even 6 years ago with my first pg, not that many people on my DDC had first tri US. I know I'm abnormal for not doing the 20 week one, but now it's becoming unusual to hear of women that don't have a first tri US, at least on forums. Or maybe I'm just sheltered, in my town even the hospital CNM's only offer an elective 20 week one that you have to go to a OB's office for.


I am a homebirther, but I feel that we should all give birth where we are most comfortable. For me that's at home, you a hospital, there is no right or wrong.

[kai28]

I had an early ultrasound because I had spotting for weeks. I had mine at about 6w. The date they gave me was right on for even my lax charting, but then again, I'm a regular 28d cycle, ovulate smack dab in the middle type. I think they were concerned with MC (the spotting), and it was really reassuring to see that HB on the screen. It certainly didn't seem uncommon to them for me to be doing all this.

There is such a thing as a midwife with admitting priveleges, I think. Not at my hospital (not that I've found), but from all the user-experiences I've heard of at my hospital, the regular OBs and nurses are pretty open to whatever you want to do. They have wireless fetal monitoring so you can get up and walk around anywhere in the delivery ward and they can still monitor the baby. They have birthing tubs. The nurses are super gentle and give you the baby immediately after birth with no intervention unless there is something really wrong. All the rooms - recovery & delivery - are private & are tastefully decorated. the recovery rooms have built in beds for dads to stay with you, and you can have your baby with you for as long or as little as you want. There is wireless internet access, and they don't care whether you use your cell phone or not (sometimes an issue in a hospital). The lactation consultants are pretty good too, I've heard. The recovery rooms all have giant flat screen TVs and giant windows that open on a nice, wooded courtyard that looks very soothing.

I was wondering about the HB option - I have hip/back problems, and I know my hip is going to go out, and I know it's going to hurt like a bitch (my hip goes out on a regular basis anyway). I think I can take it (happens frequently), but if I get into structural problems with my back/hip, I don't want to have to deal with a 30 min ambulance ride while some bone is breaking or something. I support HB, but don't think it's a good choice for me. This hospital seems to be the best alternative for me.

I found out yesterday from a friend that one of the 3 OBs at the practice I go to had her own natural birth at some point. She looks to be about my age, so it couldn't have been THAT long ago, so I'm taking that as a "she's on my side" type of thing. Although I really don't think this practice cares, and will support whatever I choose. They do seem U/S happy. And while I understand the concern with needless U/S, I would also like to have as much info as possible about the health of my baby. I have 2 more U/S scheduled - one to check the fetus' neck as a screening for Downs Syndrome (info I def. would like to have) and the 3rd is to check to make sure all the anatomy developed correctly, and all the organs are there in the right location and quantity. If my child is going to have severe issues, I'd like info in advance so I can prepare for it.

My husband was 2 months premature, and wouldn't have survived without intervention, and he turned out to be a brilliant, perfectly healthy guy, and I'm very happy my MIL got the care she did. He almost killed her.

[MI_Dawn]

Originally Posted by kai28

I have 2 more U/S scheduled - one to check the fetus' neck as a screening for Downs Syndrome (info I def. would like to have) and the 3rd is to check to make sure all the anatomy developed correctly, and all the organs are there in the right location and quantity. If my child is going to have severe issues, I'd like info in advance so I can prepare for it.

Ditto here. When I got my first (at 10 weeks) it was transvaginal, and the tech asked, "Have you ever had one?" and she looked shocked when I said, "No."

"But you've had four other children?"

Well, yeah... but the last two were born at home, so no u/s, and the two before that were born in 1990 and 1993, respectively...

"Ohhhh! No wonder. They didn't do office u/s back then. We do them on everyone now."

So the times, they have a-changed!

[Azreial]

I've had 2 early u/s, both for suspected miscarriage. I have notcied that even from dd's pg (she's 3) the increase in standard early u/s. I dunno I don't get it. It might be me but normally I don't see the point of it. Personally I find u/s very uncomfortable and almost invasive. I just don';t laying there pants pulled waaaay down with a towel tucked in belly haning out....

Oh and the transvaginal ones. Totally un-cool. I can't think of any instance where I would consent to one again

[nancy11]

I had one at 8.5 weeks. Because of a miscarriage last year, I needed to see something alive. My OB uses a portable u/s right in the exam room and my husband and I got to see Peanut swimming around. It was awesome, and my OB is a doll. I got lucky with her, I think. She came on recommendation from a friend.

Anyway, I don't consider this early, since you can see a heartbeat and other fun things. I don't like pointless procedures.

[KnitLady]

I've had four ultrasounds so far with this pregnancy. Obviously I'm comfortable with them. The first was for bleeding and dating as I wasn't charting and there was actually a 4 week window of when I could have ovulated. My cycle was super long because of breastfeeding.

The second was because my CNM couldn't find a heartbeat at 10 weeks. I have a retroverted uterus and everything was fine.

I am at higher risk for open nueral tube defects and I want to know ahead of time what I might be facing so I'm doing the sequential screen. The first try they couldn't get the measurement they needed because of my retroverted uterus, so I went back a few days later.

I had my DS in a hospital with a midwife. She is a CNM. Is that an option for you?

[kai28]

I'm not sure I "get" the transvaginal ones. I had a regular one (little paddle thing the squish across your belly, with the goop, and the pants pulled down a bit) at 6.5 weeks. Still saw the HB, still was able to measure the fetus to get a date. Right in the Dr's office. I was happy I didn't have to put on an embarassing robe - thought it was great. Any exam that doesn't require me to change clothes is OK in my book.

I dunno. I guess after spending a lot of time in the trainers room getting my back worked on while playing soccer, this stuff doesn't seem that bad to me. Now... lying on a table in the middle of the trainers room, with 2 people working on my back with and all sorts of suggestive remarks flying around from the men's football and basketball teams... that was awkward.

[wobblykate]

Yikes!

I think the point of the transvag is that at an early u/s they can see better. And I certainly wouldn't call it fun, but it was way easier than I thought it would be.

[Azreial]

With my pg with the twins I was not sure about dates. I only had 2 very irregular pp periods (something like 60+ days between #1 and #2) and I think it was close to 3 months from period #2 that I decided to do a "just in case" poas. I had ZERO pg symptoms, well except for growing two babies

When I saw the mw at the bc. she did a ve said my utreus was about 11 weeks sized so she used that to base the edd on.

The boys were born a bit early and in the nicu they do a gestanial age based on a varity of things and Aaron was right on where he should be based on the mw's dd; Dominic a little behind (personally I think Dominic was conceived AFTER Aaron anyway)

So it is possible to get an edd without an u/s

[sdmoose]

It is NOT standard across the board to do the early u/s. My boss is a family doc who does OB and he doesn't even do the 20week u/s. The only time he does u/s is when dates are totally unclear and if they detect any issues. He is very non-traditional, though, and serves mostly underinsured/uninsured patients so cost is also a big factor.

I have to go with an OB this pregnancy (at least the first part of the pregnancy because of an insurance glitch). I have chronic hypertension and the midwife group covered by my insurance will not even see me. I did have a midwife with my first pregnancy who delivered in the hospital and had a very positive experience with her in spite of having to be induced for hypertension week 37.

I just had the nurse visit for the OB I have to see and she indicated there is a "routine" 20 week u/s, but not an early one. I'm less than excited about pre-natal visits this time around anyway, but am nervous about having to be seen in this OB practice. Ugh.

I would suggest looking for a midwife who delivers in the hospital. With your history of pre-eclampsia you may be limited....depending on the local practice environment. Good luck.

[MI_Dawn]

Originally Posted by sdmoose

It is NOT standard across the board to do the early u/s. My boss is a family doc who does OB and he doesn't even do the 20week u/s. The only time he does u/s is when dates are totally unclear and if they detect any issues. He is very non-traditional, though, and serves mostly underinsured/uninsured patients so cost is also a big factor.

It used to be recommended by ACOG at 16 weeks. They dropped that standard recommendation, mostly because insurance companies and lobbyists said it drove up the cost of insurance. (Of course... it does. And yet they'll support elective c-sections? *scratching head* and won't pay for midwifery care? but don't try to figure out insurance companies... *sigh*) Now it's based on whatever a doctor can justify to insurance, really.