What does your OB do at appointments? - Mothering Forums
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October 2011 > What does your OB do at appointments?
DragonflyMom's Avatar DragonflyMom 08:46 AM 08-21-2011

Whats a normal Ob appointment for you?

I like my OB a lot...mostly because she does not do a lot and I have a fear of doctors so anything to keep it quick and easy but my husband went back with me for the first time last week and was like "Thats all she does?" so it has me wondering.

 

Normally when I go back her nurse (who I LOVE!) takes my weight and b/p and asks if I have any concerns.

 

Then my OB comes in, asks if Im doing OK or have any issues, checks the baby with the doppler and thats normally about it.

 

She has never done a physical/vaginal exam (Im going into my 34th week)...I dont want her to...should she?

 

 

 



nicolian's Avatar nicolian 08:49 AM 08-21-2011

I don't have an OB, but it sounds like your OB does basically what my midwife does. Take BP, and weight. Check urine. Palpate baby and listen on doppler to her heartbeat. Measure belly. Talk. My appts are usually about an hour, so more time than an OB would usually have, but if she's checking up on you to your satisfaction, all sounds well to me! I don't think vaginal exams are necessary or useful during pregnancy.


AlexisT's Avatar AlexisT 09:02 AM 08-21-2011

My 2nd trimester appointments were like that. Check BP, check urine, do doppler (or ultrasound if we had a problem with the doppler), run through my meds list, check for symptoms of preeclampsia (I've had it before so I get grilled every time)--so, they check my hands and feet for swelling, ask about headaches, etc. I had a full exam done at the beginning.

 

At this point I'm on twice weekly NSTs--the NP/CNM does one and the OB does the other, with urine dip, BP, and exam at each visit.

 

Cervical checks are up to the doc and do depend on your situation (I don't believe in driving women nuts with them, but there are reasons to check).They'll do a GBS swab soon. Everything else depends on your situation--they don't need to do other things routinely. In a normal pregnancy, there's not much to do. The OB is looking you over, and s/he does notice... but if everything's looking good, there's just not much to do.


emmaegbert's Avatar emmaegbert 09:05 AM 08-21-2011

this also sounds like what MWs have done in all three of my pregnancies to date. Routine vaginal exams are not necessary as far as I am aware and I have never had them. And you can always decline them if you don't feel like they are necessary (your HCP should always be able to explain why you are having an exam!). They may want to check your cervix as you get to full term, but I don't really think there is any reason to do this, at least not before you are in labor. And, during my labor for my second child, there was no time to check my cervix and my baby was born just the same, imagine that!


livacreature's Avatar livacreature 09:37 AM 08-21-2011

I go, I pee, they dip a stick.  If I was silly and peed before I left work, they just have me do it at the end of the appointment.  I get weighed.  They test my bp, ask about any drastic blood sugar changes.  They check her heart beat, and measure my belly, ask if I have any questions, and we schedule the next appt.  Nonstress tests and twice weekly visits start this week, but I imagine they won't be too different except for being hooked to the monitor.  I've remained fully clothed for everything but my initial visit that they did an overdue PAP.  They have told me they try to avoid those exams unless there is something that indicates otherwise, which I must say, doesn't bother me in the least!  Oh, and I have started having monthly growth check ultrasounds that take about five minutes.  They are actually some of the least stress-filled doctors visits I've had.


AlexisT's Avatar AlexisT 10:04 AM 08-21-2011

By "reasons" I meant not routine but if they think you might need to deliver (you definitely want to check before you induce someone!), or you've been having contractions, or something. Not just checking because it's 37 weeks and we need to know if you're dilated.


DragonflyMom's Avatar DragonflyMom 10:18 AM 08-21-2011

Does NST mean non-stress test?

Im suppossed to have one of those soon due to my high blood pressure and stuff....

 

I shared my birth plan with her at this last appointment and she was really open and positive about it (Im hoping for a natural/no meds birth) but did warn that if it looks like Im developing Pre-eclampsia she will want to induce but even then she is confident I can get through the rest of it naturally barring and emergencies.

 

 


AKislandgirl's Avatar AKislandgirl 11:16 AM 08-21-2011

Sounds like my appts. Pee check, weight, BP, listen to baby's heart and check my measurments. No internal exams. Chat about any concerns. I'm bringing my birth plan to my next appointment. I never had any internal exams with my last pregnancy until I was at the hospital in labor. I never did a non stress test either. I'm 33 weeks tomorrow.


AlexisT's Avatar AlexisT 11:31 AM 08-21-2011

Yep, non-stress testing. Pain in the proverbial! (it's not a hard test... just that it's Murphy's law in action: you go on the monitor and baby falls asleep. then baby wakes up, and moves around so much they keep losing the signal. Or baby is in a weird position, and you wind up doing the test lying on your side with the table pulled flat.) But as a chronic hypertensive with a history of severe pre-e, they're taking no chances. I'm also getting regular growth u/s (Both HTN and the meds used to treat it can cause IUGR. Fun times!)


Rosemarino's Avatar Rosemarino 12:46 PM 08-21-2011

Weight, bp, measuring, doppler, questions. No urine ever.


AKChix0r's Avatar AKChix0r 01:17 PM 08-21-2011

I show up, they send me to the bathroom to dip my urine and weigh myself (I just give them my weight from that morning at home for consistency).  I come out and tell them if there was any issue with protein or glucose on my dip.  They take me to a room and take my blood pressure, ask how much the baby is moving, measure my belly, feel for baby's position, use the doppler for his heartrate, and then we talk.  My midwife usually leads the conversations, and her two apprentices usually do the measurements and stuff.  They have a checklist of things to ask at each visit depending on how far along I am, and they let me ask any questions I have.  Then we schedule the next appointment.  Usually totally uneventful and under 30 minutes, but I've found that we talk about a LOT more when I go by myself (without DH).  Lately it's been breastfeeding and cicrumcision discussions, and me freaking out that I somehow forgot to ever go interview pediatricians (that's my goal for the next two weeks - FIND A PEDIATRICIAN).


dollyanna's Avatar dollyanna 05:15 PM 08-21-2011

I've never had my urine checked on a regular basis.  Is that for protein/pre-e?  They did bloodwork & took urine around 20 weeks, but that's it.

 

My Dr's office: weight, BP, temp check. Ask about any concerns. Measure fundal height, check heartbeat.

 

 


livacreature's Avatar livacreature 05:26 PM 08-21-2011

Yep.  The one my doc runs checks protein, glucose, and ketones.


akayerich's Avatar akayerich 06:18 PM 08-21-2011

My midwife appts sound a lot like what everyone else's are like.  Pee, weight, BP, talk/questions, measuring fundus, doppler.  No internal checks yet.  What I remember from my last pregnancy is they start offering at 36 weeks, but always left it up to me whether I wanted to be checked or not. 


emmaegbert's Avatar emmaegbert 08:04 PM 08-21-2011

So yeah, now I read your post more carefully Dragonflymom. If your OB wants to do an internal exam, make sure she can explain really well why she wants to do it. If its just to check dilation, I would personally refuse. I know I went from not dilated at all to holding my son in my arms in under 12 hours the first time... b/c I happened to start having regular contractions at my regular weekly MW appt, she did a check (basically was, I think, ruling out just sending me on to the birth center). I had him in the wee hours of that same morning. In fact, even under 4 hours before he was born, when I showed up at the birth center, they did an internal check and said I could go home or stay, I was right on the line of what they "require" for being admitted (4cm I think?)... (I knew I needed to stay, and I was right!). And I know plenty of people who walked around for a long time a couple of cm dilated... so whatever. It doesn't mean a whole lot unless you are in labor, or they suspect labor, or you are planning induction, stuff like that. In which case, the dr/mw would be able to explain to your satisfaction why it is needed.


AlexisT's Avatar AlexisT 07:27 AM 08-22-2011


Quote:
Originally Posted by livacreature View Post

Yep.  The one my doc runs checks protein, glucose, and ketones.

 

The value of these dips is pretty hotly debated, though. You won't reliably spill sugar till your BGLs are over 200 (which is why providers have begun using GTTs instead of relying on dips). The protein measures concentration, so is not terribly reliable (if your urine is particularly diluted or concentrated, it won't give you a reliable result... though if you're coming up 3+ or 4+, chances are you'll fail a 24 hour) and I've heard of preeclamptics who passed random dips. That's why a lot of OBs will have you do a 24 hour collection for any raised BP--it measures the total protein and is much more reliable.


4midablemama's Avatar 4midablemama 07:39 AM 08-22-2011

Same as everybody else. Pee check, blood pressure, back to the exam room to listen to the baby's heartbeat, basic "How are you feeling? Is the baby moving okay?" questions, measure the belly, ask any questions I have, out to schedule next appointment, done. I spent more time in the waiting room than I did actually seeing the MW. No internals offered/required until the last few weeks, and I usually refused them then. .


StephandOwen's Avatar StephandOwen 08:10 AM 08-22-2011

Pee check, weight, blood pressure, nurse asks questions (along the lines of "feeling baby moving?", "how are you feeling?" type of stuff). Then dr comes in and checks the heartbeat, asks if we have any questions, discusses anything we want to, then we schedule the next appointment. The dr doesn't measure the fundus every time, which is fine with me.


KABB's Avatar KABB 08:25 AM 08-22-2011

Sounds like what my OB does but each appointment is spent reviewing bloodwork/labs too because I am high risk. 

 

I don't think it's necessary for your OB to check you. If you thought you were in labor/having contractions, etc. then I could see why your OB would want to check or if there was some concern with your cervix changing prematurely I could see routine checking or ultrasounds to look at length. Other than that, there's really no reason to be checked-you could be at 1 CM until your water breaks or be at 3 from now until 38 weeks. 


yellowdart's Avatar yellowdart 09:32 AM 08-22-2011

Until recently mine were:  assistant (super nice girl) does weight, BP, review meds, then midwife come in to do fundus check, doppler, and ask if I have any questions.  This is at a clinic in a huge hospital but somehow they run extremely efficiently for routine visits and I never wait more than five minutes or so.

 

Now:  all of the above, plus I'm doing scans and NSTs - for the NST, I go back to a long room with a bunch of comfy chairs and monitors, with curtains that can close off areas, and they strap two monitor disks on my belly (using reusable straps that I bring back every time) and stick another monitor on my finger for my O2 and heartbeat measurements, then the test proceeds.  I have been kinda pushing the monitor this way and that into my belly to make sure the signal is strong, and I have to go 20 minutes or through two fetal heartbeat accelerations, whichever is longer.  So far 20 minutes has been plenty of time.  

 

For the scan, I go back to the US room, get lubed up and they do their thing very efficiently and inevitably give me a printout picture of baby's spine because she's hiding her face, then I wait for a long time while they chase down an MFM fellow or high risk OB to tell me what my AFI means this week.  

 


saoirse2007's Avatar saoirse2007 11:10 AM 08-22-2011

I am 31 weeks and my visits so far have been 5-7 weeks apart and even thought hey want 2 weeks I bargained for 3 :)

 

I dip pee (glucose and protien) wieght, bp, hr, fh, palpate

 

I like that the ob dips your pee for you because I just realized that for my last 2 pregnancies (MW) I have been reading the stick upside downduh.gif

 

no biggie...last pg there was never any change in the stick so I didn't notice, but this pg I ended up with 2 GTT's because I thought I had glucose +1 in my pee...turns out it was protien...they are not worried because all tests and stuff are great...lol

 

as for internal exams...I think got them last time at 40wks or later...can not remember...for my first kiddo with an ob - I think I was getting them a lot sooner


yellowdart's Avatar yellowdart 01:25 PM 08-22-2011

Oh yeah, regarding pelvic exams, I had one at an early visit and I had (an unplanned) one at 28 weeks when they thought I might be leaking.  I don't know how they handle exams toward the end.  I think I will decline, although we'll see.  


StephandOwen's Avatar StephandOwen 01:29 PM 08-22-2011


Quote:
Originally Posted by yellowdart View Post

Oh yeah, regarding pelvic exams, I had one at an early visit and I had (an unplanned) one at 28 weeks when they thought I might be leaking.  I don't know how they handle exams toward the end.  I think I will decline, although we'll see.  



I had one at the very beginning of pregnancy (needed a Pap) and none since. My OB is very hands off and won't do any unless I ask.... which I don't plan on doing.


DragonflyMom's Avatar DragonflyMom 02:34 PM 08-23-2011

Good to hear things on my end seem normal, I was not worried but the husband was a bit put off.

 

I should say, I am high risk due to blood pressure but we have kept that under control well so far.

 

I should be doing my first NST this Friday...hoping that goes well.


Mama~Love 06:33 PM 08-24-2011
I'm seeing an OB. Nurse calls me back, weight, pee, BP, pulse. Any concerns to note for Dr. Then Dr. comes in, we talk about anything we need to, then fundus & doppler check (which can take a bit with twins!). That's about it.

Tomorrow I'm bringing my birth plan, and discussing birth options (like if I need to deliver early, would it be there or a different hospital). Also, I'll be having weekly biophysical profiles after next week's U/S on the babies just to monitor their growth (we're a bit concerned about the girl mostly).

After my appointment, I'm meeting with my doula. Can't wait, she's so fun & interesting!
akind1's Avatar akind1 06:48 AM 08-25-2011

I see an OB as well, Pee and weight check (can I say how much I hate PIAC? - it's really hard to aim . . .) blood pressure, then back to the doc for doppler, measurements, and questions. I'm a VBAC hopeful so there is a little more to it than I remember with my first - both pregnancies are uncomplicated, but the docs discuss a little bit more about what they will and will not do with a VBAC -

 

I have one more every 2 week visit at 36/37 (doc has my EDC a week later than I know it is, which is fine with me), then I go weekly. The next visit is a GBS swab, and maybe they want to do a cervical check. (I guess since they're down there anyway with a swab? LOL) I won't be induced with this baby, since I am a VBAC, so I don't really see the point of a cervical check. I was 1 cm for probably a month with my first. The only thing that changed was effacement. 

 

I didn't do any NST"s with my first until I was after 40 weeks, seems like they are pretty routine for many of you.

 

The last two OB visits they've talked alot about kick counts which I think are a little silly - I never write anything down, but can tell you for a fact that she moves at least 10 times in a 2 hour period. usually in less than 10 minutes when she's really active!


StephandOwen's Avatar StephandOwen 06:57 AM 08-25-2011


Quote:
Originally Posted by akind1 View Post

I didn't do any NST"s with my first until I was after 40 weeks, seems like they are pretty routine for many of you.



I was wondering about this too. It seems like a lot of people in this thread are getting NST's regularly and wondered why is that? I never had any with my ds, and likely won't have any with this one either (unless something comes up, but as long as everything goes the way it has been then I won't have any).

 

I did every 4 week visits until 32 weeks. Then I am doing every 2 week visits (34 weeks, 36 weeks) and then weekly visits (37 weeks until delivery). I watch my BP between visits though, just because I'm at risk of developing pre-e.


AlexisT's Avatar AlexisT 07:01 AM 08-25-2011

I have chronic hypertension and a history of severe preeclampsia. Both the HTN and the meds used to treat it have risks to the baby, so I get monthly growth scans and twice-weekly NSTs. I went to 3 weekly visits at 24 weeks, two-weekly visits at 30 weeks, and weekly at 34 (the way it works, at one NST I see the OB, and at the other, the CNMs can read the NST if the OB isn't there).


DragonflyMom's Avatar DragonflyMom 08:20 AM 08-25-2011

Now see, I have hypertension that is being managed with meds (usually still int he 130s/90's) and have yet to have a NST...it was mentioned at my last appointment by the nurse but never done and Im 34 weeks 3 days.


~pi's Avatar ~pi 08:28 AM 08-25-2011

 

Quote:
Originally Posted by akind1 View Post

I didn't do any NST"s with my first until I was after 40 weeks, seems like they are pretty routine for many of you.
 


 

Quote:

Originally Posted by StephandOwen View Post

 

It seems like a lot of people in this thread are getting NST's regularly and wondered why is that? I never had any with my ds, and likely won't have any with this one either (unless something comes up, but as long as everything goes the way it has been then I won't have any).



NSTs (or other types of extra monitoring) are recommended when there are reasons that someone might be at higher risk, as is the case for everyone who has posted about them, I believe.

 

The protocol can be different in different places, though. For example, I mentioned in the chat thread that in Canada, facilities that have the equipment and techs will do four-part BPPs in place of NSTs, and only do an NST if there is a concern.

 

I am type 1 diabetic and I see both a midwife and a high-risk OB, as well as an endocrinologist. These are the routines:

 

midwife:

  • pee and check the strip if I want (I check for protein and ignore glucose, because, duh, I have much better measures of that)
  • measure belly
  • check BP
  • listen to heartbeat
  • talk (she has a list of things that she will bring up at different time points, and then we talk about anything else I want)

 

high-risk OB:

  • BPP and size u/s, get report (this started at 32 weeks, prior to that, nurse checked heartbeat as well but now it's just part of the BPP)
  • get called in by nurse, pee and check strip if I want (I check for protein and don't really pay attention to the other 4)
  • weight check (I declined these at the beginning, but do them now as we get closer to the end)
  • nurse asks how I'm doing and we talk about any concerns
  • s/he runs through any tests at that point, fills out requisitions for me (e.g., this week it was GBS, she explained what to do, gave me the swab and left me to it)
  • then either I see a resident/fellow who then presents to the supervising OB, or they just all come together, and we talk. Topics have ranged from interpreting my most recent test results, how the pregnancy is affecting my career plans, vbac vs. repeat c/s statistics in the context of my health, to anything I should keep in mind when canoeing. Sometimes the conversations take a while, especially if I'm chatting with a fellow.

 

endo:

  • talk to student/fellow, who takes a report (including weight and BP) and then reports to endo
  • sometimes download data from pump/meter, sometimes just talk about reports I printed and brought in
  • endo comes in, we review and discuss anything of concern

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