37 week visit with dual care OB - Mothering Forums
 
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#1 of 10 Old 02-05-2008, 03:22 PM - Thread Starter
 
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So I have an OB that I'm established with just in case I need a transfer. She agreed to this relationship if I would do a 12 week, 20 week, and full term ultrasound... which I am fine with. So I went in for my 37 week ultrasound today and everything looks great. I wasn't really worried, though... and the ultrasound merely confirmed everything that my MW has been able to tell through palpations (including weight).
But it was an opportunity for me to ask what to expect from her if I did transfer. Basically, she said that they would do everything they could to prevent a c/s (yay!). If I transferred they would probably do a spinal block because by that point, I would probably need it. They won't insist on internal fetal monitoring as long as they can get a good reading from external fetal monitoring. She makes a point not to do episiotomies (another yay!) and has only done 2 during her entire practice.
I asked about how her hospital typically handles neonatal routines. She said that there is rooming in and the baby never has to leave me unless we choose circumcision (which we're not doing). She also said that he is my baby and they will do or not do whatever I want (unless there is an obvious medical need)

So all of this I'm fine with. I mean we are talking a situation of transfer, which isn't going to happen unless something isn't going well and it's necessary.

There were a couple of things though that I feel kind of iffy about. First, if I get to 40 weeks and haven't had the baby yet, she wants me to come in for a visit. She said she'd want to see me twice during week 40. And if I go past 41 weeks, she said she'd want to see me every day or every other day. These visits would be for either NSTs or Biophysical profiles. She did say that she wouldn't insist on induction unless one of the tests showed that my baby was in distress or that there was some problem going on. I guess the part that I'm iffy about is seeing me twice during week 40. I mean, I konw that on average first time pregnancies go over 40 weeks. And it isn't really something that I want to stress about. Her point was that at 40 weeks the risk for something bad happening starts to increase greatly. I don't know, I guess that basically now I feel like there's this pressure for me to go into labor before or on my due date just to avoid all these extra appointments. She actually had me set up an appointment for my original due date (which is only 2 days after the due date estimated by the 20 week ultrasound).

The other thing that I'm feeling iffy about is that she wants me to go into the hospital before my due date and sign up for the spinal. What she told me is that if I came into the hospital and really needed a spinal, they would give me one. But if I came in and only wanted one, but it wasn't medically necessary, then they wouldn't give me one. But she really stressed that it would be a good idea to go in and sign up so that I could watch the video and learn all about the risks and benefits so that if I decided I wanted one, that option would be available. Ummmmmm... here's how I feel about that... I'm not one of those women who's going to "try for a natural childbirth" I'm going to "have a natural childbirth." I think that women who say they're going to try NCB, but sign up for the anesthesia "just in case," are highly unlikely to actually go through with it because they know they have an easy out. Granted, I'm going to be at home, unless something goes wrong... but still, I don't want to have it in the back of my head that it's there just in case the pain gets too bad.

So I don't know. I mean, I'm grateful that I have an OB who knows my history that I can turn to in case of transfer. And I don't want to risk losing that b/c I don't want to go to the hospital just to end up with someone who has no clue who I am or what I want. But I also don't know that I feel comfortable with starting NSTs just because it's my due date and I haven't delivered yet. And I also don't see why it's necessary for me to sign up for anesthesia ahead of time.

I'm going to talk to my MW and my doula about it before I make any decisions.

What do you all think?

mommy to Christopher 2/29/08
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#2 of 10 Old 02-05-2008, 03:36 PM
 
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Much nicer than the OB I was considering for backup.

I'd let her make the appt... then I'd call and reschedule... and then call again and reschedule... I WOULD just not show up but some DR's offices will charge you for that.

And I wouldn't sign up for the spinal. Just tell her "I'm not getting one unless I need a c-section, and that's fine with me."

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#3 of 10 Old 02-05-2008, 06:13 PM
 
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I would sign up for it, in the event a c-section would be needed. It is my understanding that insurance will not usually cover spinal unless it is pre-requested. I know medicaide won't pay.... Meaning, if you NEEDED a c-section, the insurance would cover general anasthesia before it would cover spinal- unless you had already requested spinal....
That may ease your mind a bit, knowing that you would not get put under in case of a c-section. It's not for "pain relief" if it's too much- it could be to keep you awake for the birth.

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#4 of 10 Old 02-05-2008, 06:37 PM
 
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wow....it all seems very cool except for this 'come on in 2x' during week 40 nonsense.

There is an often forgotton fact in the world of mainstream medically-managed childbirth: there's an anesthesiologist involved. I think it would be a great oppertunity to meet w/ the anesthesiologist in a non-emergency setting to talk about your pain control options in case of c-sec, because there is more to the drug cocktail hour than just spinal v. epidural. Also, you want this MD to know your weight and your height so that placement is done properly.

There are lots and lots of little things that different anestheseologists do routinely or differently depending on what is going on or what the mom requests. Sometimes, right after baby is born, a blob of some form of morphine is injected into the IV, which can affect mom's alertness in recovery. There are all sorts of different kinds of happy-drugs that can affect different women differently, and it's all about talking about choices to discover the ones that would probably work best for you--but who does that? who has that talk? only the handful of empowered 2nd and 3rd time planned c-section mamas I've known. How lucky for you, to have that talk now.

I've also heard it's not the OB, but the anesthisiologist who is in control of the OR. You can think about what type of c-section you want....ICAN offers a white paper describing a family-centered cesarean:

http://ican-online.net/index.php?opt...per&Itemid=165

A big question is this: would you want your hands free during the cesarean? because protocol is to strap them down, and the person who could offer you alternatives and assure that they happen is the MD by your head, your anesthesiologist.

This would be an oppertunity to ask about your choices and options, and have that stuff written down in anestheiologist lingo and in your chart, so in the super-rare event you went in, you'd have none of that to worry about.
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#5 of 10 Old 02-05-2008, 06:47 PM
 
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just going to quickly add my 2 cents- i think pre-registering at the hospital is almost always a great idea. people can and DO end up NEEDING interventions such as spinals/epidurals, narcotics, c/s. sometimes they are necessary and it can be helpful to have your ducks in a row beforehand. i had both my kids at home with no complications, fwiw. i just think that while birth is normal and natural, there is the possibility of complications and i don't see a drawback to "signing up" for a spinal. less paperwork should you end up needing one.

i agree that it all sounds good except the 2 visits in week 40. unnecessary IMO

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#6 of 10 Old 02-05-2008, 06:53 PM
 
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Quote:
Originally Posted by sunnymw View Post

And I wouldn't sign up for the spinal. Just tell her "I'm not getting one unless I need a c-section, and that's fine with me."
just a quick comment- sometimes an epidural (or narcotics) are truly useful and can actually make the difference between a vag and c/s birth. again, both mine were born at home naturally but i have assisted at some labors (all planned home or birth center births) where pain relief is a blessing.

epidurals aren't evil, people!!! (i am not saying that you think so, sunnymw)
they are an intervention that carries significant risk, but that can be wonderful when used appropriately.

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#7 of 10 Old 02-05-2008, 11:08 PM
 
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Originally Posted by homemademomma View Post
just a quick comment- sometimes an epidural (or narcotics) are truly useful and can actually make the difference between a vag and c/s birth. again, both mine were born at home naturally but i have assisted at some labors (all planned home or birth center births) where pain relief is a blessing.

epidurals aren't evil, people!!! (i am not saying that you think so, sunnymw)
they are an intervention that carries significant risk, but that can be wonderful when used appropriately.
I certainly don't think epidurals are evil or any pain relief for that matter. I just wouldn't want it to be offered or pushed on me, and that would be a good way to let the DR know, YOU will ask for it when YOU need it, don't offer it unless you're wheeling me to the ER... kwim? I didn't mean to come across as hating epidurals

It was also from the POV that I've seen too many times: mom wants to have a natural childbirth desperately, gets pressured into epidural, then feels like a failure and has post-partum depression. A lot of these mamas wish that epis hadn't even been available where they were.

But anywho, back to originally scheduled discussion

Sunny coolshine.gif: gun toting, retired breastfeeding, car seat loving, guitar playing, home birthing and schooling mama to Jakob (10.06), Mikah (07.08) and Korah (07.11). uc.jpg 

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#8 of 10 Old 02-06-2008, 11:30 AM - Thread Starter
 
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Originally Posted by sunnymw View Post
It was also from the POV that I've seen too many times: mom wants to have a natural childbirth desperately, gets pressured into epidural, then feels like a failure and has post-partum depression. A lot of these mamas wish that epis hadn't even been available where they were.
This is why I'm hesitant to sign up for the spinal ahead of time. I mean, yes I'm going to birthing at home (if all goes well), so it isn't like the spinal would be immediately available. But I'm afraid that knowing that I can just derive up to the hospital and get medical pain relief if active labor gets too intense for me might make it easier for me to decide to get it kwim?

Although, it's in my birth plan and I have explained to all who will be present that just because I ask for drugs during labor does not mean that everyone should start packing up to leave fo the hospital. I have told people to respond to that kind of request with positive support (i.e. you're doing a beautiful job, let's just get through this ctx, etc.) I have told everyone that my MW will know if it's something that is medically necessary and only then should we start getting in the car... not just because I all of a sudden become a big weenie

So I still haven't decided what to do about that part

As for the 40 week visits... my scheduled appointment is for tuesday morning. I know that I am scheduled to be at work that morning (starting next week, I'm working 4 hour days up until I go into labor)... and I also know that I will have an appt with my MW in the afternoon. So I will just wait until the day before and call the OB's office and say, "I'm sorry, I can't make the appointment tomorrow. I can come in on Thursday, though." Then by Thursday, there's no way she will be able to have me schedule a 2nd 40 week appointment. Which means she will just have to wait until week 41 to see me again. Sad for her. I'm okay with one 40 week check up... but I don't think that NSTs or a biophysical prophile are necessary at that point... so I will probably opt out of that and just let her do a basic exam on me.

mommy to Christopher 2/29/08
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#9 of 10 Old 02-06-2008, 01:55 PM
 
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I think your OB has some misconceptions about why and when people transfer. Specifically, I think she's too narrow.


The "come in every other day at 40 weeks" is nonsense. You aren't even "late" until 42 weeks and you can start non-stress tests then if you really want them. Before that you'll be checking for movement and your midwife can check the heartbeat if she comes for a visit.

Just don't make the appointments.

Oh, and if you do have appointments, keep your pants on. Minimize the number of V/Es you have since they don't provide useful information (you're 2cms dilated!--soooo, you could go into labor, good since you're full term. You're 30% effaced!----sooooo, you could go into labor, good since you're full term.) and just create an infection risk.
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#10 of 10 Old 02-06-2008, 11:24 PM
 
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Originally Posted by sunnymw View Post
I certainly don't think epidurals are evil or any pain relief for that matter. I just wouldn't want it to be offered or pushed on me, and that would be a good way to let the DR know, YOU will ask for it when YOU need it, don't offer it unless you're wheeling me to the ER... kwim?
very true!

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I love someone with ataxia telangiectasia http://www.atcp.org

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