[*kyle*]

AGGHH... I know this is going to be forever-long, but I am trying to squeeze nearly a year's worth of complicated medical stuff into one post... so bear with me...

Alright, here's the deal. I chose my OB because she came very highly recommended from a number of those rate-your-doctor type websites. She had a high number of ratings that were overall very positive. I didn't know anyone in the area who'd had a good pregnancy/delivery experience to give me a personal recommendation. I was hoping that the "wisdom of the many" via Google would guide me to a good choice. Well... yes and no...

During my first pregnancy, she diagnosed the blighted ovum in a timely manner and was supportive/sympathetic about it. I was happy with not only the ease of getting an early u/s and a timely diagnosis, but also with her bedside manner. Then... she pushed me to have a D&C. I know a lot of people just want to get it over with, but I wanted to avoid an unnecessary surgery if possible. I've never had any surgery before. I ended up doing some research on my own and found out about misoprostol, a pill you insert to bring on the miscarriage. Not a pretty picture, but to me, preferable to surgery (anasthesia, risks to the uterus). When I mentioned the misoprostal to her, she was like, "Oh yeah, there's that... but it's not guaranteed to be effective and it's soooo painful, and the heavy bleeding will just scare you." I insisted this was what I wanted, and she did prescribe it for me, and I went on to induce a (fairly painful and bloody, but not ridiculously so) miscarriage with no lasting complications.

The second time I got pregnant, I debated going back to her because I felt she'd mislead me with the D&C thing. But, the fact that she gives ultrasounds basically on demand won me over. It was the early u/s that once again diagnosed my spotting as a miscarriage. This time no need for medical intervention as I m/c naturally only a few days later. The OB's response was to run all of the blood tests they give to women who have repeated m/c. She tested me for everything like Factor V Leiden, MTHFR, thyroid issues, anything that can contribute to early m/c. I agreed with this approach as some doctors wait until you have 3 or more m/c before they will investigate causes (as 2 could be a fluke, but 3 usually isn't). I appreciated her aggressive approach to figuring out what could be wrong. Feeding off of that, I did some of my own research (again) and found out about balanced translocation, a rare but serious cause of repeated m/c. On a whim, DH wrote himself a script and had himself karyotyped. It is only because he's a medical practitioner that he even had access to a lab to do this. About a week later, on the same day, I got the OB's results (MTHFR mutation) while he got his own results (balanced translocation carrier). Due to the MTHFR, my OB immediately had me go on 10 times the normal folic acid intake as well as a baby aspirin per day.

We consulted DH's medical textbooks on both conditions and it soon became clear that his was the more serious problem. MTHFR is only statistically linked to problems (like m/c, blood clots, and heart attacks) when your blood level of something called homocysteine is too high. When homocysteine is elevated, it shows that your body isn't processing proteins the way it should, this can interfere with folic acid absorption among other things. So, the huge amount of folic acid made sense, and the baby aspirin wouldn't hurt anything really, I stayed on those (and still am to this day).

However, when we consulted my OB with the balanced translocation info, she completely dismissed it. She obviously did NOT know what a b/t is and she insisted it was my MTHFR that was causing the losses. So... I got my own blood drawn and a fasting homocysteine level taken. The level was 3.6 whereas you don't even need to worry until it reaches 12-15 or higher. All of the empirical research DH could find (as he reads medical journals with more expertise than me) says there is no effect of MTHFR in pregnancy unless you're dealing with elevated homocysteine.

Once again on our own, DH and I found an RE in our area who had done research and studies on balanced translocation patients. We paid out of pocket for a consultation with her and discussed our odds of conceiving naturally and the availability of IVF with PGD (preimplantation genetic diagnosis) to get around the multiple losses that can occur with b/t. Natural conception is between 40% to 50% and IVF success rates are around 40% in her practice. The RE also referred us to a trusted colleague of hers who is a genetic counselor. We consulted with the genetic counselor a couple weeks later and got a lot more detail about DH's specific b/t and the way it all works on a genetic level. Both the RE and genetic counselor were professionals that we found on our own, not referred by my OB. She did not even know we were doing all this.

So... jump ahead just a couple more weeks to my "surprise" third pregnancy. I was so burnt out on medical interventions that I didn't even make an OB appointment until I was 8 weeks along. I did not want to deal with blood draws, beta numbers, 5-week ultrasounds or anything of the sort. I returned to the same OB out of a sort of apathetic familiarity. At the 8-week u/s when we saw an actual baby with an actual beating heart... my OB's response was, "let's get you started on Lovenox right away." Lovenox is a high potency blood thinner that you have to give yourself via a daily shot. She explained this was her "protocol" for MTHFR patients. I convinced her that based on my homocysteine level I didn't need it, but agreed to periodically re-check the level throughout the pregnancy. At the 12-week appointment, she drew blood for a bunch of stuff (HIV and all that). Well, she included homocysteine in that set of draws. But this is supposed to be a fasting level, and she drew it at 5 p.m. after I'd pigged out all day. When the level came back at 12, the OB freaked and tried to prescribe me the Lovenox again. I, however, once again on my own got a fasting level drawn... it was UNDER 2!!

Now I'm at a crossroads with this doctor. She knows I'm not going to blindly follow her "protocol." She knows I do medical things to myself, like get blood draws and consult other physicians, without her knowledge or consent. I'm a bad/hard to manage patient, and I know it, but I also do not really trust my doctor, and that makes a terrible combination. It's not like all of her decisions have been bad ones, but I see a pattern emerging here. I worry that her overreliance on medical interventions (surgery, Lovenox) does not bode well for my eventual birth experience. I do want to deliver at the hospital she's affiliated with... and I don't want to be "black-balled" as a problem patient.

Do you girls see huge red flags, or am I overreacting? Should I try to address my concerns with her directly (I would schedule a separate appointment for that) or just fire her at this point? Would you be upset if you were in my position?

[Mod-LadyCoconut]

I wouldn't say that you're over-reacting, I think you have a right to be concerned. I don't think these are huge red flags or are worth finding a new doctor over. For one, finding a new doctor, especially halfway through a pregnancy I would think is kind of a PITA and hassle so unless there's a major major issue... I don't think (for me anyway) it would be worth it to make the switch.

Here's how I view the situation as you described it and as how I remember it when it was 'present' situations --

She's fantastic for being willing to do early ultrasounds and testing so early on in your pregnancy and seems to really listen to you and take you seriously. When you have differences in option (the lovenox for example) it didn't sound like you really had to FIGHT her for it... you're able to stand up for what you know to be true. As long as you're willing to say how you really feel and have the balls to tell her what you think and are comfortable with then I think you're in a safe place with her. None of the things she's done or rx'd have been dangerous... if anything, to me, just a little over cautious. The extra folic and baby asprin makes sense... especially since your levels could change from time to time.

The biggest red flag to me is that she wasn't knowledgable or too concerned with Eric's balanced translocation. At the same time though, if it's rare ... how often are you going to find a doctor who really does just know everything about everything? If you feel like she's dismissing it entirely then clearly that's an issue... although at the same time -- is it going to cause future problems? Now that it's already been established and you know it's a factor... you'll be prepared for it in future pregnancies, as will she. Does it do anything now that could become an issue with this pregnancy with your son?

I think no matter how comfortable you are with your doctor it's important to do research and learn as much as you can about the goings-on of your pregnancy. You're really fortunate that Eric was able to do his own bloodwork, and has access and the ability to comprehend medical journals.

Overall, I think you might actually make a great match with your doctor simply BECAUSE you aren't blindly following her lead. No matter the scenario I think it's important to be researching into this because any doctor can make mistakes or not chose the best course of action for a particular patient so if its possible for you and Eric to gain knowledge about your situation from other sources then that seems like the responsible thing to do. From your description it doesn't sound as if your doctor has issues with you seeking additional opinions. You wouldn't be know as much as you do now if it weren't for your own research. On the same token, if it weren't for her taking your losses more seriously than it seems the average doctor does in the very beginning... you wouldn't have known all that you do know either.

I feel like I'm not being helpful but just kind of talking. haha.

I think if you want to schedule an appointment to talk about how you feel about the situation then it might not be a bad idea. Get it off your chest that you aren't intentionally stepping on her toes or thinking her knowledge is useless. Make sure she's still comfortable treating you and doesn't have any ill feelings towards your actions. But all in all, I don't think her 'slips' have been worthy of firing her if you're otherwise comfortable. I also don't think you're a problem patient at all. You're making good choices and I'm sure she can respect that. It's not like your'e going against her advice because your grandma didn't agree or something. You've spoken with other medical professionals and have had tests done to figure out your issues, etc.

Sorry if none of that came out coherent. haha

[Mars]

I think you are absolutely right for doing your own research and not just following orders especially with so much medical intervention involved.

I wanted to know if your OB made any comments about you doing your own research or do you feel any tension when you are with her? Have you ever thoroughly discussed your concerns about wanting to try a more "natural" approach first?

I would have a discussion about what I really want with the rest of the pregnancy and for delivery and see how she reacts to that. Then, based on how that goes, make a decision.

[.Brandi.]

Kyle, I agree with what Shannon said, but I think you should tell your doctor where you stand!!! Tell right out, point blank.....so there isn't any confusion as to where you stand on her pushy-ness of medical interventions. If you become uncomfortable with her, I would find another. I wish I had found a different OB with Preston, because I had an appointment the day before he was born, and the nurse said I was in labor (which I thought but wasn't sure since it was WAY different than my labor with Edward), but my OB NEVER said anything about it and when I mentioned it, she just said I was fine. And I went into harder labor that night and Preston was born the next day....I blame a lot of that on her because she knew I was already in labor. Go with your gut!!! Especially when it concerns you and your baby and both your health!!!

[Resi]

Do what you feel will make you the most comfortable with your doctor. I think what you did was the right thing and I would have done the same thing if I was able to.

I basically ditto everything that Shannon said.

You are a unique case being that you are very highly educated and that Eric is in the medical field. You and Eric can put 110% of yourselves into your diagnoses, while to your OB, you are one of many. It's just a fact. From the sounds of it, she went above and beyond in what she has done so far. I only say that because I highly, highly doubt that 9 out of 10 doctors would do what she did.

That being said, you completely have the right to feel how you feel. There are a couple of red flags, but they are small ones that barely blow in the breeze In my opinion, of course.

In my dealings with my FOUR OBs in my practice, all flippin four of them through up red flags to me (one said that she NEVER saw a successful Hypnobabies birth, another one wanted to induce with Cervadil instead of the gels and was adament about it, one was on the fence about extended delay of cord cutting). I had to decide if those flags were big enough to risk losing all of the positive things that I saw in them (wouldn't induce until I went over 42 weeks, great bedside manner, could labor and birth in any position, approved at the hospital that I wanted, 10 week ultrasound, supported my decision to avoid all tests on the baby except the anatomy scan).

Keep this in mind as well- everyone tells you how little you see your actual OB until its time to actually start pushing. I didn't really take that for much, but girl, it's TRUE! The 23 hours I was in labor, I saw an OB for maybe 2 hours total - once at check in, and then after I started pushing and was beginning to crown. (the nurse got me started on pushing)

Start researching the NURSES at your hospital. My God, I was so, so, soooo blessed with the 2 best nurses I could have imagined. My first nurse was so pro-natural (pain med free) birth that when I decided to get the epi, I was honestly worried about disappointing her! The next nurse, who was there when I actually gave birth, was the kindest and most encouraging nurse I have met in my life.

In the future, I wish that I could select my NURSES and let the OB happen by chance

I think you will be just fine if you stick with this OB, but talk to her and be honest about your feelings.

[**Jenn**]

I don't know what your plans are for your birth but whatever they are make sure you are very upfront and clear about them now. Tell her what you want and see what she has to say. It sounds like she's a bit intervention happy but will go the alternate route when you mention it. If you go into your labor/birth with your wants/needs/wishes clear than there *should* be less fight once you're in the midst. I just don't want to see you get unnecessary interventions during labor because she's an alarmist (which it seemed like with the shots she wanted you to take). Personally, I'd rather not have an OB at all but I did have one with my first baby and it wasn't bad. I agree with Breanna that it was my nurse who was awesome--very pro natural and encouraged me all the way. None of the OBs in my practice (and there were about 9 at the site I was at, another 7 at the other site) were very encouraging of me going natural but I only saw the OB twice during my labor and the second time was to deliver so I didn't have to worry about it. I kinda wonder though if I hadn't progressed quickly if I would have gotten interventions I didn't really want.

I'd talk to her at your next appointment and see how she feels about everything and make it adament about what you want. If you get the feeling that you're gonna be in for a fight during your birth process I'd look for a new one. There's plenty out there that are supportive of what you want, you don't need the stress of having to fight whith staff while you're in labor.

Have you thought about getting a doula? I never used one but they are invaluable especially with a hospital birth.

I think the masses (aka Google) is a great search tool but the masses also don't care much about interventions/drugs/etc during labor. So you kind of have to take that with a grain of salt.

Good luck!

[soImarriedAnerd]

Ok I'm the weird one----I would change. If I wasn't comfortable with the options the doctor was giving to the point I felt I need to research everything they are doing, because I didn't think they were giving me all my options....well that right there is enough to make me change. Just the fact your asking this question is a red flag---if your asking if you should change---its usually because you have that gut feeling you should be. ...listen to your gut.

[*Anna*]

I would look for a new dr. Because with childbirth and l& d things go fast. U have to trust your dr who's delivering your baby. And if u find a dr who u trust- I'm sure with your history they will do u/s often too. When I had my ob who was going to deliver Alexa-I didn't trust her and followed my gut and found my midwife who was so wonderful and helped me have the birth of my dreams and she is on my facebook cuz she is so awesome and I'd refer her to anyone. She's here in mi though.

Angelas midwife is in Chicago right? Could she help u find someone? When I lived in Chicago I had a great ob - her name escapes me but I'm sure I could find it for u. She was near northwestern hospital but I think she had affiliation at other hospitals too.

[Mod-LadyCoconut]

Any update on the situation & how you're feeling?

[*kyle*]

I have talked it over with Eric and he feels the same way about her, for slightly different reasons. My main gripe is about feeling pushed and like the doctor doesn't give me all of the information, or options available to me, and just wants to push interventions on me. I'm also annoyed that she would draw a blood level of something at 5 p.m. that is supposed to be a fasting draw, it seems irresponsible to base medical decisions on faulty results. Eric feels most concerned that she did not know about, OR educate herself about what a balanced translocation is. As a medical professional whenever Eric comes across a new or rare diagnosis, he'll spend an hour or two reading up on it because he is interested in becoming better at his job. He feels like the OB did not put in the effort to do this and is pretty insulted by that. He is in favor of just switching docs now, but I feel like I should at least attend my 20 week appointment next week, and bring up some of my concerns with her directly, then decide.

[soImarriedAnerd]

Originally Posted by *kyle*

I have talked it over with Eric and he feels the same way about her, for slightly different reasons. My main gripe is about feeling pushed and like the doctor doesn't give me all of the information, or options available to me, and just wants to push interventions on me. I'm also annoyed that she would draw a blood level of something at 5 p.m. that is supposed to be a fasting draw, it seems irresponsible to base medical decisions on faulty results. Eric feels most concerned that she did not know about, OR educate herself about what a balanced translocation is. As a medical professional whenever Eric comes across a new or rare diagnosis, he'll spend an hour or two reading up on it because he is interested in becoming better at his job. He feels like the OB did not put in the effort to do this and is pretty insulted by that. He is in favor of just switching docs now, but I feel like I should at least attend my 20 week appointment next week, and bring up some of my concerns with her directly, then decide.

I couldn't agree more with that!

[Lash]

Seriously Kyle, imagine our field. If someone comes to you with a cultural experience, life experience, or some form of a diagnosis that we haven't encountered can you imagine yourself going forward in treatment blindly? Just saying "well I'm a therapist, so really I know enough, I dont need to know more about this. I have a degree, thats enough. I mean surely I've been doing this long enough that I dont need to figure out specifics for my client"

Imagine someone coming to you of Native Alaskan heritage, or from Germany or having experience Military combat and you not looking up anything about those specifics and just plowing ahead

Hold her to those standards. Dont pay money to someone when they aren't showing you the same consideration you'd give to your own clients, and they dont even have medical issues on the line

[niknok]

I agree with Angela and Kyle- I'd look for a new OB as well. I think those red flags are pretty big ones.