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Prenatal Appointment #4 / Pregnancy Ultrasound #7

Today we had our 20-week general prenatal appointment with the OB. It was a brief appointment, mostly for giving us the results of our Quad Screen (mentioned in a previous post) and our recent 20-week “anatomy scan” ultrasound. Both the Quad Screen and the ultrasound results were completely normal! With a normal Quad Screen, normal NT scan, and normal ultrasound findings, the risk of Down Syndrome, Trisomy 18, and neural tube defects is very very low. What great news!

The OB did do a quick ultrasound, but only to see where the twins were located so she could find their heartbeats with the external Doppler – the ultrasound peek was so quick, we didn’t get any photo printouts. Baby A’s heart rate was 142 and Baby B’s heart rate was 135, both normal for their gestational age.

With all of this positive news, one would think we would leave the appointment ecstatic. It was quite the contrary, though. We’ve had a rather tough time dealing with our OB, for multiple reasons. First, we started off on the wrong foot when it was extremely difficult to schedule an initial appointment with her (the OB), instead of the Certified Nurse Midwife – it took until 16 weeks gestation for us to be able to see the doctor…with a pregnancy that had already been classified as “high risk” due to multiples and Molly’s bleeding disorder! We were willing to oversee this scheduling difficulty if we could schedule future appointments way in advance, which we’ve since been able to do. At our first appointment with the OB last month, we didn’t exactly “click” with her or particularly like her very much, but again, we wrote that off as going into it being defensive about the many scheduling issues we had, not only with her office, but also coordinating between her office and radiology. So we tried to go into today’s appointment open minded and kind of “start over” with her.

I can say with confidence that our OB takes a very “hands-off” approach. This is simply not compatible with two people who are prone to anxiety about big, important, and often scary things – like, you know, having a baby. Or two. The OB’s general lack of providing us with information has forced us to seek it elsewhere, mostly from other people we know having recently had or are pregnant with twins…and the internet (dangerous!).

At today’s appointment, the OB said she would recommend one more formal (radiology) ultrasound at 28-32 weeks. This took us by surprise as everything we’ve heard (from other people as well as radiology themselves) indicates, even if everything is normal, they do a formal ultrasound every four weeks in twin pregnancies. Our OB’s recommended next ultrasound is 8-12 weeks from now, not four! The OB also said that she would consider putting Molly on disability from work at 32-34 weeks, unless preterm labor (defined as cervical change, not just contractions alone) occurs before then. This also took us by surprise. Molly’s already feeling uncomfortable, and certainly being pregnant in general would be uncomfortable (and twins moreso!), but we’ve heard of many twin pregnancies getting put on disability as early as 28 weeks, sometimes routinely, not just if complications are occuring. If she’s uncomfortable now, what’s the future going to hold? Will she really have to wait until 32-34 weeks for this reason alone? And why should something have to go wrong like preterm labor before action is taken? This crap drives me crazy – that’s why my career choice is in preventive medicine!

So the irony is that the reasons we are unhappy after today’s appointment are directly due to the fact that everything is completely normal with the pregnancy. The OB wants to do less monitoring than we were expecting, but only because there hasn’t been a single reason to indicate otherwise. We really should consider it a blessing that we don’t need to be seen, other than a general check up appointment, for another eight weeks! Certainly, our other sources of information (other people, the internet – which we have been forced to rely on based on her lack of communication to us), don’t consider all aspects of our individual pregnancy like a doctor does (or should) – so logically I know that we should trust what our OB says, and if we don’t need any formal monitoring for another 8-12 weeks, then that should be great news! And I understand the rationale – there’s no real intervention that would be done until 28 weeks or so. If, at 28 weeks, they see the babies are growing incongruently (or some other issue), then that is when they weigh the risks and benefits of delivering early versus letting them cook a little longer. It just all wasn’t what we were expecting. We expected to have some kind of ultrasound (formal or in the office) every four weeks and the potential for disability at 28 weeks. Neither of those were communicated at today’s appointment.

So we basically have two options:
1. Continue with our current OB and hope things change or that she at least listens to Molly’s needs as the pregnancy progresses, or
2. Change doctors and hopefully get one we like.

The problem with option #2 is that choosing a new OB is not only a blind process (so we may not like next one just as much), but the way the health insurance company works, there are no backsies – once you switch, you can’t go back, you’re stuck with your new doctor (unless you want to switch yet a third time). The ability to get any kind of consultation beforehand is limited.

Another issue with switching OBs is scheduling. We’ve now managed to schedule appointments with our current OB that mostly fit in with my busy class schedule. Changing doctors risks the new OB not having availability that fits both Molly’s and my schedules (mostly mine). Personally, I’d rather stick with our current doctor and be able to attend the appointments, rather than switch doctors and risk not only not liking them anymore than our current OB but also risk me not being able to attend appointments.

Is it selfish of me to want to attend the appointments, at the price that we stick with the OB that we don’t really like, but whose medicine is most likely truly acting in our best interest? Is being involved in the appointments something I should be willing to sacrifice so that Molly can attend appointments alone with a doctor she (might) like better? The thought of switching to another OB that we may like better, but who doesn’t have appointments that fit in my schedule, makes me feel like my involvement in the pregnancy isn’t important. During a pregnancy, the other partner is “pregnant,” too – I hope this blog can help folks understand that, because many times it gets overlooked – and I think this is a perfect example of this dichotomy.

I pride myself on carrying many characteristics I learned from being raised as a girl (patience, compassion, empathy, etc), but am I being too sensitive in this issue? Molly could tell I was very hurt by feeling like I would be excluded if we switched to a doctor that perhaps we like more but doesn’t have availability that allows me to attend the appointments. After talking it out with Molly, above and beyond our current OB’s scheduling, ultrasound frequency, and disability issues, both Molly and I feel that our current OB’s method of communication is just not what we need during this pregnancy. Our current OB is very sterile and clinical, and I think we are looking for someone who is more reassuring and warm. We decided to look into switching to one of three OBs we’ve heard good things about, with the caveat that we’ll make sure the OB has availability that allows me to attend the appointments before we switch. Ultimately, even if we do switch, I can’t imagine another OB being even more hands-off/minimal monitoring/clinical than our current OB so we don’t have much to lose by looking into other OBs’ availability.

Overall, I can’t forget the most important thing we learned from today’s appointment – all is going perfectly!

2 responses to “Prenatal Appointment #4 / Pregnancy Ultrasound #7

  1. I think your conclusion to switch doctors on the caveat that the new OB has schedule availability that meshes with yours is the right one.

    It is important for you to attend the appointments (even taking out the emotional/mental side of it for you, it’s wiser to have two sets of ears listening and disseminating information than one) and it is also important to have a doctor you both are comfortable with. If you’re not comfortable, you are likely to be less forthcoming with information, less likely to ask questions, and less likely to really trust the OB when you need to.

    My wife and I went through something similar recently with her OBGYN, and we got her switched to a new, extremely supportive, totally awesome doc. I’ll keep my fingers crossed for you both!

  2. Ethan,
    so sorry to hear about your OB! I think it could make all the difference to switch, we did just prior to our pregnancy and haven’t looked back. For a reference point, I was put on halftime work at 32 weeks but have a friend who went to 38 without any work reduction. The Internet and books scare me to death, but it is possible to have a healthy twin pregnancy without preterm labor no matter what they say! We are 33 weeks today…both you or Molly are welcome to be in touch if you want support or to comiseate. I can say the physical discomfort definately gets worse but other things get better! We think of you often and are thrilled to hear how well thongs are going. Best, Stephanie

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