Today we’re at 35 weeks, 5 days and we had our 36-ish week OB appointment. From the very beginning of this pregnancy, we’ve had drama about getting appropriate medical care, and recently our OB (now ex-OB), who was surprisingly helpful at our previous appointment with her, “HIGHLY suggested we find another provider.” Yep, she broke up with us, because of yet another miscommunication about appointments and expectations. Really, it was just the last of a long string of things, the proverbial straw that broke the camel’s back.
At our previous appointment with her, we discussed when we would see her next and the plan from then on. We already had appointments set for two weeks later (today, coincidentally) and three weeks from today. That means at our previous appointment with her (at 33.5 weeks), we were scheduled to see her at 35.5 weeks (today) and at 38.5 weeks. She told us that radiology would be calling us to schedule the 36-week routine ultrasound, and that she would have her assistant call us to make an additional appointment between 35.5 and 38.5 weeks. That all seemed totally appropriate, considering everything we’ve read and heard from others (even those with singletons) indicates most see their OBs at least every two weeks, if not every week near the end of the pregnancy. Considering this one is twins and additionally high-risk due to Molly’s bleeding disorders, I really didn’t want to go three weeks without being seen – so making an interim appointment (at her suggestion) seemed appropriate and necessary. Not to mention that when we originally made the 38.5 week appointment, we were all laughing because it seemed silly to even be making that appointment when we were originally told they would just take them at 38 weeks (of course, this also turned out to be inconsistent information).
Needless to say, radiology never called to schedule the routine ultrasound, and her assistant never called to make the appointment. Days went by, and Molly finally called radiology to take care of it herself (this wasn’t entirely surprising to either of us as it has happened this way almost every time, and this is obviously a systemic problem and not necessary the fault of the OB). Molly also called the OB’s office multiple times to try to schedule the interim appointment herself, only to be told that the assistant would call her back. When that never happened, Molly emailed the OB and asked if the assistant would call to schedule, and the OB replied by email saying her assistant would call Molly that day. Not surprisingly, a few more days went by with no such call. After Molly emailed the OB again to find out if someone was going to call to schedule, the OB replied by email saying that actually the appointments we had scheduled (35.5 weeks and 38.5 weeks) were fine and there was no need to schedule an additional one between them. Of course, this was seriously frustrating, considering the interim appointment was at the OB’s suggestion and certainly seems most appropriate. Finally, one night Molly couldn’t sleep because of the stress surrounding the issue so she emailed the OB again and (in a much more polite way than I would have said it), said that she was concerned about some communication problems and conflicting messages we’ve been given and that, in an effort to gain some trust in the system, we’d really like to talk about them before she potentially performs surgery on her in a few weeks.
Seriously, Molly has enough things that could (and are) keeping her up and night – stressing about the quality and trust in a doctor who may be performing surgery on her shouldn’t be one of them!
It was almost an entire week later before we heard anything from the OB. The OB’s email back was all about how she had done this and that and this and that and worked through her lunch hour repeatedly to meet with us, etc. and that she “HIGHLY suggested we find another provider. Good luck.” Now, I don’t know how long her lunch break is, but it must not be very long, because I don’t think we ever spent more than 15-20 minutes with her, the longest of which was, appropriately, the first one. Maybe she was trying to make us feel bad about the extra five minutes it took her to look at something under the microscope? Well here’s a newsflash: That’s your job. I refuse to believe that we are the ones expecting too much and that the true problems lie with the doctors/medical conglomerate that is Molly’s medical insurance provider. I think they are just so disconnected from their patients, and they are probably so pushed to stick to 10-15 minute appointments, that they can’t be bothered to make sure their patients needs are actually getting met.
Anyway, good riddens. So at today’s prenatal appointment, we saw a new OB, the third during the pregnancy. He’s an older guy, been practicing OB/GYN since the 70’s, so I wasn’t sure what to expect. Would he be old school and insist on a scheduled C-section at 38 weeks sharp? Would he be up to date on more “current” thinking of waiting until 39 weeks? After our repeated let downs with the entire system, I tried not to expect anything. And wow, he really surprised – and impressed – me.
It was immediately obvious that he had read Molly’s entire file and had done some background research on her bleeding disorders (von Willebrand’s and Platelet Storage Pool Deficiency). He articulated exactly what I wrote about in my last prenatal appointment post about how Stimate, which causes release of von Willebrand’s factor, won’t necessarily solve the entire problem so further plans need to be in place to be prepared for any bleeding that may occur. He had done his research, communicated the plan to us, and reassured us that Molly would be watched carefully and taken care of – oh wait, exactly what a good doctor should do and has been completely lacking thus far. All of this happened without any prompting by us, which is the way it should be.
He also did a quick ultrasound to check the positions of the babies (Baby A still breech, Baby B still head-down), and he claimed that really the babies could flip around…it’s still possible. On the cervical exam, he said Molly was 50% effaced, not dilated at all, and that he could feel Baby A’s butt and Baby B’s head basically duking it out for first place. So really, Baby B could decide to engage first, meaning a vaginal birth of Baby B first, then breech extraction of Baby A may still be a possibility – that’s great news! He said we could just go on with our business as usual and just wait until Molly goes into active labor, ie. no need to schedule a C-section for 38 or 39 or whatever weeks. When the contractions start coming at a regular interval, we’ll go to the hospital as usual and the fate will be determined by which baby is in the pelvic canal. If Baby A wins (and is still breech), then C-section it is. If Baby B wins (and is still head-down), then it would depend on what doctor is on call as some will do a breech extraction of the second twin and some won’t.
Again without prompting by us, he said he wants to see us in two weeks from now, then weekly thereafter. On our way out, he added, “I see you have your 36-week ultrasound next week – a couple days after you have it done, email me and tell me the date/time it was done, and I’ll email you the results.” Really? Did you just offer to give us test results without us having to prompt you multiple times? Wow, OK, I was just expecting to get the results the next time we saw him, which until now has even been quite the “demand.” The ironic part is that we’ll be seeing him the week after the ultrasound – so he didn’t even need to offer to email us the results.
There was only one weird thing – he didn’t even introduce himself to me. For most of the appointment, it was as if I wasn’t even there, or that I existed solely to hold the ultrasound probe for him while he got a second johnny from the cabinet. Near the end of the appointment, I did ask a couple questions and he answered them directly to me (and Molly). And he did shake my hand before he left (“Nice to meet you”….even though we never really “met” in the first place). Whatever, in the end, he’s there to take care of Molly, not me. And he definitely impressed me with his knowledge of Molly’s case and plan of care.
Overall, we’re both extremely happy with how the appointment went and (so far) feel lucky to have found him, even if it is at the very end. He’s kind of in a win-win situation, too, because, in the 2-4 or so weeks left in this pregnancy, there are minimal systemic problems he’ll have to take the fall for (radiology not calling to schedule ultrasounds, office assistants not scheduling promised appointments, lack of communication with other departments, and all of the other many problems we’ve had along the way…). Here’s to hoping things continue to go well!