Should I be relieved or concerned??

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Re: Should I be relieved or concerned??

Post by nov_mum » Thu Oct 25, 2012 02:32 am

Well I saw my OB again today. He was not worried at all that baby has gone from 85th percentile at 19weeks to 50th at 27 weeks. I wonder if some of that is to do with me now being on meds. My BP was 158/92 and he seemed content with that. I asked him to sign a letter to say I could go on a four hour flight and he said he was comfortable. He has no clinical basis except for that my condition could change. Hmmm. So he agreed to see me in three weeks and if all is well he will sign me off to fly. We are moving countries and I want well away from the hospital as I don't trust them as far as I can throw them. I will take copies of all of my bloods and ultrasounds plus I have all of my old notes but none from the OB this time around. I am slightly concerned re the growth and I self monitor well so I am happy to self present at L&D at the mere sight of things getting out of hand but man o man, this OB is fickle. Should I be concerned with the change in growth or do you guys think it's just perhaps bubs was having a growth spurt last time around?

Re: Should I be relieved or concerned??

Post by nov_mum » Tue Sep 04, 2012 04:56 am

Thanks for your reply. I would adore a HB but I gave up on that idea last pregnancy. Begrudgingly I must admit, but I have resigned myself to a hospital birth, most likely as a result of induction. I guess that is all I know after three pregnancies with the same outcome. My outcomes are good, they are just hospital based ones which I have grown to accept. I admit I like the idea of a less interventional approach but I guess my confidence is shaken as I think he is barking and barking up the wrong tree altogether. I will see how it goes. The good thing is that I am getting a scan next month, I have done the darn GTT so can prove it isn't GD and I am comfortable monitoring my situation. I am still responding to very low dose labetalol (100mg BD) so I am happy so far with how things are progressing.

Re: Should I be relieved or concerned??

Post by p+h » Tue Sep 04, 2012 03:16 am

Wow, what a tricky situation. I guess I'm wondering, if you know the symptoms and can monitor regularly enough for all of them for YOU to feel comfortable, could his stance be ok? Can you keep asking the questions to make sure every base is covered, while being thankful you aren't being prematurely labeled high risk? I'm only asking because the stance of you Dr. sounds like what *I* could be comfortable with, and seeing that you'd like a HB if at all possible makes me think that could be to your advantage to have a more relaxed doc. But then, if things start looking serious to you and he doesn't agree, I don't know how your system would handle that.

Re: Should I be relieved or concerned??

Post by nov_mum » Tue Sep 04, 2012 02:52 am

Well, I got the GTT done as as I suspected, it is perfect! I'm not even close to the top figure for GD. The OB seems concerned that I went undiagnosed as a diabetic in previous pregnancies despite the three tests with my larger baby and no sign in any other prengnacy and seems hung up on the idea I had a large baby. 8lb130z isn't teeny but hardly a giant! I am worried he is relaxed about the PE despite my history actually showing that it occurred in each and every pregnancy. The CHIPS study is determining whether borderline hypertensives make bigger babies (alongside other findings re medication I believe) and I told him that I believe my boy was on the larger side as my BP was unmedicated in that pregnancy until after delivery. He refuted that and said that no one knows if that hypothesis is correct or not. I did question him why they might under take a world wide study if there was no link what so ever. Unfortunately I really don't get to pick my OB. It is a public service and health insurance in our country doesn't cover obstetric complications what so ever. I spoke to my husband and he is encouraging me to go to one more appointment with him before making a request to change. The problem is then that I will be labelled a difficult patient and as I work in health care, I know what that will mean. I think I will hav to just wait until afterhours to present with any concerns and pray his team isn;t rostered on call. Crap isn't it??

Re: Should I be relieved or concerned??

Post by angieb » Thu Aug 30, 2012 09:59 am

Honestly, he sounds a little too laidback for my tastes. I'd probably keep looking around. After three pregnancies of getting preeclampsia, he's only giving you a 10% chance of getting it a fourth time? I am not a medical professional or a stats person, and I don't know your history, but those odds seem a lot lower than what is logical to me. And given all of the things that can go seriously wrong if they wait just a little too long to deliver, I would be a little concerned. We've seen here time and time again with new posters, doctors that let things get pretty bad before the decision for delivery is made. (While I don't agree that inducing at the drop of that hat is necessarily the right move either, I would much rather someone have a slightly pre-term baby with some NICU time than a stillborn baby planning their funeral.)

I met with two different MFM's before getting pregnant after my first pregnancy. One of them was pretty concerned about pre-e, gave me a fairly high chance of getting sick again, but would be monitoring closely, etc. (As is appropriate with someone who had HELLP and a loss at 23 wks.) The other one just kind of shrugged it off, I remember her saying, "I'll sleep okay at night if you get pregnant with just one baby. I'll have a little more trouble sleeping if you get pregnant with twins." (while the other MFM was adamant I could NOT get pregnant with twins- the multiples topic came up b/c we were doing fertility treatments.) She was more concerned with my vertical c-section incision and the risk of placental accreta than pre-e. I since have made a friend who also saw the very laid back MFM,pre-conception, after she developed severe pre-e and had to deliver her son at 29 weeks. The MFM did no underlying condition testing on my friend (it turns out now that she has a blood clotting disorder and aplastic anemia), and told her that the pre-eclampsia was a fluke, wouldn't happen again, go ahead and get pregnant, we don't need to see you. Well, my friend got pregnant with twins on unmonitored clomid and delivered at 25 weeks and both of her babies ended up dying. So much for a "fluke" and "won't happen again". My friend still struggles with a lot of guilt that she just accepted what that MFM told her.

Anyway, my point is, too laid back can have disasterously bad consequences, as I'm sure you already know from being on the forums anyway. I sure wouldn't want that stress of feeling like you may have to talk him into inducing you if you get sick down the road. I think you have to go with your gut on this one.

Should I be relieved or concerned??

Post by nov_mum » Thu Aug 30, 2012 04:10 am

I saw an OB today and he at first seems pretty sensible to me. Watch and wait and monitor and it all seemed ok. He then told me that he suspects I might have had GD in previous pregnancies (despite never testing positive for high sugar levels and on my second pregnancy which was my biggest baby I had three tests including one only days before I was induced!). He then told me he thinks that despite me having PE in all three previous pregnancies that he thinks I have about a 10% chance of developing it this time around. If this was in previous pregnancies I might have gotten excited and experienced a sense of relief while setting off to plan my home birth but I feel one of us needs to be a realist. On the plus side he won't over monitor me and induce at the drop of a hat. On the negative side he could leave things too long. I long ago gave up my dream of a home birth or even starting off labour independently let alone getting to 40 weeks only to be told that it is all possible. What do you guys think? Is my Dr on drugs or am I just too pessimistic?