Did you get more than one opinion before TTC again?

[LeosMom]

Hi everyone. I have a 16 month old son who was born at 29 weeks due to HELLP, also with IUGR & placental abruption. I never had any high BP, only abdominal pain that drove me to the ER where I was told I had low platelets, elevated liver enzymes, and protein in the urine and then induced. Unfortunately, I can't return to the hospital we went to last time due to our insurance not covering it, which sucks because we had a great NICU team there and private NICU rooms (though I never saw the OBs there as I was transferred in from a local hospital.)

Anyyay, after much discussion, my husband and I are ready to talk about TTC again. I saw an MFM last year that is affiliated w/ my new OB and was told I have a 50% chance of recurrence due to the early onset and severity of my HELLP, but that once we conceive I will continue to see my regular OB with additional MFM visits only after 25 weeks. I feel like I'd rather see the MFM the whole time. I am very scared to TTC again after my last experience which came on with no warning as I am fit and have had no health problems in my life up to this point or after, that I know of. The only change in TTC this time is that they recommended I take extra folic acid in addition to a prenate for at least 2 months prior to TTC and then after conceiving I will take baby aspirin. Is that really it? I know there is nothing they can do to prevent it, but I expected there to be something more in the way of high risk care. Should I see a different doctor to get a second opinion about my strategy before we TTC? We are lucky to have 3 excellent birthing hospitals here in Cleveland, two of which our insurance covers, so it's hard to decide who to see and where to deliver. I'm having a hard time deciding if I've picked the right team.

[sam10]

If you unsure about the prenatal care you'd receive, I'd say shop around until you find the right doc/team. Have you been tested for clotting disorders?

[flori]

I saw two unaffiliated MFMs who told me the basically the same thing: lda and ultrasounds monthly until 20 weeks, then every two weeks until 28, then weekly until delivery. One MFM was fine being my primary doc throughout, the other would co-manage with an OB. I am still on the fence about who to see, but will probably go with the MFM only care approach. I had a bad experience with the OB I saw last time (I think he missed things that should have been warning signs) and I don't want to repeat that.

I second what Julija said, if you are uneasy with your care get a second or third opinion. Good luck.

[lisa112]

I haven't been on here in a while because I felt like I needed to take a break. I saw three MFMs with meeting the last one last Friday and I am going to go with that doctor. I found that there was not much of a difference in the way I would be treated and monitored, but feel like this doctor was very easy to talk to, I liked her approach, and felt the most comfortable with her. I think it's important to find a doctor/team that you are going to feel comfortable with, trust, and makes you feel like they can get you through a pregnancy. If your having doubts it wouldn't hurt to shop around a little bit more.

[LeosMom]

Thanks everyone for your input!

Sam10: I was tested for the clotting disorder APS because the afterbirth examination showed that my placenta was full of blood clots, but I tested negative for APS so no one ever seemed to give an explanation for that. It is so frustrating to not have answers! Argh.

Flori: same here. I switched OBs immediately after my first birth. When I tried to report my HELLP pain, she told me to take tums and go back to sleep. Luckily we went to the hospital instead. She also said my routine ultrasound looked fine 2 days before delivery, when they told me my son was IUGR and only measuring 24 weeks at 29 weeks. I don't know if she could have told these things, but combined with her utter lack of concern about what happened, I never want to see her again.

Flori: My MFM advised the LDA immediately after conceiving. Is that what your said, or was it while TTC?

Lisa: thanks for the suggestion. I felt like this MFM was very competent in treating my physical needs, but I feel like this time around I need someone who will also treat my emotional needs. I will need constant assurance that everything possible is being checked. I'm going to be a nervous wreck!

[flori]

Both MFMs said LDA after a positive test but were fine if I took it prior to TTC. I decided to start prior just in case.

[JB]

I felt like this MFM was very competent in treating my physical needs, but I feel like this time around I need someone who will also treat my emotional needs. I will need constant assurance that everything possible is being checked. I'm going to be a nervous wreck!

I think it's really important to be comfortable with your doctor. I switched OBs when I got pregnant again, mainly because my previous OB really wanted me to get sterilized and never have any more children, so I thought she would be judgmental and blame me when I ended up getting pregnant again within six months of delivery. I also simply didn't "vibe" with her very well, and disliked the care I received from one of the doctors in her office while I was in the hospital (he wore shoes with skulls and crossbones all over them, so my mom nicknamed him "Dr. Death." It wasn't the main reason I disliked his care, but gallows humor isn't something you want to see from your physician when you and your child are deathly ill in the hospital). I had moved to a new city halfway through that pregnancy and her practice was the only one at our hospital with openings for new OB patients around my due date, so I had to take what I could get. My OB this time is very cautious and runs just about every test in the book, but never sounds pessimistic or judgmental. The MFM I consulted at the beginning of this pregnancy was not worried about me at all, which was reassuring, but not as much as having all the tests and feeling closely watched.

I didn't get a chance to have TTC counseling before I got pregnant, so I'm not sure if my OB and MFM would recommend LDA for TTC, but once I got pregnant my new OB put me on LDA right away (after consulting with the MFM) and had me see the MFM at 12 weeks. Because he was so optimistic about my pregnancy he left me under my OB's care. She occasionally consults him (like when my blood pressure went up a bit last week), but it has been very nice having her as my primary physician.

[angieb]

Our cases are fairly similar, I had HELLP but normal bp, etc., our daughter had severe IUGR, small placenta with infarcts and clots.(23 wks) I was given 12% odds of HELLP, 70% odds of preeclampsia.

I met with 2 different MFM's. One said lda and close monitoring but she wasn't really that worried, the other wanted me on LDA and lovenox with close monitoring. Her thought is that I likely have a clotting disorder that there isn't a test for yet, and with as early and severely and atypically that I got sick, plus our daughter's severe IUGR and placenta, it was worth the risks. I was on LDA from a + test and lovenox from 7ish to 28ish weeks with DS, had a relatively uneventful and healthy pregnancy, he was born at 36 weeks (on purpose due to my classical c-section) at 7.4 lbs. We stopped lovenox at 28 weeks because DS was clearly NOT at risk for IUGR at that point and everything was going so smoothly.

This time I am also on lda and lovenox though my MFM said we will likely stop the lovenox at 24ish weeks if everything seems to be going well still.

Anyway, I would definitely get a second or even third opinion. Some doctors aren't willing to try lovenox (the other mfm I met with said absolutely not) , others will recommend it depending on the patient and history and stuff.

[amjon]

I saw two different MFM (one was after I was pregnant, but supposed to be preconception- they're soonest appt was 8 weeks out). They had 2 totally different opinions. One thought I wouldn't be high risk at all and the other was pretty sure there was some sort of problem that caused Taylor's death. We will probably never know for sure what killed her. I did have my new OB do thyroid testing after we lost the second and it came back as hyper, so it could have been that. I want to go see another that I have heard rave reviews about, but they require a referral. I'm not sure if our OB would be willing to refer me.