Do I really need a high-risk pregnancy specialist?
A.L. Bell
and mostly very healthy (other than being fat). Risk factors: moderate
thyroid issues (TSH 6.0, plus thyroid antibodies); a 7 cm fibroid in
the wall at the top of my uterus; and one 140/90 blood pressure
reading (after I ran to the ob/gyn's office from work).
The ob/gyn, who delivers at a small, "level 1" hospital, told me I
should be under the care of a maternal-fetal medicine specialist, a
perinatalogist, or someone else who specializes in high-risk
pregnancies.
I know I need an ob/gyn who delivers at a big hospital, but I was
wondering if there's some independent way to figure out whether I
really need a high-risk specialist, or just a regular ob/gyn who has
easy access to a high-risk specialist. It seems, from reading info on
Web sites for high-risk pregnancy specialists, that their typical
patient is facing bigger risks than I'm facing. On the one hand, I
want really good care. On the other hand, I don't want to waste
medical resources by seeing a high-powered specialist when all I need
is a regular ob/gyn who takes continuing ed classes seriously.
Also: I AM going in for a regular prenatal check-up tomorrow (Friday)
and will ask the ob/gyn these questions, but I would feel better if I
also had some independent feedback from women who've been there, done
that.
Larry McMahan
A.L. Bell <all...@vnet.net> writes:
: I'm 37, 14 weeks along with my first, extremely comfortable pregnancy,
If you are feeling well in your pregnancy, that is an important sign.
: and mostly very healthy (other than being fat).
Uh, how can I say this? :-) You don't give any numbers, so I will. :-)
Monika was 38 when she gave birth to her first, and weighed 204 before
becoming pregnant, and we had a very successful homebirth. If we had
been high risk, we would have been risked out. We know of other mothers
upwards or 250 who have also had uneventful homebirths. I don't think
it would be an issue unless you were close to 300, although that would
be bad for other longer term health issues.
: Risk factors: moderate
: thyroid issues (TSH 6.0, plus thyroid antibodies);
I don't know s*** from shinola about thyroid, so someone else can
comment on that. :-)
: a 7 cm fibroid in the wall at the top of my uterus;
Well, maybe others who have more experience with fibroids can give you
a better answer, but I don't think 7 cm is that large, and if it is on
the top wall of your uterus, I should not be any hindrance to labor or
delivery.
: and one 140/90 blood pressure reading
OK. Did he take it as soon as you got there? Did he retake it later
in the exam to see if the reading had changed. If your answers are
yes, no, then he is an idiot! :-) I certainly would not be worried
unless I was repeat reading above 90 with an occasional 100 or more.
Again, we dealt with readings higher than this and had an uneventful
home birth. You can read all about it (including the PIH) at
http://home.attbi.com/~mcmahan
: The ob/gyn, who delivers at a small, "level 1" hospital, told me I
: should be under the care of a maternal-fetal medicine specialist, a
: perinatalogist, or someone else who specializes in high-risk
: pregnancies.
Why? Did he explain it to you? Already I don't trust his judgment
about what constitutes high risk and what does not. I am concerned
that someone with this view would be intervention happy and would
create more problems than he solved. Do you have any opportunites
for a second opinion or even better yer, alternatives for care?
: I know I need an ob/gyn who delivers at a big hospital, but I was
: wondering if there's some independent way to figure out whether I
: really need a high-risk specialist, or just a regular ob/gyn who has
: easy access to a high-risk specialist.
Why do you think you need an OB who delivers a a big hospital. Studies
have consistently shown that the complication rate at small community
hospitals are much lower. Teaching hospitals are often the worst.
Unless you have an already identified condition such as pre-eclampsia
or placenta previa that would inevitably necessitate a c-section, a
larger hospital would often be the wrong choice.
: easy access to a high-risk specialist. It seems, from reading info on
: Web sites for high-risk pregnancy specialists, that their typical
: patient is facing bigger risks than I'm facing.
Exactly, they are geared to react to major problems like I noted above,
they often do not know how to deal with a birth that can be managed
with a minimum or interventions. They tinker until they create a
problem that is big enough for them to deal with.
: On the one hand, I
: want really good care. On the other hand, I don't want to waste
: medical resources by seeing a high-powered specialist when all I need
: is a regular ob/gyn who takes continuing ed classes seriously.
A high tech specialist does not equate with really good care unless
you actually have the exact condition the specialist is trained to
deal with. To a carpenter, every problem looks like a nail!
: Also: I AM going in for a regular prenatal check-up tomorrow (Friday)
: and will ask the ob/gyn these questions, but I would feel better if I
: also had some independent feedback from women who've been there, done
: that.
Read our story. We had a battle with PIH for the last several weeks
with both of our babies. However, it was always marginal, and we
had two successful homebirths in spite of it. If we had given in to
the medical establishment, we would have probably had much less
successful experiences.
Good luck,
Larry
Cheryl M.
"Wendy Furness" <roughl...@hotmail.com> wrote in message
news:mdslduo0b000fcno8...@4ax.com...
<snipped>
"Earlier in the post being overweight was mentioned. I wondered if the blood
pressure was taken with a too tight regular sized cuff? If you are
sufficiently
overweight to need the larger cuff, that would make a significant difference
ie too tight cuff = falsely high reading."
Just to piggyback on this... to ensure the right reading is being taken,
check the "index mark lines" on the inside of the cuff before they begin to
take your bp. If you can see that the arrow on one side of the cuff does
not fall within the index guidelines, the cuff is too small for your arm.
This can make a big difference in bp reading...
HTH,
theother Cheryl
sue
Go to the high risk specialist. She/he won't miss anything, and THAT is
what will allow you to have a normal pregnancy and birth without
(preventable) emergencies and complications. I had similar issues,
thyroid, age 37 with my first, and later, gestational diabetes with my
first. It was managed perfectly and everything was fine. With my
second, I didn't have GD, and my pregnancy was as uneventful as could
be. I was still with my expert in maternal fetal medicine. I had a
completely natural birth at the hospital.
Don't get scared away by a big title. A friend of mine went to a
regular OB and ended up with complications because the OB missed things
that a high risk group wouldn't.
kwl
not as I'm 1) not an MD and 2) not familiar with your particular
issues. But, if your current OB does not feel comfortable treating
you, I'd certainly look elsewhere.
At the same time, I wouldn't be afraid of seeing a high risk
specialist...I've been seeing a maternal fetal specialist at a big
Harvard teaching hospital for my current pregnancy (previous preterm
birth, DES exposure, 39 years old)and have found them to be quite
conservative in treating me. I've had a few problems (far fewer than
last time and far fewer than I was expecting!) and the approach has
consistently been to try the least interventionist solution first
before moving on. The practice deals with a wide range of pregnancy
complications and also sees women with normal pregnancies...I've never
felt as if I was dealing with a "hammer looking for a nail".
Good luck!
K
Hillary Israeli
Larry McMahan <mcm...@spike.cup.hp.com> wrote:
*OK. Let me take these one at a time.
*
*A.L. Bell <all...@vnet.net> writes:
*
*: I'm 37, 14 weeks along with my first, extremely comfortable pregnancy,
*
*If you are feeling well in your pregnancy, that is an important sign.
*
*: and mostly very healthy (other than being fat).
*
*Uh, how can I say this? :-) You don't give any numbers, so I will. :-)
*Monika was 38 when she gave birth to her first, and weighed 204 before
*becoming pregnant, and we had a very successful homebirth. If we had
Just for clarity - it's possible to weigh 204 and be hugely obese, or to
weigh 204 and be a very large, muscular person :). I can weigh 180 pounds
if I've been working out a lot, without being fat. Usually, however, I
weigh 165 and am somewhat flabby. And more recently, I went up to 180
pounds and WAS actually fat - I ate a lot after 9/11 due to generalized
stress and anxiety related to the whole terrorist thing as well as some
personal crises. :) How tall is Monika, anyway? I always imagine her as
sort of Amazonian (and I mean that in a complimentary way. I am 5'10"!)
--
hillary israeli vmd http://www.hillary.net in...@hillary.net
"uber vaccae in quattuor partes divisum est."
newly minted veterinarian-at-large :)
Mary Gordon
high risk?
Age alone doesn't make you high risk - I had my second baby at 37 and
my third at 41, and I was eligible to use midwives with no doctor
involved, and they can only provide care for low risk moms in Ontario.
My thyroid quit entirely back in my early 30's and I've been on
replacement hormones ever since, so a failing thyroid or even outright
failure that is being treated doesn't make you high risk (although, by
the by, you probably should be starting replacement hormones now, your
TSH is creeping higher than it should be to feel well -ask to see an
endocrinologist and don't let your GP or OB deal with this). Fibroids
are a dime a dozen - tons of women have them, and a single higher
blood pressure reading - !!! I can't see one reading being a deal
breaker.
I think you need to ask some questions what you have described
wouldn't seem to add up to anything of particular concern.
Mary G.
A.L. Bell
> I'm confused - did they not give a reason they want to class you as
> high risk?
It turned out that I misunderstood why the doctor thought I was high
risk. A couple of weeks ago, I had a little bit of spotting after sex
(which I forgot about when listing the risk factors here). Since I
haven't spotted since, it seems I've fallen back down into the
doctor's normal risk category.
I'm not really sure why a little spotting after sex put me in a
possible high-risk category, but maybe a little spotting combined with
a midsize fibroid means more than either factor by itself. Or
something. I'm starting to wish I'd taken a course in college on
"pregnancy business management skils."
> My thyroid quit entirely back in my early 30's and I've been on
> replacement hormones ever since, so a failing thyroid or even outright
> failure that is being treated doesn't make you high risk (although, by
> the by, you probably should be starting replacement hormones now, your
> TSH is creeping higher than it should be to feel well -ask to see an
> endocrinologist and don't let your GP or OB deal with this).
I did go to an endocrinologist. He verified the high-ish TSH and also
found the thyroid antibodies, but he didn't seem interested in giving
me thyroid pills. I guess the issue during pregnancy is that, even
though hypothyroidism is bad, hyperthyroidism is worse, so maybe
doctors don't want to tinker while a woman is actually pregnant.
Anyhow, I'm a little uncomfortable letting the thyroid issue slide,
but I don't want to be a patient who shops around for doctors till I
get an opinion I like.
Larry McMahan
: Just for clarity - it's possible to weigh 204 and be hugely obese, or to
: weigh 204 and be a very large, muscular person :). I can weigh 180 pounds
: if I've been working out a lot, without being fat. Usually, however, I
: weigh 165 and am somewhat flabby. And more recently, I went up to 180
: pounds and WAS actually fat - I ate a lot after 9/11 due to generalized
: stress and anxiety related to the whole terrorist thing as well as some
: personal crises. :) How tall is Monika, anyway? I always imagine her as
: sort of Amazonian (and I mean that in a complimentary way. I am 5'10"!)
Now we are getting personal. I hope she isn't reading this thread!
5'7" That said, she does have a rather muscular build, but maybe
not THAT muscular. :-)
I didn't say any of this,
Larry