Ob no longer delivering me due to having GD and insulin dependent, 35 weeks - what to do?

[Anonymous]

Anonymous wrote:I hope you find a good Dr. OP. I am a type 1 and delivered in another state. I worked with both a group of Obs and a MFM. A random doc from the group that I had never met started my delivery and another one finished it. So the important part is to get in with a group that can handle you and your baby and have the baby at a hospital that can handle high risk. BTW my baby was perfect. A little over 7 lbs and no blood sugar issues. I bet you have better blood sugars than I ever had. Good luck!

Thanks so much, it's always great to hear about good experiences - Op

[Anonymous]

Anonymous wrote:I don’t think an Ob can discharge a patient this late. I’d complain to the medical board.

I had a hard time getting a new Ob to accept me and I was much earlier in my pregnancy than you. If I were you, I would go to the Georgetown Er with a complaint (like another poster said). They will give you an Ob so that someone is familiar with your case. Also, go pick up your records from your old Ob. Some offices take weeks to transfer records.

Thanks! It looks like Georgetown is willing to accept me as of now, but they need to see my records first. I've been rejected by two other places recommended on here already since it's too late. It's so frustrating. - OP

[Anonymous]

We’re all rooting for you! Hope gtown works out. Keep us posted.

[Anonymous]

Anonymous wrote:I was diabetic before being pregnant and was immediately put on insulin by my endocrinologist (I didn't take insulin before pregnancy). I was told that the recommended diabetic protocol was having frequent monitoring ultrasounds, and that they wanted the baby delivered before 39 weeks, and preferred it to be a scheduled c-section. I was scheduled for a c-section right at 37 weeks and went into labor a few days before. My baby was just under 7 pounds at that point, and had low blood sugar issues but we ended up supplementing with formula. I'm flabbergasted that your doctor didn't figure out his/her discomfort with this until now. In terms of shady grove, I guess if you're going to be scheduled early as a c-section, it's manageable. But what a crappy situation all around!!!

My MFM is the one to make delivery date recommendations as it depends on how well my GD is managed, and they have been optimistic at my last few check ins that I'd make it to 39 weeks with a vaginal delivery. I thought my Ob would be offering me different options and manage it in conjunction with my MFM, but instead I just got dropped when I asked about options.

[Anonymous]

Anonymous wrote:We’re all rooting for you! Hope gtown works out. Keep us posted.

Thank you so much! I really hope no one else has to go through this and I'll definitely keep you all posted! - Op

[Anonymous]

Anonymous wrote:I would call this doctor back, say no OB would take me at this late date and let him know that you’ve decided to have the baby at home. Preferably leave that as a message.

If this is not true, there’s a good chance the OB who dumped you would find out. The Ob’s at Sibley are like a bunch of 12 year old gossips. They are most likely all aware of you.

[Anonymous]

I’d sue the dumping Dr for mental anguish.

[Anonymous]

Were you just started on insulin? The fasting number is the most important one. I hope you let us all know who this OB is, so women can avoid his practice, and good luck to you!

[Anonymous]

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Anonymous wrote:I would call this doctor back, say no OB would take me at this late date and let him know that you’ve decided to have the baby at home. Preferably leave that as a message.

She's already been discharged from care due to being high risk (insulin dependent, out of control blood sugars, macrosomia) and her original OB cannot care for her anymore, it happens. She has already been referred, but doesn't want to see that OB for whatever reason. Your advice would make her seem crazy.

OP It doesn't seem like you understand you are a high risk patient, and both you and you baby can have serious outcomes during pregnancy, birth, and even after birth. You really should see who were referred to.

Op here. The baby hasn't been diagnosed with macrosomia yet btw and my blood sugars are 95% under control. I am only on bedtime insulin at a low dosage and my MFM said my case isn't that serious at all. My last growth scan was 32 weeks and baby was measuring in the 99th percentile (he's also very tall btw). I will have another growth scan soon to see where he is at. I may be diagnosed with macrosomia then, but not yet.

It's not possible to diagnose macrosomia until after the baby is born, because late pregnancy prenatal measurements can be wildly inaccurate. All they can do until s/he is born is make an educated guess.

There is a great article on Evidence Based Birth about macrosomia and the shoulder dystocia risks for a baby whose mom has insulin-dependent GD.

Op here. Do you mind sharing that article? Would love to read it, thanks!

I think this is the one: https://evidencebasedbirth.com/evidence-for-induction-or-c-section-for-big-baby/

As a PP said, ultrasound measurements, particularly weight estimates, late in pregnancy are notoriously inaccurate. I had several friends due around the same time I was. All were under the care of OBs and were sent for growth scans. All were told they were having babies over 8.5 pounds. Only one baby ended up over 8. I saw midwives and zero ultrasounds after my 20 week anatomy scan. 2 days before baby was born, midwife estimated baby to be 7 pounds 14 ounces and 21 inches long ("he's lanky!"). He was 8 pounds exactly and, yep, 21 inches.

Did you or any of your friends have gestational diabetes controlled by insulin?

Stop it with suggesting that OP turn to non-medical sources for her care. She needs to see an OB.

Huh? Everyone on here has recommended seeing an OB. EBB is written by a nurse PhD and medical researcher in consultation with physicians.

Does information scare you?

Evidenced-based birth is a website written by a non-medical professional selling medical advice (that is now several years outdated).

OP needs to talk to an actual doctor.

Why don't you "stop it" with the medical paternalism? Suppressing/discrediting valid information is not ok. Telling people what to do, also not ok. Where do you think YOUR OB gets the info to make evidence-based care decisions? That's right, from PhD researchers like the author of EBB (who meets the definition of a medical professional), combined with their own judgment.

That blog post is incoherent, outdated, ramble written by a "nurse researcher" with no training or clinical practice in obstetrics, and is SIX years old to boot. I won't go into the evidence because I don't think OP needs a long discussion about the risks she is facing, but suffice it to say that the blog post is way out of date and incorrectly minimizes the risks.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP: I had the worse possible outcome at Sibley a few years ago because they are not prepared for anything out of the ordinary. My next two high risk pregnancies (not GD) were managed successfully from beginning to end through MFM care at Georgetown. If you doctor refers you to an MFM at Georgetown, why on earth would you not just do that? Because Sibley is nicer and that's where the rich deliver? Please. Do the right thing and take care of your baby and stop being stubborn.

Op here. I was actually the one that brought up delivering at Georgetown knowing that it would be safer for my baby, Ob has only pushed for Sibley and the moment I mentioned a different hospital he said he'd drop me. My current MFM is not at Georgetown btw.

I'm in touch with Georgetown trying to get an appt with an Ob there. Might end up transferring my MFM there too, we'll see.

Wait....you brought up delivering at a different hospital, which he doesn't have privileges at? So he realized you wanted to deliver elsewhere and he wasn't going to get his $$. Private practitioners get their compensation when they attend your delivery (as opposed to hospitalists who get a salary for hours worked), which is why they sometimes get territorial.

And this after you were pushing back on scheduled early term delivery. Sounds like your mention of delivering elsewhere was the last straw.

Yikes.. you got dumped hardcore. The good news is, you definitely dodged a bullet! No one needs to be in the care of someone like this. Please do come back and share the name!

[Anonymous]

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Anonymous wrote:I would call this doctor back, say no OB would take me at this late date and let him know that you’ve decided to have the baby at home. Preferably leave that as a message.

She's already been discharged from care due to being high risk (insulin dependent, out of control blood sugars, macrosomia) and her original OB cannot care for her anymore, it happens. She has already been referred, but doesn't want to see that OB for whatever reason. Your advice would make her seem crazy.

OP It doesn't seem like you understand you are a high risk patient, and both you and you baby can have serious outcomes during pregnancy, birth, and even after birth. You really should see who were referred to.

Op here. The baby hasn't been diagnosed with macrosomia yet btw and my blood sugars are 95% under control. I am only on bedtime insulin at a low dosage and my MFM said my case isn't that serious at all. My last growth scan was 32 weeks and baby was measuring in the 99th percentile (he's also very tall btw). I will have another growth scan soon to see where he is at. I may be diagnosed with macrosomia then, but not yet.

It's not possible to diagnose macrosomia until after the baby is born, because late pregnancy prenatal measurements can be wildly inaccurate. All they can do until s/he is born is make an educated guess.

There is a great article on Evidence Based Birth about macrosomia and the shoulder dystocia risks for a baby whose mom has insulin-dependent GD.

Op here. Do you mind sharing that article? Would love to read it, thanks!

I think this is the one: https://evidencebasedbirth.com/evidence-for-induction-or-c-section-for-big-baby/

As a PP said, ultrasound measurements, particularly weight estimates, late in pregnancy are notoriously inaccurate. I had several friends due around the same time I was. All were under the care of OBs and were sent for growth scans. All were told they were having babies over 8.5 pounds. Only one baby ended up over 8. I saw midwives and zero ultrasounds after my 20 week anatomy scan. 2 days before baby was born, midwife estimated baby to be 7 pounds 14 ounces and 21 inches long ("he's lanky!"). He was 8 pounds exactly and, yep, 21 inches.

Did you or any of your friends have gestational diabetes controlled by insulin?

Stop it with suggesting that OP turn to non-medical sources for her care. She needs to see an OB.

Huh? Everyone on here has recommended seeing an OB. EBB is written by a nurse PhD and medical researcher in consultation with physicians.

Does information scare you?

Evidenced-based birth is a website written by a non-medical professional selling medical advice (that is now several years outdated).

OP needs to talk to an actual doctor.

Why don't you "stop it" with the medical paternalism? Suppressing/discrediting valid information is not ok. Telling people what to do, also not ok. Where do you think YOUR OB gets the info to make evidence-based care decisions? That's right, from PhD researchers like the author of EBB (who meets the definition of a medical professional), combined with their own judgment.

That blog post is incoherent, outdated, ramble written by a "nurse researcher" with no training or clinical practice in obstetrics, and is SIX years old to boot. I won't go into the evidence because I don't think OP needs a long discussion about the risks she is facing, but suffice it to say that the blog post is way out of date and incorrectly minimizes the risks.

One of the articles posted (not the "Q&A" style one) was updated in 2016. It reads like a literature review which it is. It's meant to inform, not to train or educate or replace real life medical care.

Anyway sounds like OP already came to her own conclusions about her care which is why her crappy doctor dumped her when he didn't agree.

[Anonymous]

Anonymous wrote:Were you just started on insulin? The fasting number is the most important one. I hope you let us all know who this OB is, so women can avoid his practice, and good luck to you!

Op here. I started insulin about 2 months ago for fasting

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP: I had the worse possible outcome at Sibley a few years ago because they are not prepared for anything out of the ordinary. My next two high risk pregnancies (not GD) were managed successfully from beginning to end through MFM care at Georgetown. If you doctor refers you to an MFM at Georgetown, why on earth would you not just do that? Because Sibley is nicer and that's where the rich deliver? Please. Do the right thing and take care of your baby and stop being stubborn.

Op here. I was actually the one that brought up delivering at Georgetown knowing that it would be safer for my baby, Ob has only pushed for Sibley and the moment I mentioned a different hospital he said he'd drop me. My current MFM is not at Georgetown btw.

I'm in touch with Georgetown trying to get an appt with an Ob there. Might end up transferring my MFM there too, we'll see.

Wait....you brought up delivering at a different hospital, which he doesn't have privileges at? So he realized you wanted to deliver elsewhere and he wasn't going to get his $$. Private practitioners get their compensation when they attend your delivery (as opposed to hospitalists who get a salary for hours worked), which is why they sometimes get territorial.

And this after you were pushing back on scheduled early term delivery. Sounds like your mention of delivering elsewhere was the last straw.

Yikes.. you got dumped hardcore. The good news is, you definitely dodged a bullet! No one needs to be in the care of someone like this. Please do come back and share the name!

Op here. If I were to sum up the sequence of events, that looks to be what happened. It honestly happened so quickly and I had no time to think or hypothesizes about why I was dropped so quickly.

I agree I dodged a bullet too, wish I dodged it earlier but I dodged it nonetheless.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OPs MFM has given her exactly one recommendation and that's to go all the way to Shady Grove. It is not like she got referred to Georgetown and is rejecting that. Her oh-so-fabulous solo practice OB suggested she just show up at Georgetown or GW. Such a responsible, caring physician.

(This has to be Footer, no?)

Op here. Did you have Footer as an Ob?

I did not, but a couple of friends did. They both ultimately stayed with him, had healthy babies, but said they would probably look elsewhere if they had a second. Neither had GD, though.

[Anonymous]

The docs in the Children's ED call Shady Grove "Shady Grave," because of the terrible quality of medical care it is apparent transfers from there have received. I would 100% not deliver there.

OP: I would definitely refer your OB to the medical board. Flat out dumping you at 35 weeks w/o ensuring a transfer you are comfortable with is against practice standards.