RE or midwife? Recommendations?

[Anonymous]

Anonymous wrote:

Re: GW midwives' management of miscarriage and their personalities, people do not say this often, but I actually REALLY liked Marsha. She helped me through the second miscarriage, which was pretty scary. Many on here do not like her as much as the others, but I thought she was great. Whitney was actually fairly cold and I didn't get a great vibe from her. I spoke with Nora on the phone a bunch during #3 and that was okay too. The first spontaneous miscarriage was frightening, but it was pretty clear that there wasn't much they could "do" for me other than see me when the process was complete, check my hormone levels and make sure I was doing okay psychologically, which they did. The second one was a little more confusing and I came in for an ultrasound to confirm that the pregnancy was actually ending. I was given misoprostol to complete it at home, which was awful and I do not recommend. #3 was more like #1 and didn't require management. Nora and Marsha were both really great about responding to my phone calls or messages in the online system. Marsha in particular was also great at INITIATING contact, which I found unusual and super reassuring.

We were sort of taking the approach that 3 miscarriages (at 7 weeks, 9 weeks and 6 weeks, respectively) is not outside the range of "bad luck". They didn't suggest testing anything until the second one. I asked for the autoimmune stuff because I was concerned that maybe I had the same illness my mother does. Everything came back normal. After the second miscarriage, my husband and I put the brakes on and the third pregnancy was not really "planned" - I wasn't on BC but we also were not having sex regularly and literally only one time during my fertile window. When that pregnancy ended, we both realized that we were kind of relieved and separated. We (and our older child) are all doing great in our new lives.

Thanks a lot. I am the PP who asked you-- I had mine with Whitney and she was very attentive and caring. I find her a little colder than others, but have the utmost respect for her experience, and she did give me hugs and initiate contact just to check on me. She said now that I have had two miscarriages, she will be my primary person and I should email her as soon as I have a positive test next time. But they didn't suggest testing anything, as my labs were normal and I had had a Day 3 lab between pregnancies that was also normal. What did they suggest for you to test?

[Anonymous]

What is the reasoning behind not going to a doctor after 2-3 miscarriages? For delivery you can always switch back to the midwifes. Who prescribed misoprostol? A midwife?

[Anonymous]

Anonymous wrote:What is the reasoning behind not going to a doctor after 2-3 miscarriages? For delivery you can always switch back to the midwifes. Who prescribed misoprostol? A midwife?

Yes, the midwife prescribed. I guess my reason for not going to a completely different care provider was that I didn't think that the care I received would be different with a new provider. I got ultrasounds and bloodwork done when I went in. It was at the GW MFA, from the same ultrasound techs and phlebotomists that OB patients see. I don't really understand what kind of procedures I would've been given by an OB under similar circumstances. I was told that the next time I want to TTC, get seen so my progesterone levels can be more closely monitored and supplemented.

Re: what they suggested for me, it was the panel of tests they run for autoimmune issues - antiphospholipid antibody - which can be present in lupus and also the autoimmune condition my mom has that is less common than lupus and which is associated with blot clotting issues and miscarriage. However, I was negative, so they went back to the idea of it maybe just being bad luck.

My issue with Whitney was that for my first m/c, I'd been in a couple days before for my first prenatal appointment with her, the confirmation of pregnancy one. The appointment was generally pretty okay - my first child was born with midwives, so we talked about that - but she had a hard time finding the heartbeat and then was oddly insistent about "If you notice any spotting, please call" and "Are you SURE about your dates?" Later, when I miscarried, I realized that the reason she'd been doing that was that I was measuring a couple weeks behind where I should have been and she couldn't find a heartbeat because there wasn't one. I understand why she didn't want to freak me out, but it felt shitty to think that someone I wanted to trust knew this really sad terrible thing and didn't tell me, especially because the m/c itself came as a total surprise. I actually haven't seen her since, though not because I avoid her so much as because she's not available.

[Anonymous]

PP here.

Other PP, I don't know that you necessarily should be testing for the things I was testing for. I don't know if it's a standard test or not. For me, it was indicated because of family history, age group, pattern.

[Anonymous]

Anonymous wrote:

Anonymous wrote:What is the reasoning behind not going to a doctor after 2-3 miscarriages? For delivery you can always switch back to the midwifes. Who prescribed misoprostol? A midwife?

Yes, the midwife prescribed. I guess my reason for not going to a completely different care provider was that I didn't think that the care I received would be different with a new provider. I got ultrasounds and bloodwork done when I went in. It was at the GW MFA, from the same ultrasound techs and phlebotomists that OB patients see. I don't really understand what kind of procedures I would've been given by an OB under similar circumstances. I was told that the next time I want to TTC, get seen so my progesterone levels can be more closely monitored and supplemented.

Re: what they suggested for me, it was the panel of tests they run for autoimmune issues - antiphospholipid antibody - which can be present in lupus and also the autoimmune condition my mom has that is less common than lupus and which is associated with blot clotting issues and miscarriage. However, I was negative, so they went back to the idea of it maybe just being bad luck.

My issue with Whitney was that for my first m/c, I'd been in a couple days before for my first prenatal appointment with her, the confirmation of pregnancy one. The appointment was generally pretty okay - my first child was born with midwives, so we talked about that - but she had a hard time finding the heartbeat and then was oddly insistent about "If you notice any spotting, please call" and "Are you SURE about your dates?" Later, when I miscarried, I realized that the reason she'd been doing that was that I was measuring a couple weeks behind where I should have been and she couldn't find a heartbeat because there wasn't one. I understand why she didn't want to freak me out, but it felt shitty to think that someone I wanted to trust knew this really sad terrible thing and didn't tell me, especially because the m/c itself came as a total surprise. I actually haven't seen her since, though not because I avoid her so much as because she's not available.

Thank you for answering in detail. I get that the quality of tests is all the same, but maybe Drs have more experience interpreting them or coming up with other possible things that need to be checked that are not part of a standard panel of tests? If you have insurance coverage why not go to a higher level of expertise available?

[Anonymous]

Because the doctors don't take it seriously if you've only had two miscarriages and there is no obvious problem.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What is the reasoning behind not going to a doctor after 2-3 miscarriages? For delivery you can always switch back to the midwifes. Who prescribed misoprostol? A midwife?

Yes, the midwife prescribed. I guess my reason for not going to a completely different care provider was that I didn't think that the care I received would be different with a new provider. I got ultrasounds and bloodwork done when I went in. It was at the GW MFA, from the same ultrasound techs and phlebotomists that OB patients see. I don't really understand what kind of procedures I would've been given by an OB under similar circumstances. I was told that the next time I want to TTC, get seen so my progesterone levels can be more closely monitored and supplemented.

Re: what they suggested for me, it was the panel of tests they run for autoimmune issues - antiphospholipid antibody - which can be present in lupus and also the autoimmune condition my mom has that is less common than lupus and which is associated with blot clotting issues and miscarriage. However, I was negative, so they went back to the idea of it maybe just being bad luck.

My issue with Whitney was that for my first m/c, I'd been in a couple days before for my first prenatal appointment with her, the confirmation of pregnancy one. The appointment was generally pretty okay - my first child was born with midwives, so we talked about that - but she had a hard time finding the heartbeat and then was oddly insistent about "If you notice any spotting, please call" and "Are you SURE about your dates?" Later, when I miscarried, I realized that the reason she'd been doing that was that I was measuring a couple weeks behind where I should have been and she couldn't find a heartbeat because there wasn't one. I understand why she didn't want to freak me out, but it felt shitty to think that someone I wanted to trust knew this really sad terrible thing and didn't tell me, especially because the m/c itself came as a total surprise. I actually haven't seen her since, though not because I avoid her so much as because she's not available.

Thank you for answering in detail. I get that the quality of tests is all the same, but maybe Drs have more experience interpreting them or coming up with other possible things that need to be checked that are not part of a standard panel of tests? If you have insurance coverage why not go to a higher level of expertise available?

I think it speaks to a difference in perspective about the expertise itself. I disagree with the assumption that it necessarily is a higher level of expertise at this practice in particular. I am certain that they would have recommended that I get a second opinion or see a specialist if that was indicated by the situation. I didn't think it was and neither did they. I honestly don't think I reached the level of # of losses or time TTC that elevated me to a specialist or a second opinion. Miscarriages happen. They are traumatic and awful and sometimes you know why they happened, but sometimes you don't. Sometimes there is just no explanation for why an embryo fails to develop or stops developing. I guess that my perspective, at that time in my life, was that what was happening to my body was not outside the range of normal and did not require the opinion of a specialists. I have also never been of the opinion that an obstetrician is automatically more knowledgeable. The midwives that I saw were not on their first rodeo. They are well trained clinicians. They also work with a population where miscarriage is not uncommon, so it's not like there is some special secret test that could have been done by an OB that the midwives would never have heard about.

I apologize for going on a tangent, but it really bothers me when people assume that CNMs would fail to do a test or miss something obvious. Those women probably know more about women's bodies and pregnancy and childbirth than the OB resident I probably would've seen if I'd requested to be referred next door. I don't disagree that there are some midwives whose practice is confined solely to delivering babies and also some who probably shouldn't be doing even that, but I don't think that applies across the board to all midwives.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What is the reasoning behind not going to a doctor after 2-3 miscarriages? For delivery you can always switch back to the midwifes. Who prescribed misoprostol? A midwife?

Yes, the midwife prescribed. I guess my reason for not going to a completely different care provider was that I didn't think that the care I received would be different with a new provider. I got ultrasounds and bloodwork done when I went in. It was at the GW MFA, from the same ultrasound techs and phlebotomists that OB patients see. I don't really understand what kind of procedures I would've been given by an OB under similar circumstances. I was told that the next time I want to TTC, get seen so my progesterone levels can be more closely monitored and supplemented.

Re: what they suggested for me, it was the panel of tests they run for autoimmune issues - antiphospholipid antibody - which can be present in lupus and also the autoimmune condition my mom has that is less common than lupus and which is associated with blot clotting issues and miscarriage. However, I was negative, so they went back to the idea of it maybe just being bad luck.

My issue with Whitney was that for my first m/c, I'd been in a couple days before for my first prenatal appointment with her, the confirmation of pregnancy one. The appointment was generally pretty okay - my first child was born with midwives, so we talked about that - but she had a hard time finding the heartbeat and then was oddly insistent about "If you notice any spotting, please call" and "Are you SURE about your dates?" Later, when I miscarried, I realized that the reason she'd been doing that was that I was measuring a couple weeks behind where I should have been and she couldn't find a heartbeat because there wasn't one. I understand why she didn't want to freak me out, but it felt shitty to think that someone I wanted to trust knew this really sad terrible thing and didn't tell me, especially because the m/c itself came as a total surprise. I actually haven't seen her since, though not because I avoid her so much as because she's not available.

Thank you for answering in detail. I get that the quality of tests is all the same, but maybe Drs have more experience interpreting them or coming up with other possible things that need to be checked that are not part of a standard panel of tests? If you have insurance coverage why not go to a higher level of expertise available?

I think it speaks to a difference in perspective about the expertise itself. I disagree with the assumption that it necessarily is a higher level of expertise at this practice in particular. I am certain that they would have recommended that I get a second opinion or see a specialist if that was indicated by the situation. I didn't think it was and neither did they. I honestly don't think I reached the level of # of losses or time TTC that elevated me to a specialist or a second opinion. Miscarriages happen. They are traumatic and awful and sometimes you know why they happened, but sometimes you don't. Sometimes there is just no explanation for why an embryo fails to develop or stops developing. I guess that my perspective, at that time in my life, was that what was happening to my body was not outside the range of normal and did not require the opinion of a specialists. I have also never been of the opinion that an obstetrician is automatically more knowledgeable. The midwives that I saw were not on their first rodeo. They are well trained clinicians. They also work with a population where miscarriage is not uncommon, so it's not like there is some special secret test that could have been done by an OB that the midwives would never have heard about.

I apologize for going on a tangent, but it really bothers me when people assume that CNMs would fail to do a test or miss something obvious. Those women probably know more about women's bodies and pregnancy and childbirth than the OB resident I probably would've seen if I'd requested to be referred next door. I don't disagree that there are some midwives whose practice is confined solely to delivering babies and also some who probably shouldn't be doing even that, but I don't think that applies across the board to all midwives.

PP here, I did not meant to imply that midwifes are newbies or incompetent, I fully respect their work and knowledge. If you decided you didn't need a specialist visit I also respect that. But I wasn't talking of going to an OB vs midwife visit, but more like RE or genetic testing. Again, thanks for sharing your views. I am the type who likes to overtest and get second and third opinions, but I also like to hear about experiences of people who go via a different route.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What is the reasoning behind not going to a doctor after 2-3 miscarriages? For delivery you can always switch back to the midwifes. Who prescribed misoprostol? A midwife?

Yes, the midwife prescribed. I guess my reason for not going to a completely different care provider was that I didn't think that the care I received would be different with a new provider. I got ultrasounds and bloodwork done when I went in. It was at the GW MFA, from the same ultrasound techs and phlebotomists that OB patients see. I don't really understand what kind of procedures I would've been given by an OB under similar circumstances. I was told that the next time I want to TTC, get seen so my progesterone levels can be more closely monitored and supplemented.

Re: what they suggested for me, it was the panel of tests they run for autoimmune issues - antiphospholipid antibody - which can be present in lupus and also the autoimmune condition my mom has that is less common than lupus and which is associated with blot clotting issues and miscarriage. However, I was negative, so they went back to the idea of it maybe just being bad luck.

My issue with Whitney was that for my first m/c, I'd been in a couple days before for my first prenatal appointment with her, the confirmation of pregnancy one. The appointment was generally pretty okay - my first child was born with midwives, so we talked about that - but she had a hard time finding the heartbeat and then was oddly insistent about "If you notice any spotting, please call" and "Are you SURE about your dates?" Later, when I miscarried, I realized that the reason she'd been doing that was that I was measuring a couple weeks behind where I should have been and she couldn't find a heartbeat because there wasn't one. I understand why she didn't want to freak me out, but it felt shitty to think that someone I wanted to trust knew this really sad terrible thing and didn't tell me, especially because the m/c itself came as a total surprise. I actually haven't seen her since, though not because I avoid her so much as because she's not available.

Thank you for answering in detail. I get that the quality of tests is all the same, but maybe Drs have more experience interpreting them or coming up with other possible things that need to be checked that are not part of a standard panel of tests? If you have insurance coverage why not go to a higher level of expertise available?

I think it speaks to a difference in perspective about the expertise itself. I disagree with the assumption that it necessarily is a higher level of expertise at this practice in particular. I am certain that they would have recommended that I get a second opinion or see a specialist if that was indicated by the situation. I didn't think it was and neither did they. I honestly don't think I reached the level of # of losses or time TTC that elevated me to a specialist or a second opinion. Miscarriages happen. They are traumatic and awful and sometimes you know why they happened, but sometimes you don't. Sometimes there is just no explanation for why an embryo fails to develop or stops developing. I guess that my perspective, at that time in my life, was that what was happening to my body was not outside the range of normal and did not require the opinion of a specialists. I have also never been of the opinion that an obstetrician is automatically more knowledgeable. The midwives that I saw were not on their first rodeo. They are well trained clinicians. They also work with a population where miscarriage is not uncommon, so it's not like there is some special secret test that could have been done by an OB that the midwives would never have heard about.

I apologize for going on a tangent, but it really bothers me when people assume that CNMs would fail to do a test or miss something obvious. Those women probably know more about women's bodies and pregnancy and childbirth than the OB resident I probably would've seen if I'd requested to be referred next door. I don't disagree that there are some midwives whose practice is confined solely to delivering babies and also some who probably shouldn't be doing even that, but I don't think that applies across the board to all midwives.

PP here, I did not meant to imply that midwifes are newbies or incompetent, I fully respect their work and knowledge. If you decided you didn't need a specialist visit I also respect that. But I wasn't talking of going to an OB vs midwife visit, but more like RE or genetic testing. Again, thanks for sharing your views. I am the type who likes to overtest and get second and third opinions, but I also like to hear about experiences of people who go via a different route.

I have a very good friend who is exactly like that and she also thought that I should escalate, but honestly, it just did not seem appropriate for me or my situation. As I mentioned up thread, if DH and I decide to have a child together, likely I would see a RE initially because of my previous issues. I just didn't think that was going to be helpful several years ago, when I was going through this.