21 weeks - not sure I am getting everything I need from my OB

[Anonymous]

I am 21 weeks with my first pregnancy, and 37 years old. I have seen my "main" OB two or three times, for about 15 minutes each. A different doctor, who I really liked (she was a bit grandmotherly) did my CVS and did the sonogram reading. Nobody has said anything about glucose testing, making a birth plan, talked to me about the hospital (WHC), recommend any type of birthing classes, test for gestational diabetes, or done anything more than listen for the heartbeat every 4 weeks and ask if I have any questions. Should I be getting more guidance and direction as a first time mother at 37? Or just in general? I am considering switching practices.

[Anonymous]

It's way too early to discuss most of those things. Glucose testing doesn't happen until about 28 weeks. I'm 37 weeks and just discussing birth plan with my midwife. GBS test will happen about 36-37 weeks. For birth classes, I would recommend checking the hospital website.

Most doctors have schedules they follow when they will discuss each item. If you have questions earlier, you'll need to bring them up.

[Anonymous]

Too early. I didn't take birth classes until 33-34 weeks. Too much before then and the info doesn't sink in. But remember it's a two-way street. If you have questions, you shouldn't wait for them to bring it up. They are asking you if you have any questions. One of them should be "what can I expect in the coming weeks in terms of glucose testing, when should I do birthing classes, when do I register at the hospital or take a tour, etc." They can't read your mind and if you say you don't have any questions they're going to be out the door.

Now, if you do ask and you do not feel they are forthcoming with their info, that's a different story. I find the nurses are most helpful with these kinds of q's.

[Anonymous]

PS glucose testing and testing for GD are the same thing.

[Anonymous]

Agree you should ask questions if you have them, not wait for them to raise things. Can't speak to the age thing, though -- I know some OB's go overboard with AMA and others try to be a little more respectful of the mother's wishes, talking over options and letting her choose what additional monitoring she wants. I don't know what's usually recommended so I can't say what your OB should be suggesting.

I will say that when I asked my OB during my first pregnancy when we should discuss the birth itself (options, c-section vs. vaginal, epidurals, pitocin, what else might happen, etc.) he said "At the birth -- what happens will happen." That was a sign to me to switch providers. I did, and my next provider was happy to sit down and talk through the whole process with me. So the burden is on you to ask -- but if the doc is not willing to answer your questions, consider switching.

[Anonymous]

congrats on your pregnancy!

i don't agree that it's too early to discuss these things, especially your birth wishes. if you wait until 30+ weeks to bring up your wishes and then find that your provider isn't a good match, it will feel harder and more intimidating to switch. i don't understand when people say not to talk about any of that stuff til later -- how would you know if the provider's the right fit for you if you don't bring it up sooner!

i think if there are specific questions you have or things you want to discuss, or if you have concerns about how your OB is handling things, you should bring it up. i don't think a lot of providers are proactive about bringing topics up, but maybe if you bring it up yourself, they will be responsive.

if you want to do your own investigation, you can find information about independent (non hospital) childbirth classes at www.birthoptionsalliance.org. the practice might have their own that they offer/recommend, and the hospital certainly would too, which you should easily be able to find on the hospital's website (along with info on tours, etc. where hopefully you can get some of your questions answered).

i switched from an OB to midwifery care during my first pregnancy because i was unsatisfied with the impersonal care i was receiving from the OB. i was really happy with the midwives and their attentiveness. they did spend a lot more time talking with me about the physical and emotional aspects of my pregnancy and the birth. i was glad i switched. so i think if you don't like the provider, you can likely find someone else you'd like much better. i was very glad i took the time to switch and trusted my instincts. best of luck!

[Anonymous]

Too early for glucose testing. As far as birth plan, hospital etc - unless you have a progressive OB, they won't bring that up. You should be asking your OB questions about issues that are important to you. Perhaps I am wrong, but I think a typical OB will just assume you're having a "standard" epi+pitocin (if necessary) unless you specifically bring up other things.

[Anonymous]

If a birth plan is important to you, definitely bring that up at your next appt.

During my first pregnancy, I asked my OB about whether/when I should write a birth plan and his response was something to the effect of "births can take their own course and are not really something that can be planned in advance" and then discussed with me a few of the "hot-button issues"--e.g., epidural and use of pitocin. That was very helpful to me and convinced me that I could cross "draft birth plan" off my list, which I personally was happy to do, because all I wanted out of the birth was a healthy baby. I'm of the school of thought that he's the one that went to med school and I planned to follow his advice as things unfolded. As it turns out, my water broke at 34 weeks and any birth plan would have been out the window anyway. But I did get my goal--healthy baby!

However, if you are hoping for a particular birth experience (e.g., no meds, being able to walk around during labor), you should definitely bring the issue up soon to get your OB's perspective.

[Anonymous]

I think you need to be proactive. I mean I go see midwives and they have a checklist of things I need to do (make birth plan, pick a back up hospital, pick child birth classes, etc.). But they always have a ton more hours in the day to see me because they have fewer patients. For an OB or any doctor I think you need to be proactive. If you have concerns talk to them, ask questions. IMO doctors are really willing to give you a lot of information if you just know what to ask.

[Anonymous]

If you are thinking of leaving your practice because of these reasons, I would say don't do it. If you are bringing these things up with your doctor and they are not answering your questions, that is a different reason.

First, I am impressed that you have had appointments that have lasted 15 minutes. I am 20 weeks along and most of my appointments have been 5 minutes, 10 max.

For my first, when I did the glucose testing, it was brought up to me by the scheduler. Simply, "make sure you allow x amount of time for your next appt...we need to do the glucose testing then." At 20 weeks, it has not been mentioned.

The hospital was not really discussed. Typically, the practice/doctor only delivers at one hospital, so there isn't a lot of discussion there. If you are not happy with, or have heard bad things about the hospital, you could bring up specifics, but I don't believe much other conversation is needed.

I think the same goes with classes you may take. It is pretty early to take them, but when it was time, I did the research, signed up, etc. The doctor asked me if I thought about classes, but by the time she did 35 weeks (?) if I hadn't have thought of it, it would have been way too late to sign up for anything...they book up way too fast.

A birth plan is a tricky thing and I think many people have different thoughts on it. I personally, talked with the doctor at the hospital, while in birth, and my husband was my advocate. But, I was at a large practice, where you didn't really know who was delivering you until you went into labor. Either way, if you want to have a birth plan, I think 21 weeks is too early.

I am also 37 years old, and this is my second child. While we are AMA (and I was with my first), the doctor said that they don't do a whole lot differently unless something presents itself. I hate that some articles/internet/people make you feel that AMA/35 is ancient to have kids...it isn't.

What you have described as your typical doctor's appointment seem normal to me. The doctor listens to the heartbeat and asks what questions you have. As you get further along, that changes (cervical checks). I would recommend writing your questions down and bringing them with you. Too often, I would feel rushed and then get mad at myself for not asking questions. This way, I feel as if I got the best out of the few minutes.

Good luck.

[Anonymous]

OP here - thanks for the advice. I was not too worried about all this before yesterday - I am extremely healthy and in very good physical shape, and have basically had no symptoms whatsoever (which I took as a good thing). In talking with a friend yesterday she asked me about all these things, which I assumed it was just too early to worry about and she kind of freaked me out and started telling horror stories about "pregnancies gone wrong" because the OB was not micromanaging. I am not worried about a birth plan, not using a doula, I just naively expect that everything will go well.

The other thing is that I have read so many negative things about WHC that I am a little concerned about delivering there. The OB recommended to me by above mentioned friend is with GW.

[Anonymous]

One little suggestion, if you're curious about the hospital, go for a tour now. If needed, you can always do a second tour closer to your due date. The hospital coordinator will be able to answer a lot of questions, and you'll tour the labor and delivery room, recovery room, and NICU. My husband and I toured GUH and Sibley when I was only 20 weeks, and it gave me some perspective.

[Anonymous]

Anonymous wrote:OP here - thanks for the advice. I was not too worried about all this before yesterday - I am extremely healthy and in very good physical shape, and have basically had no symptoms whatsoever (which I took as a good thing). In talking with a friend yesterday she asked me about all these things, which I assumed it was just too early to worry about and she kind of freaked me out and started telling horror stories about "pregnancies gone wrong" because the OB was not micromanaging. I am not worried about a birth plan, not using a doula, I just naively expect that everything will go well.

The other thing is that I have read so many negative things about WHC that I am a little concerned about delivering there. The OB recommended to me by above mentioned friend is with GW.

What are your concerns about WHC? I delivered there and have no major complaints, and the things that did bother me were things that friends who delivered elsewhere also dealt with, so I don't think they were specific to WHC.

[Anonymous]

I was a high risk pregnancy, due to chronic hypertension, and all of my visits with the OBs were short and sweet. If I had questions, they were happy to take the time to answer them and didn't make me feel rushed. My appointments with the OBs were about 5 minutes. They kept a watchful eye over me by doing growth ultrasounds each month and weekly NSTs and biophysicals.

I just went with the flow and trusted their judgement. I delivered a healthy baby boy about 4 weeks ago. In my experience, if something doesn't look right, they are quick to investigate further.

[Anonymous]

OP, I second the PP who suggested doing the hospital tour and if possible, tour another hospital as well for comparison. I was at WHC for the first part of my first pregnancy, and for various reasons was not very satisfied with the OB's there and the "atmosphere" of the hospital itself. I switched to a practice in NoVA, and delivered at VHC, and it was like night and day...