OP here. Thanks to all who offered advice. The numerous responses and back and forth highlights why I asked now rather than later - I want to do some research, and I know it will take time. And, yes, a preconception appointment was recommended by both my primary care doctor and my reproductive endocrinologist ahead of any transfer - so I don't think that I'm jumping the gun. It is also, as those of you who have been through infertility treatments can probably understand well, something that I can cross off the list while we wait.

Thanks again!

Anonymous wrote:Ahh the midwife defenders are out in full force tonight on a thread requesting OB recommendations. WTF.

Yes being AMA makes you high risk. Literally I just asked this at Georgetown and one of the lead OBs said that alone means you are treated as high risk because AMA puts you at greater risk for a host of complications. Some of you treat this like a personal affront or a character flaw when it’s a medical reality. I’m AMA and I don’t take it personally, and you shouldn’t either. I choose to delay having kids and I have no one else to hold responsible for that but myself. Yes, being obese puts you at a much higher risk of a C section and other complications. Yes, IVF puts you at higher risk for certain complications. Doesn’t mean you’ll have them but that they are more likely.

A hospital based midwife having backup OBs doesn’t necessarily mean the OB gets called in when they should. Midwives and OBs can have different ideas, perspectives, risk thresholds, and ideas about when an OB should be alerted or if they should be brought in to a delivery at all. Collaboration is only great if everyone is singing from the same songbook. Midwifery students and medical students are currently taught from different songbooks. And there is plenty of evidence is available in the media and elsewhere that shows what happens when midwife/physician collaboration works poorly. You can also easily search the DC Superior Court cases for medical malpractice. Undisclosed settlements with NDAs mean the news never reports the stories from the affected families, but the cases are easily found if you search.

I'm the first PP who suggested either a CNM practice or a small OB practice. I also went through IVF and was AMA for my first. Pregnant again with my second (I'm 40); still seeing midwives. Yes, as AMA, I am certainly at a higher risk than I would be if I was, say, in my 20s. I'm not denying that. I've already been told by the CNMs that I see that I will need extra monitoring due to my age and, if I develop any sort of complications, obviously I will be risked out. That's fine with me. When I was initially under OBGYN care for my first (at 37), they did not view me as "high risk", just due to AMA. There were no referrals to an MFM; they did not plan on extra monitoring just due to my age. Frankly, every practice (yes, even OBs) seems a bit different with their level of panic over AMA.

I made the suggestion for a hospital-based group of CNMs because OP stated that she was looking for someone who might be more sensitive to anxiety. I read that as maybe wanting someone who would spend more time with her at appointments, provide more reassurance, etc. That, typically, is a hallmark of CNM practices. Not saying that it can't be found with OBGYNs, either, which is why I also suggested looking at a smaller OBGYN practice. I was just offering my recommendation based on my own experiences in a very similar situation. Honestly, I didn't even realize CNMs were an option in this area until my RE suggested I look into it after our successful IVF.

Ahh the midwife defenders are out in full force tonight on a thread requesting OB recommendations. WTF.

Yes being AMA makes you high risk. Literally I just asked this at Georgetown and one of the lead OBs said that alone means you are treated as high risk because AMA puts you at greater risk for a host of complications. Some of you treat this like a personal affront or a character flaw when it’s a medical reality. I’m AMA and I don’t take it personally, and you shouldn’t either. I choose to delay having kids and I have no one else to hold responsible for that but myself. Yes, being obese puts you at a much higher risk of a C section and other complications. Yes, IVF puts you at higher risk for certain complications. Doesn’t mean you’ll have them but that they are more likely.

A hospital based midwife having backup OBs doesn’t necessarily mean the OB gets called in when they should. Midwives and OBs can have different ideas, perspectives, risk thresholds, and ideas about when an OB should be alerted or if they should be brought in to a delivery at all. Collaboration is only great if everyone is singing from the same songbook. Midwifery students and medical students are currently taught from different songbooks. And there is plenty of evidence is available in the media and elsewhere that shows what happens when midwife/physician collaboration works poorly. You can also easily search the DC Superior Court cases for medical malpractice. Undisclosed settlements with NDAs mean the news never reports the stories from the affected families, but the cases are easily found if you search.

Anonymous wrote:

Anonymous wrote:Hmm, I delivered successfully (vaginally, if it matters) with midwives during that same previously described pregnancy. There was an OB overseeing in case of complications. The practice I mentioned above includes both midwives and physicians and all births are attended by OBs. Additionally, the OP didn’t say she’s obese or morbidly obese - she said overweight. You don’t seem like you came to this thread to offer anything supportive or helpful.

No, I’m annoyed by all the people suggesting midwives when they are not appropriate for a high risk pregnancy (or potential pregnancy in this case) and when the OP is asking for an OB recommendation. It’s obnoxious. Midwives are only suited for low risk pregnancies. It’s not a personal insult to tell someone they have more risk factors for a negative outcome and therefore need a provider fully equipped to handle the full range of outcomes.

Pretty sure the midwives and the hospitals they practice at are more capable of determining who they can safely see than you are. The midwife practice I’m with (not in DC - I moved right before pregnancy) has no problem seeing obese women, AMA women, or IVF pregnancies. They deliver at a major hospital so OF COURSE have back-up from OBs and MFMs. Many also have doctorates in nursing. I trust their judgment and the judgment of the institution they work at.

They do screen out some people for risk - insulin-dependent diabetics at the beginning of pregnancy, multiples, and others. It’s not like they’re accepting everyone. But someone who’s fat? Certified nurse midwives actually do generally know how to handle most fat-people pregnancies.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:i would wait till i get a positive home pregnancy test (or the one with the RE - aren't you supposed to be with them till 8 weeks or so) to schedule an appointment with obgyn. i seen no point whatsoever in preconception appointment and most of them will think you are crazy for doing it, if they even agree to do schedule it. you need to understand that your preconception appointment happens 10 minutes after they just delivered twin via emergency c section and before they are going to deliver additional baby or two. they have multiple mothers who just delivered resting in their rooms, and yes, at that moment, they all matter more than you do.

that said, i recommend virginia physicians for women (dr elliott). i was ama, overweight with IUI conceived baby and they accepted me mid-pregnancy with no issues (i moved from another city). they are very experienced and know what they are doing (they are at VHC). you will be seeing all 4 doctors during your pregnancy and they have different personalities. a one or two might tell you too keep your weight in check.

You clearly don’t understand how OBs work. They don’t go from L and D to outpatient visits and then back. They don’t delivery babies in between seeing patients there for annuals, paps, UTIs, preconception visits, or pregnant women there for their x week check up. A preconception appointment is not something they will think you are crazy for - it’s a billable medical visit and it’s a good idea for anyone who is expecting to discuss individual health conditions, risks, etc. and also to establish care with a new OB.

my obgyn work exactly as i described (they are literally next door to l&d) and those are the ones I am recommending.

Absolutely no OB does this. You don't see patients while you're ON CALL for births. That is insane.

Yep I’m the PP and this make zero sense. In this situation, women getting an annual exam would have to be admitted to the hospital and would be taking up a L and D room? I have NEVER heard of anything like this. Unless the PP is in a totally remote area with a tiny rural access hospital or something similar to that I think she is misinformed.

huh, what are you prattling about? i am talking about a practice that has VHC privileges in arlington. i gave the name of the practice which is often recommended on this board. their office is next door to the hospital, like, the door to L&D is 20 feet away but no, women getting annual exams are not admitted to L&D, idiot. the office building is attached to the hospital. i had a doctor tell me they had an emergency delivery which is why they were running late. they deliver tons of babies.

maybe you want a doctor who will hold your hand during the "preconception visit" . personally i prefer doctors who deliver several babies every day, they have seen everything.

I came here to recommend this same practice and yes - this is how they work. Their office is adjacent to L&D and there may be impacts due to a Dr. being on-call. That said, I've always been seen promptly (maybe by someone other than my scheduled doc once in a while). They were great with my IUI twins pregnancy (and an early miscarriage before that). I was overweight (borderline obese per BMI) at conception and gained quite a bit w/ twins and never heard anything about it, though YMMV. They also worked wonderfully with the MFM practice downstairs which was great as far as scheduling appointments.

Anonymous wrote:

Anonymous wrote:Hmm, I delivered successfully (vaginally, if it matters) with midwives during that same previously described pregnancy. There was an OB overseeing in case of complications. The practice I mentioned above includes both midwives and physicians and all births are attended by OBs. Additionally, the OP didn’t say she’s obese or morbidly obese - she said overweight. You don’t seem like you came to this thread to offer anything supportive or helpful.

No, I’m annoyed by all the people suggesting midwives when they are not appropriate for a high risk pregnancy (or potential pregnancy in this case) and when the OP is asking for an OB recommendation. It’s obnoxious. Midwives are only suited for low risk pregnancies. It’s not a personal insult to tell someone they have more risk factors for a negative outcome and therefore need a provider fully equipped to handle the full range of outcomes.

I am overweight, IVF, over 35 and had a smooth and easy delivery with the GW midwives - no pain meds, no tears or stitches. If OP wants to check out the midwives with privileges at VHC, then the midwives will make the call about her risk factors and whether she is a good fit. Midwives are more likely to see the whole person and not weight shame and take the time during appointments to advise her if anxiety is an issue. If OP wants a gentler experience than one of the cattle call practices like Reiter Hill then a midwifery practice might be a good fit for her to consider.

I’ll add that I did Hypnobirthing and hypnosis with Lori Nicholson and I found it eased a lot of my anxiety around pregnancy and birth.

Anonymous wrote:

Anonymous wrote:Hmm, I delivered successfully (vaginally, if it matters) with midwives during that same previously described pregnancy. There was an OB overseeing in case of complications. The practice I mentioned above includes both midwives and physicians and all births are attended by OBs. Additionally, the OP didn’t say she’s obese or morbidly obese - she said overweight. You don’t seem like you came to this thread to offer anything supportive or helpful.

No, I’m annoyed by all the people suggesting midwives when they are not appropriate for a high risk pregnancy (or potential pregnancy in this case) and when the OP is asking for an OB recommendation. It’s obnoxious. Midwives are only suited for low risk pregnancies. It’s not a personal insult to tell someone they have more risk factors for a negative outcome and therefore need a provider fully equipped to handle the full range of outcomes.

Different PP, but I don’t see anywhere in OP’s first post that indicates she is high risk. I guess that would depend on how overweight she is, but slightly AMA and pregnant from IVF don’t constitute a high enough risk to not qualify for midwife care. At any rate, the well known, hospital based CNM practices in the area consult with OBs routinely and refer you to other care should you become high risk.
But, certainly, if OP is high risk, she is better off going to an OB.

CWC does preconception visits.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:i would wait till i get a positive home pregnancy test (or the one with the RE - aren't you supposed to be with them till 8 weeks or so) to schedule an appointment with obgyn. i seen no point whatsoever in preconception appointment and most of them will think you are crazy for doing it, if they even agree to do schedule it. you need to understand that your preconception appointment happens 10 minutes after they just delivered twin via emergency c section and before they are going to deliver additional baby or two. they have multiple mothers who just delivered resting in their rooms, and yes, at that moment, they all matter more than you do.

that said, i recommend virginia physicians for women (dr elliott). i was ama, overweight with IUI conceived baby and they accepted me mid-pregnancy with no issues (i moved from another city). they are very experienced and know what they are doing (they are at VHC). you will be seeing all 4 doctors during your pregnancy and they have different personalities. a one or two might tell you too keep your weight in check.

You clearly don’t understand how OBs work. They don’t go from L and D to outpatient visits and then back. They don’t delivery babies in between seeing patients there for annuals, paps, UTIs, preconception visits, or pregnant women there for their x week check up. A preconception appointment is not something they will think you are crazy for - it’s a billable medical visit and it’s a good idea for anyone who is expecting to discuss individual health conditions, risks, etc. and also to establish care with a new OB.

my obgyn work exactly as i described (they are literally next door to l&d) and those are the ones I am recommending.

Absolutely no OB does this. You don't see patients while you're ON CALL for births. That is insane.

Yep I’m the PP and this make zero sense. In this situation, women getting an annual exam would have to be admitted to the hospital and would be taking up a L and D room? I have NEVER heard of anything like this. Unless the PP is in a totally remote area with a tiny rural access hospital or something similar to that I think she is misinformed.

huh, what are you prattling about? i am talking about a practice that has VHC privileges in arlington. i gave the name of the practice which is often recommended on this board. their office is next door to the hospital, like, the door to L&D is 20 feet away but no, women getting annual exams are not admitted to L&D, idiot. the office building is attached to the hospital. i had a doctor tell me they had an emergency delivery which is why they were running late. they deliver tons of babies.

maybe you want a doctor who will hold your hand during the "preconception visit" . personally i prefer doctors who deliver several babies every day, they have seen everything.

Anonymous wrote:Hmm, I delivered successfully (vaginally, if it matters) with midwives during that same previously described pregnancy. There was an OB overseeing in case of complications. The practice I mentioned above includes both midwives and physicians and all births are attended by OBs. Additionally, the OP didn’t say she’s obese or morbidly obese - she said overweight. You don’t seem like you came to this thread to offer anything supportive or helpful.

No, I’m annoyed by all the people suggesting midwives when they are not appropriate for a high risk pregnancy (or potential pregnancy in this case) and when the OP is asking for an OB recommendation. It’s obnoxious. Midwives are only suited for low risk pregnancies. It’s not a personal insult to tell someone they have more risk factors for a negative outcome and therefore need a provider fully equipped to handle the full range of outcomes.

Hmm, I delivered successfully (vaginally, if it matters) with midwives during that same previously described pregnancy. There was an OB overseeing in case of complications. The practice I mentioned above includes both midwives and physicians and all births are attended by OBs. Additionally, the OP didn’t say she’s obese or morbidly obese - she said overweight. You don’t seem like you came to this thread to offer anything supportive or helpful.

I highly recommend Russell bridges. He’s a solo practitioner who delivers at sibley. He was very kind & helpful with my infertility struggles. I was 42 when I delivered my youngest.

Anonymous wrote:I did not have fertility treatment for my first but was obese (250 start weight) and was treated kindly and effectively by the VHC MFM practice — I did not see an OB who delivered at VHC but was considered high risk due to anxiety medication and my weight, so bear in mind that you’ll likely see the MFMs at some point even if everything is fine. The MFMs did my anatomy scan due my weight and then eventually I developed preclampsia. I saw Dr. Akoma who no longer works at VHC but have heard good things about other docs at that practice. They are not alarmist or condescending or overly eager to intervene if not needed. At any rate, I think VHC is a good choice but I don’t have experience with the OB practices that have privileges there. I delivered at Inova Alexandria and do not recommend for a “plus-size-friendly” experience. When seeking trusted opinions based on this previous experience for an OB practice for my second, I was referred to Physicians to Women or Arlington Women’s Center (specifically midwife Karen King, though she does prenatal care only and no longer delivers).

A midwife is not appropriate for someone who is obese or morbidly obese. They just aren’t.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:i would wait till i get a positive home pregnancy test (or the one with the RE - aren't you supposed to be with them till 8 weeks or so) to schedule an appointment with obgyn. i seen no point whatsoever in preconception appointment and most of them will think you are crazy for doing it, if they even agree to do schedule it. you need to understand that your preconception appointment happens 10 minutes after they just delivered twin via emergency c section and before they are going to deliver additional baby or two. they have multiple mothers who just delivered resting in their rooms, and yes, at that moment, they all matter more than you do.

that said, i recommend virginia physicians for women (dr elliott). i was ama, overweight with IUI conceived baby and they accepted me mid-pregnancy with no issues (i moved from another city). they are very experienced and know what they are doing (they are at VHC). you will be seeing all 4 doctors during your pregnancy and they have different personalities. a one or two might tell you too keep your weight in check.

You clearly don’t understand how OBs work. They don’t go from L and D to outpatient visits and then back. They don’t delivery babies in between seeing patients there for annuals, paps, UTIs, preconception visits, or pregnant women there for their x week check up. A preconception appointment is not something they will think you are crazy for - it’s a billable medical visit and it’s a good idea for anyone who is expecting to discuss individual health conditions, risks, etc. and also to establish care with a new OB.

my obgyn work exactly as i described (they are literally next door to l&d) and those are the ones I am recommending.

Absolutely no OB does this. You don't see patients while you're ON CALL for births. That is insane.

Yep I’m the PP and this make zero sense. In this situation, women getting an annual exam would have to be admitted to the hospital and would be taking up a L and D room? I have NEVER heard of anything like this. Unless the PP is in a totally remote area with a tiny rural access hospital or something similar to that I think she is misinformed.

I did not have fertility treatment for my first but was obese (250 start weight) and was treated kindly and effectively by the VHC MFM practice — I did not see an OB who delivered at VHC but was considered high risk due to anxiety medication and my weight, so bear in mind that you’ll likely see the MFMs at some point even if everything is fine. The MFMs did my anatomy scan due my weight and then eventually I developed preclampsia. I saw Dr. Akoma who no longer works at VHC but have heard good things about other docs at that practice. They are not alarmist or condescending or overly eager to intervene if not needed. At any rate, I think VHC is a good choice but I don’t have experience with the OB practices that have privileges there. I delivered at Inova Alexandria and do not recommend for a “plus-size-friendly” experience. When seeking trusted opinions based on this previous experience for an OB practice for my second, I was referred to Physicians to Women or Arlington Women’s Center (specifically midwife Karen King, though she does prenatal care only and no longer delivers).