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#101
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frustrated with Doctor. Am I rightfullt so? (a bit long, but
Elfanie wrote in message ... On Fri, 21 May 2004 04:01:34 GMT, zolw wrote: I just want to make sure that my sister's problems do not repeat. & I am sure unless he is a fortune teller or has some magic abilities, external examination is not accurate. Sure...it absolutely is accurate. =) That's the entire reason that they even do a fundal height measurement at every appointment...because if there is something unusual then they will know and be able to take further steps. Accurate for what? Fundal height was way off for me-and got worse as the pregnancy progressed. The u/s may pick up the problem before the fundal height changes sufficiently to cause alarms. If you experiences placental insufficiency...amniotic fluid would drop, baby would begin to stop growing as rapidly...and therefore fundal heigh measurements would become off. If that happened, THEN they would order an ultrasound (if fundal height measurements became abnormal)... which could be too late... so yes...external examination is very accurate. In fact...in the third trimester, did you know that an ultrasound is the LEAST accurate method of determining fetal size? And is not all that accurate in determining fetal well being. It's not talking about fetal size. Talking about diagnosing placenta insufficiency before it causes a problem. #1 most scientifically accurate method of determining fetal weight prior to birth? Asking mom. #2 most accurate? External palpation by a trained care provider. #3 most accurate? ultrasound. Mum won't necessarily know on first pregnancy. I was well off for both mine. #1 most accurate method of determining fetal well being before labor? Fetal kick counts. A moving kicking baby is a baby that's doing well. #2 most accurate method? Ultrasound #3 most accurate? listening to baby's heartbeat either by fetoscope, doppler, or external fetal monitors. I wouldn't have said that #1 was the most accurate. Most important as it's always there, yes, most accurate no! So you already have the tools to make sure that your baby is doing well....you know when your baby is active, you can measure your fundal height at every appointment...that's why we do these things. Because they ARE accurate! You are at risk of sounding that you're sweeping her concerns under the carpet rather than listening to them. Debbie |
#102
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frustrated with Doctor. Am I rightfullt so? (a bit long, but
Welches wrote:
Elfanie wrote in message ... Sure...it absolutely is accurate. =) That's the entire reason that they even do a fundal height measurement at every appointment...because if there is something unusual then they will know and be able to take further steps. Accurate for what? Fundal height was way off for me-and got worse as the pregnancy progressed. The u/s may pick up the problem before the fundal height changes sufficiently to cause alarms. But the question is not which can pick it up first. The question is whether they pick it up before it becomes a problem or before treatment is necessary. In general, abnormal fundal height identifies problems in time. It is not as definitive, and therefore it flags women who don't have any problems at all, but that's what screening tests usually do. If you experiences placental insufficiency...amniotic fluid would drop, baby would begin to stop growing as rapidly...and therefore fundal heigh measurements would become off. If that happened, THEN they would order an ultrasound (if fundal height measurements became abnormal)... which could be too late... Have you any evidence where it was diagnosed too late because an u/s wasn't done? I did a quick Medline search and couldn't find a *single* recommendation for routine u/s screening for placental insufficiency before 40 weeks in a normal pregnancy. (It would be recommended in situations like pre-eclampsia, PIH/TGH, etc. or in women with certain conditions like diabetes, of course.) It seemed to be quite accepted that fundal height measurements and palpation were sufficient for screening. Best wishes, Ericka |
#103
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frustrated with Doctor. Am I rightfullt so? (a bit long, butneedhelp!)
JoFromOz wrote:
I will talk to the consultant OBs at work about this - I've honestly never heard of P.I. being more likely in subsequent pregnancies. I have, however heard of IUGR being more likely, most probably due to lifestyle factors. I'm not working again 'till Monday, but I'll get back when I find out for you. However, I don't see how seeing two doctors can avoid problems if there is P.I... zolw wrote: That's actually not true. My sister had 3 pregnancies (2 children, since she lost one of them in the 9th month) & in all 3 cases she had placenta insufficiency. Actually the doctors (she was seeing 2 doctors at te same time, to avoid having the same problem as with her unborn child) all agreed that if a woman has placenta insufficiency once, she is at much higher risk to have it every time. And I can't help wondering *how* the placental insufficiency was diagnosed in the subsequent pregnancy. It's fairly common for doctors to be edgy when a pregnant woman has had a prior loss at or near term and to recommend early induction to these patients to "prevent" another in utero death. I'm not pooh-poohing the idea that placental insufficiency could be the result of a genetic condition in the mother that runs in the family at all, as that doesn't sound improbable to me. But I would rather suspect that the two doctors treating Mona's sister would have been inclined to induce labor in those subsequent well before any external signs of placental insufficiency cropped up. Unless Mona's sister's placentas were determined to be calcified or otherwise abnormal when her babies were born (which may well be the case), then there's no way to be *certain* she would have experience actual placental insufficiency in those pregnancies. It would not have been peculiar, however, for her doctors to have been proactive in trying to prevent a repeated loss and to claim that "repeated placental insufficiency" was the reason they were doing it. -- Be well, Barbara Mom to Sin (Vernon, 2), Misery (Aurora, 4), and the Rising Son (Julian, 6) Aurora (in the bathroom with her dad)--"It looks like an elephant, Daddy." Me (later)--"You should feel flattered." All opinions expressed in this post are well-reasoned and insightful. Needless to say, they are not those of my Internet Service Provider, its other subscribers or lackeys. Anyone who says otherwise is itchin' for a fight. -- with apologies to Michael Feldman |
#104
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frustrated with Doctor. Am I rightfullt so? (a bit long, but need help!)
zolw wrote:
I also feel that so far into my pregnancy it will actually be inconvenient for me to start shopping for another dr. Especially that there is no guarante that the next dr I see won't be exactly the same way. I will probably have to put up with what I believe to be not proper care giving. I do not care if he is an OB or a midwife, there is ABC treating other people. He can not always treat me like he is doing me a favor. Actually he gets paid much more than his service deserves & he should have the decency to treat his patients better. I am not asking him to sit there & hug me or comfort me but he can smile every now & then, he can listen to me when i have questions (instead he gives me those patronising looks. I even caught myself sometimes apologizing for having questions, which is real sad). I don't think your expectations in this regard are unrealistic at all. What I think is unrealistic is your expectation that he change the way he's treating you (when that's clearly just the way he is) instead of taking the initiative and finding another care provider. No, there's no *guarantee* that another provider will be a better match for you than *he* is, but there's pretty much a 100% certainty that he's not going to magically become a better match for you. Seems to me that the chances of getting a better match if you shop around are considerably higher than they are if you just stay put. If it seems too inconvenient to change, then you sort of forfeit your prerogative to complain about it because, after all, you picked it. I *almost* changed care providers in the 38th week of my third pregnancy. I wanted a second opinion about my high BP and whether induction at 40 weeks was really indicated. The OB I consulted with was great and I considered switching to his care because I felt he'd put less pressure on me for the induction and he'd have been willing to take me as his patient, but in the end I stayed with my midwifery group and that was the right choice. Still, the point is, it's *never* too late to switch if you're not getting the care you need. For example, when i asked him about contraceptions after I have the baby (I thought that if I put a loop ( no idea what these are called in the US) then it would be done right after delivery). FWIW, an IUD placed right after birth wouldn't stay put--it's a tiny little thing that would fall right out of your still-open cervix, probably without you even noticing it in all the lochia. Not to mention that it would be very foolish to put something into the uterus that could cause an infection when the wound from the placenta was attached to the uterus. I hadn't even mentioned to him what kind of contraception i had in mind & he just said that I will come back 6 weeks after delivery & discuss it. Why couldn't we discuss it then? Why can't I have ideas & options now, so that 6 weeks after my delivery i would have a certainty of what I want? Well, I certainly think it's reasonable to discuss your options now, but in most cases, a decision can't be made about placing an IUD until after you've been checked at 6 weeks and it's determined that the uterus is both healed and returned to its normal size. Other types of birth control, like oral contraceptives (only the minipill if you're breastfeeding, BTW) can be prescribed at the 6-week appointment and it is atypical for providers to recommend that you start using such methods before that 6-week postpartum check-up. It would have been nice of him to tell you that, though, instead of brushing you off, and it's one more reason I *don't* think you're getting adequate care and should take the initiative to find someone who's better able to meet your needs. -- Be well, Barbara Mom to Sin (Vernon, 2), Misery (Aurora, 4), and the Rising Son (Julian, 6) Aurora (in the bathroom with her dad)--"It looks like an elephant, Daddy." Me (later)--"You should feel flattered." All opinions expressed in this post are well-reasoned and insightful. Needless to say, they are not those of my Internet Service Provider, its other subscribers or lackeys. Anyone who says otherwise is itchin' for a fight. -- with apologies to Michael Feldman |
#105
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frustrated with Doctor. Am I rightfullt so? (a bit long, but
Elfanie wrote in message ... On Fri, 21 May 2004 18:25:48 +0100, "Welches" wrote: So you already have the tools to make sure that your baby is doing well....you know when your baby is active, you can measure your fundal height at every appointment...that's why we do these things. Because they ARE accurate! You are at risk of sounding that you're sweeping her concerns under the carpet rather than listening to them. Debbie Interesting that you would say this...and I felt that listening to her concerns and listening to them was EXACTLY what I was doing. Point by point...addressing her concerns. The fact that I know enough about pregnancy/development/labor/delivery to not be as alarmed as she is doesn't mean that I'm sweeping her concerns under the table. Rather, I am sharing with her my education and reasons why I'm not as concerned as her to help aleviate her fears. Okay, it came across to me as "silly woman. don't worry, dr. knows best, no matter what" (paraphrasing quickly) Just because someone is scared and you aren't doesn't mean you're dismissing their feelings - I addressed her fears to the best of my ability (which is to say that ultrasounds are not necessary just because she may be at risk for placental insufficiency...and that what is standard routine is there to catch it and it is effective). I'm just remembering a badge we got for my brother it said "just because you're paranoid, doesn't mean they're not out to get you". What I mean is that she's scared that she might have the same problem as her sister, and the chance (from what I can tell) is pretty remote. However it is possible she could have the same problem, and I don't think you totally addressed her worries. Maybe if you could say how the dr. would tell placenta insufficiency from external monitoring etc. so she could see how he may be checking for this? I only know that ultrsound can tell because someone told me so!! I'm sorry that you disagree with the way I responded to the original poster. Sorry if I misread you. Debbie |
#106
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frustrated with Doctor. Am I rightfullt so? (a bit long, but
I am sorry I can not help worrying. I may be comforted
if my dr would tell me that I have nothing to worry about, because .... (medical facts or statistics). BUT him telling me ok (like he is just taking in info & not even writing it down), I agree that your doctor could be more personable and empathetic. However, the best response to unneccesary worry in the patient is NOT to do unnecessary tests (in this case, lots of u/s's.) The best response is for him to listen to you and explain things. If he isn't doing those things, by all means switch caregivers (as many have suggested.) But don't expected that a new caregiver will be any more willing to do lots of unnecessary tests either. Naomi CAPPA Certified Lactation Educator (either remove spamblock or change address to to e-mail reply.) |
#107
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frustrated with Doctor. Am I rightfullt so? (a bit long, but
So now, how do we define a normal pregnancy? I thought everything was
normal until the US scan and I shudder to think what would have happened otherwise. The question then becomes, when and where do we draw the line? Do you do daily u/s's lest something happen between visits? Hospitalize all pregnant women throughout the pregnancy so they can be continuously monitored? Yes, of course there are cases where problems arise that do not first show as clear symptoms But those are very rare. And it is simply not cost effective or practical to do millions of tests of millions of healthy women with normal pregnancies, to catch one or two problems. Suppose you had had your routine scan at 34 weeks instead of 36? Perhaps nothing would have been found. Or, suppose the problem you have at started a bit earlier, so 36 weeks would have been too late? Research has found no statistical benefit to routine ultrasounds ... even one of them. So to do them repeatedly isn't going to any more beneficial, but will be much more costly. May be I would have been lucky noticing when the baby started to become less active. But there is no guarentee. Very, very true. There are no guarantees. We have gotten to the point where we believe that our technology guarantees good outcomes. But it doesn't, and it can't. There will always be the occassional woman who is helped by routine testing, and there will also always be many more women who are NOT helped by it. There is simply no way to guarantee a healthy baby for every pregnant woman. And more u/s's will not guarantee that for the OP. Naomi CAPPA Certified Lactation Educator (either remove spamblock or change address to to e-mail reply.) |
#108
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frustrated with Doctor. Am I rightfullt so? (a bit long, butneedhelp!)
zolw wrote:
So, I thought all that may be real important for him to know), he just said ok. Didn't even jot it down or anything. He listened to your laundry list of your relatives pregnancy problems. But there is nothing he can *do* about those problems. And he cannot guarantee you that you won't have similar problems. What exactly do you want from him? You may need to be really specific about what you want. For example, I had a great midwife who was very emotionally supportive. She liked to give me hugs. Great, except I did not want to be hugged! I wanted advice. Several times I mentioned to her a specific problem, and each time she listened and said "that's normal". But I wanted to know what I could do about the problem. Finally I realized we were not communicating. Rather than find another care provider, I started finally *asking* my questions, not hinting at them and expecting her to read my mind and organize my thoughts for me. You need to do the same. Even on this newsgroup, you don't state your specific concerns, you only refer to them. But in this newsgroup many of us know or can guess your specific concerns. Ovviously, your OB cannot or will not do the same. Probably for good reason! Many pregant women don't want to talk or even think about possible bad outcomes. How is your OB supposed to know how open to be with you, if you are not really open with him? So, you ask your OB: "I fear developing placental insufficiency like my aunt did. What are the early signs of placental insufficiency? Do I have any of these signs? If there are no signs, could I have it anyway?" Yadda yadda. Pologirl |
#109
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frustrated with Doctor. Am I rightfullt so? (a bit long, butneedhelp!)
"pologirl" wrote in message om... You may need to be really specific about what you want. For example, I had a great midwife who was very emotionally supportive. She liked to give me hugs. Great, except I did not want to be hugged! I wanted advice. Several times I mentioned to her a specific problem, and each time she listened and said "that's normal". But I wanted to know what I could do about the problem. Finally I realized we were not communicating. Rather than find another care provider, I started finally *asking* my questions, not hinting at them and expecting her to read my mind and organize my thoughts for me. You need to do the same. Even on this newsgroup, you don't state your specific concerns, you only refer to them. But in this newsgroup many of us know or can guess your specific concerns. Ovviously, your OB cannot or will not do the same. Probably for good reason! Many pregant women don't want to talk or even think about possible bad outcomes. How is your OB supposed to know how open to be with you, if you are not really open with him? So, you ask your OB: "I fear developing placental insufficiency like my aunt did. What are the early signs of placental insufficiency? Do I have any of these signs? If there are no signs, could I have it anyway?" Yadda yadda. This is really excellent advice. Donna |
#110
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frustrated with Doctor. Am I rightfullt so? (a bit long, but
I don't think you were sweaping my concerns under the carpet. I mean,
the whole purpose of writing in a newsgroup is to learn from other people's experiences. I have the option of taking someone's advise or not to. BUT to find out what others had to say sure makes it much easier for me to decide in one way or another. Thank you. Elfanie wrote: On Fri, 21 May 2004 18:25:48 +0100, "Welches" wrote: So you already have the tools to make sure that your baby is doing well....you know when your baby is active, you can measure your fundal height at every appointment...that's why we do these things. Because they ARE accurate! You are at risk of sounding that you're sweeping her concerns under the carpet rather than listening to them. Debbie Interesting that you would say this...and I felt that listening to her concerns and listening to them was EXACTLY what I was doing. Point by point...addressing her concerns. The fact that I know enough about pregnancy/development/labor/delivery to not be as alarmed as she is doesn't mean that I'm sweeping her concerns under the table. Rather, I am sharing with her my education and reasons why I'm not as concerned as her to help aleviate her fears. Just because someone is scared and you aren't doesn't mean you're dismissing their feelings - I addressed her fears to the best of my ability (which is to say that ultrasounds are not necessary just because she may be at risk for placental insufficiency...and that what is standard routine is there to catch it and it is effective). I'm sorry that you disagree with the way I responded to the original poster. Stephanie Soderblom CLD CCCE CD(DONA) ICD Mesa, AZ Mommy to Mikael 5/9/95 - Kerstyn 8/6/99 - and Kevin 8/30/02 Student Midwife Birth Doula / Childbirth Educator / Pregnancy and Birth Photography http://www.birthdiaries.com - Birth Story Diaries=REAL BIRTHS = REAL PHOTOS |
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