frustrated with Doctor. Am I rightfullt so? (a bit long, but needhelp!)

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

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

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

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

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

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.)

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.)

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

"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

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