Sunday, October 31, 2010

Question: high risk versus regular OB?

I hesitate to even think this question, let alone write it, because I am sure it will doom the pregnancy, but I also know I better get going on this or the best OBs will be booked for my due date.

So, being optimistic for a moment and assuming this pregnancy continues to progress, I'll ask my question. Any and all thoughts/experiences welcome.

Does the fact that I'm on lovenox and prednisone at least through the first trimester (along with all of my other fun meds) mean that I will need to see a high risk OB? Or can a regular OB monitor someone on these meds?

I don't think there's any other reason I'd "need" to see a high risk OB, and I actually think that the low-risk OBs are a little less busy - and therefore a little more available - at the hospital where I'll be receiving care and delivering (ha! as though I would ever get that far). My husband and I work and receive our medical care at a major academic medical center here in New York, so even the "regular" OBs are pretty darn good (as long as they won't flip out about the lovenox/prednisone).

Anybody out there know? I just realized that even though I'll still be in limbo for awhile that I better get a first appointment booked or I'm not going to be able to get one at all with the provider of my choosing. Yikes.

Oh, and another question - can a regular OB measure cervical length? If we can make it out of the first trimester with everyone still alive, that is my other big fear - that I might have cervical issues since I've had 3 D&Cs. So would want to see someone who can regularly (as in every visit probably) check that things are ok in that regard.

This time around, should I get to the point of needing an OB, I've given myself permission to ask for extra visits and extra reassurance. We've been through hell and back, and if a little hand-holding can reduce our anxiety, I'm going to go for it. I suspect our days of once-a-month visits are behind us. I can't imagine just biding my time for a month between visits at this point. Hopefully, I can find an OB who feels that that's acceptable.


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  1. I say make both appointments and choose the doc AND THE PRACTICE that makes you feel most taken care of-- no kidding.
    High risk docs are more used to folks like us BUT that does not mean a great normal people OB group could not step up and be just as responsive.

    I ended up pingponging back and forth during the complications-- normal people OB for general care and then the high risk folks for second opinions and expertise.

    the main thing is to feel taken care of and that also means the folks answering the phone, relaying messages to and from the doc, etc.

    so again, my vote? "interview" both, and make sure you end up with the one you are most comfortable with-- this really is about you sweetie, and after ALL OF THIS you deserve to be taken care of really really really well.

    with such love,

  2. Ask your clinic for their recommendations? I did that, and they recommended me to an ordinary OB--who had gone through five IVFs herself. She was great, and took my extra medication in stride.

  3. I actually found my high risk ob to be much more available than the regular ob. I would definitely go with the high risk ob, they understand the need for extra reassurance. They have also more experience dealing with issues and are more quick to diagnosis and treat. Lynne

  4. I was on lovenox and because of it had to see a high-risk doc. My OB was there when I had my losses and saw my IF struggles so she gave me weekly ultrasounds, and if I was scared she'd let me in anytime- and she never condescended (unlike other doctors in her practice). My BIGGEST advice is to find an OB who is kind and good and gets what you went through. . . BUT also make sure that the PRACTICE is also similar. At least for me, we had to rotate once I was at week 24 and unfortunately most of the other doctors SUCKED one of them actually told me quite rudely to "get over it" regarding my fears due to past miscarriages. And lovely lovely she delivered my son. My point is- as nice as an OB can be, if the practice sucks and they deliver based on who ever is on call the day you go to labor- the other doctors matter too.

  5. This is a tough one to answer.
    I think the bottom line is that you need to be with an aggressive doctor, one who will be proactive in ordering tests etc. I'm not very confident that OBs fulfill that requirement because of my own experience. My OB (who saw me through my first short lived pregnancy) was a lovely person, excellent at hand holding, splenty plenty of time with me, etc but utterly useless at diagnosing me. We only discovered my baby had normal chromosomes because I insisted on getting the fetal material analyzed. Even after the tests came back as normal, she refused to have any further testing done, saying 'these things just happen, try again'. My RE was much more proactive, he said the entire deal was suspicious, and he discovered I had anti-thyroid antibodies because HE ordered that test (and many others)

    Maybe it was my history (or lack of it) that made my OB so complacent, but I think it was just her general attitude. I dont mean to tar all OBs by the same brush, but I was really not impressed by the one I had.

    Right now I'm with a perinatologist who is reputed to be very aggressive, who is supposed to consider and treat for all contingencies. Time will tell if she is as good as she is reputed to be.

    This is what I plan to do- stick with the big teaching hospitals with an excellent reputation. These have a reproductive medicine department with many perinatologists and OBs, and keep seeing the perinatologists (Its been my experience that you will see multiple doctors because of availability issues) atleast for the first 5 months, and then play it by ear.

    I'm doing this in San Diego (I'm with UCSD) and once I move to New York, I want to be with Weill Cornell.

  6. Jay, you're moving to NYC? Did I miss this somehow? When is that happening? Cool!

  7. Hi Mo....I actually see both....I would say make a appt with your Regular OB and get their take on things...Some are willing to handle the special medication/needs and some are not either way usually if you need to be seen by a high risk Dr. they are not your sole provider...they still want you to go to a regular Ob for routine things and also in IL your OB is the one who delivers you even if you are seeing a high risk Dr.

    In my pregnancy I was considered high risk right from the start because of my past history of losses (4 in the past year)....a heart issue I have...Clotting factor...and my immune issues....Saying that even though I see both I go to my regular OB on a weekly basis because I had a bleed develop and some issues with my cervix...However I only go to he high risk at this point once a month or if my regular OB would feel I need to see them sooner then he would call them....the high risk also did the NT scan and my 20wk anatomy scan but I will say they are really busy and there are 3 docs in the practice and you are kind of passed between the three and its just not as personal...however with my regular OB I get the personal attention I need.

    I guess if I was you I would be managed by both its pretty common and usually you have to have a referal to see the High Risk and usually they dont see you on their own...and if your OB feels you should see the high risk they will be able to get you in fast:) If you have any questions dont hesitate to ask:)

  8. Mo, I'm being forced to move to NYC because my job. Its going to happen in January or Feb, and I'm not very happy about it, but hey, I'll be in Manhattan! I hope and pray I never have to see an RE for an insemination atleast for the next 4 years, but I'm going to be in the same building (Langone medical center) as the famous Dr. Liccardi- kinda cool!

  9. I'm a pediatrician specializing in genetics/birth defects. I would personally recommend seeing a high risk OB because they are more aggressive and proactive than a regular OB. If a regular OB can't handle things that may arise during the pregnancy, they will refer you to a high risk OB anyways, so better to start seeing one from the gecko. I have seen quite a few errors from regular OBs because they like to "wait and see" rather than take a proactive approach.

  10. Even if you see a regular OB, many of them prefer to work together with a high risk OB. This is what we did. I saw my regular OB for regular appointments plus frequent NST's and BPP's and then the specialist for cervical length checks and fluid checks (although the regular OB can also measure cervical length using trans vaginal ultrasound).

  11. I like Kate's suggestion to interview both and go with who makes you feel most comfortable. At this point, you deserve that. (I don't have experience with high risk OBs though).

    Good luck, and I LOVE, LOVE, LOVE that you are focused on the positive and believe that this summer there WILL be a baby in your arms. Yay!

  12. Jay, sorry you have to move from sunny san diego to snowy NYC in Jan/Feb, but hey, at least I can promise to welcome you to our fine city. And NYU is not a shabby place to work. So that's a good thing. Re: transferring OB care to Cornell, you might want to line that up sooner rather than later - the good folks get booked early. Not that there are really bad folks, but still. You'll have a lot more choices now.

  13. Here in the UK, where you get given your OB automatically according to your perceived need (unless you are fantastically rich and can afford to go private throughout!), I was automatically assigned a high-risk OB and I'm really pleased. She not only knows more than the others, but has access to a range of other specialists by more direct routes. I got her because I have a range of health issues on top of my previous losses, but two friends whose "only" risks were their previous losses were both assigned to high-risk OBs too. It also seems to mean more frequent appointments and ultrasounds without having to ask for them - always a bonus. Plus, if you start with a low-risk OB and by any chance you become more high risk along the way, you then face having to change medics and establish a new relationship at a fragile time. I say, aim high!

  14. My pregnancy is high-risk, with me being on prednisone and aspirin for the entire pregnancy, and now with a partial previa. I see a regular OB. I did have a preconception consult with a Peri, and saw the Peri once during my first trimester, due to my neuromuscular issues (CIDP vs MS, possibly with RA or lupus thrown in the mix). He ordered some labs, gave us an action plan of regular monthly ultrasounds starting at 20 weeks and NSTs weekly starting at 32 weeks, plus conferred with my neurologist about when I can start prednisone, dosage, etc. So far we haven't needed to confer with him again, but he is there to consult or take over if things change from their current status quo path. My OB is able to manage me just fine right now. I would at least get a consult from a Peri, due to the multiple losses, meds, etc. A Peri can have great ideas for monitoring needs, or for anticipating possible bumps in the road.

  15. I would see both if you can. That's what I do. I am considered high risk due to age, MTHFR, and 2 previous m/c, despite being in great health and transferring normals. My OB associates with a prenatal group.

    BTW I had 2 D&Cs, plus a LEEP years ago and so far (knock wood) no cervix issues (currently in 3rd tri).

  16. oops, I meant my OB associates with a perinatal group

  17. no idea about the OB/ high risk OB issue but I know that if I were in your position I'd wnt someone high risk on the important mission to getting you to a live, take-home baby (as my RE said).

    I LOVE that you've given yourself permission to have as many scans, etc. as you need - LOVE THAT!

  18. I don't have specific experience with the drugs and high-risk OBs, but I do recommend going ahead and getting an OB of some sort. I kept delaying and delaying, waiting for the miscarriage to happen. It got to the point where I had kind of waited a bit too long. Luckily I had a wonderful RE who totally got where I was emotionally and she made a recommendation and helped me get in with an OB she really likes.

    I wish I were a little pushier about getting some hand-holding. You are doing to right thing to be upfront about needing that; kudos to you. After what you've been through, I think that is definitely the right way to go. You gotta do anything you can to get into a comfort zone.

  19. Here is a link to the original points schedule that OBs used to assess risk in pregnancy:

    That said, I may have commented before that because of the number of intracervical procedures you have had, you may want to consider weekly cervical monitoring from 15 - 24 weeks as that is when Incompetent Cervix (IC) is likely to present itself (and when an emergency cerclage would have the best outcome).

    No one (not my RE, my OB, or my gynecological surgeon) felt that I would be a candidate for IC, but I requested the monitoring anyway and my OB completely agreed given my recurrent miscarriages and given how hard we'd tried to achieve the pregnancy at hand. He suggested alternating the weekly cervical ultrasounds with a perinatologist, something the peri also agreed to even though he didn't think I was a candidate for IC either (but, I did have enough combined risk factors to warrant seeing a peri in the first place). A lot of the "high risk" assessment has to do with what your insurance will cover because it is more costly, so having an OB and peri that are on the same page is helpful.

    My IC presented itself at 16w6d. My outcome was successful but all agreed that it was due to the weekly cervical checks. Otherwise, I would have been going every 4 wks at that point, and given the nature of my IC, would have lost the pregnancy.

    I don't say any of this to be an alarmist, but I do believe in being an advocate for your care. Knowledge is power (and, someone on one of the boards I belonged to encouraged me to press for the weekly checks and I just want to pay it forward. I therefore had WEEKLY ultrasounds from week 6 - week 28 and then went to bi weekly for one month before returning to weekly again. No one discouraged me or thought I was crazy and I owe a debt of gratitude to all that managed my care).

  20. Whoever will give you extra scans and visits/comfort is who you want - so if the high risk people are too busy, maybe a combo (as suggested earlier) is a good idea. Or if a "regular" ob is available and understanding of your situation that could be the way to go. Interview several. If you think this is bad, just wait til you get to the pediatrician! At least you and Will should be able to get inside info on some of these obs...

    I did have a high risk ob and it was great to have regular u/s, staff was great and the office was much nicer - even cloth robes instead of the nasty paper sheet (that covers about 1/3 of your pg body)!

  21. I would make appointment with both. I didn´t have a choice in the matter not possible to buy private healthcare. But I was referred to a high risk OB due to gestational diabetes and high blood pressure and protein in urine (which never developed into pre-eclampsia as I reduced my workload and gestational diabetes was not a problem as I could control it with diet). The high risk OB then deemed my pregnancy after some appointments and monitoring to be normal and I was sent back to the normal OB (which I never stopped seeing, during the time I was seeing the high risk OB).

    Is there not a possiblity for you to have them both, the high risk OB just for counseling and advice and the other one for regular check ups.

  22. Depends on the doc. My RE referred me to my OB (they went to med school together, I think) and she had no problems with me being on heparin. I had monthly ultrasounds for growth and cervical check, and NSTs later on. All that was done right at her office. I did end up seeing a perinatologist ONCE the week before LG was born, because they stuck me in the hospital for monitoring. If I ever get pregnant again, though, I'd likely be seeing both...

  23. my "regular" practice monitors my cervical length (or at least tries -- they can only ever find one of the suckers, but i am a special case that way).

    i'm not sure which medical center you're affiliated with, but i've gone to a high-risk place a few times (for better scans) that is associated with the university medical center on the east side in the 30s, and i've really liked the doctors i've met there. if you'd like the name, feel free to email.

  24. it is what it is, thank you so much for this detailed info about IC. It is a huge fear of mine if we ever get out of the first trimester, especially because the first D&C was somewhat brutal (unanesthetized and involved manual scraping after the vacuum aspiration didn't work, which b/c I was unmedicated, had me writhing around - worry that I may have been more dilated than intended b/c the whole thing was a 45 minute long nightmare). I will read all of this carefully and advocate for us if we get to this point. I really appreciate your taking the time to send all this and as you said, "pay it forward." thanks.

  25. As some of the others said, I think it's most critical that you're comfortable with the doc, regardless of their distinction. I'm in Boston so same thing -- the regular OBs here are all pretty good. And of course if any complications arise they will refer you to a high risk doc anyway (I stayed with my regular OB and did monitoring in MFM so I had the benefit of a lower-key experience for regular visits and the specialized expertise when things got hairy). My trusted RE actually referred me to my OB, and when she agreed to personally do a quick (unscheduled) ultrasound to check for the heartbeat for me at the end of our very first meeting (at about 5:00 p.m. when the u/s techs had already gone home), I knew I had found the right doc.

    Personally, I think there's something to be said for going with a regular old OB after going through so much (assuming, of course, that it's medically appropriate). I think it puts the emphasis on "normal pregnant person" versus keeping you in another category, you know? After all the "abnormal" it sounded like a breath of fresh air to me to try to blend in a little and stop thinking of myself as unusual. But you should do whatever feels right for you.

  26. I don't know which hospital it is, but if it is Mt Sinai, I highly highly recommend my practice, Maternal Fetal Medicine. They are a large group, half are peris, half are obs and they are all fabulous! Compassionate, great listeners, well run office with ultrasounds at every appointment to check heartbeats, great ultrasound department in the same building covered by the same docs. I never went more than 2 weeks between visits.

    They do cervical length and fFNs from 18 weeks on.

    OK. enough of my 2 cents. I just hope and pray you make it to that point soon!

  27. I went to a terrific perinatal center and never had the "regular OB" experience, therefore my opinion is one-sided. If I were in your shoes, I'd find the best possible practice, and the MFM specialist I feel most comfortable with. In my case, I worked backwards: I first selected the hospital with the highest level NICU, then found a perinatal center with docs that delivered there, and then selected the best perinatalogist from the bunch. Given all of your experiences, I'd recommend finding a proactive team that will make you and Will feel the most reassured (and not falsely so), cared for, and confident throughout your pregnancy and the postpartum period. (Yes, I know, hard to imagine, but you'll get there!!)

    Good luck with this tough choice.

  28. Mo, yes, it will be super cool to be in the same city, are you in Manhattan? And thanks for the tip with the hospital!

  29. I agree with all the PP's who suggest making one with both. That way you can see which one you like! Also, I just moved you from my TTC to my Pregnancy blog list! So exciting!!!! I'm SOOOOO happy for you guys!

  30. I love that you're getting a ton of advice, here's mine ;-)

    I too had 3 D&C's and I too had one of them in an emergent and awake fashion - I would not wish that on my worst enemy!!! I too took 40iu/Lovenox (until week 37) along with other meds - pred in first tri.

    I was NOT referred to MFM. I spent 31 weeks (from 8 to 39) with my normal OB.

    I too was concerned about IC. I had it measured at 25 weeks and it was insanely long ... Like 5mm??

    Anyhow, my OB would do whatever I wanted, but I found that going to her, someone who didn't flinch at every round ligament pain, but brought me in for extra monitoring when needed ... It normalized the pregnancy for me. With my history I needed a little NON-drama ... and that was fantastic!

    What I might encourage you with - maybe a combo of both and if things are really tame you could skip the high risk appts.

    Lots of hugs,

  31. I would lean toward high risk, but I think you should interview both. Good luck.....and keep positive WILL all make it and have your happy ending! Thinking of you!


  32. with your history, i would want to be under the overall care of a perinatologist or mfm group. whether you see on ob simultaneously, you want the peri to call the shots. this pregnancy was intensely hard to achieve, and you have valid issues to begin with, so go to the best mfm group you can find and start there. in my own experience, to whitewash the situation ('maybe i am having a normal low-risk pregnancy' lalalala) has always ended up leaving me with regrets- treat the pregnancy as high-risk from the get go. you don't want to be in a situation when you want more care but the ob you chose, while super-friendly etc, is hesitant to give the extra care. you want to have the extra care offered before you even think you may want it, and perinatologists have 'seen it all'- they will know what is coming around the corner.

    its tough to be thinking about these decisions in early pregnancy, but it the responsible thing to do- just like you take your prenatal vitamin every day, your lovenox shot... setting up the proper care is just part of that process. all the best to you!

  33. Thoughts on the OB. When I was pregnant, there were a few women on lovenox and they went to a regular OB, so I think you can still go to a regular doc. Also, you are right, you might get better (and more sympathetic) care there because they aren't all that used to patients with interesting histories or concerns. I hate the search for an OB. For me, it had to do with doctors that rely too heavily on medical intervention (but I also wanted a REAL doc who would go the medical route IF NECESSARY) and a doctor who would be sympathetic to my panic attacks regarding miscarriages. I got neither! But, I was strong enough to fight for both and, in the end, it worked out. I think you'll be staying with your local clinic for the beginning of the pregnancy, right? At least until you are weaned from meds? After that, definitely test your doc out and have the important conversations early because it is very hard to change doctors after the 2nd trimester. Good luck! looking forward to seeing what you decide:-)

    BTW...CONGRATS!!! And, I LOVE your boxer puppy! What a cutie! We have 2 boxers and they are amazing with my 8 month old. I swear, boxers are like potato chips, you really do get addicted:-)

  34. My 3 cents to add to the pile....

    I think it depends on your regular OB, some docs are comfortable managing pts on meds like blood thinners, or those with more complicated med histories. But my gut says you might do better with a high-risk OB. Both can monitor your cervical length (my regular OB does this because I had a LEEP).

    And CCRM wants you to see an OB around week 8, so even though you will still be monitored by CCRM for weaning off the supplemental hormones til week 11-12, they want you under OB care after a heartbeat is seen. So it is sooner than you think!

  35. My RE referred me to a regular OB. I have a number of high risk factors including a massive dose of Lovenox (90 mg twice a day per the hematologist), high blood pressure, and AMA. I asked my RE specifically about a high risk OB/Perinatologist and she said that a regular OB would be the primary and refer me to a Perinatologist when necessary. As an aside, perinatologists are few and far between here in MD due to it being a high risk/low reward practice and insurance laws that are forcing both regular OBs and high risk OBs especially out of practice. That, at least here in MD, can mean long waits for Perinatology appointments. My first appointment with the OB, sure enough she referred me to her sister in law who is a high risk OB. That practice will also perform the NT scan in a day or so and any follow up genetic testing we decide to do. They also provide the genetic counseling while the regular OB manages the more mundane day to day pregnancy issues. I like the OB because she is easy to get in to see, a solo practitioner and on call five days and week and every other weekend, easy to reach by telephone, etc. The Perinatology center is a shared practice and not very accessible, harder to get appointments, etc. but I like their expertise so I'm ok with this hybrid approach.

  36. I would go high-risk. I went for my quads and honestly I got so much more monitoring, and I think you get that kind of monitoring no matter what the circumstances. You might want to have an appt at the regular OB too just so you have your foot in the door and then when you feel safer you could move to the regular OB if you prefer.

    CONGRATS on your sweet baby! Praying hard that he/she continues to grow strong and soon you see a heartbeat!

  37. I'm pregnant with twins and see both an OB and a high-risk. I had to go to the high-risk office anyway for the 1st trimester screen, anatomy scan and for bi-monthly cervix checks. My OB recommended I consult with the MFM doctor in case I need their care down the road, I will have established a relationship.

    This may just be my office, but my OB checks my cervix manually, and the high-risk checks by ultrasound (much more accurate).

    So far I'm pleased being under the care of two long as they are associated, they will take a team approach to your pregnancy.

  38. I agree with everyone, see the high risk AND the OB. The high risk dr monitors way more than the regular OB.

    I am currently 20 wks and see both dr's because of my history of miscarriages (and was on lovenox). I see the high risk dr every two weeks to measure my cervix. So glad I get to see the baby that frequently.

    Good luck!!

  39. Hi...I have no experience with High Risk OB' I don't have any advice for you. Just wanted to pop in...say I've caught up with your blog (YAY for seeing a gestational and yolk sac!!!!). I'm praying for both of us for good ultrasounds this week!

    Lots of Love and ((HUGS))

  40. I would go with high risk. They are more thorough and have seen it all. I also found they that they are used to us IF's and all our questions, fears and requests.

  41. Due to my crazy-ass pregnancy, I never saw a "regular" OB and was a "total care" patient with my perinatologist. I echo what others have said... most women would have to see a regular OB and consult with a peri.

    I consider it an advantage to have only been followed by a high-risk specialist because although I knew of a really good OB I would have used, the peri that took care of me was always thinking down the road (it seems they are always working out contingency plans for coming complications). But I think even consulting with a peri (if your insurance won't allow them to be primary), would serve the same purpose.

    As a bonus, I had an ultrasound at every visit, even if it was just to check cervix and heartbeats. I think that would be difficult to do if you only see a regular OB.

    Happy deciding:)

  42. Posting, then running out to the chiro. Will read all the other comments when I get back. I vote high risk. Simply put, you will get more monitoring. I also don't think a regular OB will necessarily be less busy. I can understand not wanting to go back to the MFM you saw last time. FWIW, I liked my dr in that practice (who, BTW, has an IVF girl of her own). Book the first appts of the day, and you shouldn't feel rushed. And call NOW. I called before by first beta. (I figured I could always cancel.)

  43. I don't know about the meds issue, but I am seeing a regular OB and because I am at high risk for preterm delivery, they do check my cervical length on a regular basis.

    Good luck!

  44. Mo... thank you so much for asking this question. I was looking into what I should do too! I want to go to an MFM myself. But I have no basis for my decision and was hence wavering!

    Looks like there is a lot of good advice from folks.

  45. First off, holy shit you are pregnant! (sorry, this is what happens when I go away -- I miss the very exciting things!!)
    Second, I think it depends on the OB -- I get pretty much monthly monitoring/ us from my regular OB just b/c of my age and my IF. If you can find that with a person you really like, then go for it.
    But mostly, I am so happy for you I could burst!

  46. I was on lovenox up until a week or so before delivery - totally experimental because I'd had 3 m/c. I went with the high risk, but saw ( all 4 docs in the practice). I think that's the way it works usually.

    I think the lovenox may have been what made the difference, btw. and was worth every poke/bruise.

    You may get more u/s with high risk.

  47. oh, and the regular ob wouldn't do a cervical check manually at 16 wks, they made me wait for the hi risk and go to the fancy u/s place which is separate from the practice. however, they can measure via U/S now which is MUCH better than manually

  48. I have no experience in this area, but I know that with all my issues (older maternal age, immune issues, et al) that I would go high risk, personally speaking. But I'd shop for one that I really like and felt comfortable with. I know that with lovenox (which I think you are on?), SCH happen more frequently and I would feel happier knowing that my OB knew what to do immediately with my meds.

  49. Will be thinking of you tomorrow!!!!

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  52. If you can find other women also taking Lovenox post-IF in NYC, I'd ask for recommendations from that group. I think it depends a LOT on the doctor, regardless of whether it's an ob/gyn or peri.

    Before we even started ttc, I searched for an ob/gyn who had worked specifically with patients who had dealt with a particular non-IF issue I had. I lucked into a great doctor who is also not afraid to deal with the Lovenox, does not freak out about the intralipids/IVIg/IV antibiotics, etc., lets me come in every week when I'm pg, and does ultrasounds for me at every appointment. However, he's also been an ob/gyn long enough that he doesn't feel the need to be a hero - I know he wouldn't hesitate to send me to a peri if he felt it was something beyond what he could confidently handle.

    OTOH, I have IF friends who were on Lovenox whose ob/gyns freaked out about that and made them super stressed for their whole pregnancy because of it.

    I also have IF friends who had to go the peri route for more significant issues than just Lovenox. (One of them was carrying twins, and one of the twins only had one artery (??) in the umbilical cord instead of the usual three.)

    Even having a much more serious issue than blood thinners, that particular friend didn't actually see the peri in most cases - she had an ultrasound with the u/s tech, and then the peri reviewed the u/s images later that day and someone from the office called her with instructions. So she didn't get to ask the doctor many questions or have many discussions with him directly. That would stress me out. But then again, we live in a place that has one of the most well regarded MFM hospitals in the world, so the doctors in that practice are often busy delivering quads, quits, even sextuplets, so they're super busy and not always available for face-to-face appointments because they're at the hospital a lot.

  53. A regular OB can definitely check cervical length. That's done during a regular vaginal ultrasound.

    I had a high risk pregnancy (triplets from IVF) and saw my regular OB more than my MFM. He was great! Literally whenever I called with any kind of concern he'd tell me to come in for an ultrasound. It got to the point where I'd hesitate before calling because sometimes I just wanted an answer to my question, not necessarily an entire ultrasound!

    The right OB will understand you've been through hell to get this pregnancy and may need more reassurance than the typical patient. And he or she will be OK with that and will let you come in for a quick doppler or ultrasound check whenever you need to know for sure.

  54. I hope you have a reassuring u/s today!

  55. When I had pre-term contractions, my "regular" OB measured my cervical length all the time. So I know it's possible.

    I would just make sure you find an OB you feel comfortable with who will meet your needs. I had to change OB's in the middle of my pregnancy because my old OB wasn't attentive to my needs, namely, blowing off my hospitalization for pre-term contractions with a "just come in next week for your regular appointment."

  56. high risk ob all the way... so glad to hear you'll be on top of cervical length checks. sending good energy your way for a long, healthy pregnancy.


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