I had my 1st OB appointment Monday. While everything is looking good with the baby, I was not happy how the appointment went overall. Well, first the good parts. The bean is measuring 9W4D and had a heartbeat of 186 beats per minutes. We could not hear the heart since the ultrasound machine lacked that capability, but we could see if very clearly. He/she has visible arms and legs and was really dancing around and showing off. My OB, pretty much unsolicited, told me that she has very few patients my age that get pregnant with their own eggs and that I'm very lucky. Don't I know it.
Now, for the bad parts. When I showed up at the office, I was given a printout with most of my personal details preprinted. Over 50% of the info was wrong and I had to correct it. I learned later that the office had just switched over to a computerized record system and from the looks of things, they were in complete chaos. I was escorted back to the exam room and my OB performed the ultrasound. She calculated my due date as 8/22 and asked me if I had made an appointment with the high risk practice ( I had).
At that point, I think as far as she was concerned, I just needed to have some blood drawn and the appointment was over, which is sort of amazing for the 1st visit for new pregnancy. I told her that I had a number of questions for her (no doctor escapes from me that easily) and she agreed that I should get dressed and meet her in her office. She did take the time to answer my questions, but I felt really rushed, which was strange, because I have always found her to be very patient and careful in the the past. I was surprised that my questions were really the sole focus of our conversation. I would have expected her to want to review what had happened my last pregnancy and to discuss how she would want to manage my care for this pregnancy, but there was none of that.
The most disturbing part of the conversation is that I asked her what were my delivery options and she actually had to look in my chart to see that I had delivered previously by c-section. That really set me on edge -- whatever issues I had with my RE, at least she always knew who I was and what was my personal history. I found out that I would be delivered by a scheduled c-section at 39 weeks -- they won't schedule before 39 weeks because the lungs are not fully mature, which seems not right to me since 37 weeks is viewed as full term. Also, the pregnancy will be dated by LMP even though that is not accurate, so 39 weeks is really 39 1/2 weeks for me. The due date she is calculating falls on a Saturday, so I may not actually get scheduled until the following week, so another words, they will do a scheduled c-section if the baby makes it to full term -- I'd be surprised if I make it that far. Now, I don't really think delivering early is a good idea unless there is a specific medical reason, but the problem is that if I end up with an unscheduled delivery I get thrown into my doctor's delivery rotation schedule, which is a real nightmare. My doctor is in a practice with 3 other doctors but on weekends, they rotate coverage with 3 other practices, so potentially my baby could be delivered by 1 of 12 doctors, most of whom I will have no opportunity to meet prior. During the week, it is a little better, but not much. Daytime coverage rotates between the 4 doctors in the practice but at night they share coverage with one of the other practices. The net result of this setup and the scheduling of my delivery is that the likelihood of my doctor actually delivering my baby is pretty small.
I wanted a list of the doctors that could potentially delivery my baby and my OB said they could give me that at front desk, but mainly what I got when I asked at the front desk was a whole lot of attitude and confusion -- they gave me a partial list, but I think counting all the way up to 12 was beyond their capabilities.
I was interested in having the option of attempting a VBAC, but my doctor says that her insurance does not allow it. They require $100,000 per year per doctor in additional premiums to allow for VBAC deliveries. I really don't think the $100K is just for VBACs -- that probably also covers the right not to be forced to deliver multiples by c-section. I found this really amazing site with VBAC and c-section stats broken out by hospitals in NJ:
http://romancathanachronism.typepad.com/ican_somerset/2008/04/nj-hospitals-vb.html
My hospital has almost a 50% c-section rate, which is quite awful and you don't really get up to those levels if a meanful numbers of VBAC deliveries are performed. For countries with advanced medicine, c-section is usually medically warranted in about 15% of deliveries. In 2007, 2.5% of deliveries at my hospital were VBAC, so there appears to be at least a few doctors who will do them.
I had no real choice last pregnancy regarding delivery. T was breach and my amniotic fluid was low, so rotating was not an option and c-section was the only thing that made sense. My initial recovery was fine, but I had pain for 18 months afterwards. It also took a week before my milk came in -- I ended up breastfeeding T for over a year anyway, but another baby might not transition so easily from the bottle to the breast.
I'm not really sure how important VBAC is to me -- I just like to have the option. If my pregnancy goes well, I would be interested in trying a vaginal delivery. If I end up having complications like last time, I think I will just be more focused on the health of the baby and won't really care how he/she makes his/her way into this world.
Anyway, my real dilemma at the moment is whether or not to switch doctors. I don't know if my doctor was having an off day due to being disoriented about the computer system change, but she was really just dialin' it in and I'm not going to want to tolerate that for my whole pregnancy. I also hate the way her practice handle deliveries and since a lot my predelivery care is really managed by the high risk practice, I feel like it would be good to leave just so I can have a delivery group that is smaller than a Softball team.
