Tuesday, April 03, 2007

Some Questions

When is the first ultrasound when you get to see the baby/blob? (I mean, for those of us under an RE's careful, not to say obsessive, care.)

When do you get to hear the heartbeat?

When does the RE usually discharge you?

Midwife vs. OB? Discuss. (Given that Co definitely wants a hospital birth...but midwives can do that nowadays so we would definitely consider it, we just don't know the difference.)

And a corollary, what questions should we ask when we meet with midwives or OBs? I know this information will be in the books and I will be diving in headfirst, but if anyone has any specific questions they'd recommend I'm all ears.

What pregnancy books do you all recommend? (So far we only have the end of our lesbian conception books which say helpful things like "The pregnancy may be difficult if your partner doesn't want the baby, too.")

Advice and assive, please. I'm way too clueless to know the difference anyway. ;-)


FosterMommy said...

I, obviously, don't have any particular advice regarding midwives/OB in a hospital birth, but I do know this -
Find thee a doula

No matter what kind of birth you have, where, a doula (if you find one that you like) is a wonderful addition to the birth plan.
They'll help out in the hospital, making sure you both are treated respectfully and all that, and they'll help afterwards by coming to your house and helping you figure out this whole baby thing. :) They can help with breastfeeding problems, and all kinds of stuff.

I'm sure you'd have a million doulas to choose from in your neighborhood. :)

Mermaidgrrrl said...

We had the same ob/gyn to conceive as what we have for our obstetric care. Love that continuity!

We first saw our little grain of rice at 6 weeks 4 days. It was just a dark blob with a flickery bit in the middle of it. We didn't hear the heart beat but the monitor counted it. We then had our next appointment 4 weeks later at 10 weeks 5 days. By then Cletus was properly formed and it freaked us right out! He even did a nice big roll for us and mooned us - so cheeky. It was an utterly surreal experience to see how much growth and development had taken place. Still didn't hear a heartbeat at that appointment since there was no doppler on the ultrasound (it was just his office one). Then we had the nuchal screening at 12 weeks which was much the same - still no heart beat.

Our next OB appointment was at 14 weeks and he got out the doppler then to hear the heart. I had actually preferred seeing on the ultrasound so hearing the heart was boring in comparison!

We only stayed with our ob/gyn because we trust him soooooo much and he is very low intervention in his approach to care. If we hadn't been able to stay with him I would have had a midwife through the hospital we work at. I think it depends on what level of intervention and monitoring you're comfortable with. Now that I've turned into a borderline high-risk case I'm so, so glad I stayed with my doctor. I think that as long as you choose a care provider that you can establish a trusting relationship with that's the most important thing. No point having a midwife if you don't trust their opinion and can't talk things over with them. Same with a high-end consultant or a doula or anyone.

Pregnancy books are tricky. I really hate "What to expect when you're expecting" because it's kind of bossy and boring and full of sexist cliches. But it also has answers to every stupid little question you could ever have to try and get a 2nd hand copy for those questions. Because I'm a bigger girl I had two books about plus-size pregnancy that I found very useful at the start for addressing my specific issues. My favourite pregnancy book is an Australian one called "Up the duff" by Kaz Cooke. It absolutely rocks and is both comforting and funny and I don't know where I would be without it. Not sure whether you can even buy it overseas and whether the Australian humour would translate well for you - what we all think is hysterically funny you might just scratch your head at! The internet of course is an invaluable source of specific information about things as long as you can filter out the crappy advice. But "Up the duff" would be the book I would choose if I could only choose one.

Sorry that I've raved on - I'm feeling chaty this morning!

Mermaidgrrrl said...

Just found out that you can buy "Up the duff" but that you have to be careful not to get the Americanised version instead. There are four of the original Australian versions on Amazon.

bri said...

My first ultrasound with my RE when pg with Penguin was at 7w6d. That was a damn long wait. This time, because the holidays were coming and my insurance was changing, I had one scheduled at 6w4d. I ended up going in at 6w because of cramping (bleeding corpus luteum cyst). So I had 2 with the RE before moving over to the OB at 7w2d. The second time around I made the OB appointment immediately upon getting a positive test. Yes, I would have had to (have Wes) cancel it if something bad happened, but the first time around it was such a stressful thing to find an OB who could take me - we live in a baby-ful city! I highly recommend making some appointments if you hear of people you like because it can be so difficult. I found my top doctor choices by cruising my insurance site and then cross referencing with parkslopepar*nts and, most usefully, urbanb*by.com. Seach the message boards. It is a catty, bitchy, fastpaced place but they have a lot to say about doctors.

I highly recommend the oft-recommended Downt*wn Women where you can have a midwife and OB's. I couldn't get in and ended up at Spring Stre*t OBGYN (also 1 midwife and 4OB's, all women) the first time and they were magnificent. Then my insurance changed and now I am with an office of 3 female OB's who have delivery rights at the Ro*sevelt Birth Center, which means that even though they are OB's, they have a nice vibe and are open to options. Not that I am considering anything other than a beeline to my epidural.

I honestly don't think the questions are as important as the vibe. I think the most important questions are for other patients, like on urbanb*by or something - do they have a good, responsive, polite staff? do they get back to you quickly and easily? You can ask about their policies for callbacks. See if they give handouts. I love my handouts.

The books have been crap for me this time - I have trouble reading ahead. Fortunately, I read What to Expect and 2 others before we started trying so at least I have them around as reference. After seeing a birth in real life, it is all less mysterious, though. I think you have to have the damn What to Expect just because. I like the weekly ones but they give really dumb Dad Tips that we just laugh and laugh at. I have a nice one called Great Expectations that I like. But none are great.

Sheila said...

Hi Co and Lo, glad to see you blogging!

We heard the heartbeat and saw Z. as a comma-shaped tadpole at 5 weeks/3 days.

Your other questions aren't the kind of thing a childbirth educator (even a new one like me) can really keep her hands off of, even though A. may have already given you some of my answers:

You want someone's who's following a midwifery model, whatever credentials they have--in other words, they should see birth as a normal function of the body. If the baby is okay and the mom is okay they stay out of the way. You don't want any routine interventions (routine=they do it whether or not it's actually indicated). Any intervention is a tradeoff, so you want to know that you'll be involved in those decisions, not have them made before you walk in the door.

Here are some questions to ask: How long do they usually spend with you at each prenatal visit, and how much continuity of care will there be? How many people in the practice, how many other babies due around your EDD? What are the protocols at their hospital if you are low-risk at admittance (understanding that high-risk is a different ball game, and also that protocols may be set for the entire hospital). Is there anything that will limit mobility during labor? Can you eat and drink during labor? How is fetal monitoring handled? Under what circumstances do they induce labor? Under what circumstances do they consider a labor stalled? Under what circumstances do they perform episiotomies?

When you go for an interview, take notes, and plan to talk to more than one practice so you can compare the answers of the one(s) that make you feel most comfortable.

And you definitely want a doula--I think this is a great gift to ask for from extended family.

Sheila said...

Oh, the early utlrasound was trans-vag b/c of an ectopic pregancy worry (persistent pain but no spotting) that we would have ridden out if we hadn't been about to move and go into a one-month insurance gap.

SandraMort said...

Another vote for a doula!!!

No idea about the u/s.
I tell the mw up front that I don't want them.

MW tend to be more wholistic and consider birth to be a normal life event whereas OBs tend to treat them as medical disaster ready to happen and in need of their management to prevent, but they're generalizations and I know there are good OBs and bad MW. Google "MEDICAL MODEL" for details.

I can't remember what else I was going to say. It's been a long day.

SandraMort said...

Oh. I can't commit to it this far in advance, but I can talk to Gary about it as we get closer if you like. I've trained as a doula, so if you want someone with you who isn't a stranger and won't charge you (doulas run about a grand, if remember correctly), I would gladly doula for you.

Gretch said...

We went in for our only early ultrasound at 8 weeks, as that is when our RE ships his patients back to the OB - and they used the wand because it was really the only way to see anything with it being so early. We were able to see and hear the heartbeat at that time.

We thought about using a midwife, but are very happy with our OB and decided to stick with her. Afterwards, we learned that NONE of the local hospitals even allow midwives to practice in their hospital, so it became a moot point anyway.

Doulas have been recommended to us, as well, and we know of one that comes highly regarded locally, but we haven't made a decision about whether or not we'll go that route.

bri said...

On the doula front, just wanted to add that when I attended Melissa's birth, the midwife and nurses kept asking if I was a doula. Melissa said I was better than hiring one because we are already so close so there was no issue about strangers or anything. Now, she was in a birth center with a midwife, so didn't have a lot of fear of unneeded interventions. But if you have that fear (I, for example, loving Western medicine, do NOT have that fear - my birth plan: GET IT OUT), maybe someone trained would be better. But if you have access to an extremely close friend, I know that her husband liked having another pair of hands and someone else around to help. This helped solidify my decision to have my sister in the room with me for mine.

Carey said...

Typically, our RE sees patients at 7 weeks - it's just a good time where you should see everything. Due to scheduling conflicts, we saw him at 6w2d (saw heartbeat). We are going back at 8w2d (we are neurotic and he's ok with seeing us frequently).

As for OB vs. midwife -- we're OB all the way. We like the shiny hospital machines and doctors. We want a hospital with a NICU and any and every little thing possible to help prevent any sort of disaster. I just wouldn't feel comfortable with anything less.

lagiulia said...

I don't know which RE you're with, but I went to the same one as Bri, and here are my answers:

When is the first ultrasound when you get to see the baby/blob?
-6 1/2 wks (two blobs!) and then at 7 1/2 wks again because I had some bleeding

When do you get to hear the heartbeat?
- I think 9 1/2 wks which was my first proper OB appointment, but we saw the hearts flickering at the first u/s. And I rented a doppler, which I used from about 10 wks.

When does the RE usually discharge you?
- Mine discharged me at 7 1/2 wks

Midwife vs. OB? Discuss.
- I don't know. I was kind of high-risk, so went to a maternal-fetal team. But I hear LICH has a good facility and that midwives deliver there. Midwives deliver at Meth0dist too, but it's not my favorite hospital (though the PICU was good at treating Picchi). If you want to venture cross the river, there are tons of good choices. I went to Mt. Sina*, and NY Presbyterian on the west side is number one rated in the city. But they are both way uptown. You have plenty of good options downtown too. Dontcha just love NYC?

And a corollary, what questions should we ask when we meet with midwives or OBs?
- I guess one big thing is who will you see each time you go and will that person deliver you or will it depend on who has hospital duty that day. Ask about their philosophy on c-sec or any other intervention in relation to your own views. Ask how often you will come, what their views are on testing, at what points do they do u/s and doppler,... . Oh, here is a BIG one: if you have a question or concern day or night, what's the protocol? Some practices have a nurse's line, and if it's during the day the nurse will call you back promptly. That's a useful service.

What pregnancy books do you all recommend?
I'm not huge on books, so "What to Expect" was fine for me. And twins books, but I don't think you'll need that.

No assvice. Just rest when you need it and take care.

Gretch said...

answer to question about changing table - it's called the "emily crib/changing table" by DaVinci (color is called ebony or black depending on where you see it)...and we first saw it online at the mega baby store with the backwards "r" in the name (they don't have them in the stores - only online)...but you can find the same set at lots of different online places if you just google the name of the set. good luck!

fostermama said...

I take it you're looking at that mini crib? Some blogging friends of ours rave about it.