There are some things in life that always seem a bit of a mystery to me. For example, how do you pick an OB? My general practitioner suggested that we interview a few. That idea went south fast when we discovered that all three of the practices covered by our insurance (in Evanston at least) charged a minimum of $170 for 15 minutes or more of face time, even if no medical advice was dispensed. At that rate, no interviews for us. And you have to pick an OB for your first appointment at 8 weeks, at which point the pregnancy was still mostly secret. So we couldnt exactly chat everyone up about it. So we got a recommendation from one friend for a midwife she had used. And a doc I really like at student health recommended an OB that she had used. So we ultimately went with the doctor-recommended OB.
And the doctor was nice. She was fine. But we just never clicked. I always felt vaguely uncomfortable and unsure whether she would really support my decision to work towards an unmedicated labor and delivery. I felt vaguely (but increasingly) unsatisfied with how simplistic answers to my questions were, and how little guidance she was giving me. At our meeting last week I didn't yet know to ask about a flu shot, so it didn't come up. Afterwards when I started looking into it I wondered why the doc herself hadnt said "hey, you might not know this because this is your first pregnancy, but the CDD lists pregnant women as one of the key groups that really must be vaccinated for the flu, so you should be sure to get a flu shot." These dissatisfactions were nothing monumental, but they just kept piling up for me.
And then, because this is always my response to uncertainty about authority, I started questioning
myself. Maybe my expectations were unrealistic. Maybe you didn't need to feel enthusiastic and rah-rah about your OB. Maybe it was enough to feel like they would exercise sound medical judgment and that was it. The only other evidence I really had for what an OB could be like, at this point, was that I had seen one episode of some documentary/reality OB show on a cable channel. And the OBs on there seemed AMAZING. But that was Hollywood right? they must be exceptional.
So then I ventured the question on an online chat forum for Chicago-area moms. I explained the situation and asked if my expectations were too high. I was so overwhelmed (in a good way) by the responses. Here's a sampling:
- Erin, if you aren't comfortable with your OB (for whatever reason), then you're not comfortable with her. You need to trust this person and this person needs to believe in you. If you don't feel that way, then look elsewhere. It doesn't really matter what your expectations are. You're entitled to get the answers you want and the information you need. You just have to feel like you're in the right place.
- Go with your gut!! I wanted to at the very least leave the door open for a unmedicated childbirth and had big birth plan expectations but was met with a very similar reaction from my OB. I didn't feel comfortable with it, but since it was my first pregnancy and I had no girlfriends to look to in the city at the time, I chose to follow my OB's advice. I followed it into an unnecessary induction, a c-section after 2 hours of pushing, and a pain management strategy (don't chase the pain! Take these narcotics!) that spiraled into a subsequent hospitalization, and a rough go bonding with my girl.
- Im due on Saturday and kinda wish I would have switched OB's earlier in the game. I like her enough but I feel like she kinda dismisses some of my worries and has this positive attitude about the whole thing to a point where I feel like she totally dismisses my worries and concerns rather than addressing them and making me feel a bit more confidant.
- i would switch, but that's just me. you only get to have that baby once.
You only get to have that baby once. And you only get to have your first baby once ever.
And then about two weeks later, after our news was officially out and about the department, I was sitting with Gabrielle and Lori (two new moms in our department) who were talking so enthusiastically about how much they loved their OB. I think raving might be putting it too lightly. And here was this evidence in front of me that real people, people I knew and respected could and did love their OB. And Lori had a natural childbirth with this OB practice and felt like her decision was wonderfully supported all along the way.
And all I could think to myself was: I want that. I want to feel that way.
And then all I had to do was convince myself to act against inertia and actually go out there and see if I would prefer to be with their OB. So I made an appointment.
I was nervous as a cat on a hot tin roof while we sat in the waiting room. I felt like I was on a first date. Maybe more like a first meeting of an arranged marriage. I wanted so badly to like her, to love her. Moreso, I wanted her to like me. Their paperwork was confusing so I was frustrated: where it said "spouses name" (I dutifully put Terence McDonnell) what they really wanted was "insured's name." The staff explained to me that most women are covered on their husband's plan. I almost exploded. It was like walking into an episode of Mad Men where the era is all screwed up.
Plus we waited for an hour. I caught snatches of conversation that told me that I wasnt actually on the book, but that I had clearly been sent the forms to fill out in advance, so they were trying to figure out how to squeeze me into the schedule.
My concerns mounted. But everything went away when Dr. Gupta came in. She is a short dimunitive woman, but her smile hooked me right away. It just seemed so real. And when I talked, she seemed to really understand me. Everything she said back to me was like she was reading a script from my dreams.
I mentioned that I had a terrible episode of migraines. My former OB just offered me drugs. Gupta asked when it happened, and then she explained that when many women enter the second trimester, their blood pressure drops off by quite a bit, and that drop can often trigger bad headaches, wooziness, blood sugar issues. Not only was she explaining to me what was going on in a way that was incredibly comforting (for me understand = comfort), but she was even explaining why I've felt so woozy lately! When I had specifically asked the old OB that, she just told me that some women feel morning sickness through week 20. But Gupta nailed it.
I am also heterozygous (one of two risk factors) for a particular clotting problem. Gupta talked me through what she would do about it. She explained that last year the top medical journal in the OB field published a big meta-study on treating my particular clotting disorder and broke it down by a variety of risk factor combinations. She said that the study's recommendation for someone like me, who was heterozygous but had no prior history of clotting, was not to treat it because all the treatments carry their own risks, and there was no evidence that the treatment outcomes were significantly better than non-treated women. But then she said, "but I am going to go and look up that article again and read through it with specific attention to your case to be sure I am recommending what is the best of evidence-based medicine right now." I was wowed. She was explaining things to me like an adult capable of understanding my body. She understood that as a grad student, understanding what was going on and why would help me feel more comfortable and confident.
When it came to talking about the quad-test (for genetic abnormalities) she was able to explain to us in detail how finding out about some of them might change the way we would do prenatal and labor care. Terry and I had been struggling to figure this out for weeks, and she was so kind and clear about it. She explained, for example, that if we found out the baby had particualr neural defects, we would want to be sure to schedule the delivery for during the day so that they could have neural surgeons at Children's Memorial Hospital standing by to help the baby as soon as it was born. Hearing that made me cry, and truthfully I am crying now just writing it again. That amazing sense of fear of such a sad event coupled with the awe at the idea that so many amazing resources would be marshaled to help the baby if that happened.
It just kept going like that. Everything was like a dreamy first date where they say all the right things. At the end she even told me I should get a flu shot, and that if I wanted they could give it to me in the office and insurance would cover it because it was standard of care for preggers.
I was totally drinking the Gupta kool-aid. I scheduled my regular 20 week visit with her office in three weeks, where we will get the hour-long ultrasound to image all the baby's organ systems and find out the sex. I call my old OB today to officially close my file at their office. I feel sort of like a traitor. But this isnt like I'm cheating on my hair stylist by letting someone else give me a cut. This is just a much bigger deal.