TTMA your obstetrical care

[mustloveerica]

I see both an MFM and an OB. I'm not sure if it's just different from hospital to hospital. So I see the MFM for all ultrasounds and the OB for belly checks/Doppler/urine tests/etc. So between the two, appointments end up being every 2 weeks with alternating ultrasounds and dopplers. I give a urine sample every time I see the OB. Both the OB and the MFM will be present at the birth. They communicate closely. I originally was seeing a midwife but they switched me to OB care a few weeks ago. The midwife will also be present at the birth if she's able to so I can still get the midwife experience I wanted.

[mustloveerica]

Wanted to add that my understanding is that in my case the MFM is monitoring the twins health while the OB is more focused on my health. I could be wrong but that's what it seems like.

[thelittleredm]

I'm not in your shoes, but with DS I didn't do a urine sample every visit while going to the on-post hospital which was weird. However, when we moved and I started going someplace new, I had to do one at every appointment. This baby has been a urine test every time, too.

[hpnegirl]

With DS, I saw an OB. Each app consisted of belly check/weight/bp/urine dip. I had two ultrasounds total (A/S and a 30+ week growth scan). GBS swab was at 37 weeks, GD screen at 28w. I saw a MFM once who basically shrugged off my case (homozygous MTHFR) and released me to my OB with advice to stop the BA once in third tri.

This time around I see a group of CNMWs. My MWs only do weight, bp, and Doppler. My MFM has me doing growth scans every 4 weeks this time around, periodic homocysteine level checks, and gave orders that I am not to stop the BA until delivery. GD will be at 28w, GBS at 36-37w

At my 20w MW app, I'm going to start pushing for urine dips at every app... my maternal aunt had HELLP with two of her three pregnancies. It was only found via urine dip; her bp was perfect when they caught it.

At 28w, I jump to biweekly MW apps and jump to weekly at 36w

[hpnegirl]

@wineandcupcakes have they said anything at all about lovenox post delivery? With DS, I was on 3 weeks of daily injections post delivery. I was already warned I will be doing the same with this one. If it's a c section, its 4 weeks of belly shots. I also had platelet issues at the end of my pregnancy with DS so they'll be watching for that again this time.

For the urine dips, I know certain practices don't feel they're necessary but having seen second hand that they can miss things because it doesn't fall into the "normal signs" category (like my aunt's BP) makes me push for it

[silvermelody]

My office does a urine test every visit whether it's for belly check or NST. They are checking for both protein and sugar. They only screen for infections once that I know of, but I'm not prone to UTIs.

[hpnegirl]

Dec 2, 2016 11:27:08 GMT -5 @wineandcupcakes said:

Dec 2, 2016 11:23:11 GMT -5 hpnegirl said:

@wineandcupcakes have they said anything at all about lovenox post delivery? With DS, I was on 3 weeks of daily injections post delivery. I was already warned I will be doing the same with this one. If it's a c section, its 4 weeks of belly shots. I also had platelet issues at the end of my pregnancy with DS so they'll be watching for that again this time.

For the urine dips, I know certain practices don't feel they're necessary but having seen second hand that they can miss things because it doesn't fall into the "normal signs" category (like my aunt's BP) makes me push for it

They haven't mentioned it yet but I do know, from other patients, that I will be on it for several weeks.

As for the BP stuff, yea, I think my MFM sees that my BP is fine and he doesn't feel the need to do the dips. I also have really subtle UTI symptoms as well, so that's another reason I want them.

Definitely push for them; if I hadn't seen second hand that it can catch things the other monitoring wouldn't, i probably wouldn't push either. I know the chances are slim but when I asked my MFM about there being a higher chance with a family history, he said there could be but probably not. Thats enough of a reason for me to push.

My aunt I mentioned above is also hetero MTHFR but she wasn't on lovenox after delivery (no idea why not). Her last two pregnancies were both C sections

[wildflower810]

I'm about as low risk as they come (at least at the moment) and I see a home birth midwife. So here's my perspective from the other end of the spectrum.

My routine care for every appointment is blood pressure, pulse, fundal height measurement (starting at 16 or 20 weeks), doppler for baby's heartbeat, and peeing in a cup to do a urine dip. My 28 week appointment this week my midwife said "eh, your urine has always been clear, we'll skip the urine dip" which took me by surprise. I didn't really react in the moment, but I'm not going to skip it again.

I get blood drawn at 12 and 28 weeks and check iron levels, glucose levels (this takes the place of the glucose drink), platelets, and probably a few other things.

Ultrasounds are optional for me and my midwife refers out to do them. We did a quick 12 week "how many babies are there?" scan and then a full anatomy scan at 20 weeks.

Internal checks are actually pretty discouraged and neither of us are fans of them. With DS1 the first time I asked for a check was the moment after the contraction where my body started pushing during labor. I wanted to make sure I was actually complete. My MW agreed, and "checked" to find baby 1/4 inch from crowning. He was born like 10 minutes later.

[icedtea]

I see an OB and have a low-risk pregnancy. I get a urine test every time I go in.

[hpnegirl]

For later reference, you can deny pre-labor cervical checks. I didn't agree with any with DS until 39 weeks except for one incident where I was in L&D for lack of movement and they were picking up contractions.

This time around, I'm waiting until 40 weeks because I walked around at 2+ cm for a few weeks and all it did was cause anxiety. I also refused the transvaginal ultrasound at my A/S to check cervical length after talking to my MFM about it.

[lola]

Dec 4, 2016 6:41:14 GMT -5 hpnegirl said:

For later reference, you can deny pre-labor cervical checks. I didn't agree with any with DS until 39 weeks except for one incident where I was in L&D for lack of movement and they were picking up contractions.

This time around, I'm waiting until 40 weeks because I walked around at 2+ cm for a few weeks and all it did was cause anxiety. I also refused the transvaginal ultrasound at my A/S to check cervical length after talking to my MFM about it.

Low-risk, seeing an OB, and I get a urine test at each visit. And seconding this post about cervical checks. Thankfully my doctor is pretty anti-invasive measures without a good reason. Since I'm a FTM and haven't been having contractions, we've been skipping the cervical checks. I'll go in for my 39 week appointment on Thursday and see if she recommends one. But she basically said you can be dilated for weeks and it doesn't mean anything. And if you aren't dilated it can be very uncomfortable or start cramping/labor unnecessarily.

[onesweetworld]

I see a midwife and have a urine dip every time.

[cosmicav]

I pee in a cup every visit, and they check heart rate with the doppler. With my first (very low risk) pregnancy, I had an ultrasound at 8 and 20 weeks and that was all. Appointments once a month in first tri, then twice a month in third tri until 37 weeks, at which point they start the once weekly appointments. Tdap shot around 28 weeks. Gestational diabetes test about that time too. The GBS swab was scheduled for 36 weeks but I didn't get that far lol.

With this pregnancy I have gotten an ultrasound at 8, 16, 20, and 24 weeks so far (I'm 28w now). Not just for funsies, they are checking my cervical length and making sure shit is right since my first was an unexpected preemie. I hate cervical checks but it is what it is. I have the same amount of check ups as last time (with exception of weekly hormone shots, but those aren't appointments, just the shot). The further you get, the more check ins they do.

[marshian]

I'm seeing a midwife group and they do a urine test every time. The explanation was you can be asymptomatic but have a UTI which they would want to treat right away.

They'll do the GD and GBS tests at the usual times during the pregnancy.

[ellabee]

+1 to considering skipping cervical checks unless they have a good reason. With my DD I was checked at ~37 weeks and my OB said "whoa, you're already like 2-3cm dialated, I'll eat my hat if you make it in to see me next week". Well, I went all the way to 39w4d, and honestly I'd rather not have had the false expectation that I would go any minute. It made those last few weeks especially frustrating because I felt like I was already overdue.

[wildflower810]

Dec 7, 2016 6:01:18 GMT -5 ellabee said:

+1 to considering skipping cervical checks unless they have a good reason. With my DD I was checked at ~37 weeks and my OB said "whoa, you're already like 2-3cm dialated, I'll eat my hat if you make it in to see me next week". Well, I went all the way to 39w4d, and honestly I'd rather not have had the false expectation that I would go any minute. It made those last few weeks especially frustrating because I felt like I was already overdue.

So much this. Just standing up from the table can change how much you're dilated. And the 1cm an hour rule during labor is total BS. If there isn't legit cause for concern, there's no reason for them to be up in my business.