Originally posted by kids-r-fun
I am pretty sure everybody knows that my oldest is pregnant with my first grandbaby...she will be 20 weeks on the 18th (same day as the US for sexing).
Andrea had her pregnancy test done at Planned parenthood, they gave her some "How to have a healthy baby" type brochures and she started following them immed: no alcohol, went from daily caffene of a pot of coffee + pop + iced tea + chocolate to almost none (she chooses carefully and less than daily), went from 2 ppd smoking to 2-4 cigs/day, limits tuna to 1 can/wk, is very careful about seafood, washes her fresh fruits & vegies, bought prenatal vitamins etc. In other words, this pregnancy may have started out unexpected and unwanted but she has from day ONE been determined to have as healthy a baby as possible.
All of her prenatal care is coming from a "welfare" clinic staffed by CNMs...not the best option but it is the only one available. They have to do the referral up to an OB/Gyn.
I/we have some questions/concerns that have been blown off by the clinic dispite my going to an appointment with her to press for answers...
I had gestational diabetes with several pregnancies..."they" say it is relevant to her pregnancy-but have done no testing.
I had inutero exposure to real estrogen (not DES)..."they" say it is relevant to her pregnancy-but have done no testing.
I had 7 (yes-seven) pregnancies lost at 14-20 weeks due to incomp cervix (probably d/t the estrogen) "they" say it is relevent...
She has had 2 ER visits for vaginal bleeding with no problems found on work up(blood/US/exam)-we suspect caffene(2 glasses of pop and a candy bar the day after having a mocha frappacino)...the clinic has not done a vag exam since her 1st appointment at 10 weeks.
One thing this clinic does (that I am not sure how I feel about) is they start doing drug testing Q month at 16 weeks and they report you to childrens services for refusal and positive tests. Fortunately drugs are not an issue for Andrea-but she feels a little violated.
I realize that by virtue of what I do as a Nurse I tend to be a bit paranoid. But does sound (to anyone eles) that she is being a little bit undermanaged?
An additional question tho less of a concern...pre-preg Andrea was 5'3" 140#) the CNM told her that they like to see a weight gain of 1#/week...she has gained 19 pounds...at her 1st WIC appointment this past week she was told to slow down on her eatting, that she had gained all of the weight she is "allowed" for the pregnancy (gee thanks, like the kid isn't already struggling with her body image)...what is a "normal" weight gain in pregnancy?
I don't expect anyone to go out on a limb and give advise...I would just like your opinions of all of this based on your experiences.
Thank you all (in advance). I am not a lot of help to her as I have no clue what a "normal" pregnancy is like...and don't want to scare the h*ll out of her.
-nancy (& Andrea)
Nancy...first let me commend your daughter for her committment to having a healthy child. I realize that severly cutting down on the smoking, and restricting her use of caffiene is an awesome challenge, in any situation! I also realize that the stress of being pregnant, and I'm sure there are other stressors...makes her ability to do this even more significant.
First I must humbly disagree with some of the above, as I feel there is some rational for testing your daughter for GDM at this time. No I'm not a MD...but I do have a little experience in OB...and life experience as well...as most here do..
I think the fact that she was borderline in pre-preg weight, (not knowing age, and bone structure...difficult to say for sure). Also her family hx, and the present of uterine bleeding UKO..makes me feel that maybe these are risk factors that could make an OB/MD place her in a HIGH RISK cat. for GDM. I did a contract with the ROADS team...and although we initially only worked with a Midwife, they later brought in an OB d/t the high infant mortility rate in the area. The ADA came out in 1998 with a new guideline for testing HIGH RISK moms, and felt that HIGH risk moms should be tested in the inital preg screening, and again at 24-28 weeks..(which is the guide line for low risk). I'm not sure of her age...but if she is 25 or over this also is a risk factor. One last fact to substain my conclusion is this. The CDC .has reccomened for several years now...that all women should be tested for GDM at the INITIAL Prenatal Screening
Next...here is another thing to consider...and may not be true in this case, but I have seen it true in others. Some CNM don't consider the 15% of pregnacies that are dx as GDM isn't rational enough to subject their pts to testing for GDM...and therefore if they don't present with significant sx, they feel they shouldn't be put thru these tests.
Also is the fact that if your daughter does test positive for GDM, this would but in the High Risk cat., and would the CMW would not be able to continue care. Also many OBs don't want to take Medicare pts...so this would mean...the possibility of higher costs. This is just information, and doesn't consitiute as to my believing that this is the feeling of all CMW...or that this is the only rational as to why your daughter might not have been tested.
This is my suggestion
...I would have her get a glucose test out of my own pocket...and then you would be sure that all is well. That is...if you feel it is warranted.
Also concerning the uterine bleeding..."I" "feel" this would warrant more than just routine prenatal care. I did read that the US show no problems..ie.
As for the weight gain.."I"...if it was "my" daughter have her see a nutritionist...and help her in slowing down the weight gain..
I hope my suggestions, and conclusions are taken as just that... mine