Should I find a new OB??

[hope3456]

I am 19 wks pregnant with my first. I am feeling increasingly uncomfortable with my MD and would like input if I should find a new one. I am not very experienced with OB care so I don't know if he is out of line. He is a family practice physician.

The first problem I have is with that AFP test that I was under the impression you have the "option" of having. He tells me at 14 weeks, "come back in 2 weeks and get this blood test done." I ask what it is for and he says, "to test for birth defects." I told him I wasn't really sure I wanted it done and he says "well you don't have to but it is better." He acted like it was no big deal, and from what I learned about it and read about it, I feel that the negatives outweigh the positives for me to have it. Also I have known of 2 people that had a false positive and were put through alot of unnecessary stress and expense.

My next appt. 1 mo later he walks into the room and says something to the effect of "go to the lab and get your blood drawn right now and then come back in a week." Again, I ask why and he tells me. I told him I decided not to have it and he says "why not - are you afraid to get your blood drawn?" I told him my experiences with the false positives and he says"it is very uncommon" and then really tries to pressure me into having it done and then seems upset when I did refuse. Basically, from what I have read, the false positives aren't uncommon. Also, I am a little unsure of my LMP and the dating sonogram put me 1 week ahead of my actual due date (what I thought it was), and from further research, I find out the age of the fetus is very imp in terms of interrpreting the results.

Okay, so then he goes to doppler the fetal heart rate, and gets it on the first try. I just don't think it sounded as fast as last time and I know I tend to be on the tachycardic side (esp after what was said) so just a hunch but I don't think he even auscultated the fhr. What I learned was you are supposed to be careful of that.

Also, he doesn't seem to be very communicative. So I am just wondering - if complications develop is he even going to tell me what is going on??

Am I being paranoid? I don't exactly know what the norm is. Can anyone give me any more advice on how to choose an OB and how you can find out what their background is?

Thanks!

[SmilingBluEyes]

The AFP is a horrible and not so useful screening tool to me. Its false- positives create more angst than it is worth. Mine w/my son came back high, necessitating a Level 2 u/s which did NOT detect the birth defect he DID Have (which had ZERO to do w/AFP anyhow). I refused AFP and amnio w/my daughter, even though both were encouraged. And she turned out fine, no birth defects or prematurity, unlike w/my son. But that is just me. For others, AFP, CVS and amnio, as well as other tests, are beneficial and useful.

Truly, I think a person having tests needs to ask herself :

What will I do with any negative or "bad" result?

IS the benefit worth the risk?

Only YOU can decide what is best, but asking yourself those questions clears up a lot about whether to test or not in certain situations....

NO dr or midwife should ever "strong-arm" a patient into any test she does not want. They can educate, objectively, and then, it is up to the patient and her s/o from that point on. Simple as that.

[wannabeL&D73]

The AFP is a horrible and not so useful screening tool to me. Its false- positives create more angst than it is worth. Mine w/my son came back high, necessitating a Level 2 u/s which did NOT detect the birth defect he DID Have (which had ZERO to do w/AFP anyhow). I refused AFP and amnio w/my daughter, even though both were encouraged. And she turned out fine, no birth defects or prematurity, unlike w/my son. But that is just me. For others, AFP, CVS and amnio, as well as other tests, are beneficial and useful.

Truly, I think a person having tests needs to ask herself :

What will I do with any negative or "bad" result?

IS the benefit worth the risk?

Only YOU can decide what is best, but asking yourself those questions clears up a lot about whether to test or not in certain situations....

NO dr or midwife should ever "strong-arm" a patient into any test she does not want. They can educate, objectively, and then, it is up to the patient and her s/o from that point on. Simple as that.

Exactly.

And many women are actually not giving truly informed consent to the AFP, and not thinking through what they would do if it came back with an elevated risk.

There are many people, myself included, who will not risk losing their baby to an amnio (I am well aware that the risk is extremely small with an experienced specialist doing it, but for me personally no risk is acceptable.) If you know ahead of time that you wouldn't have an amnio, then the AFP is completely useless. I would not find it reassuring whatsoever.

I also am well aware that the decision to have definitive prenatal testing is not done solely for the purpose of terminating if there are abnormalities...but 90% of people, for example, with a prenatal diagnosis of Down syndrome, choose to terminate. And specialists who insert their own opinions into the matter, i.e. "I don't believe it is God's will that a handicapped baby with a heart defect be born" (exact quote given to a woman who was 22 weeks pregnant to pressure her to terminate, by a well respected MFM in Chicago last month.) should stick to the facts.

If someone wants a more accurate screening test the Ultrascreen given around 12 weeks is approx. 90% accurate. But again, I believe the mother needs to be clear on what she will do with the test results ahead of time, and be confident that the dr. will handle her choices with respect and not try to pressure her to choose one path over another.

Shannon

Edited to add: Just to be clear, I have a strong opinion about the AFP and prenatal testing...my baby was diagnosed with Down syndrome at birth. Personally I am glad that I did not have a prenatal diagnosis. I am not opposed to prenatal testing...just strongly feel that women should make an informed decision about it, and that providers should provide accurate, up-to-date information and leave their personal opinions out of the patient's decision about whether to have testing and what to do with the results.

[Dayray, RN]

I'm not that familiar with AFP so I can't comment as to its validity but Smiling is a very well read so I would trust what she said.

What I will say is that, it is very important that you have good report with your doctors especially your OB. If this guy isn't talking to you and respec5ting your wises then ditch him. Even if he disagrees with your decisions he should explain why he disagrees and then offer you the choice. I always tell my patients "doctors work for you, their job is to explain things and give recommendations based on their knowledge not to decide what happens to your body. Only you decide that."

It sounds to me that he is too easily dismissing your wishes and concerns. If you are having this much of a problem with him and its just a blood test, I wonder what it will be like with episiotomy and other issues in labor.

Also even though Family practice doc's can be great at OB they are still not an OB or CNM. Two of my four children were delivered by a family practice doc and he is truly one if the best OB doc's I have ever worked with. Still I see him as the exception to the rule. I have seen some scary things with Family practice docs when it comes to OB. They just don't do it often enough to be good at it. Sure some of them can be really good but unless you have first hand knowledge if his skill level I would find an OB or CNM.

[JaneyW]

I think the main 2 points here are that you are uncomfortable trusting him and that he is unwilling or unable to fully explain your plan of care. You are hearing your little RN voice telling you that you don't understand and that isn't right. You are being your own patient advocate. Get a new doc.

[Princess74]

Why in the world are you not seeing an OB in the first place?? Please save your self the stress and find a OB Doctor, they are more qualified to take care of you during your pregnancy and delivery. I don't have any problem with GP's, they are great doctors for many, many things. However I would NOT use one for pregnancy, that is why we have OB's and midwifes.

You should be comfortable with any physician that you choose so please shop around.

[imenid37]

I hate to see anyone stereotype a certain group of practitioners as "no good". There are many family practice docs that do a good job taking care of their healthy uncomplicated pregnant patients. I think the issue here is finding a caring practitioner who will listen to you. It may a CNM, OB-GYN, or another FP. There are lots of worries during pregnancy. Many you cannot avoid. Having a PCP that doesn't suit you is one you have total control over. Remember there are some who have a multitude of "knowledge" but are incapable of being emotionally there or relating well to people. I can think of a perinatologist I know who could do a C.section on a 3 foot tall Martian pregnant with quints, was too rude to give a visitor directions to the cafeteria. This guy told a 14 year old, it wasn't "his job to explain how she got gonorrhea. Ask your mother!" Your doc just doesn't "get it". He's clueless and you can't connect to him. It isn't necessarily due to the fct that he's a FP doc and not competent to care for you by virtue of that fact. As a nurse for over 18 years, 15 in OB, I can tell you no one group of physicians has a monopoly on stupidity when it comes to the care of their OB pt's. Have a HAPPY HAPPY pregnancy and the best of luck to you. You deserve a practioner you can trust and relate to.:)