What Dr. K said

I was just going to respond to Niobe’s question about what Dr. K told me to expect this pregnancy in the comment section, but then it got really long so I thought I’d just post it.

She told me she expects that I’ll be very anxious during this pregnancy, but assured us that they want to help us through that. I described to her what happened in my last pregnancy, the dynamic cervix and the frequent contractions. She has my records but she wanted to hear how I would describe it all.

She said that my small frame and my history of contracting a lot in my last pregnancy will probably mean that it will happen again this pregnancy. She said she knows that will be very upsetting, but that we will watch it very closely with frequent appointments and many many of those lovely trans-vaginal ultrasounds.

She wanted more information about my labor, more details about the treatment choices made at the hospital, especially my reaction to the medications. She was careful not to say she disagreed with anything the hospital doctors did, but said that with the benefit of hindsight we can make different, hopefully more effective decisions (what those would be will depend on circumstances as/if they happen). Of course the first goal is to have me go to term without problems.

She said we would definitely do the cerclage, and that they have great success with that. Of course I know that it’s not 100% effective, but I want some optimism. Regarding progesterone treatment starting at 16 weeks she wanted to consult with the whole team at the practice, and we’ll talk about it next Friday. They’ve had great success with that too but she’s wary of deciding right now to do it, before we watch how this pregnancy progresses.

She assured me that if I called with complaints about contractions, I would be seen right away, they wouldn’t just assume B-H. That seemed to bother her, that I wasn’t seen enough about that, and that Dr. M’s office didn’t make an appointment with me right away after I’d gone to the ER with contractions at 19 weeks last time. But she was very diplomatic in saying that that’s the benefit of hindsight.

Aurelia asked why we had an appointment with a nurse anyway. I don’t know why that is, but it was that way at Dr M’s, and at every other office I called. The nurse at Dr. K’s office, S., though, was a thousand times nicer and more knowledgeable than any of the nurses at Dr. M’s. I felt like she took all my anxieties seriously and that she definitely understood why we are struggling to be excited and at ease over this pregnancy. Even the receptionists were nice and supportive.

Of course, I don’t want to go through this pregnancy fearful and nervous the whole time, but I certainly think it’s understandable and I’m so relieved to be treated like that’s normal under the circumstances, rather than a burden and some sort of pathology on my part.

9 responses to “What Dr. K said

  1. You’ve got a wonderful doctor! Her reactions to your descriptions of your previous experience shows what a true professional she is. She kept her cool and explained to you calmly what should have happened. Most importantly, she let you tell the story in your own words. That is a skill MOST doctors do not have.

    To answer the questions about the nurse visits before seeing the doctor in obsteric care….Seeing a nurse first was not originally done for insurance/monetary savings. In the US, medical doctors are not trained during medical school and little if at all during residency in nutrition or preventive/supportive education/care, while the nurses are or should be. (The doctors in Canada appear to have training in those areas and the US medical schools are very slowly adopting some curricula from Canadian medical schools in those areas.) In most cases, the most important parts of the first visits after finding out about the pregnancy are nutrition information, education in other aspects about how to handle being pregnant, and the prenatal vitamin prescriptions.

    The caveat to seeing the nurse first is that the nurses assigned to do the consultations should have special training in Ob protocols and procedures so that they know to send the patient to the medical doctor right away. Ideally a nurse practioner or another nurse with an MS in obstetric care should be assigned to do the consultation, but a general RN with written certification in the area and experience could do the job. Even if the patient is not having problems at the time of the appointment but is very anxious about what could happen (especially if something(s) did happen in previous pregnancies), it is standard procedure to ask for a doctor to come in to talk to the patient. It appears the university ob system does not follow protocol.

    I am very disturbed to find out that Sara was not seen by Dr. M’s office after her ER visits. This is very much against general protocol that is followed in the US and Canada for any condition.

    I know that other parts of the university medical system does follow the ER visit protocol including neurology, which has a backlog as big or bigger than Ob. My husband’s neurologist came in on her day off to see him after his ER visit for his neurological condition a could years ago. It appears that neurology needs to send OB a memo on how to handled ER cases.

  2. I forgot to add that the phone consultation screening that the university does for newly pregnant women should only be done when the women cannot come into the office due to geography or other major physical barriers. It is important that the first consultation with the nurse be done in an office where a doctor or a Certified Nurse Midwife is easily accessible should the patient have any questions or appear to have any problems. If the patient has any problems and there is not a doctor available, an appointment to see the doctor needs to be made ASAP if the condition is not presently life threatening. Obviously if it is, the woman needs to go to the ER. Ideally, there should be a separate ER to handle pregnant patients like at the University of New Mexico. Okay, I’ll shut for now. This is what happends when one is studying for a graduate degree in a School of Public Health and has many friends who are medical doctors.

  3. This is great Sara. I am so glad you have a team that understands your anxiety and will give you the care you need.

    I wish I could have had that doctor with my subsequent pregnancy! Some of the docs in the peri. practice I went to were great, but there were a few who always looked at me like, “why are you here?” They dismissed my loss as a “twin thing” and didn’t think there was any reason to be concerned with my carrying a singleton. It not only angered me but hurt to have my experience minimized by the very health professionals who are supposed to understand the most.

  4. It sounds like you found a very understanding doctor. That’s great news! I wish you all the best!

  5. Well, Gwynne and you have answered my questions, but now that I know it was a nurse-midwife it makes more sense. Although (sorry) guys after all my contact with provincial health departments, and the medical system, part of it is about money, as well as discussing pregnancy.

    That said, I’m glad you have such a great Doctor. And that she is open to the progesterone treatment. It really has become the gold standard of treatment up here, along with the nitro patch for dealing with premature labour. She sounds like someone who is interested in newer studies and treatments.

  6. Ah, yeah, this time the nurse was a nurse/midwife, in the last practice just an RN apparently. So while it makes sense in this context….

  7. I am so glad you have found a practice that will be dedicated to your well-being. Dr. K is a winner.

  8. Thanks for sharing your progress with us Sara. I, too, am glad that this doctor sounds like she is taking your history very seriously and making contingency plans now. All good signs. I look forward to many more updates and a healthy delivery down the road. I know I should not put the horse in front of the cart and take it a day at a time…but just for today I am feeling cautiously optimistic for you!

  9. I am absolutely thrilled with your new doc, and so glad that you are happy with her. I continue to have high hopes for you.

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