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Not So Much - Karen's Musings
Random Rambling
Not So Much
My perinatologist had recommended that I see the midwife practice that is part of the OB practice that finally took me. The midwife practice is owned by the OB group, but they operate relatively independently within it. Since they're part of the OB practice, though, there's *always* an OB back up should it become necessary (this practice always has an obstetrician on site 24/7 at the hospital I'll be delivering at). When she'd first suggested it, I still hadn't found an OB to take me on, but I made an appointment for today (several weeks past my original call - but it was the first available appointment). In the meantime, I'd gotten an appointment with the OB practice and they'd agreed to take me on, but I figured it wouldn't hurt to talk to the midwives anyway.

And it didn't hurt to talk to them. They were lovely. Not comfortable taking on my care, but lovely nonetheless.

So I'll be sticking with the OB side of the practice (unless, by some miracle I get off the Zofran pump, get the PICC line out, and cease needing IV meds - in which case, they'll slide me over into the midwife practice... let's just say I'm not holding my breath). This is fine, and essentially what I had anticipated anyway. At least now I know and I won't have to wonder later why on earth I didn't try to see the midwives.

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4 comments or Leave a comment
kmelion From: kmelion Date: January 15th, 2010 10:12 am (UTC) (Link)
I'm not clear on something... what's your issue that's making you so high risk (aside from the severe nausea/vomiting thing)?
estherchaya From: estherchaya Date: January 15th, 2010 12:02 pm (UTC) (Link)
Hyperemesis alone puts people in a high risk category - the rate of preterm labor goes up significantly in the population of women with hyperemesis vs. women who don't have it. I have a significant problem staying hydrated, which increases the risk of PTL. (I'm better hydrated on the weekends when I can run the IV fluids continuously).

That's not really the whole issue though. If I had hyperemesis that could be relatively controlled with oral medications (as it was with my triplets), that would be one thing. But the PICC line presents a significant risk of infection. This is particularly true in my case because of the horrific skin reaction I have to the line and the adhesive around the line (which cleared completely up while I was on the steroid, but now that I'm getting off the steroid, it's flaring right back up).

I started having pretty severe contractions at 16ish weeks. My risk of PTL was unknown before - most triplet pregnancies have PTL, but the PTL I had started awfully early even for a triplet pregnancy. They didn't know whether I was going to be high risk for PTL based on the triplet pregnancy, but now it appears that I am. They've started me on progesterone injections, which have helped with the contraction severity significantly.

In the case of this particular midwife practice, it's not just the high-risk that's an issue. They actually do a very good job of working with the OB practice that they are a part of and of working with the perinatology practice I see.

It is, simply, the complexity of the care I'm receiving. I'm literally on 20 medications (some of which I'm not taking often b/c they are oral medications, but they count in terms of what has to be managed), I have a patent foramen ovale that has to be monitored, I've got PTL risk, I've got a PICC line, a Zofran pump and may very well be looking at a terbutaline pump down the line, I want a VBAC, and I'm already contracting too much. I also had preeclampsia and/or cholestasis with the triplets, among other insults that I'm at risk of recurrence for. Any ONE of those issues isn't a huge deal (though the PICC line keeps most practitioners from wanting to touch me). But you put them all together into one patient, and the midwives' concern is that they'd have to be consulting with the OBs for every appointment making all my visits double appointments - and I'm already seeing the perinatologist more often than I see the OB, so it's actually triple visits for me. Their concern is that I would be shuffled around so much, I would actually receive inferior care if I switched to the midwives. Frankly, they're probably right and I never anticipated that they would take me on. I only kept the appointment because my perinatologist encouraged me to do so.

I expect that I will have an uneventful delivery and that basically nothing horrific will happen between now and then. However, when a doctor (or midwife) looks through my records and talks to me about what's going on with me - they have to weigh the odds and decide whether they're equipped to manage a patient with this combination of issues. Most doctors (let alone midwives) don't want anything to do with me. This is, I'm sure, fueled by the fact that we live in a litigious society, in an extremely litigious geographic area, in a state with terrible Tort Reform (Maryland). They don't know that I have no intention of suing them. They just see me as a walking liability.
skatured From: skatured Date: January 16th, 2010 04:40 am (UTC) (Link)
Can you remind me of your due date again? This baby is going to be one hell of a baby after all that you have gone through. Probably win a nobel peace prize or write a really awesome sitcom.

Hang in there.
estherchaya From: estherchaya Date: January 17th, 2010 10:16 pm (UTC) (Link)
I haven't told anyone my due date. I think Seth might know what it is, and my doctors know. Beyond that, I just don't want to go there. I already feel like I'm in a ridiculous (and stressful) countdown with just us knowing.

And yes, this better be one hell of a baby. And I'd better get a slice of that million dollar nobel prize money.
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