Tuesday, July 26, 2011

In Limbo

I feel like I'm in Doctor Limbo.

I'd like to talk to a doctor about TTC #2, while breastfeeding, after a csection, with an infertility diagnosis, and a blood clotting disorder.  I just feel like I should have my ducks in a row before peeing on a stick.

I'm not sure what to do or who to make an appointment with, but the way I see it I have 4 options:

1. General Practitioner.

I must admit that although I HAVE a doctor, I don't really know her.  I've been to her office approximately three times since January of 2007.  I actually haven't seen her since she gave me the diagnosis of PCOS since after that I was seeing the RE or midwife, and I haven't needed to go to the doctor since I had Hannah.

So I don't really KNOW her, and the last time I met with her and asked for an obgyn referral she was utterly useless, I just don't think she's the best bet.  Also, she's not affiliated with the hospital that I delivered Hannah at, although I'm not 100% positive that I want to deliver there again.

2. Fertiliy Clinic.

I know them, I like them, but I feel like it may be jumping the gun a bit.
The bonus is that they are with the affiliated with the hospital and were great at giving referrals once I conceived Hannah.  But should I really just head back to the fertility clinic when I'm only on my third post partum cycle?

3. Midwives.

Ideally I'd love to just go to the midwives.  I love them.  I truly loved working with them.
Since they're affiliated with the hospital they'd be able to direct me to a hematologist or OB if need be, and really - who else is more familiar with the post partum body?  But I'm not pregnant.  Can I make an appointment with the midwives BEFORE I'm pregnant? 

4. Find an OBGYN

An OB would be a good resource to discuss my concerns with VBAC and the Factor V Leiden blood clotting disorder, but I don't HAVE an OB.  Do I just look one up and go in to talk to them?  Plus if I start working with an OB at the hospital, wouldn't I have to find a whole new OB if we switch to a hospital closer to home?


See, we originally chose OHSU hospital because it had the fertility clinic. 
Then we stayed with them because they had the midwifes, water birth, NICU and hospital I was looking for (and should really HAVE given my likelihood of complications).  

But there are other hospitals in the area that are closer (which would make it easier with Hannah during birth #2) and still have midwives, and since a waterbirth isn't an option in hospitals after a csection, that shouldn't factor in.

My gut is telling me to make an appointment with the midwives, but I'm wondering what other women do in this situation. 

Who did you talk to before trying to conceive baby #2?


  1. It sounds like you are most comfortable with your midwives, so, I would definately start there. I watched your TTC breakdown with Hannah. I cannot imagine the dedication and the work you both put into bringing a child into the world. So, back to the midwives being all knowledgable and comforting they would be a great resource to start with.

  2. I would start with a midwife. Midwives generally do everything related to woman's health ie yearly exams, paps ect. I think they would be the most supportive. If you call them I would see what their policies are on VBACs When I was pregnant with my second attempting a VBAC there were some practices that would not touch me due to hospital policy. Have you looked into if your hospital allows VBAC?

  3. If I was in your situation I would make an apt with a Midwife. Get familiar with who you want to see, tell them your wishes, ask them questions, they will help you decided whats best for the next step etc. I went for my normal yearly check up (pap)and told them that we wanted to start trying with in 6-12months and it was a OBGYN and he suggested i loose weight first and start taking vitamins. GOOD LUCK!

  4. Since you are wanting to attempt a VBAC, I see the midwife as the best choice. Especially since they are already at the hospital. It's like the best of both worlds, really. IMO, midwives seem to be a lot more supportive of doing VBACs. And you can go to your midwife without being pregnant. One of the services they offer (at least mine does) is "reproductive counselling". They can talk to you about your options and probably the best way to proceed. And because of your history, they may tell you to go ahead to the fertility clinic so that you can conceive as quickly as possible. I know time is a factor for you because of your family history.

  5. Obviously, I am still working on healthy baby number one but I have lost all faith in general practitioners- so def no to option one. Number two seems to be the best option if you are ready to get preggers in a matter of months. You know what works for you and I hope you have quick success. Switch to a midwife or obgyn after getting preggers. Just my two cents. You are a very smart woman so I know you will figure out the best thing for you and Chris.

  6. I think option 3 or 4... and this is coming from someone who hasn't deal with a midwife. I do know that Jeni met with one before she conceived her second baby. I think they would be very very helpful in whole still breastfeeing and cycles issue. I think they would be knowledgeable on that.

    I would also think you should look for a good OBGYN as well. Maybe see both? You are lucky to live a pretty progressive part of the country, so I would hope that any OBGYN would be helpful in working with you for a VBAC. Maybe could you get a good OBGYN referal from a midwife? I think Jeni's midwife recommended a Dr. for her to see

  7. I think you should go with the midwives. It sounds like you trust them, and they may be able to point you in the right direction even if they themselves can't help you. GP generally don't help much simply because they don't deal exclusively with pregnancy. An OB would be good if your midwives can't help, but I think they are a better place to start having already gotten to know them.

  8. kate AllnaturalmamatobeJuly 26, 2011 at 12:41 PM

    I think you should go with the midwives, get them to decide how involved the CAN be in your TTC, pregnancy and VBAC journey. I think they would be a wonderful resource and they would have great recommendations of OB's that would fit with your values. Just call them and talk to them about making an appointment while TTCing. I think they would be able to do what they can, and give you good referrals for what they can't do. Good luck!

  9. All of the above? Im not a mom yet and taking into consideration that Im poorer than a church mouse I wont be trying to have a baby anytime soon... BUT I do know that it is a good idea to cover all your basis. make appointments to meet with all of them and compare and contrast what they all have to say. and who know, maybe you'll find a unique to you option that nobody has ever done before! I sure hope you have an easier time with conceiving and being prego with baby number 2, but I know that he or she will be as cute as little Hannah! :)

  10. I would find a new GP regardless of whether you go to them now or not. Will the midwives take you if you're not pregnant? Will the Infertility clinic see you if you aren't first referred by an OB?

  11. I think if you are most comfortable with a midwife then you could start there. I am not sure if they can prescribe medication in the states though, if you needed any. (I can't remember if you used clomid last time but I think you did?) If not then you could see an ob-gyn and transfer your care over when you get pregnant. I think since you had problems in the past seeking help after 3 pp cycles even though you're breastfeeding makes sense.

  12. I say go straight to the fertility clinic, why waste time? :) I wish I had gone sooner than I did and next time, I won't hesitate. Good luck! Lots to think about.

  13. I think you should go with the place you feel most comfortable. Pre conception appts are very common so there is no need to feel uncomfortable that you are not pregnant. As for the hospital OHSU sounds like your best bet. I too had an emergency c-section and would like to attempt a VBAC next time around. After all of my research i have decided that OHSU seems like it will provide the highest possibility of achieving a VBAC because the number of successful VBACs at OHSU are so high.
    -Tess McArdle

  14. Midwives.... they are a good starting point, and at this point you need someone who will talk with you more than anything else.

  15. In my opinion I would go to the fertility clinic. I think they can give you the best answers on how to achieve baby#2. It would be a consultation appt. to help direct you in your options to conceive.

  16. I think the best option is to go straight to the RE. They know what worked for you guys to get Hannah and that would be the most direct first step. It was for me. I think maybe making the appt. with the midwives just to be prepared, but for me, do what you know worked in the past. I think it's interesting to read the responses from people who did have to use an RE versus those who didn't. Wishing you all the best!

  17. I would make sure your midwives do VBACS. If they don't I would find some that do. It sounds like OHSU will be your best bet as long as you had a good experience there, since your fertility clinic is associated with them. It is possible you won't need any fertility help this time, but you could schedule an appointment with them to get some advice to see how to proceed. I do know that it is recommended to wait 1 year after a csection to allow your uterus to heal. Did you use a Doula for your last labor? If you did and you want to use one again, you could hire 2 doulas for your next baby, 1 to help you and 1 to watch Hannah. Good Luck!

  18. A friend of mine lives in Portland area and has had 4 kids by c-section. During her third she was going to attempt a VBAC but had a hard time finding a hospital around there that would allow it. She found one but ended up with a c-section anyways...but yeah, you might want to check which hospitals allow VBAC before making a definitive choice. - Aimee Hunter

  19. I know you want a VBAC. But that comes much later. First of all you need to get pregnant, isn't it? So choosing midwife right away, only to get VBAC, may not be such a great idea. I feel you need lot more close monitoring and specialist care especially with your clotting disorder and PCOS. So I would suggest you see an OB and (or) RE. I am sure you are already on baby aspirin if not you should ask your doctor about it. For some women, they suggest heparin injections instead of aspirin once you get pregnant. Then they will monitor your clotting/bleeding time and adjust the dose.All these are to address clotting disorder. I wonder if midwives have so much expertise to handle all this. Of course you can always add a midwife care down the line once you get pregnant. As for selecting a hospital close to home, may be you can look at fertility clinic associated with the closest hospital right now and go there for baby#2 from the get go. Good luck with everything :)




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