OB/GYN Appointment and CD3 Labs

I had my first appointment today with an ob/gyn. I was fully expecting an exam and a pap, along with having some questions I wanted to ask about soon-to-be-TTC and asking her to order CD3 labs (today is my CD3, which was just a happy coincidence, as I scheduled this appointment 6 weeks ago, having no idea what my cycle would d0).

No exam. No pap. Apparently paps are only necessary every 3 years and I had one in June 2010 - this is a new guideline, so I wasn't aware of it, and also just thought she'd want to do one prior to me TTC. I wasn't at all sure what to make of this. I just assumed she'd want to do some kind of exam/pap prior to me TTC, and since I thought I was due for one anyway, I had every reason to believe I was having this done. I even called the office a couple of days ago to ask about having a pap during my period, once I realized where in my cycle this appointment would fall. The nurse who responded to my message said they could do a pap during light bleeding/spotting, just not during heavy flow. No problem, I'm only heavy during my first day-and-a-half or two days. The doctor today said she doesn't like to do paps during menstruation. I even clarified with her that she didn't think I needed or should have an exam prior to beginning TTC, and she said she was happy to do one, but that she didn't think it was necessary. Don't get me wrong - I'm not exactly "unhappy" about not having to have an exam or pap, but I feel a little as though it would make sense to do prior to TTC and thought it was par for the course (probably from reading the SMC forum and many SMC's blogs!).

I also had to talk her into ordering my CD3 labs. She said I might have to pay for them out of pocket, since she didn't think my insurance would cover them. I told her when I'd called my insurance they said fertility treatments wouldn't be covered unless/until I had a diagnosed fertility problem, but that testing to determine that would be covered. She was somewhat surprised. I also told her I'd pay out of pocket if I had to, and she did order the tests. She tried to have me wait until I talk to the RE, but I said that appointment isn't until midcycle, which would push the labs until the following cycle, and that I really needed to know my numbers NOW (just really want to know to give me a better idea of what kind of TTC journey I may be facing!). I kind of got the feeling that she thought I didn't needed to have the labs done at all, although I don't know that for sure. But I talked her into it. So now I have to wait to get the results, and if it's this hard just waiting to know my FSH level, I can't even IMAGINE what a 2ww feels like!!!

So to be honest, I have a slight unsettled feeling about this appointment.

I did learn some things, though:

* Her practice does some extra monitoring for pregnant woman over 35 - an ultrasound at 30 weeks, and monitoring of baby's heartbeat, level of amniotic fluid, etc. from 30 weeks on.

* Don't check your cholesterol while pregnant. It goes up while pregnant - and is supposed to - and you also can't take cholesterol meds while you're pregnant or nursing, anyway, so it's not worth it. (This she told me after I told her I already have high cholesterol, to the point that I would be starting meds if not for almost ready to TTC).

* I asked her about testing for my CMV status, since I've heard a lot about if you're negative, only using a negative donor, etc. She was confused, seemed as though she didn't really know what I was talking about, and said you can get reinfected with CMV, so it doesn't make sense to test for it. I'm VERY confused by this, as it contradicts everything I've heard about this, and plan to ask the RE next week!

* At age 36, my chance of having a baby with Down Syndrome is approximately 1 in 180, so less than 1%. It's higher than for younger women though, and the chance of Trisomy 13 and 18 is also higher. She can screen/test for these things if I want, and will support whatever decision I make if anything comes back positive.

* She thinks I may want to do some genetic testing since I'm of Ashkenazi Jewish descent. I think sperm donors are tested for this stuff, so wouldn't me being a carrier be a non-issue? Not sure about this - a question for the RE. She suggested I speak to the RE about it, anyway.

* She suggested I think about testing for the BRCA (breast cancer) gene. I have enough of a history in my family that she said it wouldn't be a bad idea. I'm not sure I want to do this, though!

When I clarified that she didn't think I needed an annual exam prior to TTC, she said something to the effect of, "We'll be seeing a lot of each other, we'll do it after you get pregnant". Now, this is when I think I REALLY screwed up... She had been assuming all along that I would definitely be using her as my OB once I get pregnant... What she didn't know is that I'm considering using a group of certified nurse midwives instead.

I very gently explained that I'm considering using this midwives group, one reason being that they may do the IUI that gets me pregnant, and I could see the same person/people from conception to birth. I also said that with all due respect, I don't really want to give birth in one of the big "baby factory" hospitals (which is of course where she and her practice delivers). She was nice about it, and said I should do whatever worked best/felt best for me, but I kind of got the feeling I insulted her in some way (completely unintentionally!!). She did give me a few things to think about:

* The hospital where the midwives practice is a smaller, community hospital, and they aren't set up for premie births. So, if I ended up delivering early (I think it's before 34 weeks), I'd be transferred to the hospital where this OB delivers, anyway.

* Also, since the midwife hospital is smaller, when they get full, they send patients over to the OB's hospital. With either of these scenarios - ending up at the OB's hospital at the last minute - no one there knows you, you don't have any sort of relationship built, yet that's where you are.

* She said the nurses at her hospital are fantastic, and that it's really the nurses that make or break your delivery. Now, this is interesting. I'm glad the nurses are great, but hearing her say it's the nurses that make or break it, actually makes me want to use the midwives! One thing I really like about midwives is that they really get to know you prior to the birth, and that they spend considerable time with you DURING labor, in your room, helping you labor, etc (assuming you want them to). I may use a doula either way, but I REALLY like the hands-on care you get with a midwife over an OB.

Should I not have said anything at this point about possibly using the midwives instead of her?? I felt bad, and like I probably shouldn't have said anything, about as soon as the words came out of my mouth! But, since she was assuming we'd be seeing a lot of each other, and that she could examine me once I was pregnant, I thought maybe full disclosure might change how she was handling things at this appointment (it didn't).

Again, unsettled. UGH.

Although, to end on a high note, she was completely unfazed when I told her I'd be having a baby as a single mother by choice. Yay.