I don't know why I forgot to mention this in my journal last week, but since I'm basically writing two in one week maybe it was my unconscious mind stepping up to make sure I had something to talk about this time! I went to a new OB last Monday for an interview. I am not going to switch to her. She wants to induce me at 38 weeks or earlier! She thinks my sugars are far too high as well and wants to put me on glucophage. She at least agreed that insulin would be bad for me because I go so low in the afternoons and evenings. The last two days I've had low sugar issues right before dinner. I'm worried that insulin could be a nightmare for me. What if I have a low sugar attack during the night and am too out of it to wake Tom or get to the kitchen for food. I could die! She thinks glucophage would help with my morning fasting number if I took it at night. I am going to talk to the midwife about that and see what she says. It was recently approved for last trimester use. My midwife said that the numbers I'm at now are fine and the only risk is a large baby. The OB agreed that my numbers didn't put me at risk for other GD complications, but she also believes that no woman is capable of delivering a 10 pound baby vaginally, "except for those fluke cases you hear about". Well I know quite a few women who are flukes then! She doesn't want my baby getting bigger than 8 pounds. I had to laugh at that. My mom's babies were 8 lbs 8 oz at weeks early (my brother) and 8 lbs 1oz (me) and I am significantly larger than my mom and Tom is bigger than my dad! Tommy was 9 lbs 15 oz, and I passed the three-hour glucose tolerance test with flying colors. I did not have gestational diabetes. My midwife doesn't think I'll ever have a baby that isn't "too big," meaning less than 8.5 lbs, but she fully believes that I can deliver a ten pound baby vaginally. She and I both would, of course, prefer that this baby be under nine pounds, but so far so good on that! I'm not measuring large at all, and at 20 weeks the ultrasound said the baby was measuring perfectly on track to the exact day that corresponded to my due date! A 50% baby so far.
Getting back to this OB. She only has a 12% c-section rate, but I don't like her methods of keeping that down. She is extremely high intervention. She also is very arrogant and had me second-guessing some of my ideas when I left. Fortunately when I got home my mom put me straight! It's hilarious to see how much I have rubbed off on my mom. Some of this OB's beliefs are that the placenta is a 40 week organ and no woman should go over 40 weeks because it isn't natural even in the absence of gestational diabetes, large babies, legitimate worries, etc. She lets no patient go over 40 weeks! She routinely induces all her patients on or before their due date. She said she would induce me as early as 36 weeks if the baby were on the large side. She said, "Why risk too large of a baby?" I felt like replying, "Why risk prematurity?" Even if I believed ultrasound was accurate, which this doctor claims she is so good at that she gets an accurate size prediction, I would still never agree to an induction at 36 weeks unless one of us was in danger. A potentially large baby just does not qualify as a danger. Not to me and not to the ACOG which does not support routine early induction of babies merely because of potential large size. Unfortunately this doctor is the only OB that is on the HMO who delivers at the hospital I wanted, so I now have to look for one at the other hospital. My doula said that she believes I can have a good birth there, but I fear the high intervention nursery especially. Hopefully everything will work out and I can switch to the PPO. That means the midwife I've been seeing would be covered. I can switch from HMO to PPO during open enrollment (which was June 1 - effective July 1), but Tom's former company said they might be pushing that back now. I'm not sure about the hospital, but the midwife accepts all PPO plans. Since she only delivers at this one hospital, I assume the hospital must accept all PPOs as well. I also have no idea how much COBRA will be for the HMO or the PPO, and I'm hoping we can afford to switch to the PPO.
Right now I just have no answers and I feel like the chance of a good birth is slipping away from me due to circumstances out of my control. I am very frustrated!
It's now close to a week later and I haven't sent this journal off yet so I figured I'd add to it. I had a little nervous breakdown today. I've calmed down a lot since, but I'm still shaky and close to tears. I called Tom's HR department again and tried calling a different person this time since the other hasn't been answering for a few days. I've been so paranoid that we'll miss the open enrollment period to get on the PPO plan so I can see this midwife. This woman isn't the "in-charge" person, but she actually answered my questions better. His company was considering switching insurances. Since they took their sweet time doing this they pushed back open enrollment until July 1 (and might not have the paperwork until mid or late July) and it will be effective August 1. But she wasn't one hundred percent sure that that wouldn't be postponed again. I'm due August 23! She also says she cannot tell me how much COBRA will cost us, I have to ask COBRA that. I still haven't received anything from them. She claims their COBRA administrator was notified about us immediately. I asked for that number. The COBRA administrator representative treated me like I was a moron. She also said I wasn't in their system. She claimed that COBRA never has delays once they get info and that it is taking so long because Tom's former company screwed up. Somehow I don't believe that. Even at its best there are always some delays with COBRA. She also could not tell me how much it would be, said I needed to ask his company. I said the company didn't know and she told me to call the insurance company. I did that and waited on hold for a long time until our cordless phone's battery died and disconnected me. Throughout all of this I started crying.
Then I realized that it was past the time that I should be eating. This last OB I interviewed has me completely freaking out about the gestational diabetes now too, but the last thing I wanted to do was eat. I'm actually still hungry right now, but food just sounds disgusting! I settled on a peach and a slice of bread with butter and a slice of cheese. That gives me my thirty or so grams of carbohydrates and a little bit of protein and fat to slow the absorption of the carbohydrates. Tom and I ended up getting into a fight over something stupid. I wanted his help in the kitchen or something and we had a miscommunication, but he walked off all grumpy and it didn't improve my mood to say the least. Now Tom is back out in the playroom reading and watching Tommy as he plays. Right now Tommy won't play in this large back room unless one of us is out there with him. Hopefully as he gets a little older he'll be more comfortable being out there alone. I was really hoping we could keep the toys to that part of the house!
My big concern right now is what to do about the medical situation! I guess I have to start searching for another OB at the "bad" hospital now. My doula gave me a list of a few that she feels would work with me a bit more than others for the birth I want, but I can't find the names. I jotted them down on an envelope and don't know where I put it. She also has no idea if they take the HMO insurance or not. I am going to call her after I get a call back from the midwife. I really feel like if I can talk to the midwife that I will feel better about things again and stop freaking out. I also want to see if she will agree to still be my midwife if I can't return to her until August 1. I just still don't know if I will be covered for sure come August 1! I wish I had some kind of recourse on this.
Well I was right! Calling and talking to my midwife (she just called back) was the best thing I could have done. She said coming back to her August 1 would be no problem. She said she would take me back when I go into labor if I want! She thinks my sugars are still okay, but that going on glucophage might help if they start to go up. They have used it with two of their patients and it didn't help at all, but they had much higher sugars and it was all their sugars and not just the fasting that were high (my fasting has been great the last four days so maybe I'm just freaking out over nothing). She isn't sure what I should do about the delivery situation if the company continues to delay and won't switch me to the PPO. She knows of no OB that she would recommend, even with reservations, who accepts HMO insurance. She's happy I have a doula and knows that will be some help if I'm in a less than idea care provider situation. We chatted for a while about how I have never met a more conceited woman than that last OB I interviewed. I asked her about the anterior vs. posterior placenta study that that OB had mentioned to me. (I don't think I brought this up. The OB said that a new study came out that showed that anterior placentas are what cause complications and uterine ruptures in vbacs, and that vbacs should only be done if the woman has a posterior placenta). The midwife said that OB mentioned it to her and her OB partner over two months ago yet refused to give them a citation for it. Neither of them has been able to find it! My midwife doesn't believe it exists, or if it does it hasn't been published yet. She also believes the theory to be untrue and unproven.
She asked me to call her again in a few weeks to keep her updated. And as far as what happens in August, she said we'll just have regular weekly appointments at that point and possibly a NST and ultrasound because of my sugar issues, but she can't imagine inducing me for any reason unless the baby is doing poorly. She also said it will be interesting to see the size of the baby, but that she doesn't put much weight on ultrasound for size estimation because they can be so far off, but mentally it will prepare us both a little and might make me feel a lot better if the baby looks small. With her assisting delivery I feel very confident that I can deliver a large baby, but it might give me a boost if the baby is smaller. I know finding out the baby is large isn't going to make me panic. I just really hope and pray everything can work out so I am with her with this baby!
Things just seem to get better and better as I keep writing. I was about to bring this to a close when the phone rang again. It was my midwife. She did some research and found an OB who is on the HMO who delivers at the same hospital as her! There are two it seems. One was the OB I interviewed before and the other is her former partner who just opened her own practice. She left due to "differences of opinion". That sounds promising! She has grouped with another woman to share office space, but they work fairly independently. I have the phone number (which keeps ringing busy) and plan to schedule an interview immediately. My midwife said she actually recommends this doctor and was very excited that she found out she is on the HMO plan again. I hope this OB will agree to work with me. I still think I'd like to switch back to the midwife if and when I can!
It just amazes me how this other OB had me completely doubting myself and second-guessing everything. I am so glad I have this midwife to call. She completely centered me and in just minutes has restored my confidence in myself. I definitely understand why women who have had successful vbacs insist that having a supportive caregiver who believes in your ability to birth a baby vaginally more than you believe it yourself is the key. I am just praying so hard that somehow things work out so that this midwife can assist me at this birth!
