I plan to post pictures from my upcoming appointment because I will have the anatomical scan! It's a longer ultrasound appointment, but it's great to see so much of the baby and have them confirm that the heart has developed well and the brain looks good and all that other stuff. Oh, and before you think of asking, we do not plan on finding out the gender of this baby. I feel like a broken record because I have to tell the sonographer every time I have an appointment. We really enjoyed the surprise with Jr. and it definitely made the emergency c-section bearable.
I'd like to take the rest of this post to talk about patient rights. I had an especially pushy doctor at my last appointment (I did not see Dr. H for my last two appointments), and want to remind you that you do not have to cave to pushy doctors.
First, I completely understand and acknowledge that these doctors have way more knowledge of medical stuff than I do (at least I hope they do!). But, it is important for every patient to know that you have the right to refuse ANY treatment. This goes for yourself and your children. I've mentioned before that in preparing for birth it will be very beneficial to know as much as you can about the procedures, medication, etc. that can take place during and after child birth. The more you know the ins and outs of what the doctor is suggesting should help reduce some doctors' inclinations to be pushy.
If you're in an appointment and they are suggesting a treatment, first ask tons of questions.
Why are you recommending this?
What is the procedure/treatment like?
Do you feel this is absolutely necessary? What are the risks/side effects?
What are the benefits?
How long do I have to make a decision about this?
Is this required by law? (Certain things may be required by law. I was not able to give birth in a NY hospital until I had the HIV screening done).
After you get your answers, take time to think about it. Even if you've already declined this treatment before and plan to again, pretend to think about. Informed consent goes two ways. They have to tell you all about the treatment options and you have to seriously consider them. It'll be hard for them to not push the issue if you give a quick denial in what would appear to be a knee jerk reaction. If the recommended treatment/procedure is something big ( like surgery) kindly inform your doctor that you will consider it and may seek a second opinion. There may be a better treatment option for you, but your current doctor doesn't feel confident in providing it and therefore may not recommend it. For example my OBGYN with Jr. felt very comfortable suggesting that we try to turn Jr.'s head instead of immediately going to a c-section. I clearly remember him stating that his colleagues thought he was crazy to attempt it, but they simply did not have the same education and training that he did (they were probably 10-15 years younger).
When in the hospital, if anyone comes in and tries to just give you a medication (some medical staff are known to do this with pitocin), start asking questions. If you don't like their answers or if they won't take your no for an answer, ask to speak with your doctor about this treatment. Even if your doctor ordered them to start the treatment, they still have to tell you about and give you an opportunity to ask questions and potentially refuse that treatment. Things are a little different in life and death situations, like when the doctor who delivered my son ordered the nurse to give me a shot to stop the never ending contraction I was having. There was no time to explain the risks and benefits as my son's heart rate was tanking and desperately needed the contraction to stop.
As I mentioned previously, this post was brought on by an especially pushy doctor. Dr. M met with me at my last appointment and was getting up to speed on what was going on with me, my pervious birth, and how things have been going so far (including what blood tests have been done and if any medication had been suggested). First we had a big discussion about the blood test for cystic fibrosis, which took her a while to get to an explination that made me want to consider getting poked again with a needle. One medication she brought up during our discussion was progesterone. I had discussed progesterone at my previous appointment with a resident and another doctor. They both explained it well, but I did not see the point in me having this treatment and told that doctor (Dr. C) I did not want progesterone. Dr. C did not record her notes from that appointment in the electronic system so I had to go over it all again with Dr. M. I told her serveral times that I had thought about it and was not interested, but she kept pressing the issue until I was no longer cool, calm, and collected, and gave her a very firm "No, I do not want this treatment." And even then I could tell she wanted to push the issue farther. I just really hope that I do not have to see her again, and I may even ask if it's possible to be sure that I don't see her and that she is not involved with the birth of this child. I know it may seem trivial, but I don't want to work with a doctor who doesn't take me seriously and who won't listen to what I have to say.
Now, for all of you who don't know about progesterone here's some information. :) The purpose of progesterone (which the body makes naturally, and is increased during pregnancy) is to help reduce the risk of preterm labor. Unless you have a known condition or an incompetent cervix, this will almost definitely not be recommended during your first pregnancy. If you have a known condition, an incompetent cervix, or a history of preterm labor, this treatment will be strongly suggested. One interesting thing about progesterone is that they don't know how it helps, they just know that it does help. Studies have shown that for women without a Müllerian abnormality, but with a history or a risk for preterm labor, it helps reduce the the risk by about 60% (please feel free to fact check. That is a percentage that I'm trying my best to remember for my appointment). For women with a Müllerian abnormality it reduces your risk by about 40%. There really are no side effects because the dosage is very small and no where near what they give the mice/rats in the test labs. Progesterone is commonly given once a week by injection (though one doctor said that they're finding that many insurances won't cover it), or every night in the form of a vaginal suppository.
If you fit any of those categories previously mentioned, do consider the treatment. I think it would be a great thing for a first time mother with a Müllerian abnormality. In my case, from what I've learned about a septate uterus and how it behaves during pregnancy, I believe that already my chance of having this baby any earlier than 36 weeks is reduced simply because it's my second pregnancy. And to me 40% isn't a big enough reduction to make me want the treatment. Plus, knowing my luck, my insurance probably wouldn't cover the shot and I would probably never get the suppository inserted correctly due to my vaginal septum.
For more information, here is a case study on the effects of progesterone in pregnant women: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3218546/#!po=35.4938
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