Conference moira::parenting

This note is being entered for a member of our community who wishes to 
remain anonymous at this time.

      Carol duBois, PARENTING co-moderator

****************************************************************

I have just recently found out I am pregnant via a home pregnancy test and had
it confirmed by my primary care physician.  I received a referral to my OB/GYN
and am trying to schedule my inital prenatal exam.  My husband and I joined an
HMO in January 1993.  I have only had one annual exam with my OB/GYN.  During
my life, I have only seen female gynecologists and that was one of my criteria
when choosing a new one under this HMO.  I also wanted to have at least one
appointment with her before becoming pregnant to make sure I felt comfortable. 

The practice she is in has 7 men and 1 woman.  I made it clear during my annual
exam that I only wanted to see her during any pregnancy and she said they
normally rotate but if I was flexible about appointments I could just see her. 
I didn't want to see a different doctor every month firstly because I didn't
want to get to know a different doctor each time, secondly because I find that
different doctors have different philosophies, opinions, etc. and lastly
because I only wanted to see a woman.  

Now I have found that the earliest I can see her for my inital prenatal exam is
February 24th.  I will be around 11 weeks pregnant at that time. Does this seem
normal?  I was under the impression that you should get to a doctor as soon as
you suspected you were pregnant.  I didn't even see my primary care physician
to confirm the pregnancy - just the nurse for a urine test.  I have a million
questions (this is my first pregnancy and we have some possible genetic
concerns) for the doctor.  I also thought vitamins were prescribed.  It seems
funny not to see a doctor until I'm almost done with the first trimester.  The
doctors office didn't seem the least concerned.  I know alot of women don't
find out they're pregnant right away, but I thought the sooner you know the
better.  Apparently, future visits won't be as hard to schedule but the inital
exams she only does one day a week and she's booked for the next month. 

There is only one other female on my HMO plan in my geographic area.  I really
hate to try to switch at this point but I'm starting to feel discouraged. My
husband and I haven't told anyone yet about the pregnancy (my Mom is out of the
country) and I feel like I have no one to ask about this.  I guess my basic
questions are:
	1) is it okay to wait 11 weeks before seeing a doctor, and 
	2) if I stay with the same practice and see one of the male doctors 
	   for the initial exam, does anyone have experience going to a
	   male for the first time after seeing only women?  

I am very nervous about being pregnant and am afraid to go through the exam
with a new doctor and a male doctor at the same time. 

    .1  Having your first prenatal exam at 11 weeks is not unusual.  I had
    my first one at 10 weeks and, like you, thought that was rather far
    out, but I have since found out from lots of friends and others that
    it's really quite normal.
    
    As far as seeing the other doctors, what are the odds that your female
    doctor will be on duty when it's your time to deliver?  Your doctor is
    not on duty 7 days a week, 24 hours a day, the practice will rotate
    weekends, etc.  When I did deliver it was a weekend my doctor wasn't on
    duty, it was a doctor I hadn't met before (I delivered before I had a
    chance to be examined by his partner).  During the delivery I didn't
    see the doctor that much, mostly it was the labor & delivery nurse. 
    Personally, I don't mind having a male doctor, but that may be because
    my doctor is a really nice guy who shares a similar philosophy about
    pregnancy and childbirth that I do, it may be different with someone
    else.
    
    An alternative to changing practices may be to see if your practice
    offers midwifery services.  That way you can continue to see your
    female doctor and the midwife (I'm assuming here, shame on me, that the
    vast majority of midwives are female).
    
    Good luck with your pregnancy,
    Susan

    I too had what I considered a late first prenatal exam.  It was a
    policy in the office that I'm now using.  They did send me a
    prescription for vitamins, however.  At least I began those well before
    the exam.  Since this is my second pregnancy, I managed okay with
    waiting.  
    
    I too have to question the odds of getting the doctor you want for
    delivery.  My doctor's office only had 3 doctors last time, and of
    course I ended up with the one I liked least for the delivery!  I did
    start with a doctor that I preferred, but since a shift change occurred
    another doctor ended up delivering my child.
    
    judy

    Hi,
    
    I was also 10 weeks when I had my first prenatal.  I found
    out I was pregnant in late September and couldn't get an
    appt until November!  When I had the prenatal bloodwork
    done, I asked for a prescription for prenatal vitamins
    (this is my 2nd pregnancy, so I knew they would be prescribed 
     at the prenatal).
    
    My OB is female also and during my 1st pregnancy she was in
    a practice with 2 other male doctors.  They suggested I see
    all of them during my pregnancy so I would get a chance to
    meet them in case I delivered.  Well, as luck would have it,
    one of the male doctors delivered my son and the other male
    doctor was the physican on duty when I was discharged.  
    As much as I wanted my OB to deliver my baby, Susan is right,
    you really don't see the doctor that much during labor...and
    by the time I was ready to deliver, I didn't CARE who the
    doctor was.  :-)
    
    I still hope my OB will be on call when #2 arrives, as we
    have been through alot together this past year.  She opened
    her own practice with another female Dr and a male dr. So
    at least my odds have increased.
    
    Have you considered going "out of geography" for your OB/GYN Services?
    You didn't mention which HMO you belong to or where you are located,
    but I have Tufts  and live in Milford, MA. They have always approved 
    my visits to my OB/GYN in Wellesley, and it isn't in the "circle"
    
    I hope this helps!
    
    Congratulations!
    
    	Linda

My first ob/gyn appointment was at 12 weeks, so it's not too unusual.

I can relate to preferring a female ob/gyn.  I went to a practice consisting
of 2 female and 1 male doctor.  I saw my primary (female) ob/gyn for the
majority of visits, but I had 2 visits with each of the other 2 doctors.
My preference for delivery doctor was 
	1) my primary ob/gyn
	2) the other female
	3) the male

When I delivered, it was the male doctor who was on duty and he was
*wonderful*.  I had an unanticipated C-section and this doctor was amazingly
sympathetic -- he seemed to know *exactly* what I needed to hear, and he
was very focused on my comfort.  Your mileage may vary, of course.  But I
thought it might be comforting to hear this story.

As far as vitamins go, my impression is that most doctors prescribe them.
Mine did not -- they gave me gobs of information on nutrition and strongly
recommended that I get my nutrition from food instead of pills.  They did,
however, recommend an iron supplement and maybe a folic acid supplement
(it was a couple of years ago and my memory is fading :-)

Best of luck with your pregnancy and your decision!

- Deb

If you are concerned about the late date of this exam, go see your Family
Doctor.  He knows you and should know enough about pregnancy to get you
through to your first ob visit.

Stuart

I seem to remember the folic acid supplement is (a) important, and (b) 
urgent -- definitely first-trimester stuff.  (It helps prevent neural-
tube impairments, such as spina bifida, if my memory serves.)  Maybe
call the obstetrician's office and ask her to call you back to discuss this. 

	My OB's office sees first-time pregnancies at 8 weeks.  Subsequent
	pregnancies (if there is an indication of risk or problems) get seen
	at 10 weeks.

	I've seen prenatal vitamins sold without a prescription - they are
	located with the regular vitamins.  I asked my doctor what the 
	difference was, and he said, "not much".  I'm assuming they use
	the prescription to help defray your costs (insurance picking up
	part of the tab), but at least in the case of my HMO, I pay
	$18.00 for a 90 day supply, and my insurance pays $2.00 or thereabouts.

	Karen

>	I've seen prenatal vitamins sold without a prescription - they are
>	located with the regular vitamins.  I asked my doctor what the 

However, the folic acid supplements, which may be particularly important, are
definitely prescription stuff.  (Read the package insert and you'll see why --
consequences of misuse include things like pernicious anemia.)

	-Neil

    10 weeks for # 1, 9 weeks for #2, and 13 weeks for #3, which was
    pushing it a little, but it was for an obstetrician my Family Doctor
    recommended as being tolerant of alternative medicine people.  I also
    saw a lay midwife in town as I had a second home birth planned.  
    
    As for prenatal vitamins, you can get them in the store, but I got
    migranes from the increased iron in them and went back to a
    multivitamin supplement every other day and ate lots of green leafies
    and reasonable meat to get the folic acid and iron.  
    
    At 11 weeks you will be in in time for genetic counseling and screening
    if that is a concern for you.  
    
    Good luck and a hpaay pregnancy and birth.
    
    Meg

    
    I was 11 weeks when I had my first exam, and this is my first
    pregnancy.  When I called to make the appointment, the assistant
    made sure I called her back with a pharmacy number to call in the
    vitamin prescription to....during my first visit, there was a sit
    down session to discuss any and all questions/concerns, before the
    exam.  I appreciated that.  During every visit since then, my Dr
    asks if I have any questions/concerns etc...
    
    

    I had my first prenatail visit with my ob/gyn at 6 weeks due to the
    fact that my first pregnancy ended in a miscarrage and they didn't want
    to take any chances with my second pregnancy.  I also have a female
    ob/gyn who at the time only shared her practice with a male but know
    they have added to their staff and she is still my primary ob/gyn that
    I chose when I started to go to her practice.  But while you are
    pregnant they like you to see all the doctors incase you deliver while
    your's is not on call.  This happened to me cause I delivered 2 days
    early and had the male ob deliver my son.
    
    As far as the Folic acid suppliments (Iron pills) they are not a
    perscription you buy these over the counter, they also have a new one
    out that does not cause constipation like most iron suppliments do. 
    The prenatial vitamins I have only seen by perscription.
    
    
    
    Good luck
    
    Liz

Folic acid isn't iron.  It's a B vitamin that's been shown to reduce the
incidence of spina bifida when taken very early in pregnancy (first few weeks).
Some suggest that women just *trying* to get pregnant make sure they get enough
folic acid.

It's found in leafy green vegetables.  Some foods are enriched with it --
my breakfast reading tells me that an ounce of Kellogg's corn flakes provides
25% of the RDA of folic acid.

I am also in an HMO.  When I found out I was pregnant, our HMO scheduled 
an appointment at 9-10 weeks but they had a "seminar" at 8 weeks for all
first time parents (you were actually required to go).  At this they covered
the basics of what you may experience or are experencing, gave you paperwork
to have ready at your first visit, the midwife was available for prescriptions
(if needed), etc...  Might see if something like this is available.
It answered alot of our questions.

The other thing is our HMO carries non-prescriptons items such as vitamins.
They typically are cheaper than what you will see in the store.

I went with the mid-wife option at our HMO they are all women (though some are
definately better).  I loved my mid wife.  I remember she spent an hour with me
on the first visit just discussing my pregnancy.  I felt like so many of my
questions were a bit stupid - but she made me feel good about asking them.
As it happened, she was not the mid-wife on duty.  The one who delivered the
baby was not my favorite but I actually didn't interact with her much.  And
in the morning my midwife was there making rounds.  One of the things I was
told about our HMO was that the doctors typically spend ~15 min with you on
a visit due to their patient load.  The mid-wifes spend more time (mine visits
were typically 30+ minutes).  This was one of the reasons I went this route.
Being an analytic - I always had questions about the process.

    	I've taken both the over-the-counter prenatal vitamins, and 
    	the prescription ones.  I specifically remember looking to 
    	see if the over-the counter version had folic acid, and they 
    	did.  At the time, I remember looking to see if they contained 
    	the same amount, but don't remember.  What I DO remember is 
    	that the over-the-counter ones had 100% of the FDA recommendation.
    
    	I also had a hard time FINDING over-the-counter prenatal vitamins.  	
    	CVS has them as a generic brand -- but it took a few trips, since
    	they were out-if-stock the first couple of times I looked.  My 
    	midwife also recommends taking them even as you are TRYING to get 
    	pregnant.
    
    	Peggy

	Over the counter vitamins, even multi-vitamins, usually have
	folic acid in them now, in the quantities recommended for
	pregnant women or women desiring to become pregnant.

	The studies with Folic Acid show that it is best for a woman
	to be getting sufficient folic acid at least one month *prior* to 	
	conception.

	I've got more info on folic acid at home.  If I remember it,
	I'll put it in here.

	Karen

    I'll second what Karen said about starting the folic acid early.  At my
    last checkup my doctor said that I should be on ~400mg of folic
    acid/day at least one month prior to conception.  I've checked the
    generic, over-the-counter vitamins and most "woman's" vitamins have
    that.
    
    Susan

    And don't forget to take the vitamins with *food,* they'll be
    easier to absorb and you won't be as likely to get sick to your
    stomach on them.
    
    You folks are wonders...remembering when you had your first prenatal
    visit with your pregnancy!  I think it was 9 weeks with my first
    pregnancy, and 10 or so weeks the second time.
    
    I have always had male OB-GYNs and never have cared one way or the
    other.  I've heard horror stories and good things about both.  Your
    mileage REALLY varies on this one!!  I would say, don't automatically
    assume that a female doctor will be any more or less sympathetic than a
    male doctor, or vice versa.  You have the right to "interview" your
    doctor and decide if s/he is the one for you.
    
    Perhaps one reason why you couldn't get an appointment for such a long
    time is becuase you asked for a specific doctor.  In a big practice,
    the "popular" doctors' calendars fill up fast, especially in an HMO. 
    When I need to go to the doctor's, but my primary care physician can't
    see me for whatever reason, I have the option of seeing his Physican's
    Assistant.  She's OK, I prefer my doctor, but if you think you have
    strep throat, you do what it takes!!  What I'm trying to say is, if the
    timing of the first prenatal is worrisome to you, ask if there is a PA
    or Nurse Practitioner that you can see.  Explain again that there may
    be some issues, and that you would be more comfortable being seen
    sooner, not later.  
    
    Good luck with your pregnancy, all will be well.

    
    << You folks are wonders.....remembering when you had your first
       prenatal visit with your pregnancy.....
    
    
    Not too hard for me, since I'm still pregnant from that 11 week
    first visit! (8  
    
    Lynne

re .19 (female not always gentlest, most sympathetic):

My wife and I describe the one female gynecologist at an otherwise all-male
practice as "Dr. Ruth's evil twin."

    
    When searching for an OB/GYN, it didn't matter to me if it
    was a man or woman.  I was shocked to hear about the reps of
    most of the women OB/GYN's that I had the choice of using, under
    my health plan.  Some of the reps would make Dr. Ruth's evil twin
    seem to be an angel of mercy...
    
    

    
    
    	I am of the camp that men have no business being OB/GYN's (Marc and
    I have heated discussions about this all of the time). Please note that
    this is a personal belief and I am not trying to convince you of
    anything.
    
    	I realize that there are some people who feel more comfortable
    with male OB/GYN's (they fit the traditional model)
    
    	I realize that there are some people who have had great, tender
    experiences with their male Doctors, but I have not. My only experience
    with male OB/GYN's is this side short of incompetence. This is not an
    issue of modesty (there is no modesty after childbirth) but rather an
    issue of trust and feeling a partner in my health care.
    
    	I use the midwives, I always will. I feel comfortable with them and
    I consider them to be my friends in the practice of generating babies
    (and I seem to be getting pretty good at it).
    
    	This is not to say, I detest all male physicians, my orthopedic
    surgeons (who have pretty much saved my life) have all been male and
    the all time best Docotr of my life was a male.
    
    	I just don't use male OB/GYN's and don't see that changing in the
    future.
    
    				Wendy

    Regarding "Dr. ruth's evil twin"  You can't have had her I did. 
    Seriously though,  I think in my OB's case it was a matter of
    experience.  I got her in her first year of private practice, and she
    must have done her residency in a real war zone.  She focused only on
    potential complications, rather than believing that I listen to my body
    and can tell when something is way out of synch.  She discounted my
    experiences in my first two pregnancies and had fits when I would
    challenge the need and/or validity of some of the testing she was
    doing.  
    
    Now my family DO was much the same way when she first started in
    private practice, but has learned to listen to her patients and have
    some faith that they know their own bodies.   I really wish she still
    did OB as she and I understand each other.  
    
    However, should I need another OB again, I will look at years of
    experience, as well as "bedside manner", and gender.  I really don't
    need the stress of a panicked Dr, who loses it at me everytime I
    question things.  I don't have the time or patience to "raise" another
    Dr.
    
    Meg 

	For my first pregnancy, I got names of Dr.'s from my PCP.

	I instincively chose the female on the list, and ended
	up seeing her earlier than scheduled for a suspected
	miscarriage.
	
	I did miscarry that pregnancy, and was very disappointed
	with the (lack of) bedside manner of that doctor.  I saw
	her 3 times over 7 days, and never felt anything but
	coldness from her.  She also did not ask me if I had any
	questions about anything until she saw me two weeks *after*
	the miscarriage was over.

	Next time around, my HMO had changed hospitals, so I was able
	to use my sister's male doctor, with whom I've been extremely
	satisfied.

	Karen

Wendy,

I think that what you've said about Ob/Gyn Drs applies to many specialties
in Drs.  What I have noticed, whenever I've dealt with a female Dr. (and
I have no prudishness ... to me as long as the doctor is truly trained,
then I don't care ... male/female) is that generally speaking, they take
that bit more care ... or at least seem to.  Whether that is a function of
the fact that that is how they survive in that male dominated profession,
I'm not sure, but it certainly seems that way.  The reason I say that is
because I've been seen by some female nurses who could only be described
as Warmaidens ... and seen some very caring male nurses.  Work that out!

Basically, I think it boils down to having an understanding and caring Dr.,
no matter what the specialty.

re experienced drs...

Having an older experienced Dr.  Sometimes that doesn't work either,
because that only means they are stuck in their ways and their ways
aren't necessarily good!  They aren't necessarily more compassionate
or caring ... after all they've been performing this job day in, day
out for years, and you are only number 6665 on their production line.

For our 2nd child, my wife had an older and very experienced anaesthetist.
(anaesthesiologist for those who prefer more letters!) She had an
epidural for a C-section.  She was clearly in a lot of pain during the
op. and he did very little to ease it, and didn't seem to care.  She
went into very mild post-op shock afterwards.  After this, one of our
friends reported she'd had this Dr, who had managed to freeze her top half
and not bottom half, and denied it was possible!  We wondered if this
guy believed that a woman MUST suffer SOME pain in childbirth!

For our 3rd child, she had a much younger anaesthetist, who, when told
about the experience reassured her that she would not repeat that experience.
(She had requested a general ... but the Dr convinced her to try the
epidural again).  He didn't lie ... it was altogether the best experience.
No pain apart from the internal pressure.

Just goes to show that experience doesn't go hand in hand with good
Doctoring!

Stuart

    Wendy,
    
    I know exactly how you feel.  I have been seeing a female OB/GYN as
    long as I have been seeing one.  The first, last and only visit I will
    ever have with a male doctor was at the birth of my son Evan.  I
    delivered him very quickly. We were only in the hospital 10 minutes. 
    The nurses said they wanted me not to push and that my female doctor
    would be there soon.  Well, I couldn't wait any longer.  This male
    doctor was in the next room with his patient.  So he came over and said
    he would deliver the baby for me.  I said that was fine.  What did I
    know.  Well, the birth went fine.  It was the delivery of the placenta
    that did not go fine.  I remember with my first son.  I pushed twice
    and it was done with.  Well, this doctor decided to try and pull it out
    by the remaining cord.  Well, needless to say the cord broke off.  So
    he said that I had two choices, he could retreive it or he could knock
    me out (those were his words!!!).  I just wanted it to be over.  So my
    husband and I told him to do it.  Well, he put his WHOLE hand inside of
    me to grab the placenta.  When he did that, I completely lost control. 
    I wrenched up off the table.  He couldn't grab hold so he had to do it
    again.  After it was over, he said, " I'm going to have to stitch you
    up now"  I said, "WHAT?"  He then said that he tore me.  Well, I lost
    control and yelled at him.  I had just delivered a 6lb 13 oz. baby.
    There was not way that the baby could have done that.  He admitted that
    he did it.  
    
    After he finished with the stitching, I leaned up looked him right in
    the eye and said, "Now I know why I go to a female doctor, you are the
    ruffest thing I have every met."  He then told me not to be so
    sensitive.  
    
    Well, about two weeks later, my whole left leg went numb while I was
    feeding the baby in the middle of the night.  I went to the othropedic
    (sp?) surgeon and was told that I had two herinated (sp?) disks in my
    lower back to due the twisting after delivery.
    
    So, Wendy, you are right, I will NEVER see another male doctor.  I
    know, I know everyone, it only one doctor. I don't want to chance it
    again.  My doctor know exactly how I feel.  She is very sensitive to
    all of my needs.
    
    Lillian

    Re: warmaiden nurses
    
    Oh boy, is this ever true!  My doctor had a receptionist/nurse that was
    the nurse from h*ll.  I can't even write in here what we used to call
    her (and I know a LOT of women who shared the same opinion).  I think
    my doctor kept her on out of loyalty (she had been with him for many,
    many years) but when she retired I know that there were alot of happy
    patients out there.
    
    My ob/gyn, on the other hand, is a gem.  I first saw him when I was in
    college and he did pro bono work one day a week at my university.  I
    had asked my aunt (office manager for a major infertility clinic) to
    check him out for me.  As soon as I mentioned his name she only had
    praise for him; she knew him personally and he had an excellent
    reputation. So, now, even though it's inconvenient to get to his office
    I still go because we've developed a comfortable relationship.  I also
    think he really likes pregnant women and delivering babies.
    
    When I was pregnant I also found out that the wives of 2 men that
    I work with went to the same doctor; they both had the same opinion.
    
    It's weird, pediatricians I feel more comfortable with the women.  I've
    seen all the doctors at our practice and I will now only book
    appointments with the women docs, I think they are more concerned about
    the family structure as a whole.
    
    Susan 

	I've got to say that I'm really amazed at the number of people 
	who would chose an OB on the basis of gender... and at the LACK 
	of people who mentioned schooling/experience/etc.

	Personally, I have absolutely NO preference if my OB is a man 
	or a woman.  However, after having been to four practices in 
	the past five years this is the conclusion I've come to:

	If you want someone who has been through the experience of 
	pregnancy, childbirth, nursing, etc., then by all means, use a 
	midwife.  I had a midwife deliver Andy, and help with several 
	nursing questions/problems.  She is one of two female midwives 
	who, along with two male OB/Gyns, make up the practice I go to.

	BUT... if there are any complications in your pregnancy, my FIRST 
	questions would be:  Where did you go to school?  Where did you 
	do your residency?  How long have you been in practice? and How 
	many times have you performed this surgery?

	I had three miscarriages, and dealt with a different practice 
	for each.  They are all happy, cheerful, and helpful as long 
	as your pregnancy goes along as planned.  But you REALLY find 
	out how good they are when something goes wrong.

	After my second miscarriage, and not being impressed with the way 
    	either of the first two offices (one male, one female) handled them, 
    	my cousin's wife suggested I start checking into the doctor's 
    	training a little more before I selected a new OB/Gyn.
    
	What a difference that made!  My current OB/Gyn is a male.  I 
	forget what school he went to, but he did residency time at 
	both USC in California, and Brigham and Womens in Boston.  His 
	partner spent some time TEACHING at a medical school.  When I 
	had complications, he was quick to react, very informed in his 
	advice, and knowledgeable about new treatments that prevented 
	me from losing a tube as the result of an ectopic pregnancy.  

	Peggy

    re .27
    
    What you experienced was not a caring doctor; you experienced a
    doctor out to make some quick extra money by performing an extra
    delivery, and do it in a hurry.
    
    It didn't have a lot to do whether the Dr. was male or female.
    
    Stuart

I had both good and bad experiences with a female OB, but both were residents
at Brigham & Women's so I knew I was going to get whoever was on at that
time.  The first one was very rude and didn't seem to care about me or know
what she was doing. When she left, I told the nurse she wasn't going to 
deliver my babies, and that if the nurse didn't take care of it, I would 
tell the doctor myself when she came back in. I still can't believe I was
that diplomatic when I was in hard labor. And I don't usually make those
kinds of snap decisions, but this lady was definitely not for me, and I
had enough complications to worry about delivering twins 12 weeks prematurely.

The second doctor who came in was also a first-year resident, but she was
much better, and I at least trusted her to be able to competently deliver
my kids.

I decided against using the midwives at my OB's office because I was worried
about how they would handle it if something went wrong. Turns out that it
really didn't matter who I chose since I didn't even deliver at the right
hospital, but either way, a midwife would not have been able to deliver
my children.

I think it all depends on what you need from a doctor, but if you're more
comfortable with a female OB, then find a qualified female OB just like
you'd find a qualified male OB if that's what you want. You have to trust
your doctor, so your need to be comfortable with whoever you get.

Cathy

The following is being posted for a member of the PARENTING notesfile
community who prefers to remain anonymous at this time.   If you wish
to contact the author by mail, please send your message to me and I will
forward it to the anonymous noter.    Your message will be forwarded with
your name attached  unless you request otherwise.

Carol Stolicny, PARENTING co-mod
-----------------------------------------------------------------------


How did you know what to do next after you find out you are pregnant with your
first?

At Week 6, I went to the doctor's office and had the blood test done.  My
doctor said he would tell me the result next day.  He never did.  I finally
called at 4:50 PM that day, and the woman who answered the phone told me the
result.  She also said, "Call back tomorrow for a referral for OB/GYN."  It's
very nice of her telling me this.  I would never have known it.  My doctor
never called me, neither did his nurse.

Last time when I had a miscarriage, my doctor couldn't see me.  (I ended up
seeing another doctor in the same office.)  Ten days later, he left message in
my machine asking me if I was still bleeding.  I didn't know if I should thank
him for remembering me...

Back to the original question.  Did your physician tell you what the next step
was (and send you the referral without your asking)?  Or, you read from the
books?  Or, you just knew it's the next logical step?

BTW, I belong to Harvard Health Plan (if that matters).

    
    At Matthew Thornton ... they didn't tell me a thing.  Make an appt w/
    Pat was as far as I got, and they have a fairly intense 'work up'
    program.  Of course I didn't actually GO until I was 3 mos pregnant.  I
    went right after I missed my period, got a positive result, they said
    "Give us a call sometime to set up an appt", went home, debated jumping 
    off a bridge for a while (this clearly wasn't planned), and eventually
    decided I'd better get my butt back there.  
    
    I finally MADE someone tell me exactly what was expected and what was
    going on .... I think it might actually have been the appointment-desk
    lady who told me.
    
    Their 'policy' anyway, is that you go see Pat-someone, who's a nurse
    practitioner, I believe, and she gets all your history and gives you
    vitamins, and weighs you, quick physical type stuff.  Then you make an
    appt w/ the Dr. who does an internal, and goes over all the stuff the
    other lady got, then you switch Drs for a while, and eventually the
    little cherub pops out (-: EASY, huh!?  
    
    Call the appt desk .... they'll probably know the 'routine'.  Just tell
    them you just found out you're pregnant and you're not sure what to do
    or who to see, or how they work it all there.  
    
    GOOD LUCK!  Sometimes it felt like I should've had to take a course in
    something BEFORE I got pregnant just to deal with all their little
    policies and intracacies.  Be firm with your Dr, and MAKE them tell you
    everything you can expect, including times that blood work needs to be
    done etc etc.
    
    Patty<

    I would make an appointment with the OB/GYN as soon as possible
    just to make sure that things are happening as they should.
    
    My first appointment was at 1 month to verify that I was indeed
    pregnant.  I went approximately once a month after that until
    the 6th month when we had complications.  Then, went once a week
    from then on. 
    
    I would suggest that you read up on what is happening to you 
    so that you can formulate some questions to ask the doctor.
    I always marvelled at the books that showed the week by week
    growth of the baby.  Also,  at my first visit,  the doctor
    tipped my uterus upward so I could put my hand on my stomach
    and feel the baby.  I know it sounds weird but this made it
    very real for me!  Once I KNEW that it was real, I started
    taking care of myself better and started really looking forward
    to the next months and for the time when "the cherub popped out!"
    (To quote Patty)
    
    Best of Luck to you!
    
    Pam

Here in Seattle we have an HMO called Group Health.  They did 
call and confirm my pregnancy.  They also had a definite 
routine they followed with first pregnancies which I was 
grateful for.  I was told to schedule a visit with a midwife
or OB/GYN my preference.  I could meet with both and then
decide if I wanted.  They also scheduled a meeting for
both me and my husband which we were to attend prior to
9 weeks.  At this meeting, which included about 6 other
newly prengnant couples, they discussed next steps, nutrition,
doctor/midwife visits, etc.  It was very reassuring.

Group Health gets mixed reviews at times but I found their
pre-natel program excellent and I loved my midwife.

    I belong to Harvard also. Generally you need to be proactive. You
    have to call to get you results. They do have a set schedule for 
    prenatal appointments.  Call you OB/GYN dept at your center and ask
    to speak with one of the nurses. They will tell how often you will
    set up appointments. Usually your first visit is the longest. The
    doctor will go over many issues with you.  I have found my best way to
    get questions answered is to call the OB/Gyn dept at my center. Hope
    that helps
    
                                         Alice

    I remember feeling a bit up in the air as well. I went to the office
    of my general practitioner and a technician did the blood test. 
    When they called with the confirmation of the home test they
    told me I should then make an appointment with an OB/GYN, of which I
    had none. I took it upon myself to open up my Healthsource directory of
    Drs and picked out the most (only) conveniently located practice.
    Called them up and got an appointment for a month out. The nurse there
    was accommodating and was willing to answer any question over the phone,
    but I had none. Between the these notes files and the books I'd read, I
    felt well informed. I just thought it was strange that no one wanted
    to see me for a month. But I've since found out that is about the norm. 
    
    Gail

   Don't forget... these folks (medical folks) are nothing more than
   service providers to you - just like auto mechanics or landscapers or
   anybody else you pay to receive a service.  You are paying good money
   (maybe with major or minor assist from insurance, but still, they get
   paid for their time) for their service, and you have a right to ask as
   many questions as you need to feel comfortable with the service they
   are (supposed to be) providing.
   
   Its your money and your baby... don't be intimidated into leaving any
   question unanwered..
   
   fwiw,
   
   - Tom

   PS - Congrats!

    I've always been a stickler for getting my yearly gyn check-ups because
    of my family history.  When I joined the Matthew Thornton Health Plan
    (an HMO) 3 or 4 years ago I started seeing the OB/GYN folks exclusively
    for my check-ups (as apposed to a family practitioner) and have been
    really pleased.
    
    My husband and I quit using birth control about a year before I
    conceived, at that point I got some preliminary info pregnancy.  When I
    missed my period (I'm extremely regular) I took a home pregnancy test
    (on mother's day, it seemed appropriate) and it was positive.  I called 
    my nurse practitioner/midwife's practice and was told I should be at
    least 6 weeks late before they would do a test.
    
    When I was in the practitioner's office I grabbed all of the literature
    that I could find to take home and read.  They confirmed the pregnancy while
    I was in the office, my midwife gave me a prescription, went over the
    warning signs to watch out for, let me ask any questions, etc.  When I
    left the office I made an appointment for the next month and that
    included a blood workup (tests for venerial diseases that could affect
    the fetus or birth, rh factor, antibodies for certain diseases,
    reubella or german measles being one...).  They also want a urine
    sample from first thing in the morning, be sure to ask about that when
    you make your first appointment.  They'll also take a fairly indepth
    history from you.
    
    I think I would try to find a different general practitioner as well,
    if I were you.  This one sounds like he's not very responsive to his
    patients.  Ask coworkers about their doctor's and ob/gyn's, just keep
    personalities in mind when you talk to them (as a somewhat shy person,
    I need someone that doesn't have an overpowering personality, someone
    who gives me time to ask questions).  If you should happen to be in the
    Nashua area I'd be glad to answer any questions!
    
    sandy

    And write down any questions as they occur to you, no matter how
    "stupid" they may seem; then make sure you take the list to your
    appointment and don't let the medical professional end your visit
    without answering the questions!  Trying to remember my questions til
    the next visit just didn't work for me (even if the doctor *asked* for
    questions, I couldn't remember them unless I had my list with me).
    
    And bring a pen to jot down the answers!
    
    Leslie

I have Harvard insurance too. As I understand it, Harvard operates differently
according to whether you are a member of a medical group (eg Nashua) versus
a Harvard medical center (eg Chelmsford).
Medical centers have ob/gyn departments, so the advice noted in .36 I presume
would apply. Medical groups generally contract out to non-harvard ob/gyns,
for which you need a referral.
As the original question included the phrase:
"Call back tomorrow for a referral for OB/GYN." it sounds like you might be a 
member of a group, like I am, so let me relate my experience.
When my pregnancy was confirmed, (I had gone to the doctor for another matter 
and only had a urine test, not a blood test), I was given a pink referral form 
to their ob/gyn providers. I was told to call them and make an apointment. 
Once I did that, everything was taken care of. 
Lab work was always done at the Harvard group practice; the initial blood
work was done at the time of my original visit as I was there anyway.
I would reiterate that you should ask lots of questions. I found that
the ob/gyn office was the best place to ask, as they effectively became the 
primary care physicians for the duration of the pregnancy.
Hope this helps. 
Good Luck and Congratulations.

Lucy 

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-----------------------------------------------------------------------


This couple of weeks has to be the worst time in my life.  I feel sick all the
time.  I don't know what to eat, when to eat, what's normal...  I borrowed some
books from the library (in addition to going through this notesfile).  Still, I
had so many questions I had wanted to ask the doctor...

I kept asking myself if I asked too much from my doctor.  But, then, I don't
see him more than once a year.  When will he take care of me if he does not
at the time like this?

The first contact with the OB/GYN Office was quite pleasant, however.  I called
them to make an appointment.  She asked me for my last period date and told me
the 1st appointment will last about an hour and is with a nurse, who will ask
me all my health history, etc.  I'll be given some literature on what to
expect...  For future visits, I'll get to see my OB/GYN, the nurse and the
other doctor.  She even booked me in for next week!!

As many people have said, this notesfile is great.  We can not only gather very
useful information, but we can get our specific questions answered timely and
patiently!

Again, thanks, everyone.

I've also found that doctors aren't the best sources of information about
things like morning sickness.

I talked to a lot of people, and eventually found a few things I could
tolerate -- after a fashion.  I also tried homeopathy, which I think helped
me.

Someone just gave me an article about a video about morning sickness.
I've heard that there is a dietician at Brigham and Women's hospital
in Boston who has made a study of morning sickness, and has written
a book.  I think her name is Miriam Erick.  I haven't seen the book.
The video mentioned in this newspaper article was done by her and
another dietician.  The article says "Morning Sickness, which is being
distributed by another Weiss comapny, Lemon-Aid Films, is available by 
calling 800-540-6400.  Both professional and home-viewing editions are
available.

Good luck!

It's torture, but keep trying things.

Beryl

    One recommendation for morning sickness (or evening or all day
    sickness) is to try to eat frequent meals to avoid having your blood
    sugar get too low.  It seems low blood sugar can make the nausea worse.  
    
    meg

Ok, I'll stick my opinion in.  I think you should change doctors
after your pregnancy is over.  You are paying good money for
medical care and advice and you're not getting it.

Until the baby is born and you have recovered, treat the 
OB/GYN as your primary physician.

The rule of thumb, particularly with pregnancy, is if you are
concerned or worried about something, call the doctor's office.
Do not worry about being a pest or neurotic, it is irrelevant
what they think. Almost all doctor's offices have nurses who 
return phone calls to help you decide if you need to come in
for some reason.

For example, if you're having lots of morning sickness trouble,
and your appt isn't until next week, you could call and tell them
this and ask for advice that will get you thru until your appt.
They expect to handle situations like that.  (And, the nurse is
very likely to be a mother too, who can give you practical advice
on top of medical advice.  I hate to stereotype, but it is true
that currently, most nurses are women).

Pat

	You have my sympathy in the morning sickness area.
	I'm in my 6th month and LUCKILY I only had morning sickness during
	the 3rd month - but I felt like it would never end.

	The thing that helped me the most (besides trying to keep a full
	stomach), was GINGER tea.  It really had a settling affect on me.
	I know everyone is different, but when you feel that awful - you'll
	try anything.  I suppose Ginger-ale would work too, but only if you
	let it go flat - those bubbles didn't have a good affect on me.

	Good Luck, and I also think you should look for a new doctor after
	           the baby is born.

	Karen T.

    I agree about GINGER tea. This is an old Indian (Asian) home remedy for
    headaches and nausea. My grandma used to ask us to chew on a small
    piece of ginger dipped in a bit of salt to help the headache or nausea.
    A piece of ginger in tea (helps to add it to the water while boiling)
    not only helps the nausea but tastes good.
    
    Shaila

People already said that this doesn't work for everyone -- but I'll say it
again.  My husband is from India and I always (normally) love ginger tea.
But now, I throw up pretty reliably with it.  Maybe later in my pregnancy I'll
be able to drink it again.

It works for some people...  just not me at the moment.

I was able to drink raspberry leaf tea, and that helps sometimes.  I just bought
dried raspbery leaves (at Spice and Grain in Concord, MA) and put some in a
tea-strainer spoon, and pour hot water on it.

The first time I was pregnant, I also found crackers helpful, but this time they
don't help me.  I did find that I could often take zwieback when other foods
weren't going down well.  Maybe because there is less taste in it.

In general, I avoid citrus and tomato right now, but I did find that sucking
on a little slice of lemon or orange occasionally has been refreshing.
Not on an empty stomach, though.  Same with drinks -- I can't drink well
on an empty stomach.

I had  trouble with getting in liquids at all at the start of this pregnancy,
and for a while I drank gatorade, then recharge (a natural foods version of the
same).  Now I'm taking sodas. I don't usually drink sweet things like this, but
I need to drink something.  I remember drinking a lot of water last time, but
I can't now.

I don't even attempt to cook or shop.  The smells are quite difficult to take.

Keep trying things, and keep asking people what helped them!  Some of the things
that helped others might help you.

Beryl

    After testing positive with the home test, I called my primary care
    physician (I belong to Fallon) and said to the nurse "I tested
    positive....blah blah blah" and she transferred me right to the OB
    dept.  They set up the appt (which was a consultation with the head
    nurse - her name was Pat as a matter of fact).  She took all the
    medical history, talked about all the drs and all the midwifes, gave me
    tons of literature, etc.  I was scheduled for my first visit (I saw the
    midwives) and was also scheduled to see the nutritionist.  Right after 
    that appointment, I had the routine set of blood tests done.
    
    I had terrible morning sickness throughout my entire pregnancy.  I was
    going to the nutritionist every week and she was charting my weight
    "loss". I couldn't eat anything -- I'm a big fish and veggie eater, but
    I couldn't stand the smell of any of those things.  She suggested
    eating things cold -- cold chicken, raw veggies, things that are cold
    do not smell as strong as when they are hot.
    
    I found Fallon to be very helpful during my pregnancy.  I delivered at
    St. Vincent's and the labor/delivery nurses were wonderful.  My
    daughter's dr. and nurses are very helpful.  I even mentioned to one
    when I had called one day to get some information "sorry to bother you
    with such a little thing like this" and she said to me, "don't feel
    anything is too small, thats what we are here for"
    
    

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      Carol duBois, PARENTING Co-moderator

**************************************************************

Hi,

I have not done a home test (couldn't get out with the snow) but I am late
for my period (2 days) and I have many signs of pregnancy and I'm *never*
late unless I'm pregnant.   What I was wondering is... has anyone ever called
their Primary Care Physician and said they thought they were pregnant and 
been told wait a week before you come in for a blood test for confirmation?  
This seems very strange to me especially since last time I was pregnant 
(ending in miscarriage at 6 weeks) my then PCP wanted to see me ASAP to 
confirm, etc...  Due to the miscarriage I am worried about this pregnancy 
and waiting another week to see the doctor to confirm that I really am 
pregnant to get referred to an OB/GYN.  I guess I'm not comfortable with 
the doctor's answer and I am considering taking the home test and calling the 
doc back and just asking for a referral.  What would you do if you were me?

Worried

    Depends on your HMO.  When I called the lab at my HMO, they asked how
    long it had been.  It's their policy to wait for 1 week for more of the
    HCG hormone to build up in your system.  Since I had waited over a week
    to call anyway (2nd pregnacy with no problems the first time) it wasn't
    a problem for me.  Did you talk to your Dr, or a nurse/lab tech?  Maybe
    your Dr needs reminding of why you want to go in early.
    
    	marianne

    dear, Worried,
    
    I certainly wouldn't wait a week! I'd do the home test and call the
    physician back.
    
    Or [if this is an option for you] call the OB/Gyn rotation on your
    health plan after the test.
    
      Annie

    
    I also don't think and HMO will give you a referral based on the
    results of a home pregnancy test. They need to do a test of their
    own for their records before giving the referral. I would say to
    call them and voice your concerns about your previous miscarriage
    and maybe they'll let you come in earlier. My doctor let me come
    in when I was 5 days late, so that's not the full week.
    
    Patty

    Voice your concerns about miscarriage and insist they give you the test
    now.  It is not too soon to receive an accurate reading from a blood
    test.  I don't produce much progesterone and had several losses right
    away as a result of this.  My physician and I worked a system where I
    called immediately to schedule a blood test whenever I suspected. 
    
    

The following is being posted for the author of 682.50.

      Carol duBois, PARENTING Co-moderator

**************************************************************

Thanks for all your replies, they helped me to realize I was not as
paranoid as I was feeling!

When I called the doctor's office I spoke with a nurse/receptionist who
spoke to the doctor.  They did know that I was anxious to get the blood
test done ASAP due to a previous miscarriage!

I took a home test last night and it showed a VERY faint pink line indicating
pregnant.  My husband and I had to really look to see it.  I thought I might
have imagined it, so I gave it to him and said... "What do you see in that
little box right there?"  He said, "Looks like a light pink line surrounded
by white" so I know it wasn't because he imagined it since he didn't know
what the right result was supposed to be.  :o)

Now I don't know what the right thing to do is.  Since the home test HCG was
obviously very low does that mean a blood test might miss it?  I don't want
to insist my doctor do a blood test and then have my HCG be too low to register.
Does anyone know if there is a difference with a blood test being done at a
hospital or lab is any different than getting it taken at the doc's office and
sent to Chicago (from MA)?

Thanks again, I'm going to call the doctors office again tomorrow.  They aren't
open today.

Worried

    re.55
    
    The home hCG tests [urine] are often not as sensitive as the hCG
    tests [urine] done at the clinic/doctor's office. I'm told that the
    blood tests are even more sensitive.
    
    I got a pale purple line on my home test. The next morning the urine
    test done at the clinic was so purple that it positively glowed. They
    didn't do a blood test on me because the urine test was gave such a
    robust result.
    
    I was two days late when I did the test. Because of my history, they
    wanted me in for the office test the next morning.
    
    As I never had a blood test, I can't comment upon the pros and cons of
    an office test vs. sending away to a lab.
    
      Annie

    The way I remember it, the blood test should be more sensitive than the
    urine test.  If you are getting a positive result with the urine test,
    the blood test should come out positive.  
    
    Something else I remember about my conversation with the lab - They
    wouldn't do a blood test until the urine test showed up positive.  They
    also want you to provide the sample "on the spot".  Since some of the
    urine tests work best with "morning urine" early in prengnancy, they
    want you to wait a week until so the urine test will come out positive
    no matter what time of the day you go in.
    
    Try asking to talk to the Dr directly - he may be getting a different
    impression from the nurse.....
    
    	marianne
    
    

    This is a little different cut ....
    
    No one would even TALK to me till after I was 2 wks late (Wait and
    see...) and I'm diabetic, so I'd have expected they'd be a little MORE
    concerned than less concerned.
    
    With Jason, I did a home test, that came back positive, and I was never
    tested at all after that (Drs blood, or urine).  
    
    I really thought that I was told that the blood test was LESS
    sensitive, (though that doesn't seem to make much sense....), but more
    accurate.
    
    If it were me, I'd tell them you got a positive on the urine test, and
    what do you need to do to start your pregnancy visits.  Don't give them
    the option of telling you to wait.  "Hi, I'm Sarah, and I'm pregnant. 
    I'd like to set up the necessary appts as soon as possible."  "How do
    you know you're pregnant?"  "My home-test came back positive"  If they
    give you flack about "not believing" the home test, then insist on them
    setting up a test.  No one batted an eyelash that it might be "wrong"
    when I said mine came back positive w/ Jason.  AND .... I was supposed
    to wait 20 mins for the circle, didn't see a thing, hubby went to bed,
    I went downstairs to log in, and came back up ~an hour later, and there
    was a thick dark ring.  I think there was only a "questionable" amount
    of hormone present, and it just needed to "cook" longer.  The test co.
    said that "letting it stand" for extra time would NOT produce a false
    positive result.
    
    And now we have Jason ....!  
    
    Patty

    In my case I wish the doctor had told me to wait a week.  Back in 
    Dec of 93 I called my doctor and asked if I could come in for a
    pregnancy test.  I was only a few days late but it was the week before
    Christmas and I really wanted to know the results before Christmas.  My
    doctor said sure.  I went in for a blood test and it came back
    negative.  By February I was having full blown pregnancy symptoms so I
    went in for another test.  I was also told this test was negative.   
    After another week I called my doctor and told her I must have a living
    tumor because I could feel the baby moving inside of me !  She had me
    come in for a third test which was positive (finally).  
    
	It turns out I was pregnant back in December, but since I was only
    a few days pregnant the hormones levels weren't high enough to
    register.  I always though blood tests were extremenly accurate.  If
    the doctor had told me to wait a few days I would have known I was
    pregnant back in December rather than March (although I have to say a
    pregnancy goes really fast when you are already in your 4th month when
    you find out about it !).  
    
    	btw - the 2nd negative result in February was because the dope
    reading me the test results over the phone looked at the December test
    results (the new ones hadn't shown up in the computer yet and she
    didn't bother to check the date).
    
	Of course if you've had problems with previous pregnancys by all
    means push for early testing.  In my case though I wish I had waited.
    
    Denise
    

The general rule for a pregnancy test is:

    If it says you're not pregnant, you may or may not be pregnant.

    If it says you *are* pregnant, then you are pregnant.


This is because of what people have already mentioned, that when you take
the test you just may not have enough of the hormones yet to be picked up
by the test.  If you take a test, it comes back negative, and you still 
don't get your period (or for other reasons still think you are pregnant),
take the test again a few days after the first test!

       Carol

I was about 4 days late when I took my first at home pregnancy test.  The
little plastic stick turned such a pale shade of pink that I didn't 
really think it meant positive.  Sounds alot like your results.

3 days later I did another at home test, this time with a different
brand of kit.  The stick was to turn blue for positive.  Well, it
turned the brightest shade of blue you can imagine.  Then next
day I went into the doctors office for another urine test, this
too was positive.

I'd go into the dr. office for a test as soon as possible.  Sounds like
you are pregnant!

Ginny

    I had the test with the little well.  After putting your
    sample into the well, you were supposed to add this little
    vial of chemical.  If it turned pink you were pregnant.  
    There was also a color strip denoting various shades of pink
    vs. how pregnant.
    
    The two times I was pregnant (lost the first), I used this
    kit.  Both times it turned the darkest pink, like a dusty
    rose color, before even adding the vial of chemical.  I 
    thought perhaps there was a problem with the kit, but not
    so.  I guess I just get "real" pregnant.  :-)
    
    					cj *->

The following is being posted for the author of 682.50, "Worried".

      Carol duBois, PARENTING Co-moderator

**************************************************************

Thanks again for all the replies!  It has helped me get through this
week!  I called the doctor's office again and spoke with a different
nurse.  She said I could come in Thursday morning.  As fate would have it, I 
couldn't go then because I had a funeral for my uncle to go to. Great 
timing, so I am stuck waiting till Monday.  I am going to buy another home
test and do it this weekend for my own peace of mind.  

Thanks again for all the help and encouragement!
Worried