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Cheryl
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| Posted: July 26 2007 at 5:26pm | IP Logged
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I have a few questions, but first I'll give you my background. I had three healthy babies with absolutely no bleeding during pregnancy. I had a bit of spotting early in my fourth pregnancy, then I had a miscarriage around 12 weeks. With the fifth, I had a one time bleeding. The nurse told me that everything was fine, maybe it was from intercourse. I called her again and she told me if I wasn't bleeding, that I needed to wait until my next appointment. I worried for three weeks and then heard the heartbeat. Everything was fine, but I felt angry with myself for not being more assertive and getting it checked out sooner. My family was saying that they should have given me an ultrasound. My sister had a bit of bleeding once and had an ultrasound that same day.
So now I'm on my sixth pregnancy. I had a little bleeding around 4-5 weeks (which is how I figured out that I was pregnant since my last period was in June 2005.) Then yesterday I had bleeding again which lasted only about a half hour. I called the office and the nurse told me that it has to have been from intercourse. I agreed that it could be, but couldn't it also be the start of a miscarriage? I hung up the phone, then I remembered that the midwife told me that if I had any bleeding, that I could come in for a hormone level test. I called back and asked if I could do that and they said yes. (Sorry this is so long, but I'd like your opinion of whether I'm not assertive enough or if I'm worrying too much, so I think I should give you the details.)
I had the blood test. Today I called at Noon and got sent to someone's voice mail. I called back and asked if I could come in to see a midwife at least to see if there was a heartbeat. I found out that my hormone levels were "up there." They didn't plan to schedule another test. They called me back about an hour later and told me I could come in for a fetal heart check, but it may not tell me anything as it's too early.
I went in and I didn't hear the heartbeat. I told her that I did hear it at 9 weeks during another pregnancy and was told that the equipment is different now. The old equipment was better for early pregnancy. I was told to come back on Tuesday for another heart check. If they don't hear it at that time, they'll try to get me into an ultrasound. The ultrasounds are really backed up right now.
I actually have a history appointment scheduled at their other office tomorrow. What would you do if you were me? Would you ask for a second blood test? How about another fetal heart check? Would you be persistent about getting an ultrasound? Or would you just pray and wait to see how it turns out? I (obviously) have a very hard time discerning how assertive I should be when it comes to my medical care. Maybe everything is fine and I'm overreacting because I'm afraid of another miscarriage. I'd like to hear about your experiences in similar situations. How does your doctor's office handle bleeding in early pregnancy? Do they do ultrasounds? etc.
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Cheryl
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Mom to Matthew 13, Joseph 11, Sarah 10, Rachel 6, Hannah almost 4 and Mary 1
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Elizabeth
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| Posted: July 26 2007 at 5:40pm | IP Logged
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I'd ask for another blood test because "up there" is relative if they're talking about HCG. On the other hand, there is a standard for progesterone and it sounds like you don't need a supplement for that. What you are looking for is if HCG doubles in two days. (I think that's the standard...) More than that though, I'd start looking for a different obstetrical office. This practice doesn't seem very concerned about your emotional well-being and you are not being treated very well. Any midwife worth her salt knows that a mom with any history of miscarriage (or perhaps no history of miscarriage) is going to be approaching frantic when she doesn't hear a heartbeat at a time when she's heard one in a previous pregnancy. To make you wait through a weekend seems cruel to me, frankly.
Are the midwives telling you this or is the office staff triaging you? Sometimes, if you can get past the guards at the gate and get to the midwife the story is much different.
Assuming your progesterone levels are okay--and it sounds like they are--you are not going in to demand something be done. At the risk of sounding cold, if the baby's heart isn't beating (and I think it is, I really do), no sonogram or test will make it beat. You want a sonogram or a different doppler for your peace of mind. AND THAT'S PERFECTLY REASONABLE!I would go into the other office for the appointment and tell them that you were under the impression that midwives are at least as concerned about a patient's emotional wellbeing as her physical wellbeing and that you don't understand in this day and age why you can't have someone assure you that the baby is healthy.
And then, you can always wait until Saturday (when office visits aren't an option), go to the ER, tell them you had bleeding...they won't know what to do with you and will probably sono. Ask me how I know 
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Elizabeth Foss is no longer a member of this forum. Discussions now reflect the current management & are not necessarily expressions of her book, *Real Learning*, her current work, or her philosophy. (posted by E. Foss, Jan 2011)
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Maryan
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| Posted: July 26 2007 at 6:09pm | IP Logged
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I have the same trouble with being assertive.
Without all the details... I have had a lot of bleeding in all my pregnancies - both in the four healthy and the two miscarriages. I always have the first bout of bleeding at implantation -- so about two weeks -- my clue of you're pregnant. Then the bleeding varies -- and I've/the doctors have done different things based on how pregnant I'm feeling.
I would ask for an ultrasound - especially if insurance covers or you can cover the cost. Spotting is not your usual occurrence in a healthy pregnancy, so, of course, you'll be concerned. And you sleep so much better KNOWING. And with four other kids to take care of -- sleep is so important.
eta -- still praying too Cheryl
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Maryan
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Cheryl
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| Posted: July 26 2007 at 6:32pm | IP Logged
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Elizabeth and Maryan,
Thank you for your quick responses. Elizabeth, I appreciate your objective opinion about changing offices. My mother suggested it today, but I don't consider my mother to be objective. The more that I think about this, I have many reasons to leave this practice. I think I was in shock last year when this happened, but looking back now I can see how dangerous this was. I had a huge loss of blood immediately after Rachel's birth. I kept telling one of the midwives that I was having tightening in my chest. I asked her many times if it could be from the blood loss and she kept telling me it was gas and giving me pills. Two days later, when my blood count was 5.4, they gave me 3 units in a transfusion. What the heck am I going back there for? 
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Cheryl
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JennGM
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| Posted: July 26 2007 at 6:39pm | IP Logged
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Cheryl, I'll second the opinion, if you can find another practice, get one! Mine isn't always ideal, but if I call with bleeding, they order an ultrasound. And I just had bleeding at 12/13 weeks. I had an ultrasound the week before, so they just said come in the office for a heartbeat check just in case.
AND with my history of miscarriages, they really, really are respective and aware of my feelings of insecurity.
When they didn't hear a heartbeat today, I can't believe they didn't order a sono right away! Blood tests are nice, but it's YOUR baby, and it would be reassuring to know what's going on--now, or in the next day. Does your insurance cover going to another ultrasound place? We have lots around here, and they usually have room when doctors call for an emergency/STAT sonogram.
I'm praying for you, Cheryl. It's not too much to ask for more information and immediate answers, ESP. considering your history. This seems to be the part of the pregnancy they should really be helping and guiding you, not closing doors.
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Angel
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I'm with Elizabeth on this one. If you called and asked for your test results, IMO, they should have given you actual numbers and actually let you talk to someone knowledgeable -- a doctor or a midwife. In my experience, you do have to be very assertive to get past the front desk/nurses in some offices. I do not like being assertive, particularly. And the thing is... in this situation you really shouldn't have to be.
When I had my miscarriage, I had no bleeding whatsoever until around 13 weeks. I called my doctor after office hours and was instructed to come in the next morning for an ultrasound, which immediately showed that my baby had died at around 9 weeks. (In subsequent pregnancies I've been started on progesterone as soon as I found out I was pregnant, just as a precaution.) When I first discovered I was pregnant with the twins, I had some spotting when I expected my period -- pretty normal for me -- that stopped after a day. Then, a few days later, it started up again. I called my doctor's office and they worked me in that day, did an ultrasound, which showed a much earlier pregnancy than expected according to my dates, had a blood test done, and went home. The office called me pretty promptly with the results, and I actually talked on the phone to the doctor about them. A week later I was bleeding again, it was Friday afternoon, and I did wait until Monday to come in for an ultrasound. That was when we discovered it was twins and possibly a triplet, which a more detailed ultrasound demonstrated as the source of the bleeding. I miscarried a multiple. 
This was in St.Louis, though, and I wish SO BADLY I could have brought this doctor with me when I moved. He was really golden. The OB's office I ended up when we moved to NY was *horrible*. Both nurses and doctors treated patients on the whole as if they weren't even people -- just move 'em down the assembly line. After the twins were born, I left that practice, and on a tip from another homeschooling mom, found the practice I'm at currently, which is MUCH, MUCH more sensitive.
Anyway, that's all a long-winded way of saying, that no, I don't think requesting an ultrasound is at all out of line. As Elizabeth said, no test can prevent a miscarriage from happening, but you know that and what you are looking for is peace of mind.
I'll be keeping you in my prayers, Cheryl.
--Angela
Three Plus Two
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amyable
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| Posted: July 26 2007 at 7:13pm | IP Logged
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Elizabeth wrote:
| I'd ask for another blood test because "up there" is relative if they're talking about HCG. On the other hand, there is a standard for progesterone and it sounds like you don't need a supplement for that. What you are looking for is if HCG doubles in two days. (I think that's the standard...) |
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Just FYI - I'm pretty sure that by 10 weeks it can take much longer for HCG to double, and it still be OK. I don't have references offhand, but with all the bleeding I had this pg I had a few tests done and remember reading that somewhere (which was very reassuring because my HCG was NOT doubling in 2 days, it was more like 3-4...
Cheryl, I don't have any wonderful advice, just my support for whatever you decide to do, and my prayers for you, the baby, and your peace of mind. We couldn't find a heartbeat at 11 weeks this time around and it was quite unnerving to wait until the next visit at 15 weeks! Although that was MY choice - they offered an ultrasound - which I would have had to pay out of pocket, or a return visit in 2 weeks instead of 4, which was just a hassle...I chose not to because I felt in the camp of Elizabeth's thought: if the heart isn't beating, an U/S or extra tests won't change that --and I didn't need to spend hundreds of dollars for "peace of mind." I just needed to trust God's will for me.
Many  for you as you wait to see what is going on.
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KerryK
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Cheryl,
I've been through the ringer with miscarriages and hcg tests at various doctors, and have never been given such a vague answer as you have received. As a patient, you deserve to hear the number, at least. Having said that, one hcg test alone doesn't tell you much, and hcg at 10 weeks is either doubling at a much slower rate or even beginning to decline, as the placenta prepares to begin supporting the pregnancy. An ultrasound is a pretty reasonable course of action to expect at this point. If you don't feel comfortable asking for that, I would definately ask the other office to try again to find the heartbeat. No, you cant' always find it at 10 weeks, but I disagree that the equipment now is "less sensitive" somehow. Even with the ones you rent, you can sometimes find the heartbeat as early as the eighth week. (Although plenty of times it does take until 12 or 13 weeks!)
I think the most important thing is that you deserve to feel like you have been heard, and that you are being cared for appropriately.
Good luck, and I am praying for you and your baby!
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Lillian
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Cheryl,
When I went through this a couple of weeks ago, they squeezed me in for an ultrasound when they couldn't hear the heartbeat. I wasn't even one of their established patients. I think you deserve much better care and shouldn't hesitate asking for an ultrasound if you want one. I wouldn't worry about hurting their feelings or seeming too assertive. If your heart wants an ultrasound, ask for one. Suggest that you would be willing to wait in their waiting room for an opening. They can squeeze you in.
Elizabeth's idea about the ER is always there too.
Praying for you and your baby and hoping that all turns out well!!
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Cheryl
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| Posted: July 27 2007 at 9:53am | IP Logged
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I'm changing over to a new OB/GYN office. They got me an ultrasound appointment (in my hometown) this afternoon at 1:30. Thank you all for your help.
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Cheryl
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kingvozzo
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More prayers coming for you, Cheryl. I hope this office is more to your liking.
For what it's worth, I have a history of miscarriage, and the docs have always been very willing to assuage my fears. With this past pregnancy, the nurse was able to find the heartbeat with the doppler very early, but I wasn't able to hear it (I didn't realize that she had heard it, and I was getting so upset...)She told me afterwards that she would have sent me for an ultrasound that day if I hadn't heard it. Even though the u/s doesn't change the outcome, it affects my peace of mind.
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Caroline
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I'm so glad you were able to find another doc who will work with you to get an ultrasound. You're in my prayers.
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Lisbet
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Cheryl, I was going to add my 2 cents, but I see you choose a course of action. I will continue to pray for you. Let us know as soon as you find something out.
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Cheryl
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| Posted: July 27 2007 at 3:55pm | IP Logged
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In case you are following this thread, here are the updated details. I went for my ultrasound at 1:30. The technician told me that she was not allowed to tell me anything. Then she called my new doctor's office and the midwife there told her to send me right over. I knew that wasn't a good sign. I waited in the waiting room, then in the other room, then a fire alarm went off and I waited in the parking lot....
Anyway, I found out that our baby died around 9 weeks. I am SO grateful that I switched doctor's offices and found out today. At least now I can begin to deal with the emotional side of this. Thank you all for being here for me.
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Cheryl
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JennGM
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Oh, Cheryl, there aren't any words to say. I'm just so sorry, but I am relieved that you know.
I will be remembering you especially in my prayers. Perhaps you might find some comfort in Our Mother's Garden of Sorrow.
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Jennifer G. Miller
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Maryan
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Oh... Cheryl.
Prayers here for you.
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Maryan
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kingvozzo
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Cheryl, I'm so very sorry for you.
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mary theresa
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Oh, I'm so sorry! That breaks my heart. I will be praying for you, Cheryl
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Chari
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Lots of hugs and prayers for you, Cheryl, as you grieve over your precious baby. I am so sorry.
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tradmom
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I am so sorry Cheryl to hear of yor loss. Prayers being said for you during this sad time. May Our Blessed Mother comfort you.
God Bless,
Meredith in FL
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Topic: Pregnancy bleeding and ultrasounds
