concerns about midwife...

i see both an ob and a midwife, but i see the midwife more. haven't seen the ob since week 10.my blood pressure had been high since the very start of my pregnancy. the average is 140/85-89 (sometimes in the 90's). i have had protein in the urine three visits but have never done a 24 hr test. i am on my third kidney infection and had to recently go to the ER beause of it. the midwife had had me on macrobid for it and the ER doc said that macrobid won't help a kidney infection. they put me on keflex. when i saw the midwife, she agreed that keflex is better for it. why didn't she do that in the first place? i have bad flank pain and it even hurts in the front and spasms. if it's not better, i have to go to the hospital to get IV meds. i haven't had an US since 12 weeks and don't have one scheduled until the 24th of may. i haven't had my cervix checked since maybe ten weeks. it's not that i want this pregnancy to be overly medicalized, but i do want to be sure that i am getting the proper care, you know?
am i just being paranoid?

 

anybody?

 

Sorry for the problems you're having esp. w/the kidney infections.

I don't think you're being paranoid at all. Have you considered seeing the OB more and midwife less since you have these medical issues? Maybe he/she would be better suited to address them than the midwife?

As far as the cervix check, that's pretty normal. Most start checking it at week 20. I didn't take my 24 hour test until 26 weeks, but I never had protein in my urine so I'm not sure the protocol once that is detected.

I think in any pregnancy, but especially in a twin pregnancy, you do have to stay on top of things and make sure you're getting proper care, so if you are concerned, you should address it.

The most I've heard twin pregnancies go w/o an ultrasound is about 6 weeks, so you should realistically be having one now I would think. I had one at 12.5 weeks, and the next one was scheduled for 18 weeks, but I went a few days early at 17.5 b/c I couldn't wait. I don't think it's unheard to do that anatomy scan at 20 weeks, but after that the norm is to go every 4 weeks until you start your BPPs and/or NSTs later on... (I started BPP at 28 weeks but this seems to be different for everyone)

 

You're not being paranoid - it sounds like there have been a few incidents where the midwife really dropped the ball. I personally have very little faith in midwives, esp for a multiple pregnancy which is inherently high risk. Others may disagree, but that is my opinion and so I have seen a peri almost exclusively throughout my pregnancy.

If your doc won't step up, then you need to get your doc to do what needs to be done and take some control over your care. Do your own research (on this website and in books) as to what SHOULD be happening at this point and if others are getting care that you are not, then go to your doc (not the midwife) and ask for what you want. My doc said a bp of 140/90 is cause for concern, and even more so if there's protein the urine. I had u/s (on the babies and my cervix) every 2-4 weeks at your stage of the game. if that's what you want as well, then don't be shy - insist on it! Ask about the necessity of 24 hour urine. Ask point blank whether your bp is dangerous or indicative of pre-eclampsia. I don't mean in any way to worry you - I just believe that doctors aren't all-knowing. Patients are almost as responsible as doctors for their care and if you're not getting what you feel is the best quality care, then do what you have to do to get what you want!

 

QUOTE(KindredSpirits @ May 11 2007, 03:07 PM) [snapback]251632[/snapback]
I didn't take my 24 hour test until 26 weeks, but I never had protein in my urine so I'm not sure the protocol once that is detected.



i am just concerned because my blood pressure has been high and there has been protein in my urine. i though it was standard procedure to do the 24hr test when those two factors are present.

 

it is - actually, i believe it is standard whenever pre-e is suspected (ie, swelling, bp, headaches, urine protein, etc). For example, I have some significant swelling and at yesterday's appt, was showing a slightly elevated bp. My doc ordered the 24 hour urine just to see what was going on.

 

My BP got high around 26 weeks and continues to be high. I see both an OB and a Peri. I haven't had any protein in my urine and my PIH bloodwork is coming back normal. Still they admitted me to the hospital for 3 days for a 24 hour urine test and other tests. All which came back normal. They have sent me home on strict bedrest and I see one or both or them twice a week. I have been told preeclampsia can happen very quickly. Also, around 14 weeks I started having growth U/S and cervix check every 3 weeks, now we are every 2 weeks. I have mono/di twins so because of the one placenta they watch me very closely.

Hope that helps....

 

that's the other thing...i have been having terrible migraines every single day for the past two weeks.

 

I have seen midwives myself since being pg, but now seeing the OB that overlooks them more, and just may go and see him only from here on out.

I have had a lot of issues with mine, and what I would think is proper care for a twin pregnancy. They were going to let me go 8wks between u/s, and I was not cool with that. Found out the OB wanted them every four weeks anyways, so that made me feel better. Sometimes they just don't want to explain things to me, but luckily the OB is great about my anxiety and fears, and gives me a pep talk. He did reassure me that a mass majority of his twin pregnancy go to full term and the babies go home with mom. I am glad to hear that, and know if I have any questions that I can ask him w/out feeling stupid (I do with the midwives). There is one midwife that I told my OB I do not want there for delivery, and he respected that. There is another midwife that I haven't seen yet, but will at the end of the month. I alternate seeing the midwife and OB for visits now.

I know with them though they don't mess around with the Pre-E. They told me that from the get go. I was glad to hear that. I would demand having a 24hr test done.

April

 

i am just worried that if i am too demanding she won't respect what i have to say. i don't know...

 

Too demanding? These are YOUR babies, not hers. You have to do what you feel is right to make sure they are safe. And you have a right to the proper care. Never feel like you cannot ask or demand what you want. If she doesn't respect you b/c of it, then you really should look for someone else.
One thing I've been happy about in my pregnancy is not being afraid to ask for anything. When I wanted the anatomy scan a bit earlier, they said fine even though they didn't think it was necessary. You should have that same right. If you don't, then there's a problem

 

well its YOUR body and YOUR baby, you need to be demanding that you get the BEST care, thats rediculous. I know that most midwives are into herbal remedies and then generally DO NOT check you ever..My SIL had a mw and she had to BEG them to check her at 38-39 weeks..

I think you are pretty HIGH RISK and you should be transfered over to an OB dr. I am pg with twins and had GD last pg so im considered high risk. I get an u/s EVERY 4 weeks. Kidney infections can cause preterm labor so they really arent something you want to mess around with.

I personally would call the OB that you were seeing and ask them if they can take you on fulltime. If not find another OB..I would find someone else before leaving the MW, cause you really dont want to be without care...

GL..i hope you get the care you need...

 

on the meds Macrobid is to treat fungal infections(if I'm remembering correctly and keflex if an actually anitbiotic

 

goodness gracious! If you haven't called already you need to... you need to call and talk to a nurse...describe what has happened from beginning to end and ask to make an appt with the DOCTOR... you don't even have to mention the midwife...just keep requesting your appts to be with the doctor.... they can't make you see the midwife...

 

my ob and midwife share a practice together. before i knew that i was having twins i actually requested to see her. i am just not so sure now...

 

go with your gut! You are your only advocate for health care. It sounds to me like you have lost faith in the MW. That would seem to mean that you need to ask to see the doc from here on out. Don't worry about hurting feelings or upsetting someone. Like everyone has said it is your babies and your body. Take care of them as you see fit!

I left the OB practice I had been going to with my first pregnancy and even before to go to a hospital with a level III NICU and to see a doc that specializes in high risk pregnancies. Starting at 16 weeks he will be seeing me every two weeks. With cervical checks every two weeks and u/s every four to check on the babies. They did everything but give me their home phone numbers. Makes me feel more confident that they are going to take care of me and check EVERYTHING. When I called the OB I was orignally going with to ask if I should do anything different I was told no. A twin pregnancy is no different really than a singleton. That is when I switched. There are too many risks and concerns,

Anyway, sorry for the rant. Just wanted to say do what you feel is best for you and your babies and don't worry about what you wanted originally. Things change! There are two babies now and that is different. Take care!

 

My goodness, hon. Never be afraid to advocate for yourself, in order to get the best possible care....remember we pay doctors the big bucks!

I, too, had a problem with my OB being too lax about my care, and he was going to let me go 11.5 weeks between growth ultrasounds (from 20 to 31.5 weeks) -- well, I made a stink (as politely as possible, LOL), and got a referral to the peri right away.

The blood pressure, protein in your urine, and migraines all sound worrisome to me. I am asked every visit if I've been having headaches, and the nurses really stay on top of these warning signs of pre-E. It's not something you want to mess with....

I would simply call, as a pp suggested, and convey that you're worried about all of these things, and ask for a 24-hour urine.

Good luck!

 

i have decided that i am switching to the OB and going to ask him to refer me to a peri as well.