My turn for a brain dump

[meltoine]

I don't have a care provider for this pregnancy right now. My midwife announced to weeks ago that she's moving her practice to Indiana for personal reasons. I've been interviewing new midwives and I'm interviewing the last two today and tomorrow and I'll make a decision after that. 

Meanwhile, the midwife who took over the other practice called me yesterday to tell me she got the ultrasound report from my anatomy scan. I have a placental lake, which is a pool of blood between my placenta and the wall of my uterus that, if big enough, can affect how the placenta functions and potentially cause IGUR. This outcome is pretty rare, but it's not unheard of. 

At my anatomy scan, the ultrasound tech asked how sure I was of my dates because the baby was only measuring 19w1d even though I was 20w1d. I'm positive of my O date and an ultrasound at 7w (in the ER when I thought I was having an ectopic) was spot on for my O date. 

Now im freaking out that my baby isn't growing, I don't have a care provider, I may have to switch to an OB and I don't like any of the ones I've met here. Of course I won't hesitate to transfer if I need to, I just have such anxiety about the OB community here. 

I want alcohol. 

[anna7602]

I'm really sorry. That's a lot to deal with. I hope you find a care provider you like very soon!

[Deleted]

I'm sorry. Hugs to you. I hope you find a great provider. Are you seeing a MFM? They don't always deliver but they can probably suggest someone.

[turtlegirl]

I'm sorry the whole midwife search has been so stressful this time around.

No real advice, but just wanted to say that when I had my anatomy scan two weeks ago my OB said he doesn't worry about measurements being off two weeks in either direction because babies start to grow at such different rates by now. So as long as I was measuring between 18w-22w he was happy with the growth rate. He's a big fan of early ultrasounds since the farther you go along the more varied there is in size and growth rate. So I wouldn't stress about the 19w measurement just yet.

[Velar Fricative]

I'm sorry. That is a lot to deal with. If you must see an OB, I would imagine your former midwife or the one who runs the current practice might have OB recommendations? I'm assuming they've had to make OB referrals in at least a few instances if they've cared for many women, and are likely knowledgeable about who the best OBs are out there.

Having said that, I would try not to worry too much at this point because of varying measurements. Easier said than done, I know!

[heygrey]

I'm sorry I know the stress can be magnified by all those wonderful pregnancy hormones too.

have you not liked the midwives you've already interviewed or just waiting until you meet everyone to make a final decision?

[meltoine]

Apr 28, 2015 8:59:56 GMT -5 @notquiteblushing said:

I'm sorry. Hugs to you. I hope you find a great provider. Are you seeing a MFM? They don't always deliver but they can probably suggest someone.

I'm not seeing an MFM. I just found out about this yesterday. 

[meltoine]

Apr 28, 2015 9:15:13 GMT -5 heygrey said:

I'm sorry I know the stress can be magnified by all those wonderful pregnancy hormones too.

have you not liked the midwives you've already interviewed or just waiting until you meet everyone to make a final decision?

I interviewed the midwife who's taking over the other one's practice and she was ok. I didn't love her, though part of that could be that I had both kids with me through the interview and it was late afternoon so they were crazy. I spent more time disciplining than interviewing. But also, she lives 1.5 hours away, and given that my last labor was only 3 hours and I wasn't sure it was labor until the last 20 minutes, I think that's too far. 

[longtimenopost]

((hugs)). I'd ask for a referral for an OB since you may need more ultrasounds moving forward.

[Deleted]

Anecdotal: Pippa was 6 days "behind" her expected size at our anatomy scan. She's fine. I believe that at this point, being off by up to a week or more is fine, as they are growing at different rates.

[karinothing]

I don't know if I would jump to a MFM already. From my googling it looks like the placental like isn't really tied to complications except in very rare cases. It seems like that could be monitored through normal monitoring. That being said, I am not sure what the standard of care is for monitoring, but your midwife should be able to advise you of that.

[Willis Jackson]

I'm sorry. That sounds so stressful.

[meltoine]

Apr 28, 2015 13:07:39 GMT -5 karinothing said:

I don't know if I would jump to a MFM already. From my googling it looks like the placental like isn't really tied to complications except in very rare cases. It seems like that could be monitored through normal monitoring. That being said, I am not sure what the standard of care is for monitoring, but your midwife should be able to advise you of that.

Standard of care is to monitor closely for signs of growth restriction. If fundal measurements are more than two weeks off twice in a row, refer for ultrasound to evaluate placental function. I don't think I'd jump right to an MFM now either. 

I like the midwife I interviewed today, and she seemed to have an adequate game plan for all of my concerns. So that's good. 

[karinothing]

Apr 28, 2015 14:11:44 GMT -5 meltoine said:

Apr 28, 2015 13:07:39 GMT -5 karinothing said:

I don't know if I would jump to a MFM already. From my googling it looks like the placental like isn't really tied to complications except in very rare cases. It seems like that could be monitored through normal monitoring. That being said, I am not sure what the standard of care is for monitoring, but your midwife should be able to advise you of that.

Standard of care is to monitor closely for signs of growth restriction. If fundal measurements are more than two weeks off twice in a row, refer for ultrasound to evaluate placental function. I don't think I'd jump right to an MFM now either. 

I like the midwife I interviewed today, and she seemed to have an adequate game plan for all of my concerns. So that's good. 

Oh yeah, that sounds good then. I didn't think an MFM was necessary (due to my google doctorate lol). My only concern would be that you mentioned having difficulty finding an OB or whomever that would do ultrasounds once you were working with a midwife, would that be a concern?

That is great that you liked the one you interviewed today!

[meltoine]

Apr 28, 2015 14:15:44 GMT -5 karinothing said:

Apr 28, 2015 14:11:44 GMT -5 meltoine said:

Standard of care is to monitor closely for signs of growth restriction. If fundal measurements are more than two weeks off twice in a row, refer for ultrasound to evaluate placental function. I don't think I'd jump right to an MFM now either. 

I like the midwife I interviewed today, and she seemed to have an adequate game plan for all of my concerns. So that's good. 

Oh yeah, that sounds good then. I didn't think an MFM was necessary (due to my google doctorate lol). My only concern would be that you mentioned having difficulty finding an OB or whomever that would do ultrasounds once you were working with a midwife, would that be a concern?

That is great that you liked the one you interviewed today!

I have my ultrasounds at a stand-alone radiology clinic for that reason. There are two OBs that are more natural-friendly and accept transfer of care from home birth midwives. They won't work concurrently with them, but if you're sure you are risked out of a homebirth and they will be your only provider from then on, they will take you. Only one is in my insurance network. 

[Saudade]

I'm sorry Meltoine. I'm pretty risk-adverse and this might be a line for me. I'd, personally, get an OB with a doula that you trust, esp. given your fast labors.