Questions for pre-conception visit?

[V]

Hi all,
I'm 30 and ttc my first. I just moved to a new town, so I've never even met
the OB/GYN I'm scheduled to see in Sept. for routine care/preconception or
prenatal depending on how things go between now and then!

What questions should I ask about my health, tests I may need/want prior to
conception, and about the way she practices so I can decide if this is who I
want to work with?

I know about asking about episiotomy rate (don't want one, and I know that
if that's what the person does 97% of the time, then you're going to get
one). What do you consider to be a good answer to number of C-sections
performed? What's reasonable?

I have an MS in Genetic Counseling, so I know alot about the heredity
issues, but the actual birth is beyond my league!

Thanks,
Amy

[Kereru]

"V" > wrote in message
t...
> Hi all,
> I'm 30 and ttc my first. I just moved to a new town, so I've never even
met
> the OB/GYN I'm scheduled to see in Sept. for routine care/preconception or
> prenatal depending on how things go between now and then!
>
> What questions should I ask about my health, tests I may need/want prior
to
> conception, and about the way she practices so I can decide if this is who
I
> want to work with?
>
> I know about asking about episiotomy rate (don't want one, and I know that
> if that's what the person does 97% of the time, then you're going to get
> one). What do you consider to be a good answer to number of C-sections
> performed? What's reasonable?
>
> I have an MS in Genetic Counseling, so I know alot about the heredity
> issues, but the actual birth is beyond my league!
>
> Thanks,
> Amy
>
>

Have you considered a midwife? If avoiding intervention is an issue for you
it might be a good option (not a guarantee obviously). I have heard that in
the states there are different rules for midwives than here in New Zealand
so maybe it's not a possibility. Just an idea.

Judy

[Ericka Kammerer]

V wrote:

> Hi all,
> I'm 30 and ttc my first. I just moved to a new town, so I've never even met
> the OB/GYN I'm scheduled to see in Sept. for routine care/preconception or
> prenatal depending on how things go between now and then!
>
> What questions should I ask about my health, tests I may need/want prior to
> conception, and about the way she practices so I can decide if this is who I
> want to work with?


There really aren't any tests you need beforehand,
except maybe to see if you're still immune to rubella. If
you're Rh- and there's a possibility you could be Rh sensitized,
you might check that first so you can decide whether you would
want to get pregnant under those circumstances.
As far as asking about the way she practices, that's
tough until you kind of know what you want. Sometimes you can
get a lot of information by asking a bunch of open-ended
questions like what's your practice philosophy?, what's the
most important ability you bring to your care in pregnancy
and delivery?, what kind of testing do you advise and why?,
etc.


> I know about asking about episiotomy rate (don't want one, and I know that
> if that's what the person does 97% of the time, then you're going to get
> one). What do you consider to be a good answer to number of C-sections
> performed? What's reasonable?


Well, *I* would prefer to hear under 10 percent, but
that would be probably leave out a lot of caregivers. The
national rate is around 26 percent now.


Best wishes,

Ericka

[Lissie]

"V" > wrote in message
t...
> Hi all,
> I'm 30 and ttc my first. I just moved to a new town, so I've never even
met
> the OB/GYN I'm scheduled to see in Sept. for routine care/preconception or
> prenatal depending on how things go between now and then!
>
> What questions should I ask about my health, tests I may need/want prior
to
> conception, and about the way she practices so I can decide if this is who
I
> want to work with?

I was in a similar situation, but was pg when I picked my prenatal care. I
went with midwife care at a birth center though, so already had a good idea
of the type of care I'd be receiving. In terms of a pre-TTC visit, I asked
about things like should they check immunities (MMR, I *think*). I also got
tested for toxoplasmosis (spelling) because I have cats. We talked about
nutrition, prenatal vitamins, stuff like that. I was on an anti-depressant,
so we talked about a schedule about when would be best to taper off that
before TTC (note, this was a personal choice due to the type of med I was
on, there are some anti-depressants that are safer for pg). I had been
charting for a good year and a half before TTC, so I had a good
understanding of my cycle. If you haven't already picked up "Taking Control
of Your Fertility", I would *strongly* recommend you do that and start
charting! Good luck!!

- Lissie
bub, EDD Sept. 8, 2003

>
> I know about asking about episiotomy rate (don't want one, and I know that
> if that's what the person does 97% of the time, then you're going to get
> one). What do you consider to be a good answer to number of C-sections
> performed? What's reasonable?
>
> I have an MS in Genetic Counseling, so I know alot about the heredity
> issues, but the actual birth is beyond my league!
>
> Thanks,
> Amy
>
>

[Dagny]

"V" > wrote in message
t...
> Hi all,
> I'm 30 and ttc my first. I just moved to a new town, so I've never even
met
> the OB/GYN I'm scheduled to see in Sept. for routine care/preconception or
> prenatal depending on how things go between now and then!
>
> What questions should I ask about my health, tests I may need/want prior
to
> conception, and about the way she practices so I can decide if this is who
I
> want to work with?
>
> I know about asking about episiotomy rate (don't want one, and I know that
> if that's what the person does 97% of the time, then you're going to get
> one). What do you consider to be a good answer to number of C-sections
> performed? What's reasonable?
>
> I have an MS in Genetic Counseling, so I know alot about the heredity
> issues, but the actual birth is beyond my league!
>

Here's what I would get if I had to do it over again as a layperson, but
some of it you may have to pay for out of pocket.

(1) Rubella immunity; if you aren't immune, you need to get the shot and
wait a few months before TTC

(2) Are you Rh-. If so are you also du-. If you are du+, literature
suggests you are really Rh+ and don't have to worry about this. If you are
Rh-, du-, find out if your husband is Rh+. If you are Rh-, du- with an Rh+
husband, then do you have antibodies from an earlier miscarriage, badly
matched blood transfusion, or elective abortion. If you and your husband
are both Rh- then all your babies will be Rh- and you don't need to worry
about this issue.

If you are antibody free Rh- du- with a Rh+ husband, then do some reading
and decide whether you will want to take prenatal Rhogam (blood product)
(controversial, but standard of care in US) or do you want to just take it
after the birth (a much easier decision).

(3) Check your thyroid function using both TSH but more importantly,
looking for the antibodies that cause thyroid disease. These would normally
be present prior to a major shift in TSH and better predict whether you will
need to be watched for low thyroid function in the critical 1st trimester
through the "postpartum thyroiditis" period.

(4) This will happen anyway, but do your pap smear and STD screens so that
the obstetrician won't make you repeat it at the first visit. If you have
any idea that you might have been exposed to HIV, you may want to have that
checked anonymously now as your obstetrician will probably run it and
possibly (in my case) without telling you at the time. Another thing that
we've heard on the board being run without notification to the patient was
the cystic fibrosis carrier screen. If you want that run, it doesn't make
sense to do it after you're already pregnant when it will just cause you
worry with no real options.

If you have any trouble with recurrent miscarriages when you get started
trying, there are other antibodies to check but checking that ahead of time
is probably REALLY overkill.

Also I would take some prepregnancy time to look at prenatal testing and
ponder whether each particular test is right for you, your husband and your
baby. Many of the ones that obstetricians are so interested in performing
do not statistically improve outcome unless you are willing to terminate.
And then of course they are not statistically improving the outcome of that
particular pregnancy are they? Like my doctor telling me he can bring my
risk of down's syndrome down even further if I will let him do the 18 week
level 2 ultrasound. As if that helps -- it only helps me not giving birth
to a DS baby. If you're not willing to terminate, there is very little
reason to expose your child to ultrasound etc. except possibly peace of mind
that your child does not have a very very very rare condition like not
having a brain etc. Downsides include suffering for months for no reason
because of false positives or what-ifs that never come to pass. And even my
very uptight first obstetrician readily admitted that they use the handheld
doppler ultrasound device at each visit because the moms want to hear a
heartbeat, not because it's medically indicated. Or as my less uptight
second obstetrician put it, there's very little for us to really do so it
gives us something to do since you've driven all this way. It's good to
hear the heartbeat sound clear and normal at some point prior to birth just
to screen, but it's useless for them to do that prior to viability. After
viability, you can hear it with a normal fetoscope (stethescope).

-- Dagny
EDD 10/6/03

[Daye]

On Fri, 8 Aug 2003 11:35:36 -0400, "Lissie" >
wrote:

>In terms of a pre-TTC visit, I asked
>about things like should they check immunities (MMR, I *think*).

Part of the MMR. They are concerned about the Rubella immunity.
Rubella is the name for German measles. If you get it while pregnant,
it can cause birth defects.

--
Daye
Momma to Jayan
EDD 11 Jan 2004