Mamas on Bedrest: You are the captain of this team!

March 22nd, 2013

IMG_3750 1x13I received the following comment to one of the blog posts from Mama on Bedrest H:

Hi, I was diagnosed with hyperechoic bowel, placentomology (?placentomegaly) with the Uterine artery showing flow reversal(IUGR) during my first pregnancy last year. My bp shot up to 135/85 during my 4th month, and I started having swelling in my tummy, yet never showed till my 6th month. My OB didn’t diagnosed anything  until the 6th month, and kept telling me that everything was fine. At the beginning of 6th month I changed my OB and was diagnosed with all the problems but then it was too late and my new OB suggested  an abortion as the arteries started reverse flow and the baby may die on its own. Now again I m pregnant and its my 4th month . I had an ultrasound done and the result  was “both  arteries showing high resistance flow”.  My OB has suggested full bed rest. Are these all symptoms of preeclampsia? I’m also taking Ex(?ternal) heparin(?) injections everyday. Please guide me. Will this pregnancy  remain safe?

While I LOVE hearing from mamas, I am always so sad when they ask for guidance. I cannot provide medical advice. First and foremost, I am not licensed to do so. I am a physician assistant but I am not currently practicing so I cannot offer medical advice. Second, given that I cannot see any of you, put hands on you or read your medical charts, even if I were licensed and practicing clinically, it would be shooting in the dark to offer medical advice on a person not directly in my care.

So what is a mama to do?

Mamas, when you are confronted with major medical complications during your pregnancy, the one bit of advice that I will give is for you to assemble your very own “dream team” of medical providers. “But I have an OB!” you may be saying. Yes, and your OB is a very important part of your team in that s/he will likely be the point of contact for all of your other “team members”. And while your OB will be your #1, your right hand Man (or woman) always remember that YOU are the captain of this team!

As Mama H’s case shows us, sometimes complications arise in bundles. While this is flat out scary, it doesn’t have to render you powerless. Assemble your dream team. Look at it this way. If you are going to remodel your kitchen (I love HGTV!!) and during the process you  find some structural problems. What do you do? Well, on HGTV, they call in a structural engineer and make sure that there is nothing that needs to be done to assure the integrity of the structure. If repairs are needed they are made. In this case, the OB has noted placental complications, so carrying out the analogy, we need to call a “structural engineer” or a Maternal Fetal Medicine Specialist (MFM). These OB’s specialize in Obstetrical complications. They see and treat the “weirdest of the weird”. So if you have obstetrical complications, a consultation with a MFM should be at least considered if not undertaken to make sure “the underlying causes of the problem are managed with the greatest skill and expertise available.”

Mama H also has some bowel problems, so a consultation with a gastroenterologist is in order. Again, it may be nothing for her to worry about and may not impact her pregnancy in any way, but having someone who sees intestinal problems day in day out give their opinion is the best course of action in my book.

Finally, Mama H has an arterial issue that is causing back flow and elevated blood pressure. That to me screams cardiologist, in particular a vascular surgeon. She may be suffering from some sort of arterial narrowing or constriction, or she may have some other cause of the reverse flow. A vascular surgeon will be able to recognize the malady and make recommendations for treatment.

Now I know that many of you may be wondering, “Is it really necessary for Mama H to see all those specialists? Why can’t her OB manage her problems?” Back to our HGTV analogy. If the contractor notes an electrical problem, he doesn’t try to fix it himself, he calls in an electrician. If there are plumbing or sewage issues, he calls a plumber. So if  “specialists” are needed for our homes, why not for our bodies?? Some of you may be saying, “But my insurance may not cover all those doctor visits? What do I do?” I wholeheartedly recognize that seeing specialists is expensive and time consuming (especially getting the referral and pre-authorizations) but it is so worth it! Because specialist deal with the issues you are facing daily, they are typically up to date on the latest treatments, the latest research evidence and the latest nuances of your condition. In my experience, they are well worth the time and expense for the consultation. (More on the expense in the next post!)

Lastly, I want to add a little word here about OB’s. I have had more than one mama write and tell me that when she asked for a referral to a specialist that her OB got angry with her for questioning their judgment and expertise.  At least one mama had her OB “fire” her from the practice for questioning his judgment. To this I say YOU have to be the captain of your team and at all times, you have to guide your treatment! Not only should you ask questions about your care, if you have any reservations or even a desire to just know more, you are well within your rights to seek another opinion. And DO NOT LET YOUR OB BULLY YOU!! If an OB threatens to fire you or withhold medical care or refuses to share your medical information, they are in breach of the Hippocratic Oath that says “first do no harm” as well as acting illegally (in the case of the medical records) and you may want to really consider if this is the person you want taking care of you and your baby. A really good OB will play a vital role in your care, but just like everyone else, they don’t know everything and you want an OB who is willing to admit that they don’t know everything and has no qualms or ego issues about consulting and working with a specialist.

I cannot stress enough the importance of assembling a dream team and assuming the role of team captain. Mamas, your pregnancies are very likely going to be the most significant medical issues of your life. Their outcomes can have significant health ramifications down the road for you and your child. This is no time to be shy or to assume that your OB knows what is best. Ask questions, stay informed and by all means, always make wise, informed health care choices! “Pro-Action” All the way!!

Leave a Reply

Your email address will not be published. Required fields are marked *