ER vs Urgent Care Vs OB vs PCP vs Waiting?

sonjanae

Potential TW: bleeding, not sure where it’s headed. 

I apologize in advance for being long winded. It’s my notorious flaw. 

I’m at the point where I’m pretty sure my continued spotting is either a SCH or early MC and I don’t know what to do about it. Ectopic has crossed my mind as well, but I don’t have one sided pain and I know the chances are slim in the first place. 

I know the straightforward advice is get checked out, and I agree! My question is how? 😭 I’ll talk about the options and why I’m confused after I explain what’s been going on. 

I’m 9+1. I have cramped and spotted intermittently throughout the entire pregnancy, so initially I wasn’t worried at all. I cramped pretty much every day, sometimes badly, from 5dpo to 6 weeks. Became less frequent after that, up until about 8+3, when it ramped up again after a hike. Spotting (brown) started around 6w, which I attributed to the luteal placental shift since everything else tracked fine and I keep hearing that it’s common enough to not be too worried with it being so minimal. 

Last Tuesday, at I think 8+2, I went on a personally long & hard hike (7 miles, half of it was super steep), and I don’t know if it’s coincidence, but I’ve been cramping and bleeding significantly more following the hike. The spotting never reached my underwear before (would notice it only when wiping), but as of this week there have been several days I’ve had to wear a panty liner and there’s been intermittent streaking. Wearing a liner a day and not filling it at all, but there has been bright red blood when wiping this week, and there have been a few times I feel pretty damp down there, which wasn’t happening before. Also, 2 days ago I soaked through my underwear with brown blood in one “gush.” My cramps are no longer intermittent— I’ve had them for about 2.5 days straight now. They’re mild but I haven’t had nonstop cramping since like 4wks so I’m beginning to feel a little freaked out. That being said, it’s been almost a week since the hike without the ordeal “ramping up”’ further and I feel like if a miscarriage had started with the increased spotting and cramping 4-5 days ago, there’d have been some progression by now? I’m still having periodic stretches of time without bleeding, including this evening. 

I will say, what makes me suspect SCH is that I have absolutely noticed a correlation between the bleeding and exercise. It all started with a strenuous hike. I rested up and the bleeding did stop for like an entire day. I then ran a lot of errands at once and bam, bled again. Rested again and bleeding stopped but I continued to spot, though more of what my “normal” was before… took the dog for a walk, and then again, bleeding in one “gush”. Somehow that makes me feel better, even though it’s not ideal overall and there’s truly no way to know without just getting checked out. It goes without saying that I will be not be making a single exertion that isn’t strictly necessary from now on lol. 

As for ectopic, I don’t have reason to believe that’s the issue other than I know endometriosis increases the chances of it happening, and I have suspected for a long time that I have endo based on severrreeeeeee periods and some of the worst PMDD my doctor said she’d seen. I’ve heard the consistent spotting can be a symptom of an ectopic as well, but I also keep hearing about many women who spotted a lot without issue. So this is more of a paranoid afterthought for me that I don’t really believe. But us pregnant people know how it is. There’s always that, “but! What if…?” 

Now, that’s the whole backstory, if it helps. I’m so sorry for all the TMI, but I don’t know what all is exactly necessary to mention that might slide the “to panic or not panic” scale one way or the other 😭

My question as a hopefully soon to be FTM is what the heck do I do? I don’t have an OB that can get me in sooner yet (did not have a preexisting relationship with an OB/GYN prior to this pregnancy and my first appointment is scheduled for 8/26 and everywhere else my husband called is booked up). 

It doesn’t look like ER is a good option because the cost seems too high to risk if everything is fine… and even if it’s not, they can’t/won’t do much unless it is an ectopic, right? We’re not getting a clear answer from the insurance on whether it would be an emergency visit (30% of total agreed cost) or be considered maternal care (pay up to $1500 out of pocket) to go to the ER. It sounds so deranged and superficial to be worried about money under these circumstances but we JUST shelled out a large amount to pay for nonnegotiable life stuff and it’s just like urrggg  I also worry that I’m just being dramatic and I’d hate to take up their time for something that doesn’t really require the ER. If I were to go the ER route, I should wait for intense bleeding and cramping, right? 
Urgent Care doesn’t have an ultrasound machine and I’ve honestly never heard of them handling maternity issues. 
Considered contacting my PCP to request staggering HcG tests to potentially catch a MC but with being 9w I don’t want to take the chance that the HcG levels are already starting to fluctuate and unnecessarily freak myself out with potentially misleading tests that wouldn’t even give an answer until close to my 8/26 appointment anyway. 

I saw in a few forums posts that some people got a referral for an ultrasound from their PCP, or that they went to urgent care and the UC referred them out? Is that something I should try to do ASAP? Are there any other alternatives? Have I missed an option? Might my appointment be moved up due to the bleeding & cramping even though the receptionist emphasized that they are packed full up for at least a month? I am hesitant to do that even if it’s an option because my husband has a major major work commitment this week, so he couldn’t attend with me and we’ve had our hearts set on him attending the first appointment (though if I gotta do what I gotta do then so be it). Or do I just suck it up and endure the excruciating wait until the 26th? 

Does anyone else have experience or insight or any wisdom at all to share? I’ve never done this and I have crippling social anxiety so all the calling around is already really stressing me out and I’m just plain worried. And now I’m worried I sound absolutely crazy and over the top to everyone lol. 

Thank you so much for any advice at all!

harpseal135

Call the OB office that t you have your appointment with and tell them what's going on. They may work with you. Otherwise your primary is the best option.  Er will just diagnose you with a missed miscarriage and tell you to go to your primary or OB.  They are not very well trained for ob. 

dpjennifer

Do NOT go to the ER, unless you already know what is going on with you.  (e.g. For my 5th MC, I KNEW what my HCG numbers were and went to the ER when I started bleeding/cramping to see if I could take stronger meds than Tylenol based upon a new HCG number and ultrasound.)  Even then, they were totally useless and made me wait for hours when they had teh stupid number they never gave me.  I almost AMA myself out when I knew what was happening.  Even with everything I knew going in, it was still stressful and obnoxious.  I can't imagine going in to that situation not having a clue what the options were or what was happening to me!

sonjanae

@harpseal135 Thank you! I ended up doing this today and they moved my appointment up to this Thursday. 

sonjanae

@dpjennifer Thank you! It seems like everyone just says, "go to the ER" in other posts I've read, so these specifics were super informational! I did not end up going, but was able to get my scheduled appointment moved up by a few days. 

virtaur

ER is really only for severe bleeding and/or pain. They don’t do much for you there and often make worries worse. Hope your appt goes well!