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Thinking about switching OB practices... (long)
Ok, I'm in a tough spot and I could use some advice if any of you are willing.
I used to go to Arlington Women's Center for many years. My GYN was Dr. Crowther and she ultimately delivered my son by c/s 2yrs ago. I had a weird c/s but none of it was her fault, and she's a great physician, I trust her etc. That being said, I don't like the practice. I don't like the staff, and I think they handled my having PPD absolutely horribly. Even Dr. Crowther could have handled it better. Actually, the only person I found to be helpful was their midwife, Karen King.
Earlier this year, when I was due for my yearly exam, I discovered that AWC does not accept Tricare (unless you're pregnant, and even that is somewhat complicated).
So, I discovered that a practice I used to go to - Reiters, Hill, Johnson etc. does accept Tricare, and I went there for 2 years when I first moved to VA (ironically, until they dropped the insurance I had at the time). So, I just figured it was easier to just go there for my yearly... no big deal. I saw their Physican's Asst whom I knew from the past, and it was a good experience all around.
When I found out I was pg, I just kept going to Reiters. I haven't been blown away by the OB's and I actually had a bizarre experience with a test results mix-up (which was a tiny red flag). Furthermore, it's a HUGE practice with 3 or 4 offices, and like 15 docs. I don't feel like I know anyone, and they certainly don't know me.
I think I need a more intimate experience with an OB's office, particularly based on my history of severe PPD. Granted, I am in a clinical study with NIH so I have doctor's that are taking care of me, sort of.
The bottom line is... I guess I don't know what to do. I can stick with the practice I'm at (although they deliver at Sibley and not Virginia Hosp Center like I'm used to). I'm more comfortable with local hosps like VHC and Fairfax but they're not deal-breakers.
- The cons are that they Reiters doesn't do VBAC's after your due date, it's not a personalized experienced and I have no idea how they'd handle me postpartum if I have any issues.
- The pros are that most of the docs are Washingtonian Best Of, and the location is practically walking distance from my house. The parking is not an issue at all.
- The cons of AWC are what I listed above, plus the parking is a nightmare, it takes like 40m of waiting to get in to your appt (which is rough with a 2yo in tow).
- The pros of AWC are Dr. Crowther. That's about it for me. But that's a BIG pro though.
Help! If anyone has other suggestions (I'm open to other practices - some of the big ones or real well known ones don't do Tricare at all though).
If you were in my situation, what would you do?
Also, I owe you a cookie if you made it through all of this!
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Re: Thinking about switching OB practices... (long)
A few thoughts:
- If you want to go natural, I think it'd be worth giving BirthCare a call & ask if they do VBACs in house. They're a midwife group practice with about 5 midwives and you'd definitely get to meet them all before your birth.
-Tepeyac in Falls Church delivers at Fair Oaks. I met about half their OBs and liked all but one of them. They're generally natural birth-friendly but also have the experience to deal with higher risk.
-From what I've read, having a doula generally helps with having a successful VBAC and since an OB attending your birth wouldn't be with you for most of labor, it might be nice to a constant supportive person around.
-There's also Loundan Community Midwives that deliver at the Birthing Inn - not too familiar with them though.
-Also the DC Birth Center has about 6 midwives and they have hospital priviledges so you would get the intimate care of a birth care for prenatal but then all the high-tech stuff you may want of a hospital.
I want my cookie:-) If it were me, I would stay but it would not be an easy decision. I dont like the idea of being a part of a huge practice with that many drs, i go to one with 4 docs and even feel like thats too much sometimes.
Ultimately you want a dr you like, and can trust but on the flip side...throughout your labor and really your entire pregnancy, you are not with your dr most of the time, you are with the nurses at hte office or the L&D nurses at the hospital. I am also not a fan of change.... The issue with lab results, I would not like that they got messed up/lost I dont think you said what actually happened, but you have to understand that they are human beings so that would not be a DEAL BREAKER in itself for me but that in addition to some of hte other things you mentioned might be.....
good luck!! I can't believe you are halfway through:-)
I like chocolate chip:)
how set are you on a VBAC? if that's your preference, don't go to AWC b/c you don't know when you'll go into labor and who'll be on call. If you go w/ a scheduled c-s, go back there b/c you can pick the Dr who'll do the c-s.
if a VBAC is your priority, then I'd pick another practice, sorry I don't have recs as I am not in your area.
i have lots of suggestions for you, but i hate bumping from my phone. will reply later with full response. 2 quick things, thoughbirth care does not do vbacs (currently participating in a study, but moms have to have had at least 1 vag birth) and i would run far from any doc who wants to impose a time limit to your pg. its not evidenced based and goes against their own guidelines (acog). more on all this later!
*******
back! i agree wtih everything 2vthokies said. if vbac is your goal, you really need to do everything you can to address that first. your ppd is currently being addressed in the study so your concern now can be your current pregnancy and upcoming birth.
she is also right that having a vbac may reduce the likelihood that you will develop ppd next time. mine was not as severe as yours (i recall your posts from those darker times), but i had NONE after my vbac. not even baby blues. this also had a lot to do wtih that! i put it in a smoothie and had one every day for several weeks.
i would never in a million years stay wtih a practice that imposes time limits. it is not supportive of vbac and why put yourself in a position to have to argue and fight for rights to your body?
OBs can and will railroad you into a RCS. even OBs who claim to be supportive of vbac will do this. you need to inquire about their vbac rates (% of vbacs compared to RCS). here is a nifty site that can help you identify OBs who really are committed to vbac. Dr. Tcahabo at VHC has one of the highest ratings in the area. unfortunately, he is transitioning to retirement (so isn't on call much) and the rest of his practice isn't as forward thinking. crowther also has a pretty good vbac rate, though i know you have issues with other factors at her practice.
attending an ICAN meeting can give you personal accounts of how OBs in this area are. many of the ladies who attend share their vbac journeys and the chapter leaders are very knowledgeable about the true intentions of area OBs, and are loaded wtih tips on how to get what you want out of them.
if you would consider a homebirth, my CPM is absolutely fabulous and many of her mamas are vbacs. there are several other HB MWs in the area with extensive experience with vbacs. i'd dare say that most of them probably have more experience wtih vbacs than most of the area OBs. the risk in vbac is mostly uterine rupture. in the hospital, machines monitor your labor. one of the first indications of imminent uterine rupture is a change in the contraction, which is most often evidenced by mom's reaction. when mom is medicated, with instrument monitoring, it is much less likely that this first evidence will be detected. it is also important to note that the rupture rate is statistically insignificant in comparison to the rupture rate for a FTM and includes all sorts of ruptures from a tiny bleed to a catastrophic event (and in catastrophic rupture, it wouldn't matter whether you were in the hospital or not, it's most usually fatal, but also extremely rare).
part of my vbac journey was to identify every single thing that could increase my chances, that included changing providers; laboring/birthing with a midwife, outside the hospital, without medication, with a doula; learning techniques for reducing anxiety; releasing all birth trauma from DS's birth; and accepting that the new birth was just that, a new birth.
HTH! and i hope that you find peace wtih whatever you decide to do!
also, check your PMs!
Shortbread cookie from Panera please!
Don't know any of the doctors you mention, but I'll speak from the VBAC experience and having had an unplanned/emergency section with DD1. If you are set on a VBAC (and I was) then find an OB practice that will allow that to be a priority - and allow you to go beyond your due date (I was allowed to go 1 week and ended up getting to go 2 weeks). I know that there are some midwife practices that won't VBAC if you didn't deliver via section with their affiliate OB (Loudoun Midwives is one - or they used to be). But there are OBs out there who do VBACs. My practice is four docs, all with their own ideas on VBACs, but 3 out of 4 are proponents if there is no medical necessity for a section (at least they were with me). My recovery from my VBAC was so different then my section recovery. I don't know what the root of your PPD issues were, but having a VBAC may actually help you on that front. I also agree that a more intimate practice will make you feel more comfortable if your PPD issues come up again.
Bottom line is you really don't sound happy with either practice, so do some homework and find a practice you really are happy with. Don't settle just because you are familiar with both practices. I know I would not be happy with a practice that had 15 docs. I was unhappy when the fourth doc joined my practice half way through my pregnancy. I only saw her twice and she ended up doing my VBAC. She was AMAZING, but I was super nervous when I found out she was on call. She is now my fav doc at the practice because of her support during my VBAC. Good luck, this is a hard decision.
You're right - I don't think either practice is truly the right fit, though I really love my OB from AWC and I can't believe I'm halfway through my pg and haven't seen her. I guess it couldn't hurt to schedule an appointment with her and see how things go. I don't know if that is weird if I'm already in the middle with another practice. I'm also in a weird situation with health insurance, and having Tricare, which I guess is not a very popular insurance to accept!
I had a planned c/s with DS for positioning reasons, and I knew about a month out that he'd be a c/s. It wasn't the worst experience of all time, but if I didn't have to go through it again, I think I'd be a lot better off... of course my worst case birth scenario (besides bad things happening with DD) is going through labor and then ending up with an emergency c/s.
I go to AWC, Dr.Masel is who I usually see, but Dr. Biggs delivered DD. I really like all of the doctors in the practice, but hate the staff, so I totally get you there. Keep in mind the staff of AWC aren't with you when you deliver, the doctors are. I made all of my prenatal appts with DD for first thing in the morning and never had to wait more than 5 mins, something to think about.
I would either go with AWC or find a third practice. That said, since you are halfway through your pregnancy you don't have a lot of time to shop around. Since you like Dr. Crowther so much, I might just stick with her.
The fact that the other practice doesn't let you have the kind of delivery you want, would be a deal breaker for me.