Vent/Whine/Talk Me Down: Cardio Consult

danuli8 · January 2013

Mobile: Vent/Whine/Talk Me Down: Cardio Consult

Not sure where I'm going with this but need to get it off my chest. I just transferred from an OB to a CNM so I can have the nice natural birth I know I am perfectly capable of, AMA be damned. The new office finally got my records from the old one, which resulted in an interesting phone call yesterday:

Backup OB at new office: Hi, this is Dr. X, and I'm calling because we got your records from [old OB's] office. They say you had a TIA (translation: mini stroke) in 2007 and testing done then revealed a PFO and a bicuspid aortic valve (translation: two minor heart defects). We would like to have you consult with a cardiologist and see if you need any kind of workup. The hospital will want to have this on file in case there is any need for anesthesia such as for a C-section or an epidural.

Me: Well, many people who seek care from a CNM plan a natural birth without those interventions, and that is certainly true in my case.

Backup OB: Well, yes, but you can never tell what might be necessary, and the hospital anesthesiologist will want to have information on your condition just in case. We would arrange for you to see a cardiologist in our group and have him look over your records from your 2007 hospital admission. Just a consult--he wouldn't do anything besides talk to you at this appointment. Would that be all right?

Me (realizing she is asking for consent and, after thinking it over, deciding that refusing will cause them to treat me like radioactive waste): Well, okay...

So now I am having some strange cardiologist who has never laid eyes on me pass judgment on me based on six year old hospital records and maybe a five-minute conversation. And I will no doubt get to pay at least $300 for this "privilege" (I am on an HSA and have to meet a rather high deductible before they pay for anything). All because some effing OB insists on undermining my confidence in my ability to give birth the way I know I can. This is CYA medicine at its finest. Oh, and if the cardiologist recommends a TEE (procedure where they stick a tube down your esophagus to look at your heart)? That requires anesthesia. Do you honestly think this is a good idea to do to a woman who is 29 weeks pregnant??? And this is all over an incident that happened nearly SIX YEARS AGO that caused no damage of any kind and has not troubled me for one instant since then.

Seriously, it makes me want to jump in my car, drive the 600 miles to Ina May Gaskin's farm in Tennessee, and not come back until I have my son in my arms.

I think my best chance is to charm the pants off this cardiologist with the many positive changes I have made since 2007 (losing weight, becoming a runner, improving diet, working less, etc.), the lack of heart issues I have had, and the awesome numbers I have been putting up throughout my pregnancy. I am hoping he will simply say that everything is fine and no special precautions of any kind are necessary. But seriously, WHY do I have to jump through these hoops again? Because of someone else's fear. It just pisses me off no end.

Anyone else been there, done that? I'm alternating between wanting to bawl my eyes out, punch a hole in the wall, and run away to Tennessee.

AmyM72 · January 2013

I don't have any good advice but just wanted to send you some hugs! Sounds like a good plan to brag a little about all your improvements.

stephzrn · January 2013

Why would you not want a check up from a cardiologist? A PFO and Bicuspid aortic valve do not heal themselves. You may have a stroke during pregnancy from the PFO and you may not want to hear this but you may need surgery later in life for the valve. Why wouldn't you want to get routine echos to make sure things aren't getting worse? They can start with an echo which is perfectly safe to do during pregnancy. They can also also do TEE as an outpatient and yes some hospitals use an anesthesiologist they don't use anesthesia. They can give you meds that are safe for the baby any just put you in a twilight sleep. I think you should listen to your doctor and see a cardiologist. I hate to sound so mean but I've been a cardiac nurse for about 9 years. Why not protect yourself, if not for you but for your baby who needs a Mom?

stephzrn · January 2013

I know you said you have made positive life changes and have been feeling good but like I said those two things don't heal themselves and congratulations on being as healthy as you can but heart disease will continue to happen if it is in your genes even with your positive changes. Please listen to your doctors. I would hate for something to happen to you.

NuggetJo · January 2013

I don't post here much after giving birth but feel compelled to answer your question.
I was born with a VSD which although is quite minor it did require some extra monitoring throughout my pregnancy. I consider myself VERY fit, I work out 6 days a week and although I felt strongly that I was healthier than most "normal" people giving birth my OB felt a backup plan was necessary. Was it a bit disappointing..... Yes but in the long run I knew she had my best interests at heart. I did have an anaesthesiology consult as well as the care of a cardiologist in the hospital I delivered at. I ended having an emergency csection after 24hrs so knowing that the anaesthesiology was aware of my situation did help with the stress of the situation. I understand your reasoning as you know your own body but its better to be prepared and know that everything is in pace should you need it to be. Good luck with everything and
I hope you have a smooth delivery

supersarah77 · January 2013

I can't speak to your medical history but I just want to say I can see how you'd be upset by this interaction. This OB feels like she's becoming a barrier to your plan and inserting intervention where you don't want inserting. I can totally see how that would feel like losing some of the control of what you want. Plus I bet you didn't see that coming so you're adjusting to hearing it afterward.

Hugs

lovelyday39 · January 2013

No advice- just wanted to say sorry you have to deal with this, I can totally understand how frustrating this must be for you. Hang in there-- ((hug))

Kmape36 · January 2013

I certainly wish you all the best but agree with some of the PP. What is the harm in the consult? Also no matter how much you think your body is capable of having a natural birth, there are no guarantees that is going to happen. So why wouldnt you rather have the consult and have the heart doctors on standby just in case things dont go as planned. Thats the thing about birth plans...they have a tendency to fall apart. I am pregnant with my second and i can tell you the delivery of my first was FAR from what i planned. The best thing you can do for your unborn child is plan for every scenario...especially the ones you think could never happen to you.

Country Girl in the City · January 2013

I can see why you are frustrated but the OB would not be doing his job if he did not send you to a cardiologist. Personally, I am sick of specialist appointments and I just got a call today that my insurance denied my kidney specialist. I just keep telling myself that I need to be sure that I am healthy for my baby. If I had a stroke then I could not be a good mom to her.

technigirl · January 2013

I'm sorry you're having to deal with this, it must be so frustrating! I do think you should go ahead with the consult though. Here's the thing about pregnancy: it's basically a stress test for your body, and it can cause health problems in even the healthiest of people. Also, while your body may very well be fully capable of carrying out a natural birth, there can be quite a bit of unpredictability to the birth process. I'm a case in point. I'm probably one of the healthiest people I know - I've been working out for years, I eat right, I'm tall and slender. Yet I got pre-eclampsia in my first pregnancy, and it didn't become severe until I went into labor. My doctor often comments that I'm not someone that typically would get it - but I did. Pregnancy can often bring unexpected issues even to us "healthy" folks. On top of that, I had totally planned on giving birth vaginally, but I ended up with an emergency c-section because my daughter's head was not turned the right way and she got stuck coming out the birth canal (they couldn't use forceps for fear of hurting her - or me). You know what they say about the best-laid plans...

OBs have seen all this and more (and worse, I'm sure), and I believe that's why they are extra cautious. I would take all the precautions you can as pregnancy and giving birth are hard on the body and it sounds like your doctors are really just trying to give you the best care they can.

Melissa

msualum96 · January 2013

danuli8:
So now I am having some strange cardiologist who has never laid eyes on me pass judgment on me based on six year old hospital records and maybe a five-minute conversation. All because some effing OB insists on undermining my confidence in my ability to give birth the way I know I can.

Sorry to butt in, but I was a member (lurker) when I was pg and still, obviously, lurk from time to time...

I'm confused about your attitude toward the medical professionals that are making YOUR HEALTH and that of YOUR UNBORN CHILD a top priority...? Passing judgement? Seriously? Undermining your confidence? Really? Is this really how you think? Or is it pg hormones talking? Because I find it really hard to believe that you think the bolded things above. I'm in the medical field, and no, I do not explicitly follow every directive of my doctors like a lemming, but damn, all the OB is asking is for you to get a freaking consult. You have legitimate cardiac issues. God forbid that you're in unprogressing labor for 36 hours or need an emergency C-section. Are you going to accuse the OB of "undermining your confidence" then? How well-planned do you expect this birth to be, exactly? Because let me tell you, you can plan it to the most minute detail, and it's going to happen the way it was meant to, plans or not.

Again, sorry to butt in, but this really bugged me. GL with your consult. I hope you get the birth you wish for.

technigirl · January 2013

msualum96:
danuli8:
So now I am having some strange cardiologist who has never laid eyes on me pass judgment on me based on six year old hospital records and maybe a five-minute conversation. All because some effing OB insists on undermining my confidence in my ability to give birth the way I know I can.
Sorry to butt in, but I was a member (lurker) when I was pg and still, obviously, lurk from time to time...
I'm confused about your attitude toward the medical professionals that are making YOUR HEALTH and that of YOUR UNBORN CHILD a top priority...? Passing judgement? Seriously? Undermining your confidence? Really? Is this really how you think? Or is it pg hormones talking? Because I find it really hard to believe that you think the bolded things above. I'm in the medical field, and no, I do not explicitly follow every directive of my doctors like a lemming, but damn, all the OB is asking is for you to get a freaking consult. You have legitimate cardiac issues. God forbid that you're in unprogressing labor for 36 hours or need an emergency C-section. Are you going to accuse the OB of "undermining your confidence" then? How well-planned do you expect this birth to be, exactly? Because let me tell you, you can plan it to the most minute detail, and it's going to happen the way it was meant to, plans or not.
Again, sorry to butt in, but this really bugged me. GL with your consult. I hope you get the birth you wish for.

I thought this was a little harsh...I think that we experienced moms know that birth is highly unpredictable and you can try to plan it, but it often doesn't go the way you want it to. But before I had my daughter, I never would have thought that way. I didn't think I would be one of "those women" who pushed for hours and hours and ended up with an emergency c-section. When it's your first time, that's just not the way you think. I think she can be forgiven for thinking the way that she does, and she should be allowed to have those emotions and express them. And who knows, maybe her birth WILL go exactly according to plan.

Melissa

msualum96 · January 2013

technigirl:
msualum96:
danuli8:
So now I am having some strange cardiologist who has never laid eyes on me pass judgment on me based on six year old hospital records and maybe a five-minute conversation. All because some effing OB insists on undermining my confidence in my ability to give birth the way I know I can.
Sorry to butt in, but I was a member (lurker) when I was pg and still, obviously, lurk from time to time...
I'm confused about your attitude toward the medical professionals that are making YOUR HEALTH and that of YOUR UNBORN CHILD a top priority...? Passing judgement? Seriously? Undermining your confidence? Really? Is this really how you think? Or is it pg hormones talking? Because I find it really hard to believe that you think the bolded things above. I'm in the medical field, and no, I do not explicitly follow every directive of my doctors like a lemming, but damn, all the OB is asking is for you to get a freaking consult. You have legitimate cardiac issues. God forbid that you're in unprogressing labor for 36 hours or need an emergency C-section. Are you going to accuse the OB of "undermining your confidence" then? How well-planned do you expect this birth to be, exactly? Because let me tell you, you can plan it to the most minute detail, and it's going to happen the way it was meant to, plans or not.
Again, sorry to butt in, but this really bugged me. GL with your consult. I hope you get the birth you wish for.
I thought this was a little harsh...I think that we experienced moms know that birth is highly unpredictable and you can try to plan it, but it often doesn't go the way you want it to. But before I had my daughter, I never would have thought that way. I didn't think I would be one of "those women" who pushed for hours and hours and ended up with an emergency c-section. When it's your first time, that's just not the way you think. I think she can be forgiven for thinking the way that she does, and she should be allowed to have those emotions and express them. And who knows, maybe her birth WILL go exactly according to plan.
Melissa

I don't think that she needs to be "forgiven" for thinking the way that she does, at all. She asked in her post title to be "talked down". Was I harsh? Yes, maybe I was. But I still feel that she was overreacting to a simple request for a consult. It's not as though the OB was asking her to absolutely have an epidural, or an induction, or a c-section. If medical professionals don't have all the bases covered, and God forbid something unfortunate happens, what then? YES OP, it's "CYA medicine". But WHY would you want it any other way? The doctors have NOTHING TO GAIN from knowing all that they can about your history and pre-existing conditions, except the ability to make the correct decisions to possibly save your life. And I DO hope her birth goes exactly as she plans, as I said before. I wasn't being sarcastic.

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