Confused

LilyLove29 · February 2013

Hello! I'm new here, I usually stay on my BMB but I'm a little confused about something.

When I was 22, 24, and 25, I had cervical cancer. I'm a lucky girl and a fighter, and through several tough decisions, had several surgeries but was able to keep all of my pieces. My doctor told me I would be able to get pregnant, but have trouble staying pregnant and I would have a csection for sure.

Fast forward to now. I'm happily married to a military man, so I now have TriCare and live in another state. I got pregnant easily and was happy to hear at my 16 week apt that my battered cervix is a champion! This was seriously the best news because my doctor now has explained that he is removing me from high risk and placing me in a moderate risk category. No bed rest! Woo! So then I asked him about a csection, and he acted confused and said that at this point it's not medically necessary, but understandable with my history if I wanted one. He recommends against it but would set me up with a consultation at 32 weeks to discuss vaginal vs csection delivery.

I was so confused because for the last 7 years I was under the impression that I had no say in the matter. I called my original doctors office who told me that my doctor had left, and could not put me in contact with her. Thankfully a family friend works in that practice and she contacted the doctor who took my number and called me. She said since she hasn't seen me in 2 years, she can't say concretely what her recommendation would be, but based on the last time she saw me, she would go with the csection, however she didn't want to undermine my current physician and she would respect his opinion.

I'm at a loss now. I have only seen this new doctor the one time. I see someone different every time I go, just the nature of the military health system, and while I want to trust what this doctor says, I'm terrified that I will do more damage and should just go with a csection.

So, I came over here to see if anyone else has been in a similar situation? I read the previous post about the optional csection, and I know everyone is different and had different experiences, and some are very against it, and others don't seem to mind, but in my situation, would you opt for peace of mind based on trusted doctor? Or go with current unknown doctors opinion?

I'm sorry this is so long! Thank you for reading.

mben1119 · February 2013

I would wait and see what your situation is at 32 weeks. Your doctors opinion could change by then too.

Also, you would have a legitimate medical reason for a csection, if you would choose to deliver that way, based on your medical history.

nosoup4u · February 2013

Did you ask specifically what your old doctor was concerned about that made her recommend a c/s? I would want to know that. And I would ask every doctor I meet in the practice what they think.

LilyLove29 · February 2013

Nosoup4you, yes I did and her concerns were mostly about how much scar tissue I have, and tearing causing more damage and scar tissue. I know that my cervix should still dilate properly, since that's what it does, but since I still have a risk of having an incompetent uterus, I have a US and cervical measurement every 3 or 4 weeks. She was wanting to avoid potential damage for future babies, in case that I'm ok this time, but with more damage I may be higher risk for IC and could potentially lose baby. There were other reasons, but minor in my opinion, and I also think that a part of it was to relax me a little knowing that at least it would be planned.

I agree with PP that I will wait and see at 32 weeks how I am doing, because it may not be sunshine and roses by then, though I hope my pregnancy is still going well at that point. I also am getting a different doctor for my 20 week appointment and will ask her at that appointment what her thoughts and concerns are.

Thank you ladies! I appreciate the comments.

ladybugpjb · February 2013

I understand the frustration with having a different doctor every time - I'm also on Tricare. We had midwife program where I delivered DS, and out of the five midwives, I ended up with the ONE I had never met there when I was in labor. It's just how things go.

I don't know how big your MTF is, but if you work really hard at it, you can usually get appointments with the same doctor. Once I discovered that, I had my last three or four appointments with the same midwife.

Make sure and do your own research. I know posting here was a step in that direction, but since you have no guarantee of seeing the same doctor again (and the next one might say something completely different), you need to really know the reasons why a c-section might be better in your situation, and make a truly informed decision. I'm not sure exactly where you would begin looking up information on your situation, but I'm sure it's out there.

Dealing with the military doctors can be frustrating. Remember that if you are really concerned and can afford it, you can switch to Tricare Standard and see a non-military OB and pay a little out of pocket. There are some restrictions with going back to Prime, but it seems fairly common for women to do that.

Good luck!

LilyLove29 · February 2013

Thanks! Funny enough, I tried getting the same doctor. I was supposed to see him at 12 weeks and he had an emergency and I saw someone else. After the 16 week apt, I tried scheduling with him again but found out that he is being stationed in Japan before my 20 week apt., so back to square one. Hopefully the midwife I have for 20 week is good and has some advice for me. The Dr I saw at 12 weeks was awful in my opinion and I don't want her ever again if I can help it. And I tried switching TriCare standard/prime and I got denied. I had never heard of that before, but apparently they reserve the right to do so. The only way to get out now is to say I'm receiving substandard care, and they will reassign me off post, but it won't be my choice who I see. It's frustrating, but not the end of the world. I knew it would be like this, and I have been through enough to realize that the doctors aren't doing anything wrong, even though it may be difficult for me.

And I agree 1000 per cent. I plan on being so well informed at my 32 week consultation that I could answer my own questions. :

Thank you again! I appreciate the support and concerns.

ladybugpjb · February 2013

LilyLove29:
Thanks! Funny enough, I tried getting the same doctor. I was supposed to see him at 12 weeks and he had an emergency and I saw someone else. After the 16 week apt, I tried scheduling with him again but found out that he is being stationed in Japan before my 20 week apt., so back to square one. Hopefully the midwife I have for 20 week is good and has some advice for me. The Dr I saw at 12 weeks was awful in my opinion and I don't want her ever again if I can help it. And I tried switching TriCare standard/prime and I got denied. I had never heard of that before, but apparently they reserve the right to do so. The only way to get out now is to say I'm receiving substandard care, and they will reassign me off post, but it won't be my choice who I see. It's frustrating, but not the end of the world. I knew it would be like this, and I have been through enough to realize that the doctors aren't doing anything wrong, even though it may be difficult for me. And I agree 1000 per cent. I plan on being so well informed at my 32 week consultation that I could answer my own questions. : Thank you again! I appreciate the support and concerns.

That doesn't sound right to me, but I've never switched to Standard. If you end up wanting to switch to standard, go ask about it on the Military board - I've read lots of comments on there about women going on standard. Also, going to see the patient advocate can help if you get really frustrated - there should be one at your MTF. A lot of the answers you get when you call Tricare depend on who you talk to. Seriously, some of them don't know what they are talking about. I'm sure it's that way with most insurance companies.

Fingers crossed that you are able to get a good doctor/midwife who will be able to give you good advice!

LilyLove29 · February 2013

Ladybug, yeah sounds messed up right? I had the option to switch when we were in Georgia, but since we lived off base, they set me up with a doctors office nearby and I loved it, but was for a regular doctor. When we moved here, we live off base, about 25 minutes away, but since im within the 30 mile radius, I go there. some other spouses were about to switch but they did so about a year before I moved here. I was ok going on base and not causing a fuss, but they don't have an OB so I have to go to another base for all of my OB related care. That base is about 45 to 60 minutes away depending on traffic. That's when I tried to change and got denied. I didn't think they could deny me, since I thought it was my choice to pay the copays, etc. apparently in the small print they can deny it, and did. I had never heard of that before and I went to the patient advocate about it, and they said that I could contest the denial based on improper care, or some other reason, but improper care would really be the only way I'd get it. Maybe I'm too nice, but I don't want the doctors, who are fine just not what I want, to be in any trouble.
Anyway, the advocate said it had something to do with them closing a base in the area and it was more cost effective for patients to go to the other base, blah blah blah, budget cuts, blah blah blah, and I just have up. I'm sure I could fight it if I really wanted, but I'm not sure it's worth it.

Also, I missed it before, I didn't mean to ignore you, there are 11 midwives and 10 doctors where I am being seen. So I may not get to find out which ones I love and want to stick with, though hopefully I do, but at least I'm not stuck with the ones I don't care for.

I'm mobile bumping so sorry for typos. And thank you again, everyone for your thoughts. I will definitely be informed and have plenty of time to research everything. I appreciate it and I hope you all have a lovely Monday!

penguingrrl · February 2013

Honestly, it seems like the thinking for what means someone must have a c-section versus having a trial of labor is constantly evolving. So your doctor saying seven years ago that you would have to have a section might well mean that under the thinking seven years ago that was true but that your body has done well and thinking and research have changed in that time and now that's not necessary. I know that 3.5 years ago the ACOG changed the standards to say that a VBAC was safer than an automatic repeat c-section. It may be that as more women with a similar history to yours went through pregnancy and labor they found that vaginal birth wasn't as dangerous as previously thought.

I think talking to your old OB was a great step and coming here is as well. I wouldn't write off vaginal birth if the new OB you'll be seeing feels it's the best option.

Good luck!

LyndseylovesHugh · February 2013

LilyLove29:
Ladybug, yeah sounds messed up right? I had the option to switch when we were in Georgia, but since we lived off base, they set me up with a doctors office nearby and I loved it, but was for a regular doctor. When we moved here, we live off base, about 25 minutes away, but since im within the 30 mile radius, I go there. some other spouses were about to switch but they did so about a year before I moved here. I was ok going on base and not causing a fuss, but they don't have an OB so I have to go to another base for all of my OB related care. That base is about 45 to 60 minutes away depending on traffic. That's when I tried to change and got denied. I didn't think they could deny me, since I thought it was my choice to pay the copays, etc. apparently in the small print they can deny it, and did. I had never heard of that before and I went to the patient advocate about it, and they said that I could contest the denial based on improper care, or some other reason, but improper care would really be the only way I'd get it. Maybe I'm too nice, but I don't want the doctors, who are fine just not what I want, to be in any trouble. Anyway, the advocate said it had something to do with them closing a base in the area and it was more cost effective for patients to go to the other base, blah blah blah, budget cuts, blah blah blah, and I just have up. I'm sure I could fight it if I really wanted, but I'm not sure it's worth it. Also, I missed it before, I didn't mean to ignore you, there are 11 midwives and 10 doctors where I am being seen. So I may not get to find out which ones I love and want to stick with, though hopefully I do, but at least I'm not stuck with the ones I don't care for. I'm mobile bumping so sorry for typos. And thank you again, everyone for your thoughts. I will definitely be informed and have plenty of time to research everything. I appreciate it and I hope you all have a lovely Monday!

I mainly just lurk on this board but wanted to chime in. The 30 mile rule has nothing to do with Standard vs Prime, if you are more than 30 miles from a MTF you would be on Remote, which means you can see a civilian doctor. I have never heard of anyone being denied Standard, did they give you a reason? I would call again and talk to a supervisor. I switched to Standard and it was literally a 10 minute conversation.

No advice about your situation, but good luck!

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