Thankful Thursday: Prenatal visit

I got a call from my OB’s office as we were traveling back from Lincoln. My OB is on medical leave, the receptionist told me, and would I like to reschedule my first appointment with one of his partners?

Except she had a question first. Are you planning a home birth? Because none of our other providers work with home birth midwives, so… I tried to explain that while we’re hoping for a home birth, we’re also intending to follow with our OB in case a hospital birth is necessary. She was reluctant to reschedule me with another provider, given my home birth hopes. I began to get a little frustrated. “I still need my labs done, don’t I?” “Well, if you’re going to give birth in a hospital, yes.”

Sigh.

I finally convinced her that yes I really did want an appointment with someone and she offered the midwife. Great! I thought. While my OB is the only one in town (to my knowledge) that works with home birth midwives, I am familiar with the practice’s nurse midwife and know that she is pro-physiological childbirth and pro-VBAC and is on friendly terms with my home birth midwife (definitely NOT givens in the large group practice my OB belongs to.)

So when I arrived for today’s appointment, I was thrown off kilter to learn that I hadn’t been scheduled with the nurse midwife but with the nurse PRACTITIONER, an entirely unknown quantity.

This week I’m thankful…

…for good first impressions
I was prepared to tell the nurse that I’m continuing to breastfeed my fourteen month old (oh my – I just realized that Tirzah Mae is as old now as my big sister was when I was born. Crazy.) I was also prepared to face disapproval for that practice.

What I was not prepared for was for the NP to knock on the door while I was breastfeeding Tirzah Mae, to have her insist that I not interrupt “lunch” on her account, and to sympathize with me over how Tirzah Mae’s difficult start meant I had absolutely NO lactational amenorrhea.

She put me right at ease.

…for gentle probing and full acceptance of my right to decline
When I asked that we try doppler to hear baby’s heartbeat rather than doing a ultrasound, she asked if I was afraid of the procedure. I explained that no, I wasn’t but preferred to use the least invasive tests necessary to obtain needed information. She explained that yes she could use Doppler but that the heartbeat might not be detectable at this point. She didn’t want me to be worried, she said.

This made clear to me that she’s used to dealing with normal pregnant women who think the more information they have (as far as prenatal testing goes) the better. But her recognition that the purpose of ultrasound at this point is more for reassuring a mother that everything is fine than for any diagnostic purpose and her willingness to skip that for me encouraged me greatly. (For the record, we didn’t hear a heartbeat on Doppler – but we have no reason to think that all isn’t well with this baby.)

…for a timely reminder
When the NP asked if I had any questions, I couldn’t think of any. But when I got home, a blog post I was reading mentioned the US Preventative Services AHQR EPSS App to help clinicians determine which screenings and preventative services to provide their patients. Medical wonk that I am, I downloaded it and entered my information. And there, under Grade B recommendations was the use of aspirin for prevention of preeclampsia. My OB had mentioned that at a postpartum visit after I’d had Tirzah Mae. I called the NP to ask her advice – and since the reminder had come at just the right time, my case was fresh in her mind and the question easy to answer.

…for prenatal peace
Given what happened in my previous pregnancy and how my previous delivery turned out, it would make sense to be anxious this time around (yes? at least, it would be plenty normal.) But I am at rest with this pregnancy (thus far). Even as I hedge my bets, seeing both my OB (who performed my c-section) and my home-birth midwife, I feel at peace about whatever the outcome may be. God is sovereign over pregnancy and preeclampsia, over care providers and birth settings, over babies living and babies dying. So while I hope and pray for a long pregnancy (Maybe I can get that 41 weeks, 1 day I expected from my first pregnancy?), for an uncomplicated unmedicated home VBAC, for a healthy baby and a healthy me both through and after pregnancy…I am resting in the reality that God knows and God chooses best.