Tuesday, July 10, 2012


It happened. I had my first official breakdown this morning, in my OBs office. Yup. That was me. The crazy lady crying in front of a stunned OB. This breakdown was several days in the making, and as KG said when I called him after the appointment, "It just sounds like you had a cry inside you needed to let out." Apparently so. This is a long one, so get comfortable.

Let's back up.

Over the last week, I have been feeling tremendous pressure about finding child care for The Nugget. I had 3 people in the span of as many days ask me the dreaded question, "Have you looked into child care yet?" Cue. Panic. Even though, to me, it sounds totally insane to look at day care when you are 15 weeks pregnant, apparently in Boston it is totally necessary. I started googling, talking to friends, and making some phone calls. Indeed, several places said that now is the time to look for September 2013. Yup, over a year in advance. So, I made some appointments to visit a few places in our area. Oh, and guess what else? You need to be ready to cough up nearly as much money per month as our rent for full time infant care. Again, cue panic. Since staying home is not an option for me (or KG) this is the reality. We'll just have to suck it up and eat ramen for a while.

So there's that.

I'll preface the next bit by saying I am a person who likes direct instruction. Don't make me guess what I should do. Just tell me exactly the right thing to do and when to do it. I follow directions like a champ. Teachers tended to love me for this reason. I generally did exactly what they asked, in order to get a good grade. Open ended assignments? That's another story.

On to today's appointment.

I saw the OB we met last month. Again, she was a bit late (30 mins) but was warm and friendly. All started well, with my uterus measuring just right and The Nugget's heartbeat sounding loud and strong. She said my blood pressure was "on the high end of normal" but that might have been from feeling annoyed that she ran 30 minutes late. Anyway, she told me not to worry about it (then why tell me?). Then, she asked if I had questions. She didn't know what she was in for.

I started off by asking about why my ovaries are still quite large from IVF (they mentioned it at the NT Scan). She kind of brushed it off saying it would go away after the baby and they wouldn't do anything about it now. I'm okay with that I guess, but it did leave me wondering.

Then I asked about exercise. How much should I be doing? For how long? Again, I felt like I got vague answers. It started out okay. She said I should be exercising every day (holy shit!). Then, I got the standard, "Don't do anything that makes you uncomfortable, breathless, too hot, etc." Okay, that's all fine. But, when I pushed her to tell me how long each day, etc. I got, "Whatever feels right." If I knew what felt right, I wouldn't be asking. It feels awfully right to sit and watch Real Housewives instead of going to the gym.

Next, was the heaviest topic. I've written before about the fact that I am on prescription medication for anxiety and depression. I am on very low doses and have consulted my psychiatrist and two years ago (when we began TTC) I even went to a special clinic that deals exclusively with pregnancy and psychiatric medication. At the time, everyone recommended I stay on my medication, even though they are Class C, because the risk of having a depressive or panic episode was overwhelmingly likely, especially postpartum. The research generally shows that the risk to me outweighs the risk to the baby and that the chemicals that the body of a depressed mother releases can be more damaging to the baby than the meds. They also said the amount passed through breastmilk is less than through the placenta, so it shouldn't be a problem. But, I wanted to make sure this OB is on board and that breastfeeding will not be an issue at the hospital. Now, I know this is a complicated issue and honestly the research sucks in this area because they aren't randomized studies. It may not be a clear cut issue at all. But again, instead of giving me a straight recommendation, she wants me to meet again with the clinic. I asked if she has other patients with this issue (she does - many) but she said it is all dependent on individual circumstances, etc. This is all true. But FUCK, I just wanted her opinion and she just wouldn't give it to me.

Then, it happened. I broke down in tears. I didn't see it coming and still don't really know why I went over the edge. She was stunned and thrown by my reaction, as was I. She babbled a bit and I agreed to make the call to the clinic.

Lastly, I decided to press my luck and ask about nutrition advice. Are there specific food groups I should be focusing on more than others? Protein? Calcium? I have all the books with some of this info, but I wanted to know from her experience if she considers some things more important than others. What did she say? I should go see the nutritionist. Another appointment. Another question unanswered. I think I'll just make a greater effort with leafy greens.

Did I mention I am meeting tomorrow with an endocrinologist because she didn't want to tell me when to go off Metformin (for PCOS, not insulin issues) without his opinion?

No one tells you how scary all this pregnancy stuff is. The thing is, I am petrified that I'll do something wrong with this pregnancy, that I'll personally make a choice that will harm this baby. And it seems that with so many of these pregnancy-related things, there is no one right answer. There is only making "comfortable" choices or doing what "feels right." Apparently this is true from everything from choosing a car seat to the question of getting an epidural. For someone like me, that is just about the worst thing I can hear. How the hell do I know what's right if I've never done this before?

Are all OBs like this? Do they all refer you out for tough questions? Are they only good for listening to a doppler and measuring your uterus?

Hell, I have a doppler at home...

By the way, today didn't start off like this. It's actually a really happy day: KG and I have been married for 7 years as of noon today. We are going to a fab restaurant to celebrate later and shake off this mood. Happy Anniversary, KG. You are the best partner to this batshit crazy lady I could ever ask for.


  1. I am so sorry you had to go through all that! I sometimes need direction too and am definitely a black and white, all or nothing person. I personally think it's bs that your OB can't give her opinion on ANYTHING without referring you to a specialist. She should be able to at least give you a starting point. IMO, this only serves to make you distrust her, which doesn't seem like a good foundation for a relationship with the person who will be delivering your baby. I don't want to add more stress to your plate, but have you thought about switching OBs? Something to consider.... so sorry again. But happy anniversary! Take care of yourself.

  2. Are you happy with your current OB? I think that she should be able to answer some of your basic questions without referring you out to other doctors. The most important thing is for you to be happy and as confident as possible throughout this pregnancy.

  3. Ugh. Yes, they are all like this, or at least mine are. My first one was so horrible (waited 8 days to tell me my baby had died) that I switched. This new one is supposed to be the best of the best....and basically he is good for measuring the uterus and listening to the heart. Yup. I feel like if I didn't ask any questions I wouldn't get any answers. And even the answers are mostly - there haven't been studies so I wouldn't advise.....he couldn't even tell me if I could get a spray tan! (Haha, i know, not exactly stressful pregnancy stuff). I am sorry you feel this way, I live in canada so this is what I expect of Drs.....but I wouldn't be surprised if you could find someone better...maybe ask your RE?

  4. I have 2 midwives who I love and I can tell you that they are not like this. They will give you THEIR opinion on absolutely anything, tell you the research, tell you what they've experienced, tell you what they've seen but in the end it is always YOUR decision. They are very much about YOU making the choices for your body and your baby but they will definitely offer up a shitload of information (sometimes too much almost!) and then let you process and make your own decision. Ultimately it is about doing what feels right to you and your partner but you should definitely have someone who is willing to give you THEIR opinion on the subject! That is what they are there for!

    1. There are some midwives at the OB's practice. Good to keep in mind...

  5. I agree with Jesica - my midwife had an opinion about everything. Sometimes (often?) I rejected it. But it was good to know where she stood. Maybe check out the midwifery practice at Mt. Auburn in Cambridge?

    1. I was hoping to stay at Newton Wellesley because I had a not great experience with an OB at Mt. Auburn a few years back and all my IVF stuff has been there. Good to keep options open though.

  6. The questions you are seeking answers to don't have clear cut answers. What can work for you for exercise could kill me, what i need for food could spike your blood sugars on metformin...every pregnant woman is different, every pregnancy a woman carries is different and therefor those types of questions won't come with a written specific prescription.

    I know that's not what you want to hear because it would be way easier to have someone else tell you exactly what to do, have you do it, and then if you lose the baby-you can blame them-not yourself.

    In the end it all boils down to you believing that what you are doing won't kill your baby in utero, and even more importantly accepting the fact that your beans destiny has already been decided. Eating a slice of pizza and watching the boob tube will not change its fate. All you can do is do your own research and make the decision you feel will give you the clearest conscious, regardless of what the OB says or any other doc-because the truth is, there really is no right answer to a lot of these questions-merely an option that will appear more right for you!

  7. Whoa. Reading all of this brought my heart-rate up.

    Couple of things:
    1) Regarding the OB. I know she comes highly recommended, but I suspect that the reason she is so is because many are comfortable with her flexible nature (she never gives her opinion and is, hence, never the bad guy). Clearly this is not what you need. So, I would recommend calling your RE clinic/talking with your endocrinologist and asking for some names of other OBs. Does that mean another appointment, unfortunately yes. But she's stressing you out with her lack of guidance/general behavior.

    2) On the daycare front: yes it is completely ridiculous that you need to line all of this up a year in advance (seriously, what are couples to do if they move to the area). But I'm willing to bet the rule isn't as hard and fast as everyone is making it out to be. I don't have any advice or suggestions on where to begin looking (I suspect Mel may have some), but what I will say is that it will be okay. And if you have to eat Ramen, I imagine it will only be for a short period of time.

    3) Congratulations on 7 yrs of marriage!!! Good celebrate

    4) Sending you love and hugs. It will be okay.

    1. Thanks for making me take a deep breath. Big hugs for you too.

  8. I think the medical community is so afraid of malpractice suits that it prevents them giving "opinions." I haven't had exactly the same experience, but my doctor definitely didn't want to tell me when to stop the meds my RE put me on. I remembered them mentioning 12 weeks, so I just stopped then.

    This process is very stressful. I feel a cry in me somewhere too. I hope it felt better once it was out even though you still didn't get a lot of answers.

    Good luck!

  9. My OB hasn't been like that, although I don't know that I have asked such detailed questions like that. I asked, can I still have sex, she said yes. Can I do prenatal yoga, she said yes. But I never asked for an *amount* of exercise, or specific foods, or whatever.

    BUT ... a lot of it IS what feels comfortable to you, what feels right. If you feel tired, then don't exercise. If you want to exercise, exercise as long as it feels right. Your body will give you signals when to stop, so just listen to your body. If you trust this doctor then you can take these responses to mean that she thinks you are fine and don't need to worry, but is giving you a direction to pursue if it is really important to you. Except the endocrinologist thing - my OB has me meeting with a thyroid specialist to monitor thyroid stuff, maybe that's what that is.

    If this is making you distrust your doctor then you should not at all feel guilty about finding one you trust!!!

  10. First, Happy Anniversary!

    Second, thanks for making me totally freak out about daycare too! I'll be looking to start Luigi next May. My OB has mentioned looking into at my last two visits, but since I'm taking 6 months instead of 3, I thought maybe I could wait a bit. I swear it is on my list for this week! I did find a good website yesterday: http://www.eec.state.ma.us/ChildCareSearch/EarlyEduMap.aspx where you can put in your location and see all the possible licensed daycares on a map. I'm not sure yet if I want to go with an in home situation, but there are literally cajillions in our area. And a handful of centers too (although that seems to be where the really big bucks come to play.) Maybe we can compare notes next week... : )

    As for OB questions/responsibilities, I feel like most of my appointments are fairly useless. Just a quick listen on the heartbeat, pee on a stick to check for protein and sugar, a few questions, and that's it. My OB has given me strong opinions on diet though (low to no carbs, go to whole foods for natural almond butter, she even pulled a granola bar wrapper out of my purse and scolded me, and told me a better brand of protein bar to buy.) But, in regards to my hypothyroidism, it's been hard to get answers. She's been checking it every other visit, although the MFM thought it should be more frequent than that. But, she doesn't want to adjust my meds since she's not the prescribing physician. My primary is, although she was happy with my levels being in not quite an ideal TTC place when I started treatment 2 years ago, and I had to keep asking her to up my dose. I checked with her recently, and she said I should go to an endocrinologist. My OB said to hold off on that, and we'll see what my next level is (taken tomorrow). And I know enough from reading other blogs that if my TSH goes above 2.5, I should just take one extra pill a week, but I can't actually get a medical professional to tell me that or prescribe the extra few pills per month. It really is amazing how they don't want to take responsibility for anything outside their expertise. So, anyway, I feel your pain.

    And I have a plan, worse come to worse, we live in neighboring towns...nanny share?

    1. I'm sorry I made you freak out! Let's discuss at lunch! Your nanny share idea has me thinking...worth a discussion for sure.

  11. I ended up switching OB's prior to this pregnancy for this same reason. My last Ob/Gyn would refer me out for everything. He was always vague and in a hurry but showed up late and it just annoyed the crap out of me. My current Ob is awesome. He answers my questions, after he checks me out he sits with me and finds out if I have any concerns or anything. I did get upset at him last week over a vague answer but with recent events everything became quite clear.
    Perhaps you should try to look into switching Ob's or perhaps look into Midwives. Good luck, so sorry you're going through this with your doc when they should be giving you peace.
    Oh and in Miami most daycares and child facilities suggest you apply 14 months before the baby is born. Stupid huh? Especially when you're going through infertility and everything is up in the air. I know its something I have to start doing soon but I'm just not ready yet. Maybe once I get out of my first trimester.

    1. Hey- I've been trying to click back to your blog for a while and I can't. Did you make it private?

  12. There are no truly right or wrong answers to your medical questions.
    I am afraid to say that I don't understand why you would expose the baby to any risk from your anxiety medication. Is it really that necessary?.
    Do you really have to return to work after the baby?. Why would you risk leaving your baby in a strangers care?.
    It sounds as if you want everything your own way and that you want someone else to take your risks.
    Enjoy your pregnancy.Eat sensibly.Exercise sensibly. Quit worrying.Take control of your life and stop blaming others.

    1. Oh, this is such a classic troll comment, it's almost funny! Dear bitter anonymous troll, please go work on your sad life and leave the rest of us alone.

    2. Cristy - :)

      Anon - There is so much that could be said. But, I don't think I need to.

  13. Most OBs I have met are limited in their scope (they are good are doing thing by their narrow book, IMO), but you can find doctors who are more involved, more informed and straighter shooters than this one. A good test for an OB, IMO, is get their stance on vitamin D levels in pregnancy. If they have no clue, then I think one is better off elsewhere.

    Most doctors really don't have a clue about nutrition. That stuff you can get educated on by yourself. And its all a personal choice, like eating organic, having DHA as a supplement, choosing the optimal source of calcium (most calcium tablet formulations drive me batty, with their fillers and crap), about whether you want a prenatal that is all natural and does not contain lovely artificial food coloring dyes (another thing that drives my blood pressure through the roof), how active you want to be in avoiding BPA in day to day life, etc. These are the things that probably wont effect the outcome of your pregnancy at all, but who knows, MAY play a role in whether your child develops a mild behavioral disorder, or has allergies, or something like that.

    If this current pregnancy of mine continues, then soon, I'm going to write an exhaustive, thoroughly researched post on this, but all of this information is already out there on the internet, its just a matter to getting it together.

    Sorry about your breakdown, but it really is good to let some of the pressure out. If that doctor was freaked out and uncomfortable, well its her problem!

  14. Your OB answered just the same as my midwife did. They can't give you a hard and fast "yes, this is totally fine" I don't think, because of liability. There are risks, and no guarantees. That's pregnancy, parenting... life!

    Your blog post starts out with lots of typical reasonable concerns, but your desperate need for answers sounds like your anxiety may have a stronger hold over you than you realize?

  15. I don't know, it's hard to tell. My midwives answered my questions like that without referring me out. If this is just your anxiety being directed toward your OB, that's one thing. But if you think your tears were indicative of a larger feeling that this might not be the right OB for you, I'd explore that a little more.

    (Look! Another non-answer! Just what you need!)

    BTW, have you looked into the research on PCOS and breastfeeding? I did a bunch of research on it after I had REALLY low supply and I think I may have PCOS and that may have been a partial cause of my supply issues. So even though if I do have PCOS, it is of the mild, ovulatory, extremely unusual variety, my endocrinologist (who I see for thyroid purposes) prescribed me Metformin and I am already taking it and plan to continue taking it throughout a potential second pregnancy and any breastfeeding after.

    Just saying, it's not a topic that's talked about much but it's worth looking into before you have a meeting about when exactly to stop taking it (though I know most people do stop taking it after the first trimester and are still able to breastfeed just fine). The woman pioneering the research is named Lisa Marasco. This blog post is a good place to start if you want to read more about it: http://gotpcos.wordpress.com/2010/07/03/metformin-for-low-milk-supply-in-pcos-mothers/

  16. I was JUST thinking about this today. What does my OB DO really? Besides listen to the heartbeat? My appointments are 5 minutes or less and I ask more questions than she asks me, and her answers are so vague. She never gave me any info, I feel like I have to google EVERYTHING. It seems I make all the wrong decisions, runny egg yolk, swordfish, eating the wrong kind of cheese. Can't she give me an information sheet or something on the do's and don't's that HER office believes in?

    I'm totally with you girl.

    Also, I'm supposed to be exercising everyday!!?!? Yikes! I've walked maybe a handful of times since I got pregnant. It makes me totally out of breath, so yes, the Kardashians seem much more relaxing than exercise!

    Somehow, we will both make it to the end!

  17. I hate the judgement that comes to anxiety/depression medication and pregnancy. In the end YOU have to do what you feel is best. My doctor made me sign all sorts of disclosures saying that she advised me not to take them while TTC. Obviously a woman who had never gone through difficulties conceiving.

    Sorry your OB wasn't very helpful :( But at least you are doing a fantastic job at keeping nugget nice and safe.

  18. I know 100% you just want the nugget to be healthy, so you want specific guidelines - what to eat when, a workout program, etc. because this is such an important thing that you are doing, but I think you need to breathe and realize that that is not a possibility.

    I think your mantra should be "women have babies every day, since the beginning of time. I can do this." And listen to your body. The nugget will tell you when he's not happy (from what I hear, by kicking and flipping). I know my opinion doesn't really matter, but I for one think you are doing a WONDERFUL job so far. You are still living your life but is cautious, not too anal.

    If you feel, and think, that it would be best for all involved to stay on your meds for anxiety, then done. Do it. Put that worry to bed. Off the "things I need to worry about" list. If you think there is a correlation with your fertility meds and your ovaries, then perhaps ween yourself off of it. Another worry to bed.

    If you want to watch RHOC and eat Olin's Donuts then do it (call me first). If you want to go to the gym or go for a walk on the Charles cause it makes you feel refreshed and healthy, then do it (call me first).

    I'm a supporter of the "liability" issues that many people have posted here too. Unfortunately.

    Let me point this out to you: you RAVE about your primary care Dr. Love how he calls you after hours, etc. There is your litmis test. You know the answer to your own question regarding the OB.

    Also, worrying about your worrying, and worrying about your crying is a vicious cycle. Chalk the crying with the doc up to hormones and frustration with her and find another doc.


    1. Well done, SMoon! I read this blog post right after it was written, and have take this long to craft a response. You took the words right out of my mouth!

      HRF - you're doing a GREAT job! Exercising every day sounds RIDICULOUS to me. But...if it makes you happy, do it. In the end, SMoon is right - women have babies EVERY DAY, and some of them are HORRIBLE to their bodies. Additionally, women have been having babies for CENTURIES without the help of Dr. Google. When I was pregnant, my mom pointed out that women of our generation know WAY too much information. She's right. Eat what you want, exercise the amount you feel comfortable with, and sleep. Everything is going to be fine. Unfortunately, because EVERY woman is different, and EVERY pregnancy is different, your OB can't give you concrete answers (SUCKS). (Though, I'd do whatever the specialists say about the medication issues - you WANT people who know the details to provide the medical guidance here.) I wanted hard a fast rules when I was pregnant (I love them as much as you do). My 2nd favorite OB in the practice laughed at me, and told me to wear my seat belt. He said women come in to his office every day and say they're not eating brie (which you can - it's hard to find unpasteurized cheese in this country), have sworn off caffeine (you can have a little), and exercise daily. Then, they get in the car and drive away without their seat belts on. His advice: WEAR YOUR SEAT BELT. And eat whatever you want.

      My final thought: Without question, and with minimal exceptions (heroin), STRESS is the worst thing for a pregnancy. Do WHATEVER makes you happy and calm. Yoga, doughnuts, laying on the couch, long walks on the beach.

      P.S. I would like to be invited on the doughnut run.

  19. OMG, your breakdown sounds totally warranted. Your OB sounds dippy; she needs to give her opinion on something, anything.

    As for the anxiety meds, my psychiatrist firmly believes that what is best for mom is best for baby (with exceptions, I'm sure). I'm sure you're totally fine since you've already gone to a specialized clinic.

    Take care, friend! Sending hugs your way.

  20. Vague answers are not OK. They are even worse for someone who is aware of and dealing with anxiety issues. I second the many people who ask if you are happy with this OB. I can only speak from personal experience here.. But this is my quick story- I gained 60 lbs with my first pregnancy. All my doctors did was scold and embarass me. "Um, are you eating ice cream every single night." It was awful. It got to the point where I wouldn't even look at the scale at my appointments. I was never given any concrete advice, suggestions or direction. Just made to feel like an awful mother-to-be. Then I switched groups with this pregnancy and quickly shared my fears of weight gain. I was given a three step plan. To include getting my glucose tested several times, a referral to a nutritionist in my 2nd tri IF the doctor got concerned over weight gain and three the evaluation that sometimes hormones throw our bodies out of wack and a large weight gain happens. My point in this little story is that in the first instance I felt horrible and in the second I felt heard and validated. This has been so important to me. Is there anyone else in the group you can see? Take care, don't be too hard on yourself and know that the fact that you even care about exercise, medications and nutrition means that you are already doing an excellent job.

  21. Doctors can be very annoying in that they don't want to give a straight answer in case they are wrong. What they don't realize, sometimes, is that they can preface and end their answers with "this is my opinion, and it may work out differently for you as an individual" and that will take care of it. Patients want answers and suggestions and guidance. Sometimes it is worth asking the nurse, and telling her that you are just looking for a starting place. Nurses are at times better at advice-giving than doctors.

    I've struggled with taking my Paxil since I started TTC'ing. I will start to wean, feel like crap, and go back to the full dose again. At this point I think it will be better to just stay on it, but I always start to wonder if that's the best thing for the baby when I'm in my 2ww. Hmmm.

    Thanks for sharing!!!

  22. Happy Anniversary! I think your breakdown was totally needed. You have a lot of stuff going on and to think about. The thing with antidepressants is so difficult. Sometimes I wish I had stayed on them but I had weaned off them preparing to get pregnant soon. My Dr said it was up to me. He had no problem with me staying on them while pregnant. Sometimes I'm like you and I just want to be told what the best thin is to do. When big choices are on our shoulders it can be so overwhelming. Hang in there hon. Whatever choices you make will be the best ones for you and your nugget. Hugz!

  23. I'm wondering how I found my way to your post, but glad to be here.

    I would show up to every OB appt with a list of questions and always got very detailed answers, some based in opinion, sometimes referencing research, and sometimes presenting conflicting evidence - detailed answers that helped me make my own decisions. My OB spent at least an hour with us at each appt. Same thing when I switched to a midwife - each appt was at least an hour and they never hesitated to share their thoughts and answer my many questions. I really needed their information so that I could make decisions.

    As far as nutrition, I gained a TON of weight during my pregnancy. I kept track of my diet using the LoseIt ap on my phone. I was able to print charts and summaries to bring to my appts and review my diet. I made it a goal to get at least 100 grams of protein everyday. Lucky for me my sweet tooth disappeared with my bfp, which made it easier to eat well.

    And finally, I can relate to the struggle about anxiety/depression meds during pregnancy and postpartum. I went on meds following a particularly difficult period of our journey. Our RE advised that I stop taking them during our ivf, but I didn't. When we got te bfp I slowly weaned off, but then my OB and GP both urged me to go back on them. They were very worried about ppd. My dh and I did some thinking and talking and decided to stay on them. It is most certainly not an easy decision to make, and not one that any dr can make for you. Now that my baby is 6 months old, I can say that I am so grateful that I made the choice to continue taking meds... This has been a really hard adjustment for me. (which is beyond complicated to think that I could want something SO much, and still be struggling now that I have it.)

    Have you thought about hiring a doula? That could be a good way to get some additional support. Most doulas meet with you during pregnancy to help answer questions and make decisions. I've only read this one post, so maybe you've already considered that, but I had to put it out there. We were so grateful for our doula.

    Good luck SIsta! and CONGRATULATIONS on your miracle babe!


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