Robyn.Bowles.es

I’ve been wanting to write about this topic ever since my first OB visit in January, so I have a bit to catch up on, but first I’d like to report that Isabela and I are doing well. She’s moving a lot and seems to get quite excited when I eat chocolate . . .

The first doctor I saw, Dr. B-M, had been recommended by an OB/Gyn colleague of a General Practitioner friend of mine, so we went into it hopeful, but within moments felt the wave of disappointment. Although he shook our hands as we entered, he barely looked me in the eye after that as he proceeded to fill out his paperwork. I had brought all the medical records from my previous pregnancy and he gave them no more than a quick glance as they sat in a pile in front of him. He asked no relevant questions about how I was feeling or any problems I was having and asked only if I was taking a vitamin with iodine.

He then directed me to follow the nurse aide into the next room to prepare for the pelvic exam and ultrasound. While I was getting ready Samuel took the opportunity to tell him that we had had a very difficult experience 3 years ago and although we hoped to be able to, found it difficult to trust medical providers in Spain. He also went on to tell him about my professional experience and knowledge.

The exam was quick and without any explanation, then on to the ultrasound – always an exciting moment for the parents to see the outline of their baby, watch him/her move and hear the heartbeat for the first time. Seeing our little baby was exciting for us, but we could tell in his tone of voice that Dr. B-M performed the scan and pointed out the body parts with all the excitement of reading the ingredients on a cereal box. Apparently the joy and wonder of pregnancy has been lost on him after about 30 years of practice.

We were once again seated at his desk to get instructions for follow-up. Samuel asked about having a doula present during birth, Dr. B-M had never heard of such a concept, but didn’t seem to think it would be a problem. I also told him of my desire to limit the number of ultrasounds – preferring just one more at 20 weeks (as long as I didn’t have complications). He dismissed this idea immediately and went on to schedule me for a 12 week scan to measure the nuchal fold, stating its importance in diagnosing Down Syndrome (which it does not, it merely screens for signs of increased risk. We later canceled the appointment.). He stated that maybe I wouldn’t need one at 24 weeks, but that it would be important at every other visit to measure growth and determine if I had preeclampsia. Wrong again: baby’s growth pattern does not diagnose preeclampsia, blood pressure readings, urine and blood tests diagnose preeclampsia.

As we walked out of his office, Samuel and I both said, “no, we won’t be coming back.”

So on to the next one. We scheduled a visit with Dr. B-V, the doctor of our friend, Heather. He had come highly recommended by Heather and Jonah and so went in with renewed hope.

This time I was much more prepared, and Jonah had told us that he had “pre-warned” Dr. B-V about us, too (Heather is seeing him for her current pregnancy). I decided to prepare a detailed medical history in Spanish ahead of time for him so he wouldn’t have to waste time filling out the questionnaire. I also had a list of questions and concerns to go over with him.

Our encounter with him was much more positive. He was much younger – 30s maybe – and provided lots of direct eye contact. He responded similarly to Dr. B-M when I mentioned my desire to limit ultrasounds, but also added that he wasn’t going to “make me” do anything, that it was always my choice. I asked about using a hand-held doppler to listen to the heartbeat that day (I was 14 weeks), and to use a measuring tape to make external measurements. He told me that the dopplers didn’t work or weren’t accurate until about 20 weeks (I reviewed in my mind the hundreds of women on whom I had used an external doppler to successfully and accurately measure the heartbeat of their babies, even as early as 9+ weeks! He also went on to say that he could not accurately measure the growth of the baby without the use of ultrasound – again in contrast to my 6 years working with the Family Practice docs who always externally measured the growth of the baby and used ultrasound only as back-up when medically necessary.

In the end, we did opt for a “quick” scan to hear the heartbeat and catch a little movement of the baby. Being 14 weeks, I really had no physical signs that I was pregnant, and appreciated the reassurance. The scan lasted about a minute or less.

We had a much better feeling with Dr. B-V and agreed that we would continue to follow him. It was a difficult visit, however, as it was the first time that someone advised me about the risks and realities of facing preeclampsia or HELLP Syndrome again.

It certainly wasn’t new information to me – I’ve done LOTS of reading about it! – but something about being told face to face about my risk and the worst case scenarios (“If it happens early, like 24 weeks, we’ll be playing with two lives and will have difficult decisions to make.”) was startling and and made it all too real. He told us that if complications were to develop before 37 weeks, I’d have to deliver at a public hospital – the only ones in Sevilla that have neonatal units – so that baby and I wouldn’t have to be in separate hospitals. He encouraged us to get to know an OB/Gyn in the public system, too – just in case.

The next few days I felt very discouraged, then got busy filling my time with other things so I didn’t have time to think about it. We just keep hoping and praying that there will be no complications! (My blood pressure now is routinely about 100/60 – very low, actually!

We’ve had one more doctor visit, with yet another doctor – a colleague of Dr. B-V – who is trained in performing high-resolution, doppler ultrasounds. We saw him at 20 weeks exclusively for this scan. He was very kind, and even spoke some English, pointing out our little girl’s body parts and naming them in English for Josiah. It was a relief to encounter another “nice one,” and I later learned he is the doctor of my Swiss friend who moved here recently toward the end of her pregnancy. She really liked him, too.

Although within the private system, most women see a doctor for their routine care, midwives are more-often the care givers in the public system and are usually only encountered in preparation classes in the private system.

Through El Parto Es Nuestro I had learned about a couple of midwives who work independently and prepare for and promote natural labor. Samuel shared my interest in meeting them so last week we did. . .

We have an appointment with one of them tonight, so I’ll share about that experience in another blog, soon.

Thanks for reading!

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