What to know before TTC

l9i · January 2015

So my previous post about going to the doctor (white coat syndrome) and the other posts about pregnancy have got me thinking....

So I planned to ask at my appointment (annual) about what I need to do to prepare for TTC. We are not thinking soon but maybe toward the end of the year we'd start trying. Either way, I'd like to know any needed info before just to be prepared.

So 1. They rescheduled me with someone else bc the person I saw before was out for a family emergency. 2. I ask the new person what I'd have to do/need to know and all I got was take prenatals and why. I thought there should be more than that and I got "don't rush, my H and I were married 3 years before kids." Not really her place to care. "My advice is don't worry about it and then you'll wake up pregnant". So yeah.... I'm not impressed and will be returning to my other doctor at my next visit for sure.

So what do you wise ladies say? I know we've got some expecting knotties that hopefully can tell me if I'm (the doc) is missing something.

LadyMillil · January 2015

My doctor recommended I start taking folic acid and a multivitamin. The clinic I go to doesn't do pregnancy so she gave me the contact information for the closest OB office.

I have paps on alternating years and last visit was supposed to be a "no pap" but she did it so I can hopefully avoid having one while pregnant. She verified that all of my vaccinations are up to date, but you should confirm this. I also had blood tests to check for immunity to Rubella, chicken pox and I think hepatitis B. I didn't need boosters, but if your antibody levels are too low you may require boosters. She did additional blood and urine tests to check kidney and liver function, thyroid, blood sugar and iron levels. I found out I'm severely iron deficient so she started me on a supplement.

If there are heritable genetic diseases in your families, such as cystic fibrosis, then it might be a good idea to see a genetic counsellor to see if either rid you are carriers.

l9i · January 2015

LadyMillil said:

My doctor recommended I start taking folic acid and a multivitamin. The clinic I go to doesn't do pregnancy so she gave me the contact information for the closest OB office.

I have paps on alternating years and last visit was supposed to be a "no pap" but she did it so I can hopefully avoid having one while pregnant. She verified that all of my vaccinations are up to date, but you should confirm this. I also had blood tests to check for immunity to Rubella, chicken pox and I think hepatitis B. I didn't need boosters, but if your antibody levels are too low you may require boosters. She did additional blood and urine tests to check kidney and liver function, thyroid, blood sugar and iron levels. I found out I'm severely iron deficient so she started me on a supplement.

If there are heritable genetic diseases in your families, such as cystic fibrosis, then it might be a good idea to see a genetic counsellor to see if either rid you are carriers.

This. All my shots should be up to date. But, like I said I feel like there was a lot missing from that coversation other than the "meh, just have sex and you'll get pregnant" attitude. As for genetic diseases there isn't anything of the nature I'd feel the need to test for.

Is this something I should be going to talk to someone more when I'm serious about TTC?

sarahufl · January 2015

Wow, bad doctor.

I loooooove my doctor. I started seeing her years ago, when I was single and in no way planning for a baby. We sat in her office for 20 min talking about my family history. We have lots of blood issues (cancers, clotting, strokes, etc) and she said I should get a full blood panel before I even think about it. She also said no hormonal BC (which I was off as it was).

The last time I saw her (regular, annual appt) she asked me for an update on my relationship. I said we had gotten married and were going to TTC soon. So she said take pre-natals and did a few tests- blood type, immunization panels, etc. because she said a lot of people don't know that info (I didn't) and it is good to know before getting KU.

She is incredibly thoughtful in her approach, which I found really helpful.

theartistformerlyknownas · January 2015

Even if your shots are "up to date," with some of them they don't truly know how soon you need a booster, so it's a good idea to check your immunity levels beforehand. We also did screening for the cystic fibrosis carrier gene (something I wanted, and thankfully something my OB/GYN feels strongly about as well). She gave some "mom advice," and the whole "don't stress out if it doesn't happen right away, since it's not considered possible infertility until 12 months of active trying, which is defined as (blablabla), but I know you're anxious so if it's longer than 6, call me and we'll talk about options."

As with EVERY line of medicine, there are often lots of opinions and lots of "right" ways to do things. If you don't feel comfortable with the way your questions were answered, you could always try another doctor. Even if you're asking crazy questions, it's important to feel comfortable asking them and trust when they say "I understand what could make you feel that way, but here's some science to put your mind at ease."

southernbelle0915 · January 2015

Mine said to start taking prenatals, which I did.

There's also a clotting disorder that runs in my family so we talked about that. She has my whole medical record, so we went over some other family history and personal medical history.

Then I asked about social factors - like exercise, clean eating, drinking, etc. She advised me on those.

I had my own goals, too. I started getting my body ready for pregnancy during late summer because I figured we'd TTC soon. So I was exercising a lot, eating really healthy, limiting drinking..

When we started TTC, I stopped drinking all together. If there was a chance we'd conceived, I wasn't about to risk it, so I stopped drinking during my fertile time and didn't drink until I knew whether I was actually pregnant. I don't think that's a very common approach though. People who knew we were TTC rolled their eyes, but I don't regret it. I ended up being pregnant and I have zero worries or guilt, so it feels good.

LadyMillil · January 2015

l9i said:

LadyMillil said:

My doctor recommended I start taking folic acid and a multivitamin. The clinic I go to doesn't do pregnancy so she gave me the contact information for the closest OB office.

I have paps on alternating years and last visit was supposed to be a "no pap" but she did it so I can hopefully avoid having one while pregnant. She verified that all of my vaccinations are up to date, but you should confirm this. I also had blood tests to check for immunity to Rubella, chicken pox and I think hepatitis B. I didn't need boosters, but if your antibody levels are too low you may require boosters. She did additional blood and urine tests to check kidney and liver function, thyroid, blood sugar and iron levels. I found out I'm severely iron deficient so she started me on a supplement.

If there are heritable genetic diseases in your families, such as cystic fibrosis, then it might be a good idea to see a genetic counsellor to see if either rid you are carriers.

This. All my shots should be up to date. But, like I said I feel like there was a lot missing from that coversation other than the "meh, just have sex and you'll get pregnant" attitude. As for genetic diseases there isn't anything of the nature I'd feel the need to test for.
Is this something I should be going to talk to someone more when I'm serious about TTC?

I looked into this. Most genetic counsellors won't see you unless you have a family history of a condition or are already pregnant and have an abnormal ultrasound.

southernbelle0915 · January 2015

LadyMillil said:

l9i said:

LadyMillil said:

My doctor recommended I start taking folic acid and a multivitamin. The clinic I go to doesn't do pregnancy so she gave me the contact information for the closest OB office.

I have paps on alternating years and last visit was supposed to be a "no pap" but she did it so I can hopefully avoid having one while pregnant. She verified that all of my vaccinations are up to date, but you should confirm this. I also had blood tests to check for immunity to Rubella, chicken pox and I think hepatitis B. I didn't need boosters, but if your antibody levels are too low you may require boosters. She did additional blood and urine tests to check kidney and liver function, thyroid, blood sugar and iron levels. I found out I'm severely iron deficient so she started me on a supplement.

If there are heritable genetic diseases in your families, such as cystic fibrosis, then it might be a good idea to see a genetic counsellor to see if either rid you are carriers.

This. All my shots should be up to date. But, like I said I feel like there was a lot missing from that coversation other than the "meh, just have sex and you'll get pregnant" attitude. As for genetic diseases there isn't anything of the nature I'd feel the need to test for.
Is this something I should be going to talk to someone more when I'm serious about TTC?

I looked into this. Most genetic counsellors won't see you unless you have a family history of a condition or are already pregnant and have an abnormal ultrasound.

This.

My OB asked me whether I wanted certain genetic tests. H and I had talked about it and decided yes, so I told her. She said they were going to take my blood now (I'm already pregnant) to test for 3 common disorders. Then they'll do the downs test at 11 weeks and the neural tubes test at 15 weeks. THEN I'd talk to a genetic counselor if stuff came back positive.

theartistformerlyknownas · January 2015

My doc offers all her patients to get screened for CF before TTC, and works with a lab where if your insurance doesn't cover it (mine didn't) they only bill $25.

The other things though, will be screened for later, just so we know what to expect. If we'd tested positive for the CF gene we could have chosen to risk it, or explore other routes.

l9i · January 2015

lolo883 said:

Even if your shots are "up to date," with some of them they don't truly know how soon you need a booster, so it's a good idea to check your immunity levels beforehand. We also did screening for the cystic fibrosis carrier gene (something I wanted, and thankfully something my OB/GYN feels strongly about as well). She gave some "mom advice," and the whole "don't stress out if it doesn't happen right away, since it's not considered possible infertility until 12 months of active trying, which is defined as (blablabla), but I know you're anxious so if it's longer than 6, call me and we'll talk about options."

As with EVERY line of medicine, there are often lots of opinions and lots of "right" ways to do things. If you don't feel comfortable with the way your questions were answered, you could always try another doctor. Even if you're asking crazy questions, it's important to feel comfortable asking them and trust when they say "I understand what could make you feel that way, but here's some science to put your mind at ease."

I don't feel comfortable with the way she handled my question and from the general look of it there should of been more than a "meh" attitude about it. The other doc I had seen the last few times is much better. I'm just now thinking when we are really thinking to start TTC I should go see her again just to clarify any of these things.

sarahufl · January 2015

l9i said:

lolo883 said:

Even if your shots are "up to date," with some of them they don't truly know how soon you need a booster, so it's a good idea to check your immunity levels beforehand. We also did screening for the cystic fibrosis carrier gene (something I wanted, and thankfully something my OB/GYN feels strongly about as well). She gave some "mom advice," and the whole "don't stress out if it doesn't happen right away, since it's not considered possible infertility until 12 months of active trying, which is defined as (blablabla), but I know you're anxious so if it's longer than 6, call me and we'll talk about options."

As with EVERY line of medicine, there are often lots of opinions and lots of "right" ways to do things. If you don't feel comfortable with the way your questions were answered, you could always try another doctor. Even if you're asking crazy questions, it's important to feel comfortable asking them and trust when they say "I understand what could make you feel that way, but here's some science to put your mind at ease."

I don't feel comfortable with the way she handled my question and from the general look of it there should of been more than a "meh" attitude about it. The other doc I had seen the last few times is much better. I'm just now thinking when we are really thinking to start TTC I should go see her again just to clarify any of these things.

I see this as the big problem. Let's face it- your OB is someone you want to be incredibly comfortable with and really trust. If you don't like her attitude, she may be a fine doctor, but you shouldn't keep seeing her. Good for you.

l9i · January 2015

sarahufl said:

l9i said:

lolo883 said:

Even if your shots are "up to date," with some of them they don't truly know how soon you need a booster, so it's a good idea to check your immunity levels beforehand. We also did screening for the cystic fibrosis carrier gene (something I wanted, and thankfully something my OB/GYN feels strongly about as well). She gave some "mom advice," and the whole "don't stress out if it doesn't happen right away, since it's not considered possible infertility until 12 months of active trying, which is defined as (blablabla), but I know you're anxious so if it's longer than 6, call me and we'll talk about options."

As with EVERY line of medicine, there are often lots of opinions and lots of "right" ways to do things. If you don't feel comfortable with the way your questions were answered, you could always try another doctor. Even if you're asking crazy questions, it's important to feel comfortable asking them and trust when they say "I understand what could make you feel that way, but here's some science to put your mind at ease."

I don't feel comfortable with the way she handled my question and from the general look of it there should of been more than a "meh" attitude about it. The other doc I had seen the last few times is much better. I'm just now thinking when we are really thinking to start TTC I should go see her again just to clarify any of these things.

I see this as the big problem. Let's face it- your OB is someone you want to be incredibly comfortable with and really trust. If you don't like her attitude, she may be a fine doctor, but you shouldn't keep seeing her. Good for you.

I agree. And I liked the previous doctor. And when I say previous I should say regular. I've only seen her twice since switching to the practice. So while I haven't seen her much (just annuals) I really like her and want her as my regular for when I am expecting. My appointment got changed the day before bc my previous doctor had a family emergency. So it was see someone else at the same time or push my appointment out another month or so. I needed a refill on BC so I thought I'd just keep it the same time.

I will for sure make sure I don't have this new doc again. All docs are not created equal. I found that out in doctor situations (love my general doctor and the practice but have seen other doctors if I really need to get in and mine is too full. They don't compare at all) so this is no different.

banana468 · January 2015

Be careful with an OB practice though. I loved almost all the doctors in my practice but the way it works for them when you're pregnant is that you see them in a rotating way because there's no way to know who will be on duty/on call when you deliver. If there are any physicians you can't stand it may be time to find a new practice.

theartistformerlyknownas · January 2015

banana468 said:

Be careful with an OB practice though. I loved almost all the doctors in my practice but the way it works for them when you're pregnant is that you see them in a rotating way because there's no way to know who will be on duty/on call when you deliver. If there are any physicians you can't stand it may be time to find a new practice.

Yup my sister ended up having the one she really didn't care for end up delivering her baby. If it's only a moderate level of discomfort but you know you'll be able to get all your big concerns addressed by your primary, that's one thing. But if it's "I don't want this fool coming near me," that's a problem.

l9i · January 2015

lolo883 said:

banana468 said:

Be careful with an OB practice though. I loved almost all the doctors in my practice but the way it works for them when you're pregnant is that you see them in a rotating way because there's no way to know who will be on duty/on call when you deliver. If there are any physicians you can't stand it may be time to find a new practice.

Yup my sister ended up having the one she really didn't care for end up delivering her baby. If it's only a moderate level of discomfort but you know you'll be able to get all your big concerns addressed by your primary, that's one thing. But if it's "I don't want this fool coming near me," that's a problem.

Good to note ladies. That is also something to check into then - thanks!

WhatawagSBNy · January 2015

Planned parenthood and some other organizations give better advice than many OB's and primary docs. In part I think because they often assume that the people coming in do not have the resources to keep coming back over and over to be spoonfed little bits of knowledge . Whereas many private practices generate income with multiple visits only necessary because they did not tell you the first time. My cynical attitude from years of nursing.

But although most people associate Planned Parenthood with preventing pregnancy, they actually are one of the best at telling you how to go into a pregnancy in the best health possible. Their pamphlets are good too. I am assuming any website would be also.

jenna8984 · January 2015

banana468 said:

Be careful with an OB practice though. I loved almost all the doctors in my practice but the way it works for them when you're pregnant is that you see them in a rotating way because there's no way to know who will be on duty/on call when you deliver. If there are any physicians you can't stand it may be time to find a new practice.

I guess this a really stupid question so I apologize in advance. Don't you just show up to a hospital and they admit you and who ever is there delivers the baby? All of my friends who have kids made it seem like they just went on their merry way to our local hospital.

WhatawagSBNy · January 2015

Hahaha Ha Ha

WhatawagSBNy · January 2015

This is the reason I gave birth at home a week ago. My OB Gyn lives 3 houses from me, and the hospital 20 miles away would have to call her after I arrived, and even if you call before leaving home to warn them , they won't call your Dr until you arrive, because there are so many false alarms. , and the only Dr. on duty my be the one in the ER.

IF you want your own doctor they have to be called in.

southernbelle0915 · January 2015

jenna8984 said:
I guess this a really stupid question so I apologize in advance. Don't you just show up to a hospital and they admit you and who ever is there delivers the baby? All of my friends who have kids made it seem like they just went on their merry way to our local hospital.

I don't think that's a stupid question.

At my office, I call the office and tell them I'm in labor. If it's closed, I connect to the answering service and tell them to page the on-call physician.

theartistformerlyknownas · January 2015

jenna8984 said:

banana468 said:

Be careful with an OB practice though. I loved almost all the doctors in my practice but the way it works for them when you're pregnant is that you see them in a rotating way because there's no way to know who will be on duty/on call when you deliver. If there are any physicians you can't stand it may be time to find a new practice.

I guess this a really stupid question so I apologize in advance. Don't you just show up to a hospital and they admit you and who ever is there delivers the baby? All of my friends who have kids made it seem like they just went on their merry way to our local hospital.

There will be an OB on call whenever you go into the hospital. If you don't call them, the hospital will. That on call person will vary, which is why you have to meet with all the possibilities beforehand. Unless you're like out of town at another hospital, then you get whoever's there.

LadyMillil · January 2015

lolo883 said:

jenna8984 said:

banana468 said:

Be careful with an OB practice though. I loved almost all the doctors in my practice but the way it works for them when you're pregnant is that you see them in a rotating way because there's no way to know who will be on duty/on call when you deliver. If there are any physicians you can't stand it may be time to find a new practice.

I guess this a really stupid question so I apologize in advance. Don't you just show up to a hospital and they admit you and who ever is there delivers the baby? All of my friends who have kids made it seem like they just went on their merry way to our local hospital.

There will be an OB on call whenever you go into the hospital. If you don't call them, the hospital will. That on call person will vary, which is why you have to meet with all the possibilities beforehand. Unless you're like out of town at another hospital, then you get whoever's there.

This. Based on recommendations from friends I'm hoping to use a midwife. The midwifery practice has 4 midwives. During pregnancy I will see all 4 of them at different visits. Whoever is on call when I go into labour will deliver the baby.

jenna8984 · January 2015

lolo883 said:

jenna8984 said:

banana468 said:

Be careful with an OB practice though. I loved almost all the doctors in my practice but the way it works for them when you're pregnant is that you see them in a rotating way because there's no way to know who will be on duty/on call when you deliver. If there are any physicians you can't stand it may be time to find a new practice.

I guess this a really stupid question so I apologize in advance. Don't you just show up to a hospital and they admit you and who ever is there delivers the baby? All of my friends who have kids made it seem like they just went on their merry way to our local hospital.

There will be an OB on call whenever you go into the hospital. If you don't call them, the hospital will. That on call person will vary, which is why you have to meet with all the possibilities beforehand. Unless you're like out of town at another hospital, then you get whoever's there.

Sorry, I must be dense because I'm still confused. My OB where I get annual exams is not in a hospital, she's in a 2 toom clinic that doesn't deliver babies.

I thought you went in like twice during the entire pregnancy to basically get testing and ultrasounds done by technicians. At what point do you just go there (hospital) 5 different times to meet all the actual delivering physicians?

theartistformerlyknownas · January 2015

jenna8984 said:
Sorry, I must be dense because I'm still confused. My OB where I get annual exams is not in a hospital, she's in a 2 toom clinic that doesn't deliver babies.
I thought you went in like twice during the entire pregnancy to basically get testing and ultrasounds done by technicians. At what point do you just go there (hospital) 5 different times to meet all the actual delivering physicians?

But they're affiliated with a hospital where they will go for deliveries.

And... no honey, at some point you'll need to go about every 2 weeks to have your cervix checked.

mrsdee15 · January 2015

jenna8984 said:

lolo883 said:

jenna8984 said:

banana468 said:

Be careful with an OB practice though. I loved almost all the doctors in my practice but the way it works for them when you're pregnant is that you see them in a rotating way because there's no way to know who will be on duty/on call when you deliver. If there are any physicians you can't stand it may be time to find a new practice.

I guess this a really stupid question so I apologize in advance. Don't you just show up to a hospital and they admit you and who ever is there delivers the baby? All of my friends who have kids made it seem like they just went on their merry way to our local hospital.

There will be an OB on call whenever you go into the hospital. If you don't call them, the hospital will. That on call person will vary, which is why you have to meet with all the possibilities beforehand. Unless you're like out of town at another hospital, then you get whoever's there.

Sorry, I must be dense because I'm still confused. My OB where I get annual exams is not in a hospital, she's in a 2 toom clinic that doesn't deliver babies.
I thought you went in like twice during the entire pregnancy to basically get testing and ultrasounds done by technicians. At what point do you just go there (hospital) 5 different times to meet all the actual delivering physicians?

I thought this too... I'm glad you asked.

theartistformerlyknownas · January 2015

Here you go @jenna8984 and @mrsdee15

http://www.webmd.com/baby/how-often-do-i-need-prenatal-visits

http://www.babycenter.com/0_what-to-expect-at-your-prenatal-visits_9252.bc

mrsdee15 · January 2015

lolo883 said:

Here you go @jenna8984 and @mrsdee15
http://www.webmd.com/baby/how-often-do-i-need-prenatal-visits
http://www.babycenter.com/0_what-to-expect-at-your-prenatal-visits_9252.bc

Thank you! I feel like no matter how much I read about fertility and pregnancy, there's still a ton out there I haven't even thought about.

l9i · January 2015

mrsdee15 said:

lolo883 said:

Here you go @jenna8984 and @mrsdee15
http://www.webmd.com/baby/how-often-do-i-need-prenatal-visits
http://www.babycenter.com/0_what-to-expect-at-your-prenatal-visits_9252.bc

Thank you! I feel like no matter how much I read about fertility and pregnancy, there's still a ton out there I haven't even thought about.

This. I feel so clueless

My friend is expecting right now and I'm hoping she'll give me the need to know after all is done. The good, the bad, and the ugly.

theartistformerlyknownas · January 2015

l9i said:

mrsdee15 said:

lolo883 said:

Here you go @jenna8984 and @mrsdee15
http://www.webmd.com/baby/how-often-do-i-need-prenatal-visits
http://www.babycenter.com/0_what-to-expect-at-your-prenatal-visits_9252.bc

Thank you! I feel like no matter how much I read about fertility and pregnancy, there's still a ton out there I haven't even thought about.

This. I feel so clueless My friend is expecting right now and I'm hoping she'll give me the need to know after all is done. The good, the bad, and the ugly.

3 of my 4 sisters and most of my friends have had kids already, so I've heard a lot.

southernbelle0915 · January 2015

jenna8984 said:
Sorry, I must be dense because I'm still confused. My OB where I get annual exams is not in a hospital, she's in a 2 toom clinic that doesn't deliver babies.
I thought you went in like twice during the entire pregnancy to basically get testing and ultrasounds done by technicians. At what point do you just go there (hospital) 5 different times to meet all the actual delivering physicians?

Just make sure you ask your doctor where they have admitting privileges/with which hospitals they're affiliated. Because if your OB is only affiliated with hospital A and you just drive yourself to hospital B, they probably can't deliver you and you'll get whatever doc is there.

If you don't have a doctor, but there's a hospital you like, just search for physicians who are affiliated with that hospital. You can find this out by going on your insurance's website and using the "Find a doctor" search.

banana468 · January 2015

PPs began to sum it up.

I think the visits are probably standard based on insurance and you go something like 1x/mo for the first 20 -30 weeks. Then you start to go 2x/week for about 5 or 6 weeks and then you're 1x a week until your due date and then it can be multiple times a week if you go later.

OR, you could be put in a higher maintenance category due to age or issues or concerns based on test results. When I had Chiquita (my first), my AFP levels were 2.5 times the mean. It meant I *could* have a baby with a higher risk of neural tube defects and as a result, I went in for non-stress tests 2x week and ultrasounds 1x week starting at 32 weeks. (note: a non-stress test is nothing like a stress test. You lay down and click a button for a non-stress test).

The practice was tied to a hospital and the staff rotated between hospital and their other 3 offices. I needed to see all 5 OBs throughout my pregnancy and because I went into labor naturally with #2, there was no choosing who delivered Chiquito. The policy was to call the after hours line if it wasn't during normal business hours (it was 2 AM on a Saturday that I made this call), they call the on call Dr. and he calls and assesses you over the phone. I labored at home and called the office again which called the Dr who called me back (yes, they feel this lovely chain is necessary) and then I said, "Dude, we're coming in because he's coming out!" He came into the hospital because he was on call and knew I'd be there and 2 hours later out came little man.

Had I labored for even 15 minutes longer, the Dr. who checked me in would not have been the Dr. who delivered the baby and a new physician would have been there. But every Dr. who came into my hospital room that weekend was one that I had previously seen through the practice.

This is why if you hate a dr in the practice, there's still a chance that he could be the one to deliver your baby. One good friend had a really unpleasant delivery with her 1st and she ultimately decided on home births for her next two kids because she did not want to deal with the hospital protocol or the asshattery from the way that he spoke to her.

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