High Risk Appointment Details

For those of you who sent me text messages asking how my appointment went, thank you.  And I’m sorry I didn’t respond.  This felt too long to type out in a text.  Overall though, the appointment was frustrating and disappointing.

First, some details about two providers at the University…

  1. Dr. Greiner – A female high-risk OB specialist known to be ‘by the book’ and rather conservative with treatment options.  She places very few cerclages and prefers to watch patients closely.
  2. Dr. Hunter – A male high-risk OB specialist, head of the high-risk OB department.  He’s known to be more aggressive with treatment and places many cerclages with good outcomes.

During my regular OB appointment last Thursday my doctor called the high risk team for a consult (while I was sitting in the exam room FOREVER) and just happen to get Dr. Greiner, who basically said, send the patient to us and we’ll follow-up.  Knowing the above details about two providers at the University my OB specifically referred me to Dr. Hunter instead, as it was her wish for a cerclage to be placed as soon as possible, preferably before I’m 17 weeks, which is this Friday.

So Mondays appointment.  I check-in and the receptionist tells me Dr. Hunter is sick and Dr. Greiner is seeing his clinic patients.  Great.

My ultrasound was first and my cervix measured 2.57 cm compared to 2.1 cm last Thursday.  Not surprising the ultrasound tech told me, as baby was head down last Thursday and breach Monday.  Apparently the head puts a lot of pressure on the cervix, which is a muscle which can change in length from minute to minute.  Usually during my ultrasounds they take several measurements, all different, over the course of maybe ten minutes.

So next, my visit with Dr. Greiner, who I hated from the first minute she walked into my exam room.  She was overly bubbly, acted like she was all that.  I hate that in people, especially doctors.  She said a lot, and I wish I had just recorded the conversation…  I felt like her and I were arguing, it was a strange interaction…  I’ll try to high-light the major points, hopefully I’m not missing anything.

  • In her high-risk world they consider a cervix over 2.5 cm in length to be normal.  Which was odd to me as I’m told it’s supposed to be closer to 5 cm by my regular OB…
  • Nothing they do will guarantee a full-term delivery for, and from my history she truly doubts I’ll get to full term, with or without intervention.
  • Since my cervix measured over 2.5 cm, I’m not a candidate for a cerclage.  She basically ended that conversation there, even though I had lots of questions about the procedure itself, recovery, and what happens after.
  • Makena injections are best for women who have already had a pre-term delivery, while progesterone suppositories are best for women with a short cervix.  Since I fall into both categories, it’s a toss-up which I want to use, she’ll leave that up to my regular OB.  Overall though, she did not speak highly of Makena.
  • The plan for now is to monitor my cervix with weekly ultrasounds, with her high-risk team, and once it gets to 2 cm or less we will talk cerclage.

Most of my arguing with her was my fear of basically waiting until my situation gets worse, until something bad happens, to actually take any precautions.  Plus, I know there is a window where cerclages can be placed, and I think I’m getting to the end of it.  Also, she said it’s easier to place a cerclage the longer the cervix is, which makes me wonder again why we are waiting for it to shorten.  Dr. Greiner just kept repeating all the risks to the procedure…  Which I do understand, but at this point I feel like it’s a better option that having another baby really early.  I’m not sure if Dr. Greiner doesn’t believe my cervix is going to keep shortening, or if she just really does stick by the book of research studies.

I did email my regular OB regarding my visit, I’m anxious to see her response, hopefully she emails me back today.  I also need to call Makena as I need another injection Thursday and I’m still not sure if my insurance will pay, or if Makena will allow the injections to be given at home.  I really don’t want to drive to Iowa City twice each week, once for an injection, and once for an ultrasound.

In the meantime, I wait, feeling like a ticking time bomb.

19 thoughts on “High Risk Appointment Details

  1. Ugh, that Doctor sounds miserable. I’m so so sorry. Stick to your gut instinct though… I would bombard my OB and high risk doctor until they ultimately did what I was comfortable with. After all, you are the patient, you are paying for these treatments, you have a history of a weak cervix, so if you want a cerclage this time, you should have it. Praying for you and the that the doctors make the right decisions in your care. Xoxo!

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  2. Also I thought when I had my short cervix issue with Bella, they said normal was over 3. Not sure about 5. I lasted 12 weeks with a cervix less than 1 cm but I’m dumbfounded by her “plan”.

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  3. It all sounds very frustrating. I had a shortened cervix in my third trimester. I was told they want to see 3+cm until about 32-34 weeks when some shortening (2-2.5) is ok. Given you’re still in the second trimester I wouldn’t be comfortable with 2.5. Hope you can sort things out with your OB

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  4. Doesn’t good bedside manner seem like a no brainer?! Honestly why did you have to feel as if you were arguing the entire time you were there? Geez, I’m so frustrated for you. Given your history….answering all your questions and reassuring you before you walk out her door would be considered a priority!

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  5. I’m so sorry Stef. I personally wouldn’t wait and would call for the second opinion. You know your body, you have done this, demand the best treatment for you. Be proactive and take every precaution possible that you want. You and your baby deserve the best care and you deserve piece of mind.

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  6. Thinking of you. WOW! Could you email the other doctor for the second opinion. Maybe he would have something different to say (or maybe he would not go against what the other high risk OB said..) Keep pushing to get what you need. You have been through so much already.

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