Complications

My travel plans over the next eight weeks are insane. No, really. California to Massachusetts to New York (and possibly to Ohinidinois) to British Columbia to Oregon to British Columbia to Ohindinois to Vermont to Ohindinois. All brief stops except for British Columbia, where I will bunk in with grad students and try to write. I'll be 26-32 weeks for the exciting parts.

The good news from Dr. Pippi-Poisson: she's totally fine with the air travel.

The bad news: she wants visits every two weeks to start at like 28 weeks, and she's totally opposed to my self-monitoring during my adventures. Look, doc, I'll take Beaker's spare blood glucose monitor, you slip me a couple of pee sticks, and, with a tape measure and a drugstore blood pressure station, what can I not do that would happen at a 30-week checkup? Okay, no Doppler, but I trust the kicks at this point.

(Remember: I've given myself intramusclar shots in the butt, lady. Lots of them.)

So there's the hematocrit. Okay, we'll do some real bloodwork in two weeks, before I leave. She's really hung up on my doing an official 1-hour glucose tolerance test, so that'll happen early, too. (She even tried to convince me that the official sugar solution had, in essence, special powers of divination.)

Well, folks: do I try to find a doctor in Canada? (Is that even legal? Can they just see Americans? And God only know what my insurance would make of it.) Shall I branch out to a midwife for that one visit, just for kicks? Or do I go gonzo, fully aware that I should get myself to a hospital pronto if anything skeevy starts happening?

I'll see my midwest OB as soon as I can, once I'm back home. Promise.

Note: I think the real issue here is dealing with a generalist doctor, who mostly sees healthy people, people who aren't really expecting to take control of their care, ever. My husband spends several hours a day on self care, and I made it through major fertility treatment: I'm not your normal pregnant woman.

Beaker hit some of the same sorts of issues when he got sent to diabetes specialists. He and his CF specialist collaborate on decision making—the doc knows Beaker's done a good job of keeping himself going. The endocrinologists just didn't want to deal with his questions, many of which were based on his having collected more blood glucose data than they'd asked for, or his suggestions. When they failed to spot a major drug interaction for three months, then acted as if they'd warned him about it from the beginning, he gave up; his CF doctor prescribes the insulin cocktail these days.

Note: alas, work pressures for both of us have cut out the drive cross-country. We just don't have time. So the car will get Fed Ex'd back home, and we'll get more frequent-flyer miles.

Comments

[robin]

re: canada. I was sick in canada last summer, and seeing a doctor was easier than seeing one in the states. It was a generalist, so i dont know if seeing an ob will be much harder, but they were happy to make me appointments or direct me to the drop in hours, and while most of the administrative people were a little confused about the idea of money changing hands at a doctor's office, they never implied that i shouldnt be seen. Eventually one of the receptionists asked me for 40 dollars-canadian and found a form for me to fill in promising that if i sued it would be based in the province of saskatchewan. Then i was a regular patient.

Obviously, i cannot recommend what you should or shouldnt do, but i wouldnt worry about finding a doctor if you want to see one.

[Ancarett]

It would probably be pretty hard to find an OB on the fly when you're up there, although many GPs are experienced with monitoring pregnancies and you can always go to a walk-in clinic. There's also the provincial college of midwives: http://www.cmbc.bc.ca/ which has a listing of practicing midwives as of May 1.

[Justine]

Being a resident of British Columbia (and 28 weeks along), let me give you the scoop.

First, no one here at all sees an OB unless they are referred because of high-risk or some emergent issue. Maternity care in BC is provided by family physicians (GP's) who do maternity as a specific part of their practice (not all do). You should be able to see one (more on this below) - you'll just have to pay obviously, and of course, I'm not sure what your insurance company would say.

As for a midwife - you probably won't be able to convince one here to see you for a single or even two visits mid-pregnancy. First, they are all REALLY REALLY busy - you usually have to get yourself on as a midwifery client about 1 minute after your pregnancy test comes back positive. Second, the whole philosophy behind midwifery care is that you see the midwife throughout your pregnancy and for 6 weeks post-partum, and that they provide a holistic model of care - ie they can order medical tests, but they view their role as much greater than that, which is why midwife appointments are typically one hour each rather than the usual 15-25 minutes for a checkup with a physician. So, beyond the scheduling problem, one or two visits mid-pregnancy to a midwife for a checkup and possibly to order a glucose tolerance test (for which you have to go to a lab to actually get done) doesn't really fit into the whole midwifery approach to maternity care.

If you are going to be in Vancouver, you may want your OB to check with the maternity department at Womens and Childrens Hospital to get info about arranging any tests or checkups in advance - I think they might have a clinic, or could at least suggest one that you can go to, so that you aren't stuck searching around once you get there. Otherwise, you will have to go into a walk-in clinic that will see maternity patients over 24 weeks (not all will) or go to Emergency at one of the hospitals,(don't do this unless you have to - you will be in for a loooooong wait if it isn't a true emergency).

That said, if you have an emergency, it is NEVER a problem for anyone here to see a doctor. If you have to go to the hospital because you are having a problem, they will treat you like any other pregnant woman who needs immediate medical care. There are always OB's on call hospitals in Vancouver, Victoria, and any other larger centre so you don't need to worry about that part at all.

If you have any questions about this, and want to email me, I'd be happy to give you any info I can.