The role of my primary care physician (PCP)

With Littles -- 2006-2007
When I said that I chose the OB closest to my house... well, that wasn't entirely accurate. I actually chose the OBs who worked out of the same medical foundation as my primary care physician. (I had chosen my PCP years before because she was the doctor closest to my house :) It was a large office with doctors covering many different specialties. Littles' first pediatricians were out of the same group, as a matter of fact.

Due to the proximity, the OBs had a unique setup where patients who had a PCP in the same group alternated appointments between the OBs and the PCP, at least until the third trimester. So, I think I had three regular prenatal appointments with my PCP, at 12 weeks, 20 weeks, and 28 weeks, with OB appointments in between. I also saw her for an unscheduled appointment after a bad fall, when I wanted some reassurance that the baby was OK.

At the time, I appreciated that it was much easier to get appointments with my PCP, as compared with my OBs, and that PCP visits usually involved a lot less waiting time prior to seeing the doctor. I'm sure it was nice for the OBs too, as it allowed them to offload appointments that, frankly, do not demand the skills of a trained surgeon.

Looking back, I think it was also nice to have my PCP involved in that major transformation in my life. As it turns out, it didn't really matter, because we ended up moving twice in Littles' first year, so I never saw my PCP after that 28-week appointment. But had we stayed in the area, my PCP, not my OB, would have been responsible for my long-term health. (In that medical group, PCPs were responsible for all regular well-woman care. Aside from childbirth, I would have only seen my OB again if I had some sort of gynecological complication.) It just made sense for her to be involved in an event that changed me in so many ways, including ways that have had a direct impact on my long-term health.

With baby #2 and Noob -- 2009
After our move, one of our first priorities was finding a pediatrician for Littles. We got a recommendation for one, "Dr. C," who actually turned out to be a family practice doctor. By this time, my husband and I had both been without a PCP for over a year, so we figured we'd start seeing Dr. C as well.

By the time I got pregnant with baby #2, I had had a physical with Dr. C, and had met her a few other times at Littles' well-child checkups. Yet it never occurred to me to contact her during my miscarriage, even after I found out I couldn't talk to my midwives about it. I guess I just figured that pregnancy stuff was the exclusive realm of OBs and midwives. Same thing after I got pregnant with Noob.

She was aware of the miscarriage (the subject came up during one of my regular visits) and, of course, of my pregnancy with Noob (through Littles' well-child visits and because we eventually talked to her about adding Noob as a patient). But that was the extent of her involvement.

With Baby Q -- October-November 2011
As I mentioned previously, as soon as I found out I was pregnant, I knew I needed to get my progesterone tested, as I had done with Noob. My homebirth midwife was unable to do this testing, and I didn't particularly want to see a random OB just to get it done, so I tried Dr. C first.

At first, I considered this to be a disadvantage of choosing homebirth. I had to convince Dr. C's staffers (who surely don't deal with newly pregnant women that often and didn't seem to comprehend the importance and urgency of my request) to find a spot for me that week, in her always-jam-packed schedule. It sure was a lot easier with Noob, where all I had to do was call my midwife's office and I had an appointment for testing a few hours later.

But since I got that spot, the care I've received has been nothing short of exceptional.

For example, when we discovered that my progesterone levels were dangerously low, Dr. C immediately prescribed Prometrium (progesterone supplements), just as my previous midwives did during my pregnancy with Noob. Unfortunately, I soon discovered that Prometrium contains peanut oil. Noob is allergic to peanuts, so I've been peanut-free since his diagnosis earlier this year, because he is still nursing. Some doctors might have told me, "The kid is almost two years old. He doesn't need to breastfeed anymore. Deal with the peanut oil, or wean him." But Dr. C responded by giving me a prescription to a compounding pharmacy, who could make the medication without peanut oil. She is very supportive of extended nursing, and has a vested interest in seeing Noob stay healthy and happy -- because he's her patient, too!

It's funny. I started off thinking that having to involve Dr. C was a disadvantage of homebirth. Now, my thinking has flipped completely, and I consider it a wonderful advantage. She'll be Baby Q's doctor after the birth, and hopefully for many years to come -- so I love that she's been involved in his/her life practically from the start! And as with my PCP during my pregnancy with Littles, Dr. C is ultimately responsible for my own long-term health (she does my yearly physicals and well-woman care), so I'm glad she's been involved in this major event in my life.

When we found Dr. C, we weren't specifically looking for a family practice doctor, but now that I've experienced this model of care, I can't imagine ever going back to having separate doctors for us and the kids. I hope we'll all be with Dr. C for a long time, but if we ever do need to find a new practice, I'll definitely look for a family practice doctor again.

The nervous early weeks

With Littles -- October 2006
The early weeks weren't all that nervous. I was aware of how common miscarriage was, but just hoped for the best, and had no issues.

With baby #2 -- February 2009
My first appointment with the hospital-based midwives I had selected was scheduled for 8 weeks. But late one Friday night, when I was about five weeks along, a few hours after my husband and Littles left on a weekend trip, I started cramping and bleeding. I immediately called the midwives' office and was told that I could not speak with a midwife or with any of the OBs in the practice, because I was not "officially" a patient yet.

It was probably the worst experience I've ever had with the medical profession. I understood the liability concerns driving it, and I didn't blame the midwives themselves. But still, I was losing my baby, I was terrified, and I was completely alone.

With Noob -- May/June 2009
I did end up seeing one of the midwives the Monday after the miscarriage started, so after that, I was officially a patient.

I started having concerns about my progesterone levels -- along with the early miscarriage, I was charting my cycles and saw symptoms of low progesterone in my charts. So I talked to my midwife about it and she agreed to do some testing.

I was really happy that she took my concerns seriously. Many doctors won't agree to testing until a woman has had three miscarriages. I think that's ridiculous. After suffering through the heartbreak of one miscarriage, my goal was to not have two more.

As it happens, the cycle when we started testing was the cycle that I got pregnant with Noob. After receiving a positive pregnancy test at home, I requested beta HCG counts and another round of progesterone testing. My midwife complied, and prescribed progesterone supplements for me when my progesterone levels did indeed come back low. My HCG counts looked great, which was a huge reassurance.

Then I requested an early ultrasound (technically to date the pregnancy, but my midwife and I both knew it was more for reassurance) and an early first appointment. Again, my midwife happily complied.

That support helped make those early weeks a little less nervous.

With Baby Q -- October/November 2011
As soon as I found out I was pregnant, I started working on getting my progesterone levels tested again. Unfortunately, my homebirth midwife is unable to write lab orders for that testing or prescribe supplements to address low progesterone. So I had to go elsewhere.

At first, I was worried that I'd have to go back to my old midwives, or find a random OB to do the testing. I wasn't really looking forward to that, because I didn't want to get into the history of my previous births (specifically Noob's place of birth) or my plans for this one with someone who might not be supportive of homebirth.

Luckily, my primary care doctor was happy to order up the tests, and to prescribe supplements when my progesterone turned out to be low again. She is truly amazing -- she's family practice, so she sees our entire family, including the kids, and she has the most wonderful personality. She always makes me feel like I'm in good hands, and this was no exception. It is still very early and I'm still very nervous about everything, but as with Noob's pregnancy, having great support helps tremendously.