Mom’s Intuition V.s Diagnosis

 

Mom’s Intuition vs. Diagnosis

What to do when your intuition says one thing and baby’s doc says another.

 

Good question — and one that many moms have experience with. When Jodi Schulz, attorney and mommy blogger (jodifur.blogspot.com) brought her three-year-old to the ER with a fever and a rash, she was sure the doc was joking when he announced that he was admitting the toddler. “Michael was running around like a lunatic, as if there was nothing wrong with him. They’d already run a bunch of tests and the nurse said they all looked fine.” The doctor did not immediately explain himself. “In retrospect I should have kept asking questions,” says Jodi. “I should have pushed harder.”

Eventually, doctors informed her that her son was potentially at risk for a rare disease called Kawasaki, even though everyone who examined him said he didn’t appear to have it. Though her gut (yep, that mother’s intuition) whispered that her child was fine, she didn’t initially push back. “You don’t want to be the parent who demands your child be released and it turns out there’s something wrong,” she says.

Over the next 24 hours, her son was placed on IV, poked, prodded, and awakened at 6 a.m. so staff could look at his rash. Eventually Jodi reached a breaking point and demanded Michael’s release. “I should have insisted much sooner,” she says. “Some of the nonsense could have been avoided.”

Jodi’s hesitancy to voice her intuition is hardly unique, particularly when it counters the opinion of medical professionals. Even when your gut is screaming that the doc is off, it’s tough to know how to handle the situation. Read on to find out how to keep Jodi’s experience from happening to you.

Get Familiar With the Patient’s Bill of Rights

This handy document comes straight from the top — the U.S. Department of Health and Human Services. Nationwide, hospitals and medical plans have adopted its tenets, which promote communication and understanding between patients and their health care providers. And how does this bill of rights apply to you? Well, when we’re talking mommy’s intuition, the most important thing to note is that insisting on getting all the info and being involved in decision-making doesn’t mean you’re pesky or difficult — it means you’re standing up for your child. More info on the two points that relate most to this situation:

The Right to Be a Full Partner in Health Care Decisions

Patients have the right to fully participate in all decisions related to their health care (or the health care of their children). Translation? Your inner mommy voice carries more weight than you might think. Don’t be afraid to make it heard. It’s not only acceptable to want to be looped in on every single decision that affects your child while he or she is under medical care — it’s your right!

The Right to Information

Patients have the right to receive accurate, easily understood information to assist them in making informed decisions. Meaning, keep asking questions! By staying up to date on the situation, you’ll be able to voice any objections you might have in the moment — rather than after the fact. From little things, like asking if your child’s temperature can be taken digitally rather than rectally, to bigger things, like choosing to forego unnecessary testing, remaining actively involved is the way to avoid any nasty surprises.

Go to the Top

Always ask to speak directly to whoever’s in charge of making decisions. If the person you’re talking to can’t answer your questions, ask them to page someone who can. The faster you connect directly with the person in charge, the faster you’ll start seeing results. If you aren’t being taken seriously over the phone, demand to be seen in person. “At 37 weeks pregnant I had a fever and felt strange about the baby,”says Kimberly, from Raleigh, North Carolina. “I called the obstetrician who told me they don’t see women for fevers and to go to my regular doctor. I insisted, and when they finally saw me my son wasn’t moving on the fetal monitor! They rushed me to ultrasound and then admitted me. I delivered my son by C-section a few hours later. See my regular doctor, huh?”

Take Miss Manners With You

Though it’s never easy (especially when the safety of your child is at stake), do your best to refrain from getting hysterical. No matter how frustrated you become, the second you raise your voice or drop an F-bomb is the same second you stop being heard. When voicing your disagreement to doctors or nurses, go out of your way to do so politely. The last thing you want is to shortchange your child on medical attention because you’ve alienated the staff.

Get a Second Opinion

If your gut still says something isn’t right, ask for a second opinion. Mothers often express regret that they didn’t take this step sooner. Worried about insulting their current doctor, or appearing presumptuous, they drag their feet — even when their intuition tells them to do otherwise. Often, it turns out a fresh pair of eyes is just what the doctor ordered. “I fought with my daughter’s pediatrician for six months before I got sick of him pooh-poohing my ‘rants’ and went with a new doctor,” says Sarah, from Sheboygan, Wisconsin. “Turns out I was right — my daughter didn’t have a hand preference; she had suffered a stroke and couldn’t use her entire right side! Sometimes doctors do know everything and mothers do.”

Call in the Reserves

It’s nearly impossible to focus on your child while trying to deal with medical bureaucracy, so try to find someone to split the load with you. Having a friend or family member available to bounce things off of could be just the affirmation (or reality check) that you need. In Jodi Schulz’s situation, her husband focused on their toddler while she dealt with medical staff. She also enlisted family members to research Kawasaki online, which is how she discovered that there was virtually no chance her son had it. “I understand erring on the side of caution,” says Jodi. “But you need to have five out of five symptoms to have Kawasaki, and Michael barely had two.” In other words, score one more for mom’s intuition!

Prenatal Care, Check-ups, And Visits!

First Prenatal Visit
Even if you take a home pregnancy test or you miss your period, you probably won’t actually see your OB-GYN until around the eight-week mark. Here’s what exactly your OB will be testing for at your first visit:

Initial Blood Work: First things first — your OB will take a small sample of blood for a long list of screenings. With it, she’ll determine your blood type, just in case you need a transfusion (very unlikely!) during pregnancy or delivery.
Your blood also will be tested for Rh, a protein present in about 85 percent of the population. If you’re Rh-negative, you’ll need injections of a medication called RhoGAM at 28 or 29 weeks, and about 72 hours before delivery, to prevent problems. That’s because if baby is Rh-positive and you’re Rh-negative, there’s a risk of complications.
In your initial blood work, your OB will also measure your levels of human chorionic gonadotropin, a hormone that indicates whether baby is developing well. Your doc will also look for abnormal hemoglobin levels or red or white cell counts, which can be a sign of anemia or infection. You’ll also be screened for hepatitis B; syphilis, HIV and other STDs; and immunity to German measles.

Pap Smear: Your first prenatal visit will also include a Pap smear. If you usually get an annual checkup with the gynecologist, you know what this is: The doc will swab your cervix for cells and then test them for abnormalities, signs of cervical cancer, and STDs like chlamydia, HPV and gonorrhea.

Urine Tests: Get ready for lots of peeing in cups! At pretty much every appointment, you’ll provide a urine sample to be tested. The sample will be screened for glucose (elevated levels can be a sign of gestational diabetes) and protein (a possible indication of preeclampsia or a urinary tract infection). If either shows up in your urine, your doctor will likely order additional testing.

Other First Trimester Tests
Ultrasound: An ultrasound uses sound waves and echoes to create a moving image of your fetus and show what’s going on inside your womb. You’ll probably have at least two ultrasounds during your pregnancy. You may get more ultrasounds if there are any issues your doc needs to monitor. And if your doctor orders it, you might have a late-pregnancy ultrasound to check for preterm labor by measuring your cervix length.
At about 10 weeks, your OB will likely do an ultrasound to detect a fetal heartbeat and confirm that the pregnancy is uterine (as opposed to ectopic or tubular).

First Trimester Screen: This is administered between weeks 11 and 13, and includes two tests: a nuchal translucency screening (NTS) and a blood test, which will help determine your baby’s risk factor for Down Syndrome and other chromosomal problems.
The nuchal translucency screening is a special type of ultrasound in which your doc will measure baby’s neck (if the area is thicker than average, it could be a warning sign).
In the blood test, your blood will be screened for hCG and PAPP-A, two pregnancy hormones. Abnormally high or low levels could indicate a problem. Your doctor will combine your results from the NTS and the blood test with your age and determine your risk factor for chromosomal problems (1 in 1,000, for example). If the odds seem higher, you may be offered further testing, since there’s about a 5 percent false positive rate.

Chorionic Villus Sampling (CVS): This an optional test for genetic disorders that you can choose to get — often parents-to-be choose to have a CVS done when one parent has a genetic disorder or one runs in the family. It’s normally done between weeks 10 and 12, and it can detect genetic disorders such as Tay-Sachs disease and sickle-cell anemia, and rule out chromosomal disorders like Down syndrome. The bonus: It also determines the baby’s gender with total accuracy.
In the CVS, you’ll first get an ultrasound to double-check how far along you are and determine the best way for your doctor to get a good sample of cells. It could be transabdominal (through the abdomen) — with a needle through your belly and uterus to the placenta — or transcervical — with speculum inserted into your vagina. Keep in mind that CVS also increases the chances of developing a uterine infection, having a miscarriage (the risk is 1 in 400) or having a baby with arm or leg abnormalities (but this risk is very low).

 

Second Trimester
During the second trimester, you’ll still see your doctor every four weeks. At every visit, you’ll get a urine test as usual. Here are the tests you can expect to get during the second trimester:

Midpregnancy Ultrasound: This is a more detailed ultrasound than the one you got in the first trimester; it’s also referred to as an anatomy scan or a level-two ultrasound. It’s usually performed between weeks 18 and 22. During the midpregnancy ultrasound, your baby will be measured from crown to rump and around his waist and head to confirm proper growth, and the ultrasound technician (and/or doc) will check his kidneys, bladder, stomach, brain, spine, sex organs and four chambers of the heart to make sure everything looks A-OK. The technician will also check amniotic fluid levels, placenta location and fetal heart rate. And, if you want to know, you’ll probably be able to find out baby’s gender!

Triple/Quad Screen Test: The triple screen and quad screen tests assess the probability of genetic disorders and chromosomal abnormalities like Down syndrome. It’s a blood screening that’s performed between the 15th and 20th weeks of pregnancy. You might choose to do this if you want a more accurate evaluation of your baby’s risk of neural tube defects than the first trimester screen offers.
The triple test looks for three things: AFP (alpha-fetoprotein, which is produced by the fetus), hCG (human chorionic gonadotropin, a hormone produced in the placenta) and estriol (an estrogen produced by the fetus and placenta). The quad screen looks for the same three things, as well as abnormal levels of Inhibin-A, which is a type of protein produced by the placenta and ovaries that could indicate baby’s risk for Down syndrome. Your doctor will use this test in conjunction with other factors, like your age and ethnicity, to decide if further testing should be done.

Amniocentesis: An amniocentesis is a test for genetic disorders (normally performed between week 14 and week 20). Your doctor may recommend you get an amnio if you get an abnormal triple or quad test result or if you have other genetic concerns about baby.
In an amniocentesis your doctor will use an ultrasound to guide a needle into a safe place in the amniotic sac and collect a sample of amniotic fluid. The procedure normally takes 45 minutes.
Amniocentesis can detect chromosome abnormalities, neural tube defects and genetic disorders. It also may be used in late pregnancy to see if the baby’s lungs are mature enough that he could breathe on his own. In general, amniocentesis is a safe procedure, but it does pose some risks. The risks of having an amniocentesis include miscarriage (very rare, about 1 in 200 to 1 in 400), cramping and vaginal bleeding, leakage of amniotic fluid, needle injury to fetus, Rh sensitization, and infection.

Cordocentesis: This is a diagnostic test (performed after 17 weeks into pregnancy) that examines blood from the fetus to check for chromosomal abnormalities. It’s different from an amniocentesis because it doesn’t test for neural tube defects. You might get a cordocentesis if you had an amniocentesis and the results were inconclusive. If you get one, you’ll get an ultrasound so the doctor can determine where the umbilical cord meets the placenta. Then the doctor will insert a needle into the umbilical cord to collect a blood sample. Note that there are a few risks to this test, including miscarriage (1 or 2 in 100 tests), blood loss, infection, premature rupture of membranes and drop in fetal heart rate.

Glucose Challenge Screening Test: The Glucose Challenge Screening Test is a blood screening that’s administered between weeks 24 and 28. In it, your doctor will gauge how effectively your body processes sugar, to see if you’re at risk for gestational diabetes mellitus. To do that, she’ll ask you to drink a sample of Glucola (a sweetened drink that contains 50 g of glucose), then an hour later, your blood will be drawn and its glucose levels will be tested. If there are signs you’re not processing the glucose normally, your doctor will likely order additional glucose testing (glucose tolerance test), in which your blood is drawn several times over the course of a few hours, to get a more accurate reading.

 

Third Trimester
From weeks 28 to 36, you’ll visit your OB every two weeks. After that, you’ll see your doctor once a week. Again, you’ll give a urine sample at each visit. Here’s what other tests to expect during the third trimester:

Group B Strep Test: Around week 36, all moms-to-be get a group B strep test. The test screens for bacteria (called group B strep) in the rectum and vagina, which is harmless to you but can be dangerous if transmitted to baby during delivery. Your doctor will swab your vagina and rectum to get samples to be tested and likely will give you results within two days. If they do find group B streptococcus, you will be given antibiotics to fight the strep so baby isn’t exposed to it at birth.

Biophysical Profile: A biophysical profile is a combination of two tests: an ultrasound and a non-stress test, used to determine baby’s (or babies’) well-being. It is normally performed if you’re carrying multiples, go past your due date, or have high risk factors like high blood pressure or kidney or heart disease.
The profile will determine baby’s heart rate, activity level, breathing movements, muscle tone and the amount of amniotic fluid in the uterus. You already know what an ultrasound is. For the non-stress test, you’ll have sensors put on your belly to pick up baby’s fetal heart rate and your uterus’s contractions. Using the data from those two tests, your doctor can be sure baby is thriving. The tests will indicate the overall health of the baby, and if he appears to be in any danger, your doctor may decide to deliver him early.