Monday, March 30, 2009

Professional Advice

Maybe I would have reacted differently if we hadn't watched Michael Moore's Sicko on Friday night.

On Saturday, I woke up bleeding. It was a very small amount. I looked it up in my Mayo Clinic guide, and it advised calling a doctor if the bleeding continued past 24 hours. Jeff and I decided not to worry about it unless it got worse. This past Thursday's ultrasound showed the little thing looking perfectly fine. And when I had some spotting two weeks ago, we rushed in for an ultrasound only to find out that all was ok.

On Sunday morning, I was bleeding again. I called my doctor's hotline and spoke to a triage nurse who asked me to call back if I started passing clots the size of a plum. I tried to rest, but when I used the restroom again, I appeared to be bleeding more. And this time, the blood looked fresh, as if I had some open wound somewhere, instead of the brownish color I had been seeing earlier. My first miscarriage started with a small streak of fresh blood in mid-afternoon. By 3am the following morning, I was dropping blood in buckets. I couldn't bear the thought of going through that process again -- sitting on the toilet, crying as my body purged itself, and feeling so out of control. I assumed that if I were already miscarrying, there was nothing the doctor could do. But she could at least help me cut the process short.

So I called the hotline again and spoke to another triage nurse. I explained that I was bleeding more, and I wanted to go in for an ultrasound. She asked me how much I was bleeding. I said that it wasn't very much but it now looked fresh, and I was concerned given my past two miscarriages at about the same stage in my pregnancy. She advised me against going into the emergency room since I was not bleeding enough. I asked her what harm it would do to just go in for a quick checkup to make sure the baby was ok.

She responded, "We have our protocol, and we don't advise you to go in unless you are filling more than one pad an hour or passing clots the size of plums." She advised me to lie in bed for the rest of the day.

I then asked her, "Do you know what is causing the bleeding? Can you tell me if this is normal?"

She responded, "No, Ma'am, we don't know the cause and we certainly wouldn't say it's normal."

I said, "Well, if you don't know what's causing the bleeding, then how do you know that bed rest would help?"

She simply repeated that that was the protocol.

I then explained that my first miscarriage started with a small amount of blood, and by that evening, I was miscarrying. Waiting until I was bleeding more to see a doctor didn't seem to make sense.

But she kept insisting that I rest in bed and not go to the emergency room.

I responded that I was going to go in and that I wasn't taking her advice. Then, she kept repeating, "Ma'am, that is not my advice. You would be going in against my advice."

I asked her what difference that made. Would going against her advice mean that insurance would refuse to cover my emergency visit? Would doctors refuse to see me?

She said, "No, maam, that's not what I'm saying. It's just our protocol, and I'm supposed to call ahead if we are sending someone."

I finally got fed up and said, "Well, I'm going in. Thank you for your help." Then I hung up.

When Jeff and I arrived at the CPMC emergeny room, there were two patients waiting. We waited for less than 20 minutes, and a nurse set us up in a room. She explained that the ultrasound in the emergency room wasn't very clear, but the doctor would be in shortly. When the doctor appeared in less than 15 minutes, he quickly performed an ultrasound. On the screen, the baby appeared alive and well, and we saw the little heart pumping away.

I asked the doctor if I needed to stay in bed for the rest of the day. He shook his head and said, "Don't lift anything heavy. Don't climb Mount Tam today. Otherwise, you're fine."

I could have spent the whole day lying in bed, fearful that I was miscarrying, reading everything on the web on bleeding during pregnancy, and counting the minutes until I could call my regular doctor on Monday morning. Instead, I spent the rest of the afternoon at my friend's baby shower, celebrating her new arrival. Sometimes, it helps not to listen to a professional.


  1. Reading your post scared me! I am glad to hear that your baby is fine. Like you, I have also had 2 miscarraiges previously. And like you I am pregnant again (10 1/2 weeks). I hate that I can't enjoy this pregnancy as much as I want to or as much as I should fearing that something is going to happen. I am always checking for any spotting everytime I go to the bathroom and I am always scared when I get cramping or backaches. I am praying everyday for this pregnancy to be sucessful and I will be praying for you as well.

  2. Yikes!! I'm glad you didn't listen to that nurse! Anything for peace of mind is totally worth it. :)

    Still sending you lots of happy healthy pregnancy thoughts!

  3. Good for you! So glad to hear everything is ok.

  4. How truly terrifying and frustrating. I have had nurses tell me some of the world's stupidest things over the phone including, and I quote, "don't worry, it's probably just part of your uterus falling out."

    Hang in there. I'm so glad to read that all is well.

  5. Glad to read everything is OK! Nurse sounds like she shouldn't be an advice nurse.

  6. I am so glad things are ok, despite the horrific scare and the frustrating nurse! What relief to have the doctor be able to show you the baby and heartbeat and reassure you instead of making you go slowly insane.

  7. My heart sank as I began reading this post. And so I skimmed further, hoping that all would be well - and it was! Very glad for you!

    I have a question. Having been in your shoes, and being currently pregnant, I am about to go in for my 10 week appt. If I may ask, did you have the vaginal ultrasound or the abdominal ultrasound done during your initial appts.? I am really nervous about having this done, but I don't think they can do the abdominal one until 12 weeks. Were you concerned about this at all?

  8. Hi, everyone,

    Thanks for your comments. Best of luck to you, Christine, Amanda, and Eingy. I hope all is going well with your pregnancies. Christine, I hear you about not being able to enjoy the pregnancy -- with this one, I've decided to let go my sense of "control" (as if I had any in the first place). Things come up but this one has been a lot less stressful than the last pregnancy.

    Anonymous at 1:53, hi! My first ultrasounds before week 12 were all vaginal. I asked my doctor about it, and she said it's hard to do an abdominal ultrasound when the fetus is so small. I wasn't too worried -- although I ridiculously wondered if ultrasounds could cause miscarriages given the timing of my prior miscarriages. Jeff and I have joked that in five years, they'll come up with a study that shows that ultrasounds are harmful to babies. But we didn't seriously worry; it was more a diversion than anything. I was glad and relieved to have the ultrasounds each time we had one. I am wishing the best for you!

  9. Hi Shinyung, Glad you are OK...I had bouts of bleeding too. My OB explained that a lot of women have small polyps in their cervix wall...sometimes the pressure of the growing uterus, or intercourse causes the bleeding. I'm glad things are well.

  10. Hi, Anonymous at 3:46, thank you so much for that explanation. I've asked a couple of doctors about the causes of bleeding in this stage of the pregnancy, and haven't received any comprehensible answer. (The doctor at the emergency room muttered something about implantation.) Your explanation makes a lot of sense. Thanks so much for sharing!

  11. Going with your gut is so important. I'm really glad you went in and that they pronounced you still pregnant!

  12. The beginning of your post made me so nervous! I'm glad everything is fine and that you didn't listen to that advice nurse! Sometimes doctors even say the dumbest things, years ago I had some tingling in my arm and leg and when I called my Dr to see if he could see me his response was "you're having a stroke get to the emergency room!" despite me not having any symptoms of a stroke.

  13. you really scared me for a sec!
    you were right to listen to your intuition. i too understand from personal experience that healthcare workers make mistakes too. thank God your baby is ok!

  14. I have to agree with the others that the beginning of your post actually made me tense up. I was relieved to hear that things are fine.

    I'm a lurker that first heard of your blog at Kimchi Mommas and I think that Angry Asian Man mentioned you as well.

    My husband (Korean) and I (Canadian) have been living in Seoul for the past few years and when we have children, it will most likely be here. I've begun to read "Misconceptions" by Naomi Wolf which perhaps is making me more concerned about my birthing options available here than is necessary at this point in time.

    I hope that you are feeling healthy and strong.

  15. OMG, I am so glad everything is okay! I've been waiting for an update since the prior post, letting us know that you made it through the 12th week, and to see how this post began also made my heart sink for you. I am SO pleased that things seem to be progressing.

    I had some unexplained 1st trimester bleeding with my first daughter, and my doc suggested that there is just so much additional blood flow to the area, that it is easy to have small ruptures that cause a little bleeding. He likened it to an overfilled swimming pool (?? weird analogy, but whatev)- sometimes we just leak, particularly after sex, or vigorous exercise, or something like that. I can say in my case that I ultimately linked it to especially intense workouts.

    Funnily enough, 2nd or 3rd trimester bleeds are typically more worrisome from an OB perspective, which is I'm sure why you got the advice you did. But given your history, especially, it was definitely the right choice to go get confirmation! I've never had a miscarriage and I would have done the exact same thing.

    So wonderful that things seem to be going well this time! I am so happy for you!

  16. Bravo Shinyung. I came to know about you from your awesome PH farewell e-mail, and this incident here once again proves that you're not one to just tamely and blindly follow "authority," and that you're capable and strong enough to make decisions that are best for yourself and your well-being. It's a great lesson for us all to learn, and I respect you for it. Best wishes as you await the birth of your baby.

  17. Hi Shinyung,

    You totally did the right thing. And you were nicer to the nurse than I would have been.

    Remember to always fight for your right for medical treatment. When I freaked out after having some bleeding during my 3rd pregnancy, I insisted on being seen (it was during the workweek). I cried to the NP who did the ultrasound that I felt paranoid and anxious about the pregnancy which is why I insisted on being seen.

    The NP said "If you need an ultrasound every week to ease your mind, you do it." Of course I didn't but it was so reassuring to know that she didn't think I was crazy, that she took me seriously, and that she understood where my anxiety was coming from.

    Take charge and follow your instincts. Kudos.

  18. So happy for you!!! I was scared too when I was pregnant. If you are up to it, i tell you what I did. I bought a listenning device from Ebay. Doppler. (not the ones they sell at BRU and Walmart, I think that's called Bebesound). Mine started working around 18th weeks. That gave me a PEACE of mind. I carried it with me when we went on vacation ... etc. Of course, you should n't use it always. But when you are bleeding ... etc, it helps a LOT. If you want I'll tell you the brand name. I haven't looked at it for a long time, forgot the brand name. Should be somewhere in the house.

  19. Whew, what a scare! Glad to hear that everything is looking fine!

    Take care!

  20. So relieved and happy to read that all is well. Thinking of you. Take care of yourself! P + H

  21. So glad everything turned out to be fine. I'm glad you didn't listen to the nurse. Good for you for going with your gut.

  22. hi; just coming across your blog. we were on opposite sides of a case way back when. i was so thrilled by your brave departure from your firm, and am thrilled to hear of your gestating little one.

    i'm sure you're all settled in at cpmc, but you should know that the docs at ucsf told me to come in to labor & delivery whenever i felt like something might be wrong, and that i should never hesitate for fear that it might all be for nothing. i went in twice the weekend that i passed a small amount of blood (around 14 weeks), and at least 3 more times later on and in the middle of the night for various things that turned out to be nothing (such as that i thought i was leaking amniotic fluid when it was pee from my uterus pressing on my bladder -- embarassing). but each time they were so nice to me, hooked me up to the fetal monitor, did an ultrasound, and i left feeling much better.

  23. Hi, Anonymous at 9:08,

    Now I'm so curious as to who you are! Please drop me an email and say hello. I'm glad to hear that the service is better at UCSF. I'll have to pass that info onto my doctor -- maybe they'll reassess their policy. So much of it is about getting your peace of mind.