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 Post subject: pediatrician vs family practice?
PostPosted: Wed Feb 27, 2013 11:03 am 
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The subject of pediatricians came up in our last childbirth class and now im a tad confused on the subject. I have two separate confusions on this subject. First was it seemed like (based on what people were saying in class) at some time after birth, while you are still in the hospital YOUR pediatrician shows up to check out the baby. after the baby is born the hospital notifies your pediatrician the baby was born and the pediatrician magically shows up (this is what it sounded like).
Here is my confusion. I called my own primary care physician a few weeks ago and I asked that office if my own dr does pediatrics and if they are accepting new patients and I told them I was starting my 3rd trimester. And they said yes to all of the above and to just call after the baby is born and they will try to get us in in the first couple weeks. And I specifically said “so I don’t need to do ANTYHING til the baby is born” and they were like “yup yup”
So I guess im confused if my dr is going to show up at the hospital. They said if your pediatrician is not affiliated with the hospital and does not have priviledges there one of the pediatricians from the NICU unit will check out your baby. my Dr’s office is one of the 8000 satellite UMASS branded medical places but I don’t know how the whole “priviledges” thing works.
So I found that confusing but overall I didn’t really care. I figure if my own dr shows up cool, if one of the hospital pedi’s shows up and send the info to my dr that’s fine too. whatever.
But it seemed to have gotten my husband thinking on the subject. Apparently he read somewhere that it might be better to have an actual pediatrician rather than a family practice doc which is what I think technically my dr is. The reasoning I guess was that actually pediatric practices are more used to dealing with babies and everything that comes along with them and might take more time with you and be less rush rush rush and they may have more flexibility in their schedule in case your kid gets sick and you need to go in that day. so he was all yammering on about that and I was like “ok how do we find a pediatrician” and of course he didn’t know and then he read more and looked up my dr and then decided it was all good and we could just stick with my dr if I like her.
Any thoughts on whether it matters? Ive never felt rushed with the actual Dr herself. The office yes I see the rush rush rush let’s get in and get out but the actual dr has always taken her time with me and made sure I had any questions answered. She’s very laid back. she’s never pushed anything on me. last year I was due for a tetanus shot and I kinda freaked out and was like NOOOOO and she didn’t push it on me but just explained why they do it and said if I changed my mind just to call and come in anytime. And that’s what I ended up doing after my mom (the nurse) yelled at me. it ended up being good anyways because it was the Tdap (dtap?) one they recommend you get if you have kids. She’s never cared about my veggieness or my veganess.
Also what on earth does the pediatrician check on your baby that an army of hospital staff hasn’t already? I think this is why it hadn’t even crossed my mind!

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 Post subject: Re: pediatrician vs family practice?
PostPosted: Wed Feb 27, 2013 11:40 am 
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The way it works here, if you've picked a pediatrician already and listed them on your paperwork then, yes, they visit the baby in the hospital. If you don't have a pediatrician, then no big and a hospital doctor will do the necessary checks (I can't really remember what all this was but it was very cursory). Either way you're going to have an office visit very soon after.

I don't really know if there's a big difference between going with family practice or a pediatrician. I feel like a good doctor is a good doctor. If you like yours and feel like her demeanor would be a good fit for being your baby's doctor, I don't see any reason not to use her.

As far as picking a pediatrician, we asked for recommendations from people and looked doctors up on review sites. Then we set up interviews with prospective doctors (some will do this, some won't). We ended up going with the first one we met with because we liked him so well.


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 Post subject: Re: pediatrician vs family practice?
PostPosted: Wed Feb 27, 2013 11:42 am 
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When you have your baby the hospital will ask who your pedi is. If they do not have privileges they will have the staff ped check him out. Nobody else really "examines" the baby officially. Nurses will check reflexes and listen to heart rate and lungs but aren't really officially checking for things like hip dysplasia or palpable abdominal abonormalities etc. and OB's really don't do much of anything with the baby past delivering it.

As far as pediatrician vs. family doctor I think it all depends on how many babies your doc usually sees as to how competent they are with them. My own "family doctor" will only see kids after age 2 (he said it is more of a vaccine thing because he doesn't want to carry all the baby immunizations) but I could see how the scheduling thing could be an issue in either setting. I like the idea of having one doctor see the whole family because they can have a more holistic view of the parent/child/family dynamics and it can relate to health but we love our pediatrician and will probably stay with her even when baby turns 2.


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 Post subject: Re: pediatrician vs family practice?
PostPosted: Wed Feb 27, 2013 11:58 am 
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Thanks!! so basically it sounds like it’s a matter of personal opinion. if I have a dr that I like and think she would be a good fit then why bother messing with the situation? Makes sense to me.
The whole family practice thing is confusing me. we had 5 couples in our childbirth class. 4 of us have regular OBs and one couple is using a family practice doc. The teacher routinely would just gush over how family practice docs are the greatest thing on the planet and how on the day you are having your baby that is what they are doing that day. they stay with you and she could eat and drink and sing merry songs all day and those of us with OBs would only see them when it was time to deliver the baby and probably not even our own OB and we wouldn’t be able to eat or drink (according to my OB that last bit is totally untrue).

So my confusion is when my husband and I decided to have kids I called my regular dr cause frankly I wasn’t sure healthwise if I needed to do anything. Since i was just about to turn 35 and am a vegan I wasn’t sure if they would recommend a physical or bloodwork or something BEFORE I got pregnant. Frankly I just didn’t know. They were all weirded out by my call and were like “usually you go to your OB for this kind of stuff” and I was like “I DON’T HAVE ONE OF THOSE I COME SEE YOU GUYS” so now im confused if family practice doctors routinely deliver babies or just some of them. I always had my pap smear done by my regular doc so she does some OB stuff. Maybe some of them just elect not to do pregnancy stuff.

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 Post subject: Re: pediatrician vs family practice?
PostPosted: Wed Feb 27, 2013 12:10 pm 
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some family practice docs deliver babies - Malpractice is so much higher when they include that service that I think pretty much most do not.


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 Post subject: Re: pediatrician vs family practice?
PostPosted: Wed Feb 27, 2013 12:10 pm 
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That is interesting Lisa. I've always gone to a OB/gyn for my yearly cervical exams, I would've never even thought about going to my family practice doctor for pap smears and the such.

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 Post subject: Re: pediatrician vs family practice?
PostPosted: Wed Feb 27, 2013 12:12 pm 
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If I had it to do over, I'd have a ped with hospital privileges where I was delivering. Our ped didn't and I thought it would be fine for us to have the staff ped examine her in the hospital and have the first visit with our ped be after discharge. So L was examined by the staff ped, who was great but more conservative than I would have liked, which is why L ended up admitted to the hospital for jaundice for 3 days after she was born, where our less conservative ped would have sent us home with a bili blanket and instructions to come in for monitoring.

You also have a lot more sway with your own ped as well, who knows that you are going to be responsible and not just ignore medical advice if you're discharged and allowed to go home. The staff ped made everything seem like a bigger deal than it was (jaundice and L had a heart murmur that cleared up by 6m), and I was really hormonal and cried a lot more than I needed to have. Our regular ped is very good about letting you know what is and isn't a big deal.

I like that our ped is also set up for things a family practice might not be, like doing blood draws on babies etc. I'd hate to have to go to the MD and then have to make a second trip to a lab for bloodwork and then wait for the test results to set up a follow-up call with the MD.

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 Post subject: Re: pediatrician vs family practice?
PostPosted: Wed Feb 27, 2013 12:32 pm 
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linanil wrote:
That is interesting Lisa. I've always gone to a OB/gyn for my yearly cervical exams, I would've never even thought about going to my family practice doctor for pap smears and the such.


usually when i would go in for a physical they would do it as part of that. since they always just did it there it never occurred to me to have it done elsewhere. i always associated OB's with babies so i never thought about going to one.

also they told me i was so low risk with the pap smear thing that the new recommendations were i really only needed one every 3 years so i figure i would just let them tell me when i was due.

not sure about mammo's as i think unless you have a serious family history or other issues they usually dont start those til 40 (?).
the women's health clinic that my OB is at is in the same damn building as my regular doc so they may just send people there for mammo's as i know they have a lot of fancy equipment there for it. that's where they told me to go after the whole "go to your OB/i dont have an OB" confusion.

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 Post subject: Re: pediatrician vs family practice?
PostPosted: Wed Feb 27, 2013 12:35 pm 
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interesting thoughts Tlish.

seems like the "seriousness" of jaundice comes and goes in waves.

i was born jaundice and my mom said that they just told her to take me home and she says she stuck me in the sun and i was fine. (never really figured out what jaundiced means other than i was yellow so im not sure what the sun has to do with)

then i believe in the 80s it became like a SUPER BIG DEAL if you were born jaundice.

i always tell people i came out yellow cause it cracks me up. i think i might have a weird sense of humor though.

for me based on recent conversations wtih my mom i think it may have had something to do with her Rh- factor.

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 Post subject: Re: pediatrician vs family practice?
PostPosted: Wed Feb 27, 2013 12:54 pm 
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I had the same experience as Tofulish. I know my ped (who I found by interviewing a few before the birth) would not have caused the stress we had with jaundice at the hospital. In fact she shit-talked the hospital ped's behavior.


If there is a next time, I'll be switching to a hospital where she has privileges.

And to address what your husband was saying, I do think our ped's office does have a rhythm set up to accommodate sick visits vs. all the well visits and other kis specifics I think I would prefer over a family practice.


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 Post subject: Re: pediatrician vs family practice?
PostPosted: Wed Feb 27, 2013 1:30 pm 
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The other nice thing about pediatricians' offices is that they are generally child-friendly - toys, books, child-friendly art, etc. And their nurses are used to working with babies.

P.S. I also liked having our own peds visit in the hospital because Malka was born with Erb's palsy (a usually temporary paralysis of a limb - usually due to a nerve being compressed when the fetus is in one position for a long time) and so the same eyes were looking at her at birth and then at five days, two weeks, etc. evaluating its progress. It definitely made me feel better about the situation when we went in for our five-day appointment and the doctors who had seen her in the hospital said "oh wow, she's looking much better than she was!" The notes on the chart from the hospital were not detailed at all and you wouldn't have been able to know if there was improvement based on that.


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 Post subject: Re: pediatrician vs family practice?
PostPosted: Wed Feb 27, 2013 1:55 pm 
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i was looking up my dr on the internet and she appears to have priviledges at the hospital im giving birth at so we'll see if she shows up or not.
i have no idea how this works!
i know i have to fill out some paperwork beforehand and put down who the pediatrician is.

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 Post subject: Re: pediatrician vs family practice?
PostPosted: Wed Feb 27, 2013 2:20 pm 
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Jaundice seems to run in families, so if your mother had it, I'd talk to your ped about what they would do of BabyPunk has heightened levels of bile and get them prepared to be there. We had it on both sides of the family, which we only found out once L was hospitalized. And L and I have different Rhs - I am O+ and she is O- and we are South Asian, two added risk factors.

Basically all babies become jaundiced in the first few days after birth, because it comes from red blood cells (RBCs) breaking down. While in the womb, the infant needs a high RBC count to get enough oxygen and after s/he starts breathing then those excess RBCs break down in the baby’s liver, turning it into a bile salt which can be excreted into the intestinal tract, and eliminated. But in some babies the bile isn't eliminated fast enough and it builds up to give the baby a yellow color (hence jaundice - like the French jaune for yellow). For most babies, the liver comes on line and the bile levels peak on day 3 and then goes back to normal. The main effect of jaundice is that the babies become tired and don't nurse effectively, but at high levels (over 25) brain damage can result causing hearing loss, learning disabilities, or a type of cerebral palsy may result. Leela's levels started out at 9 on day 1 and got to 18 on day 3. The bili curve is really interesting - for it and more: http://pediatrics.aappublications.org/c ... 1/297.full

There are 2 main treatments (1) feeding the baby a lot so that they eliminate the bile in their excrement (which is why lots of hospitals push you to formula feed so they can make sure the baby is nursing enough) and (2) phototherapy. The type of phototherapy seems to depend on the MD - some think a bili blanket (a UV light fiber blanket) is sufficient and they'll let you go home and arrange for monitoring so that they can make sure the situation is resolving. Others, like the staff ped think that the only reliable treatment is sticking the baby under lights until the levels come down.

I would want to know what my ped would do at what levels, and whether they were open to you breastfeeding (if you want to), doing the bili blanket (the staff ped was absolutely not), and that they could be there after birth and take over the monitoring, ideally at your home or their offices (that means that they would have to have a nurse ready to do heel sticks and take blood from a new born, which isn't always easy). I would also want to know what my insurance would cover - we were told that some insurance companies won't cover a hospitalization if the bili levels of the NB are too low, so parents could end up on the hook for the treatment cost (ours was around $8,500) if the staff ped insists on hospitalization at levels that the insurance co won't cover.

Sorry I wrote a novel! I just feel like I got broadsided on this and I'd rather it not happen to other people!

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 Post subject: Re: pediatrician vs family practice?
PostPosted: Wed Feb 27, 2013 3:18 pm 
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LisaPunk wrote:
linanil wrote:
That is interesting Lisa. I've always gone to a OB/gyn for my yearly cervical exams, I would've never even thought about going to my family practice doctor for pap smears and the such.


usually when i would go in for a physical they would do it as part of that. since they always just did it there it never occurred to me to have it done elsewhere. i always associated OB's with babies so i never thought about going to one.


Well OBs are babies/pregnant women only, gynecologists are women's health so they deal with reproductive health and everything else, no pregnancy, pre-pregnancy, post-pregnancy, etc, etc. Unless you have a problem, then a family doctor should be able to cover everything a gynecologist would cover but I have PCOS so a gynecologist was pretty important to me. Most OBs are also gynecologists and most gynecologists are also OBs but sometimes you'll find an OB who is just OB and a gynecologist that is just gynecologist. Generally they are designated as OB/gyn.

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 Post subject: Re: pediatrician vs family practice?
PostPosted: Wed Feb 27, 2013 4:19 pm 
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We are on our 4th doctor for my kids. The first was a family practice doc and the other three were pediatricians. I really liked our family practice doc. She took her time, was cautious but not crazy. She ended up moving away. The next pediatrician was just awful. The next pediatrician was amazing, and the best doctor I have ever encountered for anything in my whole life, but she passed away very suddenly. We are now on number four, although technically it's a multi-doctor practice, so we have seen a few docs there, and some have been better than others. So my opinion after all of these doctors is that family practice vs. pediatrician matters very little. Find a doctor you like and go with it.


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 Post subject: Re: pediatrician vs family practice?
PostPosted: Wed Feb 27, 2013 7:08 pm 
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thanks for the jaundice info Tlish.
ill have to ask about it at my next OB visit to see if they know what the hospital typically does.
im O- and my husband is A+ so there will be a very large chance the baby will have + blood. (though i got my mom's O- blood type)

i know my MIL said her 2nd son (who was very coincidently also born the same day as me but one year later) was jaundiced (like me!) and they had to bring him to the hospital (she had all her kids at home) and she said the drs wanted him under the light and she kept yelling at them that he just needed to nurse cause my MIL thinks breastfeeding will cure all ills. i guess in this instance more feeding was the right idea.

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 Post subject: Re: pediatrician vs family practice?
PostPosted: Thu Feb 28, 2013 6:01 am 
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I was also jaundiced as a baby and they took me away from my mom for a couple days. It was greatly upsetting to my mother but I survived.

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 Post subject: Re: pediatrician vs family practice?
PostPosted: Thu Feb 28, 2013 9:38 am 
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Raygold was jaundiced and the usually overbearing health visitors told us to put him in his moses basket in front of a sunny window!

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 Post subject: Re: pediatrician vs family practice?
PostPosted: Thu Feb 28, 2013 2:31 pm 
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also - not all babies exhibit yellowness as a sign of jaundice. Sierra's levels were something like 11 I think on her 2nd day, and we'd noticed that she was almost brick-red and very wrinkled at birth. Turns out the redness is also a sign of jaundice!
we were "lucky" I guess in that we were supposed to stay in the hospital for at least 72 hours anyway due to C-section, so it was covered by insurance. I was freaking the fork out though because the hospital almost let me go home after 36 hours and I wanted to get outta there so badly, but I was able to stay while she was under the lights for 18 hours and go in and breastfeed her every 2-3 hours. If I'd already been discharged, it would've sucked,


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 Post subject: Re: pediatrician vs family practice?
PostPosted: Thu Feb 28, 2013 2:33 pm 
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LisaPunk wrote:
thanks for the jaundice info Tlish.
ill have to ask about it at my next OB visit to see if they know what the hospital typically does.
im O- and my husband is A+ so there will be a very large chance the baby will have + blood. (though i got my mom's O- blood type)


If one of his parents also had - blood, you've got a fifty/fifty chance of your kid being negative/positive.


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 Post subject: Re: pediatrician vs family practice?
PostPosted: Thu Feb 28, 2013 2:38 pm 
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Yes, I was discharged on Friday and she was re-admitted on Saturday and kept until late Monday. I spent 3 days sitting on a chair next to her, and it wasn't the best thing for my postpartum healing ladybits. I had a really easy birth, but even so, the last thing you want to be doing is sitting on a hard chair, with no where to lie down and sleep. And the hospital was an hour from my house, so I just stayed with her, because I wanted to be able to BF every 2 hours and make sure they didn't give her formula (which they were pushing) and that she was well-taken care of.

I'm not going to rehash all of it, but it was horrible, and I am still upset at how it was handled. There are many situations where your child has to be admitted and I think that the hospital is great for those. But there are also things like jaundice where different doctors have different protocols, and there, if I could, I would prefer to err on the side that has me go home and heal up with my child and do the monitoring there, rather than stay in the hospital. Esp. because L wasn't in the nursery, she was in the Children's Hospital, and there were lots of very sick kids around us, which made us very nervous.

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 Post subject: Re: pediatrician vs family practice?
PostPosted: Sat Mar 02, 2013 10:40 am 
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Yeah, for bili levels between ~16 and ~20 there's a lot of variation in care.

The doctor wanted to treat V (16.9 at 48 hours) as an inpatient, and while it would have been much more pleasant than Tlish's experience (they let mothers room in with the babies and put the light beds in the rooms, but a military hospital's cost considerations are also different than a civlilian hospital's!), we stood pretty firmly against that and got a bili blanket instead, possibly because my husband outranked the doctor (I'm sure this is not an official consideration in standards of care, but it seems to play out in a way similar to racial/class privilege in medical care - they assume a certain education/maturity and are more open to patient advocacy).


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