Poor military OB care?

[hilseb]

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I have a friend whose cousin got pregnant. She is enlisted in the Army and was on her way to Iraq when she found out, and she got sent back to Fort Bragg, NC. She tells her cousin that she has not seen the same OB twice (not a big deal, I guess) and she is 22 weeks pregnant. She has gained 17 pounds (not outrageous) and has been told to go on a diet. (Normally not advisable to a pregnant woman, but I wasn't there. Maybe they just told her to cut out certain things)

BUT she is retaining water and has edema, and apparently they are not doing routine urine dipsticking on her, for protein or anything, not even as part of her routine visit. I find that worrisome. I am not an OB, but I have worked in maternity care. Isn't urine dipsticking standard of care for ANY pregnant woman, much less one with edema? She also is working a 24 hour shift every other day, and has been told she cannot adjust her schedule.

Any advice? She feels helpless because she is enlisted, and thinks she is possibly being punished for getting pregnant and not facing combat.

 

[BigNavyPedsGuy]

I have a friend whose cousin got pregnant. She is enlisted in the Army and was on her way to Iraq when she found out, and she got sent back to Fort Bragg, NC. She tells her cousin that she has not seen the same OB twice (not a big deal, I guess) and she is 22 weeks pregnant. She has gained 17 pounds (not outrageous) and has been told to go on a diet. (Normally not advisable to a pregnant woman, but I wasn't there. Maybe they just told her to cut out certain things)

BUT she is retaining water and has edema, and apparently they are not doing routine urine dipsticking on her, for protein or anything, not even as part of her routine visit. I find that worrisome. I am not an OB, but I have worked in maternity care. Isn't urine dipsticking standard of care for ANY pregnant woman, much less one with edema? She also is working a 24 hour shift every other day, and has been told she cannot adjust her schedule.

Any advice? She feels helpless because she is enlisted, and thinks she is possibly being punished for getting pregnant and not facing combat.

I understand you're concerned. However, this forum is a place for people to discuss military medicine. This is not a place to seek medical advice! If she wan'ts a second opinion she needs to find one - in real life. Turning to an internet message board for advice on care is a terribly bad idea for many many reasons.

 

[Droopy Snoopy]

I understand you're concerned. However, this forum is a place for people to discuss military medicine. This is not a place to seek medical advice! If she wan'ts a second opinion she needs to find one - in real life. Turning to an internet message board for advice on care is a terribly bad idea for many many reasons.

Absolutely. And that's to say nothing of who knows what the real situation is after it's been through your friend's cousin to your friend to you and now to us. Any advice offered would be transmitted back up the line in a similar fashion, like that whisper game we all played back in elementary school, resulting in the person actually needing the information getting something less than worthless, potentially harmful.

I would discourage you from looking elsewhere on the internet for the info or for that matter becoming involved in this person's medical care at all. Being that you are someone who has worked in maternity, your friend's cousin might lend undue credence to any advice coming from you.

The idea of a physician punishing a woman and her unborn child with negligent care because he thinks (or someone told him) she got pregnant to avoid deployment? No way jose. Whether the stuff about her schedule is some kind of retribution on her I don't know, but the OBs couldn't care less whether she deploys or not.

 

[hilseb]

Thanks for replying. I don't want someone to diagnose her or give any medical advice, and I guess I did not make that clear. What could you possibly tell me that could be harmful for her? All due respect, but I have a lot of experience in prenatal care and I don't think my advice would be harmful to anyone, regardless if you think any credence to what I say is undue. I know enough not to tell someone something careless. If she goes into seizures, it will not because I told her something, it will be because someone was not screening her.

I want advice from anyone who has experience navigating military medicine, which I have no idea about. Is this normal standard of care, and if you don't feel comfortable discussing what I have described as her care, what would you say to someone IN GENERAL thinks they are having poor OB care in the military? Are there any medical advocates, social workers, anything?

 

[cdreed]

I have a friend whose cousin got pregnant. She is enlisted in the Army and was on her way to Iraq when she found out, and she got sent back to Fort Bragg, NC. She tells her cousin that she has not seen the same OB twice (not a big deal, I guess) and she is 22 weeks pregnant. She has gained 17 pounds (not outrageous) and has been told to go on a diet. (Normally not advisable to a pregnant woman, but I wasn't there. Maybe they just told her to cut out certain things)

BUT she is retaining water and has edema, and apparently they are not doing routine urine dipsticking on her, for protein or anything, not even as part of her routine visit. I find that worrisome. I am not an OB, but I have worked in maternity care. Isn't urine dipsticking standard of care for ANY pregnant woman, much less one with edema? She also is working a 24 hour shift every other day, and has been told she cannot adjust her schedule.

Any advice? She feels helpless because she is enlisted, and thinks she is possibly being punished for getting pregnant and not facing combat.

Here's a related article that FPs use at an Air Force Fam Med Residency I rotated through. I think it may help answer some of your concerns.

www.jfponline.com/pdf/5411/5411JFP_OriginalResearch.pdf

 

[hilseb]

Thanks! I will save and read the article.

 

[grayce79]

Well, I'm partial because I am an ob/gyn resident in the military, but I think that overall military ob care is pretty great. For one, it's free! I am sure that it can vary base to base just as ob/gyn practices in the civilian world vary from city to city. To make a generalization based on what one physician does would be ludicrous. I am at one of the largest bases and if I could pick any hospital to deliver at, I would pick my hospital.
Without giving specific medical advice, I will answer a few of your questions.
1. We do not routinely check urine on every single routine ob visit. If a patient has elevated blood pressure, headache, vision changes or right upper quadrant pn we would routinely check pre-e labs and urine.
2. Swelling used to be in the criteria for diagnosis for preeclampsia. However, since it is so common in pregnancy, it was removed from the criteria.
3. Excessive weight gain during pregnancy can be very dangerous. We do recommend "dieting" to pregnant women if they are gestational diabetics or if they are gaining too much weight. You may be picturing some sort of extreme diet or something, but telling a woman to eat vegetables, fiber, complex carbs, and protein etc instead of cheetos and ice cream is not unreasonable. This is called eating a "healthy diet"
4. FYI- preeclampsia at 22 weeks would be extremely rare (although still possible)

As for her feeling punished, I agree with what others have said- the ob/gyns could care less if she is deployed or at home. The people who may be mad could be the coworkers who are making her work the crazy shifts. To be honest, I seriously doubt that she works 24 on/24 off everyday without any breaks. Unless of course she is an ob/gyn resident and then I would want to know how she got such an awesome schedule. 🙂

 

[Galo]

Care depends alot on where you are, and I believe in who you are. When at my base dependents were allowed to have their babies off base, the vast majority jumped at it. Who want to be seen by a different doctor on every visit? Who wants to know that their chart is not available a majority of the time? Also, as paranoid as it may sound, if you are even perceived as going against the grain, I have no doubt that there is subtle retribution.

If she feels there really is an inpropriety, (am not sure there is or not), she should ask for another attending and make sure its documented.

 

[hilseb]

Thanks again for all of your replies. I am sure care can vary from practitioner to practitioner and from base to base.

It is early in her pregnancy. I thought edema was still part of the symptom profile for preeclampsia, but I guess it depends on if you are pitting, if it is the hands, how sudden it is, and of course, if you have other symptoms like headaches with visual disturbances and hypertension. I didn't even say preeclampsia in the first post because I didn't think it would be possible she would have it with only edema as a symptom, but I didn't want to get too into the medical part, since, as people have since pointed out, I am not her doctor. I worked at a prenatal clinic for two years that did routine urine dipsticking as initial screening, and if someone presented with other symptoms that would indicate a chance of preeclampsia, including a +1 or higher protein as one of a few criteria that would need to be met including increasing blood pressure, we would collect more urine and have the creatinine and protein analyzed.

I just worried about her and was not aware that apparently the dipstick is not considered a useful tool in predicting preeclampsia, and was surprised she wasn't being screened, considering I thought edema would be a reason to consider someone at higher risk for future preeclampsia. I know edema is common, I had it, mildly, in one of my pregnancies and many of the women at the prenatal clinic where I worked had it, and we had very very few preeclamptics. Now that I understand that it dipsticking is not considered routine everywhere, I would think they are using blood pressure readings and other screening tools with my friend's cousin.

Does anyone know if pregnant enlisted people in general are given some sort of leeway in their shifts, or does it again really depend on what they are trained for and what purpose they serve in the military, and their overall health? And yes, I forgot to point out before she doesn't think it is the OBs necessarily who are angry at her, but possibly whoever is working her schedule.

Thanks for an intelligent discussion and treating me like I could understand it.

 

[grayce79]

All pregnant women in the military are put on a profile at their new ob visit to limit certain physical activities and to make sure that they are not exposed to things that could be harmful during pregnancy.
As for the "leeway", it is not given unless the patient develops some sort of medical problem. Pregnancy is not a disease! And this does not just apply to enlisted pregnant females. This also applies to officers. Every single one of my fellow ob/gyn residents who have been pregnant have worked their butts off up until the day of delivery.

 

[colbgw02]

In the Army, I believe that females are expected to work their normal hours (within the confines of their profile) up until 20 weeks EGA. I'm not aware of the specifics of their restrictions past that point.

Unofficially, I know several women who have used (and abused) their pregnancy as a reason to miss shifts or go home early well before 20 weeks. So, I'm sure most of it has to do with how strict the supervisor decides to be.

 

[megadon]

I do know what the specifics are with ionizing radiation (nuclear reactor). You aren't allowed exposure in the third trimester. A good friend of ours fell in this category (nuke SWO) and fortunately her doc backed up her conception date while the CO wanted a later date (more workable hours, very dysfunctional command). Based on that, I would say it can be worse for officers.

 

[hilseb]

All pregnant women in the military are put on a profile at their new ob visit to limit certain physical activities and to make sure that they are not exposed to things that could be harmful during pregnancy.
As for the "leeway", it is not given unless the patient develops some sort of medical problem. Pregnancy is not a disease! And this does not just apply to enlisted pregnant females. This also applies to officers. Every single one of my fellow ob/gyn residents who have been pregnant have worked their butts off up until the day of delivery.

Yeah, I worked during both of my pregnancies, the first until the day before my due date, and I delivered on my due date, and the second I went into labor two weeks early while working. She seems concerned about her hours being too strenuous, but I suppose that is between her and her OB and supervisor.

 

[Ex-44E3A]

Hilseb,

I've gotta ask, because it doesn't look like anyone else is going to...

What's up with your avatar? There's so much conflicting imagery in it that I'm not sure what it's supposed to represent.

 

[Droopy Snoopy]

Hilseb,

I've gotta ask, because it doesn't look like anyone else is going to...

What's up with your avatar? There's so much conflicting imagery in it that I'm not sure what it's supposed to represent.

Looks like a Jesus fish with titties, maybe something out of a Dan Brown novel?

 

[texdrake]

she has not seen the same OB twice

She has gained 17 pounds

routine urine dipsticking on her, for protein or anything

1. She should go to FP if she wants continuity. Most of the major medical center OB's (training sites) do not provide continuity because residents move around a lot, however it is required in FP.

2. 17lbs by the 22nd week is not a whole lot but it is a little high. In the first trimester they should gain about 5 lbs, then 10lbs in the 2nd and 10-15 in the third trimesterd (25-30) total. She is halfway through her 2nd trimester and should have only put on about 8-12 pounds, still I wouldn't recommend a diet, just watching what she ate (Either bad instruction, or misinterpretation)

3. Urnine dipsticks are not routine and routine UA is not recommended. Edema is quite common in pregnancy and pre-eclampsia at 22 weeks is pretty rare. I could see doing a UA to establish a baseline, but after that I wouldn't do one without regular symptoms. All pregnant women spill some protein so a random UA isn't going to tell you much.

 

[73BARMYPgsp]

She feels helpless because she is enlisted, and thinks she is possibly being punished for getting pregnant and not facing combat.

Of course! Because we all know that's how the Army works. They even have the OBs at Womack Army Medical Center involved in makng sure you get punished for getting pregnant.