Why is it so hard to get an early prenatal appointment? : NPR

Question: I just found out I'm pregnant. According to my period tracking app, I'm about five weeks along. But I can't get my first doctor's appointment until I'm nine weeks old. I'm very stressed. Why can't I see a doctor earlier? And is it worth waiting so long?

First of all, congratulations!

And don't worry. When you see two parallel lines on a positive pregnancy test, it's normal to see your doctor right away. But it's also quite common to have trouble getting an appointment to confirm you're pregnant.

A doctor friend of mine recently went through this too. Even with insider connections at the hospital, she was unable to see a doctor for another month. So she texted one of the OB/GYNs at her office and asked her to do an ultrasound between her scheduled appointments!

My friend was lucky that she was able to access this workaround. But I've always wondered why early pregnancy care isn't available to those of us who don't have an OB/GYN on speed dial.

Many maternity care providers don't sign up patients until they're eight or nine weeks pregnant at the earliest. Waiting a month to see a doctor isn't necessarily a bad thing, since most pregnancies are healthy.

But it can feel like long time, since most highly sensitive home pregnancy tests I can confirm pregnancy on the first day of a missed period, which usually lasts about four weeks.

So, if you're looking to book an appointment early, here's what you need to know.

Do you have a medical question that you would like an honest answer to? Write to us at [email protected]and we will consider your question for the column.

Many people want earlier prenatal care

In one 2016 study, approx. 15% of participants They said that they could not get to the first consultation with pregnant women as quickly as they wanted.

Dr. Kavita VinekarAn obstetrician-gynecologist whose work focuses on early pregnancy believes the number could be even higher.

Vinekar became interested in caring for patients in the earliest stages of pregnancy because it is a very vulnerable period.

She interviewed patients at Jefferson Health in Philadelphia and learned that people were doing everything they could to confirm pregnancies, even when prenatal practices refused them.

About 50% of patients had an ultrasound elsewhere before their first prenatal visit, and 25% went to the emergency department.

Nearly 15% of those who had ultrasounds were at a so-called crisis pregnancy center, which offers counseling to prevent abortions without a licensed medical provider.

Why is it difficult to get to these meetings?

Seeing patients in the early weeks of pregnancy is a radical departure from what many doctors learn during their training, Vinekar said.

In the earliest stages, it is difficult to give patients clear answers about the state of pregnancy. This is because early pregnancy can be difficult to visualize on ultrasound.

“We were told, ‘Don’t date people early in pregnancy,’” Vinekar said. “You're just opening up a whole can of worms. You will create stress, although they don’t need stress.”

But some patients experience stress when they can't see their doctor, especially if they are concerned that they may have a miscarriage.

Unfortunately, Vinekar says the risk of miscarriage is actually the main reason why antenatal practices don't prescribe patients early. They are not designed to take care of An estimated 15% of pregnancies end in the first trimester.So they try to delay seeing patients until eight or nine weeks, when the likelihood of miscarriage is lower.

Early miscarriage can be difficult to diagnose and may require several urgent follow-up visits. Additionally, practices may be reluctant to keep these meeting spaces open because if no one schedules them, they may lose money.

Here's what you can do while you wait.

If you're looking forward to your first doctor's visit but want medical advice sooner, your best option may be to contact your primary care physician. If you have an obstetrician-gynecologist, you can also make an appointment with him.

In my primary care practice, I often speak with patients who have just found out they are pregnant. They have questions about everything from the risk of miscarriage to whether they can eat sushi.

Many of my pregnant patients begin to feel nauseous several weeks before their scheduled appointment. They are frustrated that they cannot see an OB/GYN to get some relief.

Instead, they call me – and I'm happy to help.

If you're experiencing nausea, heartburn, or breast tenderness and haven't yet made an appointment with your OB/GYN, don't hesitate to call your family doctor or go to the emergency room. Even if we are not pregnancy experts, we can usually offer treatment for these common and bothersome symptoms.

What to do if you're worried about miscarriage

As a family physician, I sometimes get calls from pregnant patients who are bleeding and cramping and are concerned that they are miscarrying.

First of all, don't panic. Light spotting during pregnancy may be normal.

I usually do my best to refer my patient for an urgent ultrasound at a radiology practice that has experience diagnosing early pregnancy and miscarriages. Unfortunately, sometimes this can take several weeks.

If you already have an OB/GYN, you can also make an urgent appointment with that doctor. If you do not see anyone for routine reproductive health care, Planned Parenthood or a community health center may also see you.

Because only an estimated 4% of miscarriages require care at the emergency department levelI try to reassure my patients that what they are experiencing is usually not life-threatening. If they are not bleeding heavily, it is safe to wait.

And, of course, I always tell my patients that if they have a miscarriage, it is not their fault. Most miscarriages occur due to fetal abnormalities. It's almost never because they did something wrong.

However, most patients want to immediately confirm whether they have had a miscarriage. In this case, an ambulance is always an option. Doctors can usually do an ultrasound and help get the pain under control. But since miscarriage is a high-stakes diagnosis and not all doctors are trained In early pregnancy, the emergency room may not answer all of your questions.

Future solutions for early care

I hate to tell my patients all this, but our health care system does not do a very good job of caring for patients who have miscarried or are worried about early pregnancy.

Take, for example, the story of Asha Spacek-Hobbs, who suffered pregnancy loss before her youngest child was born. A Philadelphia mom couldn't get an immediate appointment with her OB/GYN. She said it was “like trying to book a flight to Antarctica.”

But the ambulance experience, she said, was also not conclusive.

“Believe it or not, I left the hospital not knowing if I actually had a miscarriage,” Spacek-Hobbs said. “No one will actually say that.”

Vinekar has seen this too many times.

“We have historically shied away from them and abandoned them,” she said. “Maybe this is when they need us the most.”

That's why Vinekar and her team opened a clinic they call the Jefferson Early Pregnancy Program, which provides near-emergency care for people who just found out they're pregnant. When patients call, they are told to schedule an appointment within a few days.

Vinekar hopes that appointments early in pregnancy will help patients get evidence-based miscarriage care right away, rather than waiting hours in the emergency room. And she hopes her model will spread, making it easier for people across the country to get help early in pregnancy.