Warranties. Guarantees. Certainties

Actually this post should be called, "Why I HATE Obs," but I don't want every rabid ob in the country to make hateful comments on my blog.

Yes, I know they are the most sued medical specialty and have outrageous malpractice insurance. I feel for them. They deal in a field where people have their hopes and dreams focused on that precious cargo, and if something goes wrong, it is far easier to blame a doctor than nature or god or themselves.

But for just once I'd like for an ob to try a little bit not to terrify me to stinking death. Some history:
In May 2006, I saw my ob for an annual exam and asked her about the use of my AD, Lexapro, during pregnancy. In her defense, she said she prefers women to use Zoloft or Prozac. I told her I can't take Zoloft due to serious side effects and that my psychiatrist was ok with me using Lexapro during pregnancy. She seemed ok with that. She didn't tell me I needed to switch.

Fast forward to last week when she tells me I need to get off my Lexapro. Uh doc, you think you could have said this last May long before I started trying to get pregnant? She mentioned things like babies possibly developing ADD or ADHD and possibly having respiratory problems at birth (which I knew about). She said something about fetal demise, and I think that is when I stopped breathing and thinking and went into panic and pissed mode.

Now I know her job is to warn me (and cover her ass), but really, when I tell her straight up I HAVE GAD AND OCD (not 1, but 2 anxiety disorders) and am medicated and under the care of a psychiatrist, DO NOT TELL ME SHIT LIKE THIS!!!!!!

And then she suggests I start taking Prozac in addition to my Lexapro until I can wean off the Lexapro (sure, expose the fetus to 2 ADs, not just 1). When I asked her what would happen if I didn't respond to the Prozac or had serious side effects, she said I would go back on the Lexapro. (I didn't tell her that Prozac tends to make patients more anxious which is specifically why my psychiatrist avoided giving it to me in the first place).

And then she actually looks at Prozac's information and tells me nevermind, Prozac has the exact same warnings as Lexapro.

How many weeks of therapy will it take me to get over all this crap?

I think I was too stunned to process a response to her. And it wouldn't matter anyway because she is ignorant like most of the rest of the world about mood disorders and medication. And her game is "avoid litigation at all costs."

So here is my response to her:

God knows, if I had my preference, I would have no need for antidepressant medication. Under no circumstances do I like the idea of potentially exposing my baby to anything that may harm him/her. However, given the extent of my 2 anxiety disorders and the fact that I have to function for myself and my daughter, it is not in my best interest, my family's best interest or the best interest of the fetus for me to change or stop my medications.

Granted I am not a physician, but I have consulted my psychiatrist and read lots of books and research concerning AD use during pregnancy. I know there are risks, but there are also serious risks if I forego my meds. It is far more risky if I switch meds when the one I use now works at a low dose. It is entirely possible that if I attempted a switch, I would have to go back on the Lexapro at an even higher dose (and I am on the lowest dose now). Plus, if I have to endure the weight loss and insomnia that occur when my anxiety rears its head, that isn't good for anyone.

Pregnancy and birth are a risky business, in general. Always have been. Plenty of children are born who develop ADD or ADHD who's mothers never took ADs. Plenty of babies are born with respiratory difficulties who's mothers never took ADs. I have mood disorders and my mother never took ADs. That is genetics and nature and chance. I accept that.

I know your job is to present information to me so that I am well-informed but the mistake you make is 2-fold: assuming I don't know shit about my own mood disorders and the resulting risks of medication and assuming you can speak to me in the flippant way you do other patients who don't take things to heart as much as I do.

There, I feel better. I told her, "Well, we'll just have to hope that everything works out ok." And isn't that all we ever do anyway in life....pregnancy or no, meds or no.