FTM choosing an OBGYN

After years of struggling through Infertility treatments, and two early loses, we are finally 8.5 weeks pregnant with our first baby, and are now searching for a good OBGYN. 

I briefly had an OBGYN whom I was referred to by my PCP for infertility and after seeing her in office once, she prescribed me Clomid for several months, then after that referred me to an IVF clinic, and that's as much as I've interacted with her. Now that I've been officially discharged from the IVF clinic and am in need of an OBGYN, I decided it was simplest to go see her as I already have a file with her, and she is based at a reputable hospital (Beth Israel Deaconess, in Boston). As a first time mom, with no older women or mother figures in the US, I've tried to educate myself on what to expect at each step, including what to expect at my first 8 week appointment. I did not get what I expected. 

I started by asking her about the hospital's philosophy and statistics on things that are important to me, and while she tried to tell me all the good things, it wasn't terribly convincing. I got the feeling that I might be a number who gets swept along a routine course of action that I'd have little control over, and would not have the freedom to advocate for myself (Too many stories of women who are ushered into C-sections unnecessarily because the doctors on staff prefer to do so), and would not be educated along the way. Being informed is very important to me. This has me thinking that I might prefer to see an OBGYN in a smaller clinic setting, so that I might have more personal and attentive care through my pregnancy, and might be heard and respected more clearly. 

She did not do bloodwork. I even asked her, and she said it wasn't necessary. I was already having blood drawn in their lab for something else, and she still said no. I understand that it is important to have bloodwork at this stage to get a pregnancy base line, and to make sure that my HCG levels are rising properly (an issue in my history), etc. Even knowing that I've had losses, she didn't think it important.

She didn't do a proper physical exam. She didn't even ask me to undress. Didn't look at my vagina or breasts or even listen to my heart or lungs. Nothing. I mentioned to her that my last gyn exam was a year ago, and so maybe it's time to do that (hoping it would encourage her to give me a pelvic exam), and she said we'd do it next year after the baby is born. I understand that a pelvic exam is important at this stage, even if I wasn't due for my gyn exam, to make sure that my cervix is looking good, to check for infection, and to make sure that everything is healthy, as I'm still on post-IVF drugs. She did nothing, even at my suggestion.

She didn't check on a known pregnancy complication. A week ago I started heavy cramping and bleeding, and after an emergency transvaginal ultrasound at the IVF clinic we found that I am having subchorionic haemorrhaging (the baby seems A OK, thank goodness). I have a medium sized bleed, that the IVF doctor recommended be monitored and measured by my OBGYN. I mentioned this to her (thought it was in my files that were transfered over to her) and she said it wasn't necessary to monitor it. She said even if we see that it's getting bigger, there is nothing we can do. I disagree; I imagine that there is something we could do, such as put me on bedrest, or keep me on progesterone, or something. I asked her if we could do it anyway, so I could stay informed about my body (again, knowing what's going on is very important to me), and she dismissed me. She did do a standard ultrasound (not transvaginal), I imagine as a standard practice, and she confirmed that she saw a heartbeat (thought I saw nothing because the quality of the ultrasound was so low), and she couldn't see anything else. it was like looking at an ultrasound from the beginning of time. 

I asked her if we could monitor my vitamin levels, specifically Vit D, Vit A, and Folic acid, and she said it's not important. She said as long as I'm taking my prenatal vitamins there is nothing to worry about. I have a known Vit D deficiency, which I've worked to manage, and told her I want to see if the levels are good now, or if I still need to increase them. She said vit D was not really important to my pregnancy. I told her I want to check that I'm not getting too much vit A, as I know that between my prenatal vitamins, and my morning nutrition shake (Vega One) I'm already getting 9000 IU per day, and want to make sure I'm not getting too much more than that through my diet, because too much is linked to problems. She said it's not likely, and dismissed my request. I then asked about testing my Folic acid, again because between my vitamins and shake I'm getting %300 the DV (whatever that daily value is; it depends on the souce), and that I'm concerned that too much during pregnancy could be a problem, and I'd like to know if I should adjust. She said too much Folic acid isn't a worry. I mentioned that just this week a paper was published by researchers at John's Hopkins Bloomberg School of Public Health that demonstrates a link between high levels of folic acid in pregnancy, and autism, and she actually snickered at me, roller her eyes, and mocked me. "A study?" I'm not talking about an article I saw in a newstand magazine, I'm talking about current science news. My husband is a scientist, and when I told him about the way she condescendingly dismissed my mention of legitimate scientific news pertinent to our situation (which he was already familiarized with), he told me to get a new OBGYN. I agree.

Lastly, I asked her if we could book a tour of the birthing ward so we could decide if that setting was right for us, and she chuckled and told me to wait until I was at least halfway through my pregnancy. First of all, it makes me feel as if she's reminding me of the painful reality that my pregnancy is still tenuous, and secondly, makes me feel as if she's trying to keep me from seeing what I'm getting myself into. 

For all of these reasons I feel that I did not have a proper 8 week OBGYN prenatal care appointment, and do not wish to continue with this doctor. I would like to being looking for another doctor. I have many questions:

1. Does a smaller clinic mean more attentive, informative prentatal care than a doctor in a large hospital? Pros/cons of each setting?

2. Would a smaller clinic still be able to offer all of the same screening/diagnostics/test, such as regular ultrasounds (to monitor this bleed), full scope of prenatal genetic screening tests, regular bloodwork, urine etc.?

3. Short of calling every single OBGYN office in Boston and asking, how can I find out which hospitals the private clinic OBGYN's admit their patients too for birthing?

4. Am I better off looking for a good doctor, and going along to whichever hospital he/she admits too, or am I better off looking for a good hospital, and then picking one of the doctors on their website? I'm concerned that if I choose a different hospital, I might end up with a different doctor, but the same cattle-call type of setting where I feel dismissed and ignored. Do all hospitals have the same impersonal feeling for prenatal care?

5. Will my choice of doctor and/or hospital limit or otherwise influence my options for hiring a birth doula?

I want straightforward, attentive care, with someone who will educate me instead of just dismissing me. I want someone who will listen to my concerns, and honor my demands; I am the customer after all. I want someone who will properly monitor me with bloods, ultrasounds, pelvic exam, etc., to make sure that I am in optimal health through each stage of pregnancy, and if I am not, action can be taken to correct it immediately. I will advocate for a natural vaginal birth in a hospital setting, so long as that is a safe option for me. It would be the icing on the cake to find someone who also has a lovely bedside manner.

Any and all insight is welcome. If you would like to refer specific doctors/clinics/hospitals, please limit them to BostonBrookline/Cambridge area.