Action, Anticipation

I finally got my courage up and called the Maternal Fetal Medicine service at our local hospital to schedule a preconception consultation... I was worried that I would have to justify or explain, but the receptionist calmly scheduled the appointment and said she'd send a preconception consultation packet - apparently they do these all the time. She scheduled it for May 28th (eek!), which is faster than I thought I'd be able to get in, but it will be good to get answers. Because I work at the accompanying university doing maternal and child health research, it was a bit complicated to figure out who to see without saying to a current or future boss, "So, um, I'm going to be trying to get pregnant in the next 6 months; you cool with that?" I ended up asking for the doc, let's call her Dr. Special, who backs up the hospital-based midwives who I delivered with last time - she also does preeclampsia research, so hopefully she'll be up on the latest.

Things I'd like to get answers/opinions on:
- My current risk profile for preeclampsia?

- I know I need to keep losing weight, but where should I realistically try to be to minimize risk?

- Should I continue on the Aldomet or try to get off of it? Chronic hypertension was unmasked last time I was pregnant, but I am currently well controlled on a low dose of Aldomet - an anti-hypertensive that is considered reasonably safe during pregnancy

- Right before I was pregnant with M, I was tested for abnormal clotting factors... One of them, lupus anti-coagulant was higher than the normal range. This could be important because these clotting factors are implicated in repeat pregnancy loss (ding!) and pre-eclampsia (ding! ding! we have a winner!) Usually, they test again in a month or two, because one reading can be false positive/negative... They didn't test me again b/c I got and stayed pregnant with M. My question for Dr. Special will be: Should I be tested again? If so what will we do? Low dose aspirin (see question below), low molecular weight heparin?

- Should I take low dose aspirin? - That's where the latest pre-e research is pointing...

- If so, when should I start? Some people start early in pregnancy to help with implantation... The thought is good implantation & vascularization results in lower risk of pre-e

- Can I deliver with the local free-standing birthcenter midwives with routine monitoring by Dr. Special? - The birthcenter midwives have admitting privileges at the hospital...

- If so, when/how should I be monitored by Dr. Special?

- If not, can I deliver with the hospital-based midwives? When should I be monitored by Dr. Special?

- When I had an epidural during M's delivery, I had a really bad allergic reaction to the mastisol (type of adhesive) they use to tape down the epidural catheter - it looked like a chemical burn and took 25 days of prednisone to calm down... I also got a staph infection from the hospital, so it was a huge mess... I am not planning to have an epidural again (see: freestanding birthcenter midwives), but if I am induced again for pre-e or another medical emergency, I know I may want one, especially if I am on pitocin and have to labor in bed like last time... My question to Dr. Special will be: Is there anything else they can use or do to tape the catheter down?

So, um, I guess I have a few issues to discuss... I'll let you know how it goes.