1. They advertise it as convenient: Endo, ob-gyn, nurses, u/s machine, all in one place! Except that you have to wait at least 45 minutes and more often two hours to get in for the first appointment, never mind the other ones, so I was spending more than half a day on them altogether. They only held them on Thursday mornings so I could not schedule them at a convenient time for work, or for me. And because diabetics are seen more often throughout pregnancy, this was every other week all the way along, progressing to every other week close to the due date (which I didn't reach, but never mind).

2. You never get an ob-gyn. There are eight in the practice, and you see all of them. Some of them are lovely human beings. Others are complete dumbasses who should be locked up before something they say gets some angry pregnant woman (not naming any names) to scratch out their eyes.

2. a) Because you never have one ob-gyn, no one actually knows you or follows you. Every week the doctor scans your file to see what the last doctor said, and then repeats it. There is no opportunity to develop a relationship or have a conversation that spans more than one appointment.

2. b) I was one of the fortunate few for whom "glowing skin" meant "the absolutely worst acne breakout known to mankind." My face actually hurt, it was so bad. I called up Motherisk to find out if there were safe medications, I did some reasearch, I asked one of the ob-gyns for a prescription for a topical antibiotic. She refused it because there had just been a study released saying that if young children had too many antibiotics they were more likely to develop asthma. Never mind that has no connection whatsoever to topical antibiotics on their mother during pregnancy, for which there is no reason to believe that the fetus ever gets any.

2. c) The one who told me, when I questioned some of their prenatal testing, that I "would be glad of it if they found something wrong" because they could "give the baby steroids." Uh huh. Thanks for that, chap. And guess who ended up delivering Frances?

3. Their standard of care is more like a prison of care. There is no flexibility, and it is based on the worst-case diabetic scenario. So, for instance, at my very first appointment at the clinic, the nurse chirruped to me: "One of the good things about being diabetic is that we won't let you go past your due date." Now, at the time, I expected to go late because everyone in my family goes late; so this sounded like, "We're going to induce you on Jan 22 2004." I brought up this requirement at every doctor's appointment in the second and third trimester, especially after the A1C tests showing completely normal blood sugar values and ultrasounds showing a small baby. Why induce? I asked. Why not wait a week? Even three days? Why not wait THREE FREAKING DAYS? Because you're diabetic and there's a higher risk of stillbirth, they said, which is true. Oh, absolutely, yes. True for diabetics with poor blood sugar control. No evidence it was true for me.

Forget about informed consent. They were very clear in their instructions, but that's what they were: Instructions. Show up here, at this time, for this test/procedure. No, we will not discuss it.

It still makes me angry, and it's been two years since I've been there.

Where I used to live, that was the only way to get prenatal care as a type 1 diabetic woman, so I had no choice. I had to go along with whatever they did, even when I knew it made no sense. I'm sure you can imagine how well that went over with me.

I'm looking forward to being able to find my own ob-gyn. Even if they turn out to be as inflexible and poorly mannered as much of the old practice was, just having a file and a history with one or a handful of doctors who get to know me as a person, will hopefully be a more pleasant experience. You never know, they might even figure out that I'm a reasonably intelligent person who works very hard to control her diabetes and is reasonably well-informed about the risks of various outcomes and procedures. But I probably shouldn't get my hopes up.

We have not, by the way, made a decision yet, so congratulations would be premature.

Before we can even think about it, I'd have to find an ob-gyn who seems human, start taking 8 glucose tests daily, refine my basal doses, go on a mega-dose of folic acid for a few months (especially important for diabetics--I need about 4x what a healthy woman needs), then get the IUD out. The fastest that could happen is three months, but it's more realistic to assume six.

But even six months is probably not likely, given that I want Frances to be over three before any potential siblings arrive. It would be best if it were close to when she starts junior kindergarten, which is in September of 2007. So we're a ways off yet. But when you're diabetic, even thinking about it requires a lot of lead time.

I guess it's progress that I'm even considering it.