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Originally Posted by cileag  mrsfatty-- just to let you know, some of those things are out of the nurses' and mds hands. The PKU test for example is a lab draw and if the lab is running behind, it's very difficult to get them done in a timely manner because the test is such a "low priority" test and so if STAT or ASAP labs need to be drawn, they get done first, or if there are many babies discharging that need to be drawn, it takes awhile. It is an optional test however, and could be done at a follow up visit. A good nurse should also be honest and open with what is causing the delays.
The other thing I'll mention is that unfortunately, in the hospital setting, your pediatrician does not have the power to discharge a baby unless he or she has examined him/her. That will be at the discretion of the pediatrician on call that day (and some are fine and some put up a fight). I would caution you about leaving AMA due to cost--most insurance companies will not cover the hospitals stay if you leave against medical advice.
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I'm not trying to be a jerk--so please don't read this that way:
The nurses and on-call drs and pedis WERE dragging their feet. They waited until the last moment to try to do things. I told them the exact hour I was going to leave--whether they were done or not. One hour before I was going to leave they told me they wanted to do the hearing test.
I was cooperative and not confrontation at all, at first. I went with. The first ear was fine--the second ear was showing up as a problem (I can't remember the exact wording the computer came up with)--but she said she didn't want to put that in the record, that she wanted to try again and again. My son was getting very agitated (and hungry). She said she wanted him to have a pacifier. I said I wasn't allowing pacifiers, so I didn't cause breastfeeding issues (artificial nipple introduction within the first few days of birth RUINED my breastfeeding relationship with my first son, and I had to exclusively pump for 18 months--and I WAS NOT wanting to do that again--so I was ADAMANT about not using ANY artificial nipples AT ALL). I asked if I could breastfeed him while he did the test--cause that would do the same thing (calm him down and he'd be sucking). She said no. Fine. I said I'm not allowing pacifiers. THEN SHE ARGUED WITH ME--and was trying to FORCE ME TO USE A PACI, and said that pacifiers have NOTHING to do with the success or failure of a breastfeeding relationship. And then made a snide comment to a fellow nurse about "some mothers," as if I couldn't hear her. I asked if I could take a couple minutes to calm my son down--I took three minutes to nurse him and shush him and he was fine. Set him in the bassinet thing (cause she said I couldn't hold him) and she kept trying for almost an HOUR--and he was continuously upset. And she was continuously complaining about how unreasonable I was being about no pacifiers. I finally told her I didn't care if it came up as "bad" or "not hearing" or whatever the crap it said. It was what it was, and there's nothing we could do about it. And it's something I'll deal with with my regular pediatrician, if there ends up being a real problem. She asked for one more time. I conceded. It came up as fine or hearing or whatever.
THEN, I pick him up (he's crying at this point cause she was yanking on his ear and being really rough with him--his ear was a little misshapened at this point, from birth it was that way--it still has a unique structure to it, but it's "normal") and start breastfeeding him and she makes a comment with a sort of face to the nurse she made the "some mothers" comment to, "doesn't he look a little yellow? I'm going to get the (whatever you call the skin flasher dealie that takes a general estimated bili through the skin)." It said a 6--she does a dramatic, freaking out, hysterical voice--"That's so high! I don't think you guys will be going home tonight! We have to do more testing!!! Call the pedi right away!" I gave her a look. The "I'm not stupid" look. I said, "really? What's your 'cut-off' number for bili?" She said she didn't know, but, a six, that was bad! I told her I was comfortable with a six and that I would be more than happy to follow up with my regular pedi within two days (cause, come on, park nicollet is a busy place, gotta give the st. louis park pedi department a choice of two days) to check his levels again. I also told her I was having a home-care nurse visit (our insurance covers a visit within a certain amount of hours after birth)--so she could check it then as well. And if those numbers were "bad" we'd be more than happy to come back--if there really is a problem. But I'm not staying here for a six. I know the symptoms to look for. He's not yellow to me. He's peeing. He's pooping. He's eating. He's not lethargic. I know the symptoms to look for and I know a bili range I'm comfortable with." She goes to say, "well I'm calling the pedi and we're going to do a blood test and you need to give him formula." To which I said, "we're leaving in 15 minutes, if you can arrange that in the time you have left, that's fine, I will consent to a heel stick for bili and you can call me with the results. And under no circumstances will I give my son formula (we've never given either of our kids formula--my first son's severe jaundice resolved with photo therapy and feeding on demand--and I think his was caused by vit k--and my second son didn't have vit k and wasn't showing ANY of the jaundice symptoms that my first had at this point AT ALL)." She huffed at me as I left--and magically, we were serviced VERY QUICKLY. The pedi on-call magically appeared. The lab techs finally came. The doctor tried the scare tactics as well...and my husband and I were exhausted and we were on the verge ama...and then the pedi said she'd call us, after we told her we'd come back if there REALLY was a problem. But that to us 6 was no reason to stay. We wanted to rest at home and we were leaving. When she called us, everything was fine, just like we thought...
SO....long story short...when I give birth in the spring...three strikes and your out with the hearing test--period. and ama sign-out if they try the jaundice thing again. and I will be speaking to a charge nurse if I get treated like I did by that nurse in the nursery doing the tests.
Why talking to my pedi about my plans in advance? Well, I wanted a homebirth--that made my husband uncomfortable--but giving birth in the hospital and leaving when I was ready was a good compromise. We've talked about what we're comfortable with for my condition and the baby's condition. I shared my plans with my pedi (good communication with your doctor is great) and she shared the on-call/policies and how to get around it and get cooperation this time (she was annoyed that the nurse/oncall pedi made ANY sort of fuss about my second son's bili levels). She explained the time in the middle of the night when no one would be AT the hospital but I COULD call in a pedi from home if I really wanted to...she was ok doing the newborn screening test in office (instead of at the hospital)...she was ok seeing my newborn on short notice (within 72 hours of birth)...talking to the pedi is important for scheduling reasons and just to maintain a healthy level of communication, honesty, and trust on both sides. She was thrilled with my "plan"--and even encouraged me to sign out ama under certain circumstances (we of course talked about certain ones we BOTH agreed we'd stay for). She was comfortable seeing us if we did sign out AMA.
And you're right--you get whoever is on call (for OBGYN and for PEDI)--but, they see all your medical records, because park nicollet has a great system that keeps everything in one place--so the on call doctor can see the notes my doctor puts in the records.
As to your comment about leaving AMA:
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| leaving AMA due to cost--most insurance companies will not cover the hospitals stay if you leave against medical advice. |
That is a lie. That is a falsehood to scare patients and parents into not signing out ama. It is ILLEGAL for insurance companies to deny coverage for leaving against medical advice. Why? Because as patients and members of insurance groups, we are in charge of our medical decisions. Insurance companies cannot make medical decisions for us. They can set ahead of time what they will and will not cover in their explanation of benefits--and they must cover it if you meet the requirements (ie if you choose an in-network hospital--they have to cover at your in-network rate)
If what you're saying is true, then all my well-child visits shouldn't be covered, because we don't vaccinate. Not vaccinating is against medical advice--yet, all the well-child visits are covered. If what you're saying is true, then all my waivers mean nothing (declining vaccinations, vit k shot, eye ointment, glucose sticks, breastfeeding instead of formula, etc.) and they shouldn't cover my stay. But, that would never happen because INSURANCE COMPANIES CANNOT DICTATE YOUR CARE. They can decide AHEAD OF TIME, in the explanation of benefits, what they will cover, but everything else is up to us. If doctors ran the show (instead of patients) insurance companies wouldn't be able to afford covering anyone.
Everything is about consent.
I can choose to sign out myself and my child ama if I so please. Sure, you may threaten the whole insurance thing (which is a lie), you may threaten cps...but it is not unreasonable for parents to be in control of their children's health care. I don't think that me signing out my kid ama, if the hospital doesn't comply with my timetable (which my pedi assured me there should be no problem, if I had a similar birth to my second son's), is unreasonable. I am still under medical care (I will have a home nurse the next day, and I will see the pedi within 72 hours)--so it's not medically neglectful. I think that any reasonable person can see that I'm choosing to do what's best (going home to rest, nursing my second child, taking care of my newborn, taking care of myself in the COMFORT OF MY OWN HOME with the support of my medical team).
OP: Don't be afraid to have clear boundaries and set limits and be prepared to assert yourself! You don't have to be a brute about it (I was polite, except for at the end with the whole bili thing--I got rude and short because I was frustrated that I had been berated for 30-45 minutes--and I couldn't take it anymore). You can be firm and polite at the same time. You CAN get what you want from birth, if it goes all according to plan! Be prepared for any obstacles that may come from your condition--and know how you want to handle it AHEAD OF TIME--cause after birth, you'll be tired and emotionally taxed--having a plan when you're as clear-headed as you can be is important. COMMUNICATE with your medical team so they're not surprised by your expectations.
Again, I'm not trying to attack you, nurse from Methodist--just had a bad experience after birth with the staff with my second child's birth...and think you are wrong when it comes to ama information. Sorry if I came off harsh-that's not my intention...
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