Tons of questions!!(some tricare/military)

[army_princess]

OK, I am NOT pregnant yet. We have been TTC #2 since March 2008. There is a birthing center here that does consults for TTC. My DH is deploying in a few months and they are doing IUI(free) for us. But I have had HORRIBLE service with the OB/GYN department here on base. I was wanting to do SOMEWHAT natural birth. I want IV meds, but not epidural. I want to walk around and bathe and only pain meds if needed at the end to help relax.

I can see a CNMW, and it will be covered, depending on what goes on, I believe....ANYWAYS! I DO NOT want to deliver at a birthing center. I want to be able to get IV meds, So that would mean I would need a CNMW who will work at the hospital along with a doctor right?? And with the showers, it is up to the hospital and if they have tubs, correct?

Military/tricare questions....

*Is it true they WILL NOT induce you till you are late or have complications??
*Do they allow CNMW on post to deliver? we have a CNMW on post, but I don't know if I like her much....
* Did you deliver at a birthing center? What did tricare cover? I have read on HERE that they will cover somethings, and you have to go through the red tape. I know I will get a better answer calling tricare...

THANKS! I just want to know what I am getting into with the military birth experience!

[EdnaMarie]

Hi!

We just got on to Tricare (my husband joined the army).

My answers, more general:

- The attitude of your base doctors, CNMs etc. will vary from person to person, base to base, etc. Nobody here can tell you what Tricare will get you. However, I have HEARD from my friends in real life that having seen so many emergencies, many military doctors and nurses are much more hesitant to go with the flow.

- Tricare does not cover homebirth but they are supposed to cover a birthing center, and at least here in Washington, they did cover a CPM.

- I do not think ANYONE is supposed to induce without indication (complications) but... we all know they do, so again, I think that is more personal.

I think that essentially, you are going to be limited like anyone with insurance, so what you should probably do is go to the tricare office on base and ask these questions to them.

Welcome to MDC.

[army_princess]

I do not want a home birth, just a mid wife IN a hospital....But I want an OFF post nurse midwife to do it, rather than the ONE that is on post...I am worried about complications and the nearest hospital is ON POST, which is a 5/10 minute drive, not including the gate and traffic, from the birthing center.

My family tends to have LARGE babies with HUGE heads....My son was 2 weeks early. We did a diagnostic ultrasound before i was induced(complications) and his head measured LARGER than a 42 weeker!!!!! I am worried if I make it to 40 weeks I will end up getting a C/S due to a large baby.....But I guess that's be the doctors decision about inducing for LGA babies.....I hate the rules here....

I am getting anxious about a delivery for a baby I am not pregnant with....I'm nuts...

[EdnaMarie]

I am just saying, the only real answer I can give you is about homebirth, because otherwise so much depends on the doctor. But CNMs are covered.

[melis79]

Your best bet is to locate a CNM(s) that work in a clinic with Ob/Gyn Md's who deliver at a local hospital if you do not want a homebirth or a birthing center birth (both of which ARE COVERED only if you are seeing a CNM not PM or LM/DM).

You can either try to get a referral from your Tricare Service Center to this off post clinic/provider for prenatal care (which can be a pain in the ass, because they usually will NOT do it if your local MTF within 50 miles of your zip code can provide the same services) OR you can disenroll from Tricare Prime once you know you are preggers and be enrolled in Standard. Standard carries a $150-300 annual deductible based on AD members rank, and depending on whether or not you see someone in network or out of network you may have a coshare of 20% of the charges. But with Standard you can go wherever you want and they will still pay something towards your care.

As far as Tricare letting you be induced, that really has NOTHING to do with tricare at all. It is up to your individual provider and/or whomever happens to be oncall when you go into labor. Tricare cannot dictate whether or not you can be induced.

Most Ob providers in a hospital have to follow a protocol to induce a patient. It either has to be: (in order of priority)
a) medically necessary, life of baby or mom is threatened due to complications, (severe eclampsia, severe uncontrolled GDM, severe IUGR)
b) medically indicated, mom or baby is having some problems that would be fixed with delivery(PIH, GDM, low AFI) or history of really fast labor,etc...
c) post dates, mom is 41 weeks or more,
d) elective.


And yes CNM that work at the MTF hospital can deliver. I saw one briefly 6 years ago at Ft Riley and she was a CNM but also could give epidurals etc...

[kirstenb]

I had my first son in the Naval Hospital on base and I am having this baby at a free standing birth center.

Regarding induction, it really depends on who you are seeing. With DS when I went in on my due date and nothing was happening, I got an appointment for 2 weeks out for an induction. He was born two days later so I didn't have to deal with that at all.

To go to the birthing center this time around, I needed to get a referral from my PCP to stay in Tricare Prime. They wouldn't give me a referral since there is a Naval Hospital 10 minutes away. I ended up disenrolling from Prime and enrolling in Standard which is accepted by my birth center.