Co-Coverage-CNM (Hospital) & CPM (Home)

[JanLukDylJul]

I just had to share my own experience after reading the "you won't get a medal" rant thread. We had a natural waterbirth in a hospital (which we had to fight staff off to get!) for our first and are planning a homebirth for our second. As I consider myself to be a realistic individual, I am continuing my care with my CNM in the hospital/clinic setting whilst seeing my Homebirth CPM as well. I would like to continue to have my labs taken (glucose tolerance, GBS) as this information will help me make the best decisions possible regarding my care. Here are two negative incidences that I have encountered while trying to maintain an open, cohesive culture of care between Hospital(CNM) and Home(CPM) practitioners.

Encounter #1 with the Medical Records Release Lady after I explained why I'd like to have my records released to my CPM: "Well your homebirth midwife better not let you make copies of your medical records or let you see them because she's supposed to charge for that. Your records are the property of the state of **! I'm not even sure I feel comfortable releasing records to a homebirth midwife!" Wow-just wow.

Encounter #2 with my CNM's nursing assistant when I called to let them know my CPM would be accompanying me to my next appointment: "Well, I think that we'll have to terminate our care relationship with you now if you've decided to have a homebirth." Seriously, can they do that?

I just feel like there shouldn't have to be such a divide between the two philosophy's of care and never the two shall meet. What happened to make hospital vs. homebirth enemies?

My husband gave me encouragement recently by telling me that we are pursuing "the correct, most efficient tool for the job." If there is no complication in my pregnancy, there is no need for a surgeon to attend it. If I am going to go to the store 3 blocks away to get a few groceries, a bike or my feet are a better, more efficient tool than a vehicle. If I grow food in the garden and preserve it for use, that is more efficient that buying canned goods from China. This helped to set me at ease...a bit.

Please let me know if any of you mommas out there have felt similar things while trying to have an open discussion between these two practicing birth fields. Stories or perspective much appreciated!

[srlpenny]

I have had coordinating care for the bulk of this pregnancy with hospital CNMs, first because I was TERRIBLY sick in the beginning and needed to have the option of being admitted, and then for the same reasons you mentioned, mostly the ultrasound to make sure the baby was healthy.
Unfortunately the reality is that most practices are not and will not be friendly to providing care for women who plan a home birth. In my area, there are 2 midwives you can see. You cannot mention it to the other MWs in the practice, forget the OBs and the office staff. It is completely unspoken outside of those two MWs, who are supportive.
Have you talked to your CPM about maybe finding someone who she knows to be more friendly to co-care? That's how I found mine. Also, if you are truly just using the CNMs to check for tests, etc. Try not talk to them much, or invest much emotionally in what they say. My CPM has never had a copy of my blood test results, etc, because they have always come back normal, I have told her that and we're on our merry way.
If you feel you need a copy, then just ask for a copy for yourself, perhaps you are going on vacation and extra-cautious you want to have them with you? They are your records, it's none of their business what you want to do with them.
The unfortunate situation in many places in the US is that birth has to be either or, there is no middle ground. And if we as mothers try to get the best of both worlds, it often means taking flack in the process.
Sorry I can't offer something more constructive ... but that's my 4 cents worth ;-)

[LisaSedai]

Medical records lady is FULL OF IT.

http://www.privacyrights.org/fs/fs8a-hipaa.htm#6
Your ability to see your own medical records is probably the single most important right you have under HIPAA. Before HIPAA, your right to see or copy your medical records often depended on your state laws. Now, HIPAA sets the national standard, or ìfloor,î meaning that states can give you greater rights to access your medical information, but state laws cannot take away the fundamental access rights you have under HIPAA.

Does HIPAA allow me to get my original records?

No. HIPAA only gives you the right to get copies of your records. Or, if you choose, you can ask to see your medical records or ask for a summary of your medical file.

Do I have to pay for copies of my medical records?

Probably, yes. HIPAA says you can be charged a "reasonable, cost-based fee." This means you can be charged for supplies and staff time for copying your records. You can also be charged for mailing records, if mailing is what you request. But, you should not be charged for time spent searching for your records. Nor, should a provider have a policy of charging all patients a flat fee

[angela40]

it may be that the cnms are worried about basically providing double care and getting reimbursed. are you using insurance for the cnm and cpm? or cash for one insurance for the other. if you are only using insurance for the cnm then they shouldn't have a problem getting reimbursed for the care they are providing though it won't be nearly as much if you have a global ob plan and they don't do the delivery. so they may be not wanting to not get paid their full fee?? especially if they have overhead to pay for.
so in essence i am saying in this economy they may just be looking out for their bottom line in the end which i think is understandable. it may not be a "war" bw homebirth midwives and cnms at all. jmo fwiw.however i am sorry it is becoming a problem!