Do you also go to an OB or CNM?

[Galatea]

In my state, HB is a-legal and not covered by insurance. Last baby we did have a HB but switched to the HB MW at 30 weeks, so I had already had all the tests, US, etc. with the CNMs at the FSBC.

This time we will be seeing the HB MW from the beginning, but I still want the tests, US, etc. So can I go to an OB or CNM practice just for the sake of scheduling tests and having insurance pay for them? And if I do, who should I go to? The reason I ask is that my local OB practice is awful, but close, and since I don't plan to deliver with them, I could just use them for the tests and then stop going at 20 weeks. But they are huge jerks and it would test my patience to go to them. I had my first two kids at the hospital with their CNMs, which is covered by insurance, and whom I really liked, but I don't want to screw them financially b/c seeing them for the first 20 weeks and then stopping. Or does that not matter?

[Youngfrankenstein]

I did parallel care. I was already about 25 weeks along before we started interviewing hb midwives. I went to have an up-to-date chart in case of hospital transfer. That way I wouldn't be seen as a "no care" patient. I would just be one from the OB group. It gave them the records on my GD status as well as my GBS status. (For example, if I transfered and had no record of my negative GBS status, they'd give me IV abx no matter what.)

It was a pain to do both and I had to keep my mouth shut about the hb. No one would have supported me at all.

I didn't end up going to my 6 week pp visit...I will have one with my hb mw and felt it was a waste of time.

BTW: My hb was not covered by insurance and was $1500. My OB care was partially covered and I've spent about $1000. It was still cheaper than the $5000 it would have cost to have a hospital birth.

[MamaMelis]

Are you in PA?

I am too, and my CPM who we are home birthing with was able to do all of the tests that I wanted for me (which in my case was just an initial CBC at 12 weeks, monthly protein/urine checks, I got my 20 week U/S through her referral through an OB who is her back up, and she will do my glucose test (which I am not doing) and my GBS swab (which I am maybe doing).

I am hopeful that I will be reimbursed through my insurance post birth ~ she submits coverage claims through a 3rd party biller ~ if you are not submitting claims to insurance than there should be no insurance issue with using an OB as you will not be double billing, you know?

I guess in your case it seems like its simply up to you ~ Do you want the tests enough to warrant having your patience tested? if so, easy, go to them. If not and you feel that it would be stressful to deal with an OB, skip the tests. Its always good to have options

[Galatea]

Yes, I am in PA. Last baby with my CPM, she didn't do billing and I already had my tests done. I'll call her and ask her. I do want a record to cover my butt in case of transfer, though, and I didn't think of that.

[xixstar]

I have a CPM in a state just below you and she's able to fill out lab requests and everything -- and takes insurance too, which floored me since technically she can't attend births here.

Have you asked your midwife about these things? I think sometimes we make assumptions about what they can/can't do before finding out (I certainly did).

[smeisnotapirate]

I'm in PA as well (have a MD CPM attending my HBAC), and my MW recommended backup care in case of transfer, but I declined. She's done all the routine testing through LabCorps. Most HBMWs will.

I actually don't like the idea of parallel care. If you have to transfer, fine, but birth (to me) is just as much a psychological event as a physical one, and seeing a Dr. that stressed me out woul really mess with the atmosphere I'm trying to create with my HB.

Just my . Good luck!

[sattygirl99]

I am another not doing backup care. Partially because I'm opting out of tests and possibly the ultrasound but also because my cpm takes insurance. Also I believe birth to be mental as well and being that I'm a hba2c, I do not want doctors in my head. If I have to transfer (for emergency) it wouldn't be to the hospital my backups are at anyway because its further away. If I transfer, I more than not will need another c and to me it doesn't matter who does it at that point.

[jdg]

When I first talked to my midwife, she was able to advise me about which OB to go to for backup care. I also live in a state where HB is not legal, but am fortunate to be in an area that has one OB who is willing to "back up" the local midwives - provide medical prenatal care including testing, be the doctor on record if a hospital transfer is needed, and allow the midwife into the hospital room in case of transfer. This OB is willing to be as hands-on or hands-off as a HB client wants and all testing is optional. He asks that I show up three times (once per trimester) to check in on how I'm doing and that I sign a release basically stating he's not at fault if something goes wrong during the HB or because I chose to decline standard testing.

[Galatea]

Originally Posted by jdg

When I first talked to my midwife, she was able to advise me about which OB to go to for backup care. I also live in a state where HB is not legal, but am fortunate to be in an area that has one OB who is willing to "back up" the local midwives - provide medical prenatal care including testing, be the doctor on record if a hospital transfer is needed, and allow the midwife into the hospital room in case of transfer. This OB is willing to be as hands-on or hands-off as a HB client wants and all testing is optional. He asks that I show up three times (once per trimester) to check in on how I'm doing and that I sign a release basically stating he's not at fault if something goes wrong during the HB or because I chose to decline standard testing.

Wow, sounds like a dream doctor! Where do you live?

[MamaMelis]

Would someone be willing to give more info on what you mean by "cover your butt" in case of a transfer?

The way I have been thinking of it is, I will transfer in the event of an emergency or because I need medical intervention (an epidural, etc) ~ in which case I will be going to the hospital to take advantage of ways in which the hospital can help me. In other words, I don't see my GBS status being of supreme importance if I am going in for an emergency CS or something, LOL An IV would likely be the least of my worries in the event of a hospital transfer, the way I am thinking about it.

What is it you fear by NOT having parallel care in the event of a transfer, I guess is what I am asking.

[Galatea]

Originally Posted by MamaMelis

Would someone be willing to give more info on what you mean by "cover your butt" in case of a transfer?

The way I have been thinking of it is, I will transfer in the event of an emergency or because I need medical intervention (an epidural, etc) ~ in which case I will be going to the hospital to take advantage of ways in which the hospital can help me. In other words, I don't see my GBS status being of supreme importance if I am going in for an emergency CS or something, LOL An IV would likely be the least of my worries in the event of a hospital transfer, the way I am thinking about it.

What is it you fear by NOT having parallel care in the event of a transfer, I guess is what I am asking.

Originally Posted by Youngfrankenstein

I did parallel care. I was already about 25 weeks along before we started interviewing hb midwives. I went to have an up-to-date chart in case of hospital transfer. That way I wouldn't be seen as a "no care" patient. I would just be one from the OB group. It gave them the records on my GD status as well as my GBS status. (For example, if I transfered and had no record of my negative GBS status, they'd give me IV abx no matter what.)

Some people transfer for being tired and wanting an epidural, not just for a section. More importantly, if you are a no care patient, they can get the state involved and take your baby away and start investigating for neglect (obviously worst-case scenario but still.)

[MamaMelis]

Yes, I mentioned wanting an epidural in my reasons for transfer ~ I declined GD testing last pregnancy with my OB, and many of his patients declined routine GBS testing anyway, so I guess that just does not seem like that big of a deal to me. I guess my point is, if I went in for exhaustion and seeking drugs, and the worst that happened to me was that I was treated as an "unknown" for my GBS status, in the midst of the other interventions I was seeking, that would not worry me.

I guess I have no worry about being considered a "no care" patient in the eyes of the state, when my midwife has thorough records of my care for the entirety of my pregnancy, including all tests that I chose. I would be curious how often that actually happens.

I guess that that fear (my children getting taken!) just seems so extreme and so unlikely, that it using it to justify double care, double appointments, and double insurance billing just isn't for me.

Plus, in relation to youngfrankensteins comment that you quoted, at 25 weeks most people haven't yet been tested for GBS OR GD, so I feel confused as to how transferring away from the OB group at that point in pregnancy would help in the event of a transfer, anyway. To have those tests on file with the OB group/hospital wouldn't you have had to continue parallel care up through your 36th or 37th week when most providers text for GBS anyway?

Thanks for the info!

[ColwynsMommy]

Our midwife was able to refer us for an ultrasound, but the insurance coverage would have been iffy (since homebirth and CPMs are alegal in my state as well). Same with the initial labwork. My OB is pretty tolerant of my choice to homebirth, so I went back to her at the start of this pregnancy so that our insurance would cover labwork and ultrasound without question. I don't plan on testing for GBS or GD, so I just stopped going to my OB after the 20 week ultrasound. She was expecting it, 'cause that's when I told her we were switching to a HB midwife when I was pregnant with my last.

As for the hassle of dealing with OB-mindset.. it depends on how good you are at letting things roll off your back. I have no problem with ignoring stupid people, so.. But if I felt like it would really bother me, I might have skipped the OB stuff. The CNM I saw for my initial prenatal this time was horrible, really and truly horrible, but I just smiled and nodded and okay'ed, then ignored her advice. The next prenatal, I saw my OB and we discussed things, and while I think she had some of the same concerns as the CNM, she was much more open to listening to my reasoning, and it was a much more pleasant experience.

[Youngfrankenstein]

Originally Posted by MamaMelis

Plus, in relation to youngfrankensteins comment that you quoted, at 25 weeks most people haven't yet been tested for GBS OR GD, so I feel confused as to how transferring away from the OB group at that point in pregnancy would help in the event of a transfer, anyway. To have those tests on file with the OB group/hospital wouldn't you have had to continue parallel care up through your 36th or 37th week when most providers text for GBS anyway?

Thanks for the info!

I continued my care up until 40 weeks. I actually stopped going to the OB at about 38 weeks but due to the circumstances, I went at 40 weeks and scheduled an induction for 4 weeks. Thank goodness that wasn't needed, but it could have been a real possibility for me and I am glad I had that option and didn't burn the bridge.

[Comtessa]

Originally Posted by Galatea

I don't want to screw them financially b/c seeing them for the first 20 weeks and then stopping. Or does that not matter?

I wouldn't worry about this in the slightest. If you want the tests and such, go to the CNM's, get the tests, have your insurance pay for them, then stop going. They get paid for the work they've done, and nobody gets screwed.

I got concurrent OB care for my entire pregnancy, which was a huge PITA, but I was SO grateful for it when I ended up transferring for exhaustion. I'd been able to develop enough of a relationship with the OB - who knew about my HB plans and supported them as much as he was "allowed" by ACOG - that he knew I'd be freaking out about a transfer and came in (on his day off!) to attend DD's birth.

IME, it's totally worth it to get concurrent care as long as the medical establishment remains such a closed system. If you aren't seen by "one of them" for prenatal care, IMO, it's much more likely that you'll be badly treated if you end up requiring their help in labor. I'm glad I covered all my bases.

[SuzyLee]

I am going to a FP doc for parallel care. I love her- she is very hands off (compared to the CNM I used for DS1!) and I would feel comfortable birthing with her if needed. The 2 reasons I am seeing her are 1. I wanted all the testing, US, had a CVS, etc. and 2. I had preterm labor with DS so I wanted to be prepared to possibly have to go on bedrest, and have to deliver in a hosp. before 37 weeks.

[Youngfrankenstein]

Originally Posted by Comtessa

IME, it's totally worth it to get concurrent care as long as the medical establishment remains such a closed system. If you aren't seen by "one of them" for prenatal care, IMO, it's much more likely that you'll be badly treated if you end up requiring their help in labor. I'm glad I covered all my bases.

You said this better than I did. Even though my hb was a "secret" to the medical group, my mw would have transfered with me and she would act as a doula and they'd be none the wiser in most cases.

[JennTheMomma]

I saw both my MW and OB until 22 weeks, then I stopped seeing my OB. I only saw my OB for shadow care, and didnt' do any tests.