Do you think shadow care is neccessary? - Page 2

[fruitfulmomma]

We don't have insurance so this isn't an issue for us, but if you get transported aren't you just going to get the doctor on-call, especially if it is an emergency? I don't see how they would have time to call your doctor in to come take care of you. Will your insurance not pay for emergency care at the hospital if the doctor is not yours? What if you were planning on birthing at the hospital anyway and your doctor didn't make it or you had a prolapse or something and *had* to go with whoever is right there?

[sellendie]

Originally Posted by fruitfulmomma

We don't have insurance so this isn't an issue for us, but if you get transported aren't you just going to get the doctor on-call, especially if it is an emergency? I don't see how they would have time to call your doctor in to come take care of you. Will your insurance not pay for emergency care at the hospital if the doctor is not yours? What if you were planning on birthing at the hospital anyway and your doctor didn't make it or you had a prolapse or something and *had* to go with whoever is right there?

This was my thought also....If I go to the ER with a broken leg, my insurance covers the contracted amount regardless of who sees me, what is the difference?

ETA: I just spoke with my sister, and she ran into the same thing with Kaiser, but it was also for post-birth issues, so the coverage would have been an issue with the infant cardiac specialists involved, regardless of prenatal care.

[St. Margaret]

Originally Posted by mntnmom

If referrals and such aren't handled the "right" way, some insurance companies will refuse to pay the resulting bills.

Yup, this. There's a practice of CNM and OBs I got established with, and one is always on call (and during the day they are all just across the parking lot at their office). By having the care established with the providers in my specific medical group ahead of time, I ensure that the insurance must pay. I've had to spend hours and hours on the phone before to get the hundreds of dollars paid for an u/s for a miscarriage when the insurance thought the proper person had not approved or referred me for it (and they never did pay! I couldn't handle talking about it over and over again like that, gave up), so I'm very wary. I made sure the practice worked at the nearest hospital, so if I had to transfer, that's where I'd go anyway. We also need to line up a ped ahead of time who has privileges at the same hospital, and then they just make sure that's who examines the baby. Obviously in some emergency on the part of the hospital or care providers, if one can't be there when they should, then it's not on me, but if I didn't establish it all ahead of time and then needed to be there for a long time, maybe a c/s or something, I could definitely get screwed by the insurance.

I'm dealing with severe sciatica right now, can't drive myself, and just canceled an appt with the practice, and they didn't care at all. That's kind of my plan for the end of the pregnancy! I hate having to give the run-around to this nice practice, but that's why we need the insurance industry to be reformed! If I had insurance that worked with midwifery and transfers, then I certainly wouldn't bother to do shadow care.

[goldenwillow]

Originally Posted by dannic

I have never had a dr's care for prenatals. I can get all the testing I need/want through my mw and if something were to go wrong it would be an emergency.
I think it would be stressful for me to have to continually opt out of treatments, ect.
The only reason I could foresee shadow care as being useful for me is if I had insurance and could get insurance to pay for testing only through a Dr's office.

Same here!

[MegBoz]

Originally Posted by dachshundqueen

I think it depends on the political climate where you are.

Ditto.
Although don't assume that because HB is illegal, you'd have to transfer in as "no prenatal care." HB is legal here in Maryland, but only with a CNM. CPMs are totally illegal. But we have several who practice anyway & 2 of them told me they don't hide who they are in case of a transfer - they're honest about the fact that they're the MW & will share records. One even is friendly with the CNMs at the hospital where I had DS!

Well, IMO, the hospital is hostile to HB or they are not. If they ARE hostile, the only way you can make it an easy transfer is to not tell them of your true plans! That means you have to go to every apt - which is generally once ever 4 weeks until 30W, then once every 2 weeks, then from 36W on, once per week. You'd have to do this with the hospital-based MWs or OBs, AND your HB MW. BIG hassle, IMO.

& insurance might not cover both.

& if they're not very hostile, then I wouldn't stress too much about transferring as an honest HB.

So my vote is kinda not to bother with it. I won't be.

Originally Posted by chelle.ra

as someone who thinks of choosing hb as a socially responsible decision, i would ask you to consider the fact that using an OB should only be done if there is a need to seek higher level of care. if you are blessed to have a healthy pregnancy and there is no indication otherwise, mw's are the way to go! unnecessary use of these high cost specialists cost us all.

I often see this sentiment posted when shadow care is discussed. I think for women in America, this is totally unfair & unrealistic. Our entire system is "broken" (As Dr. Marsdan Wagner stated in his book, "Born in the USA.") The system is hostile to HB. Many states ban direct-entry midwifery or require MWs to practice with "physician backup." Considering AMA& ACOG's ardent anti-HB stance, well, not too many are gonna go out on a limb & back-up a HB MW! (they also think being official back up would raise their already astronomical insurance premiums.)

So the HB MWs go underground.

& those in the system still think hospital birth is best & OOH birth is reckless & dangerous. Therefore, HB transfers are seen as "train wrecks" & proof that HB is reckless, dangerous & we're stupid for attempting it. So the transfers are treated with hostility & sometimes even abused.

So I think saying "it's an irresponsible waste of resources to get OB shadow care" (at least in America) is a classic example of blaming the victim. Women who chose shadow care are simply covering their own behinds & attempting to give themselves the best chance for the best care they can get even if they need to transfer.

[Mrs.Music]

I do parallel care. The midwife I see actually sends all her patients to this OB for their 20 week u/s and it does sort of establish something in case of an emergency transfer since as a CPM she doesn't do hospital births at all. As someone who is high risk, I find it extremely comforting to have someone who my midwife likes and recommends at my back if (and generally WHEN) I end up in the hospital. Look around for a GOOD OB though if you do it. I think it could be undermining and get you treated just as badly when you transfer if they find out you were just using them as back up, kwim? My OB actually believes in home birth. He's surgeon and he knows it. And when I end up in the hospital for PTL, he's always doing his best to get me back home for my bed rest because he said himself that it's safest.