Shadow care: help me think this through

[msmiranda]

The thought of doing shadow care all the way through this pregnancy stresses me out something awful (and I haven't even met the OB yet!!). I'm seeing a practice that cannot drop me from care because, well, at the risk of too many identifying details, it's Kaiser, so they are my insurer as well as care provider.

So I was thinking that maybe the way to go would be to see them through 20 weeks so I can have my ultrasounds, initial bloodwork, and the quad screen if I decide to do that, for free. They would have some records for me. Then I would just say, I am seeing a midwife and if I need obstetrical services later on (for breech, preeclampsia, etc.) then I will come back. I would say it at the last appt I intended to go to so that they would only have one opportunity to harass me about it. The only lab testing I will need after 20 weeks is the GBS, which I'm okay paying for out of pocket and doing with my midwife. I have a glucometer, so I can do GD screening at home.

I guess my one concern is whether, if I needed to transfer during labor, they might try to get out of paying for it. The whole reason we got this insurance to begin with was because it included maternity coverage, so that's a pretty big deal.

Does this sound like a workable plan? Is there anything I'm not thinking of?

[emnic77]

I guess my first question is, if the thought of shadow care stresses you out so much, why do it? Just for the ultrasound?

I see a lot of people do shadow care, and I guess I've just never understood it. A huge HUGE part of the reason I chose homebirth was to avoid all the crap that goes along with prenatal visits from your general institutional care. If anything comes up during the pregnancy that your midwife feels is out of her scope of expertise, you could transfer care.

[msmiranda]

Sorry, I should have clarified: I would be doing shadow care in order to have my lab work and ultrasounds for free (well, not free, as we pay for our insurance! but not an additional out of pocket expense, as we will already be paying our midwife $4k or so). I know some people are fine going without ultrasounds, but I feel more comfortable having an early one to establish viability and dating, and the 20 week to reassure me that all organs and body parts are present (or not, as the case may be).

I do see your point -- it would be nice not to have to deal with an OB at all and just transfer care in the event of a need to do so. If labwork wasn't so darned expensive, and I didn't want ultrasounds, I would definitely consider that.

In a more general sense, I'm a nervous nellie and want to have all my bases covered in the event of something unexpected.

[Evergreen]

Originally Posted by msmiranda

Sorry, I should have clarified: I would be doing shadow care in order to have my lab work and ultrasounds for free (well, not free, as we pay for our insurance! but not an additional out of pocket expense, as we will already be paying our midwife $4k or so). I know some people are fine going without ultrasounds, but I feel more comfortable having an early one to establish viability and dating, and the 20 week to reassure me that all organs and body parts are present (or not, as the case may be).

I do see your point -- it would be nice not to have to deal with an OB at all and just transfer care in the event of a need to do so. If labwork wasn't so darned expensive, and I didn't want ultrasounds, I would definitely consider that.

In a more general sense, I'm a nervous nellie and want to have all my bases covered in the event of something unexpected.

The insurance reason is also one of the reasons I am doing shadow care. I didn't do any shadow care last time because I was under the impression I wouldn't need it. I didn't want a u/s or blood test. This time I do. Additionally, I developed anemia in late pregnancy which resulted in a long and tiring labor. While everything was fine with the baby mentally I was a mess so I transferred to the hospital in labor. If I were to have to do that again for any reason I would feel more comfortable having a doctor whom I knew and trusted who could see me. Since CPMs are not licensed here it just covers another base for me.

[lyterae]

I went to the OB office once at 16 weeks to get my blood work and schedule my ultrasound. It was a HUGE headache, my midwife wasn't able to schedule/do those things. I needed the bloodwork as I have had thyroid/iron level issues previously, and the ultrasound because we're having a VBAC.

If you can avoid the stress of it I would, otherwise I think that next time I might do as you have talked about and go for the 12/16/20 week appointments and get the bloodwork and ultrasound done and then "transfer" care.