First-time pregnant-- Do I need to see a doctor/midwife now?

[nmouse]

Hi, I'm new to this pregnancy thing and wondering what kind of stuff I should be considering getting done, medically. I am very homebirth oriented and will want to work with a midwife for the delivery. But in the meantime, I have all kinds of questions, (like, is my multivitamin good enough since it has 800mg of folic acid? is it okay to take Tums if I get heartburn?) and I'd like to have someone to talk to.

My health insurance is a PPO, and "midwives" is not a category of provider I can even look up, which doesn't bode so well. Money is tight, so I want to do as much on insurance as I can. But I also have the feeling that I'm going to want to see the MD as rarely as possible. I'm pretty doctor-shy and don't usually enjoy my visits to the western medical establishment.

So can you folks give me your opinions, especially those of you who've been pregnant before? What are the important things to get done at the doctor's office, and what can be skipped or done by a midwife?

Also, on the insurance topic, has anybody ever gotten care (pregnancy tests, blood tests, or what-have-you) done by a midwife and paid for by a PPO, at least at the out-of-network rate? Does insurance *have* to pay for midwife care at the out of network rate, or does it depend on if the midwife is a certified nurse-midwife?

[bubbagirl]

Welcome & Congrats NMouse!

I don't really want to tell you what is best for you, but I can tell you that I know how exciting & confusing it can seem right at first. I did a lot of research here at mdc in the homebirth and uc forums and they cover a lot of info and address questions that you didn't even know you had.

While I searched there I was led to a few outside sites with a lot of helpful info as well.

I don't have much more to add right as my brain is in a fog at 4:45am (woke up & couldn't sleep), but I wanted to say hello, welcome & so glad you are joining us!

[tank]

Hey nmouse!  You can start by locating a few midwives and giving them a call to set up interviews.  Most won't see you until 10 or 12 weeks for an actual visit but you can ask tons of questions in the interview if you want.  I am being seen at 8 weeks because I had a m/c and ddin't get seen after that so I need to make sure everything is right with my body.  Your prenatal should be enough of everything you need.  I don't have any other answers really since I was only preggo for 12 weeks last time but I am planning on only seeing a midwife the whole time.  The midwife should be able to tell you if there is something she can't handle or doesn't do and you need to see a doctor for.  For instance I don't think my midwives office uses ultrasounds so if I need one I belive we go to the hospital for one.

Oh and as far as insurances go I think it depends on the office and you will have to check with the midwives office about what insurances they cover and extra costs.  I am on medicaid for pregnancy and the only out of pocket cost I will have is the birth which is $300 hospital $800 home birth and more for a vbac.  Different offices have different policies though.  If money is tight you should check out medicaid even if you have insurance.

[Gemini529]

I don't know if the multi vitamin is enough because it all depends on your diet and whether or not you get enough folic acid through food, too.  I would personally err on the side of caution and just do a regular prenatal vitamin to make sure I was getting enough, but that's me. Although at the beginning of my pg last time, I was allergic to the vitamin I tried at first and the doctor told me I was ok taking 2 flinstone vitamins a day until I got to 20 weeks.  Then he said I would need additional iron.  I had awful heartburn during my last pg and took Tums when it got bad but I didn't take like 20 a day or anything.  Even if you don't stick with a regular doctor, I would go in at least once so you can get those questions answered and get a baseline for your blood pressure, temp and get your urine and blood checked.  

Again, that's me.  I had a very uneventful pregnancy last time up until I was about 35 weeks and then I ended up with preeclampsia.  If I had not been seeing a doctor, I probably wouldn't have noticed it until it was too late because I had no idea that my blood pressure had gone up as much as it did.  They test your urine once a month and towards the end, once a week to make sure everything is normal, you aren't leaking amniotic fluid or spilling protien.   

A friend of mine was just rushed in to the hospital because she was spilling amniotic fluid in her urine.  It turned out she was dilating and she went into labor there and gave birth to her baby 3 mos early.  Sorry, I'm not meaning to scare you but while the visits seem pointless when there's nothing wrong, you just never know.  I wouldn't avoid medicine altogether because sometimes things happen.  If you see a doctor and they seem to be pushing you into something you aren't comfortable with, switch doctors or see a midwife. 

Congrats on the pregnancy!  I know the first one is so confusing!  

BTW, when I finally got on a prenatal I wasn't allergic to, my insurance covered it and it was only like $5.  HTH!

[emmaegbert]

coverage will depend on what state you are in and what plan you have. You can call and ask what is the policy on in-network and out-of-network coverage for licensed midwives. my ppo covered 60% of my HB (#2). that was in california. They said nothing about MW in their policy, but when I read it carefully, they said that "doctor" refers to any licensed medical professional operating within their license (I/E a licensed midwife, a nurse-practitioner, etc)

If you are not totally sure you want a HB, or, if you want "shadow care" that is easier to cover with your insurance, then you can look at what hospitals are in network, and whether there are midwives on staff there, and whether they have a birth center. You can call free-standing birth centers (if you have one) and ask what insurance they take. the same PPO covered my birth center birth (#1) at almost 100% b/c it was in-network.

With both of my previous pregnancies, I couldn't even get an OB/CNM appt until I was almost 12 weeks. I think its pretty normal to do a dating ultrasound and a butt-load of bloodwork. Also a pelvic exam. Weigh and measure you. Crazy amounts of blood tests! Like vial after vial. they test you for every STD known to man, as well as Rh factor (matters later if they will recommend rhogam or not) There are also some earlier blood tests you can get now that show risks for genetic abnormalities or other things that are not normal with pregnancy hormone levels.

You can take a good quality pre-natal vitamin without a doc or MW telling you to do that :) I heard that it is sometimes better for folks to take it at night and that is true for me (less gag reflex, also supposed to help morning sickness to take the b-complex vitamins at night for some reason?)  I also take DHA, vitamin D, magnesium, and calcium (and separate the mag and cal into different times of day). My midwife for #2 suggested it, the CNMs and OBs at the hospital practice never gave me much practical info on supplements or diet.

they will continue to check you for growth of the baby, protein in your urine, and heart rates at OB appointments. MW can do this too. There are more screenings depending on the practitioner (and your health insurance coverage).

I did "shadow care" with the hospital-based MWs (CNMs) for my homebirth baby. HB MW billed my insurance just for birth and pp care- and the insurance covered the prenatal care with the CNMs (I saved my insurance company a TON of money this way, not that they thanked or rewarded me in any way, of course). I saw the OB/CNM practice partly b/c it would be better to be an established patient at a good hospital IF I became high risk and needed to be with them. Also it was partly b/c they could write me prescriptions (for blood glucose meter strips-- I had gest diabetes and those strips are SO EXPENSIVE, I was doing very successful diet control and needed to test often to tweak the diet). And they could do tests that would be covered by my insurance. That said, they wanted to do WAY more tests than I was comfortable with and I had to constantly sort of refuse and negotiate that with them, which was annoying and stressful. Also, it meant double the time spent at appointments which was kind of annoying.

With this (#3) I will see what I do. I am likely to be on medicaid and not sure how that will work with "shadow" care or getting tests and doctors. So I might just use a clinic for any medical screening that the midwife cannot provide. I will also let my MW guide me on some of the decisions- as I am very sure I want to have a HB again.

FWIW my HB Midwife was very against Tums. I don't really remember the reason. I didn't have heartburn so it never really came up. I know she suggested using enzymes to help digestion, adjusting diet and frequency of eating (diet logging to figure out what might be triggering heartburn), and using things like peppermint and ginger tea.

Hope this helps! Start finding the right practitioner for you, figuring out as you go along the financial piece, and at least the OB/CNM practice I saw for my mainstream care never seemed in any sort of rush to see me in early pregnancy.

[Gemini529]

That's interesting that the ob's in your area didn't want to see you until 12 weeks. I called the other day to ask a question and they were encouraging me to come in for my first appointment asap. They did the same with my last pregnancy. I think doctors can just vary drastically from place to place.
Your midwife might have been against tums because of the aluminium in them. I'm not sure but my doctor said they were ok in moderation. Whatever you do I would sugget checking in with a medical professional along the way just to make sure everyhing is ok. I only had to get blood drawn twice during my pregnancy last time. Once at the beginning and once for the diabetes test. Oh yeah three times! Another time when I was starting to show signs of pre e. I think I had a pretty laid back doctor after reading some other stories.

[emmaegbert]

nmouse, I saw on another post that you plan to move soon. in that case, why not just go to the ob practice that is most convenient to you and covered by insurance? You can do all the initial stuff with them, and then when you move, take those records and at that point look for the person you really want to have attend your birth. you won't have to redo stuff like blood tests or dating ultrasounds, and I can't think of any good reason to wait. (or go to an OB practice with CNMs, and you can see a midwife or possibly nurse-practitioner for those initial appointments.)