I would like to thank you all for your contributions to this discussion. I am currently going through the ordeal of getting some coverage for my 2nd homebirth, and a friend of mine is getting flack of a different kind from the same MTF. I want to ask a few questions.
I am on Active Duty. My husband also is. We live off-post, about 15 minutes from West Point, where we are permanently stationed. Our first child was born there (when I had 7 years in), and our postpartum experience was so horrific, we vowed to never give birth there again. (Delivery itself was OK, but not ideal according to my standards.)
Two years later (9 years in service, all at West Point) I informed the new OB at West Point during my 36-week appointment that I was planning to have my baby at home, that I had been seeing a midwife concurrently with my OB care from the MTF. My commander required that I keep the relationship at the MTF because of the ease of obtaining profiles, etc. I thought it good sense to maintain the relationship in case we needed to transfer there. He recited a litany of obstetrical nightmares he had personally borne witness to (in hospitals, of course) and threatened to call CPS on me for endangering the welfare of my unborn child. (Then he handed me a "gift bag" with a formula sample in it and I gave him a piece of my mind.)
At my 38-week appointment, Dr. Doomsday (MAJ Doomsday, I suppose), with my chart in hand, informed me that he was changing my EDD to a week prior to what was in my record, because of an ultrasound that was performed at 8 weeks (which the other, civilian OB at the MTF ordered because I *couldn't possibly* have known when I got pregnant...I was still breastfeeding child #1...but have been using Natural Family Planning for years and was 100% certain, within 36 hours, when I had ovulated.) He also let me know that New York State law forbids homebirth after 42 weeks gestation. He took great joy in cutting me short a week, but I wasn't concerned.
Dr. Doomsday was deployed the following week. He is no longer stationed at West Point. Civilian doctor who attended first birth there is still providing care, as is the COL who was the Deputy Commander of the hospital when my son was born -- he's now (again) the Chief of OB/GYN.
I gave birth the day before 40 weeks gestation (now almost 41 weeks by his modified chart) at home with my LPM. This delivery was amazing and comfortable and ideal and the stuff dreams are made of (despite being what the OBs might call "needing intervention" or "an obstetrical emergency"). I had not even considered Tricare assistance for this birth, gladly paying $4000 out of pocket over 2 years to the midwife because she was not a CNM.
Bloodwork and observation proved that my 2nd baby was going to need phototherapy by day 2, so we went in to see our pediatrician at the MTF (who was aware of our plans to give birth at home and watch for jaundice of early onset), and he admitted us to the mother/baby ward for phototherapy.
We were treated like lepers and again, I vowed never to return to that floor of the hospital. the treatment we received there was abhorrent. I did speak up and request that the nurses treat me with respect, but I never wrote a letter to the command or filled out any surveys documenting my dissatisfaction (knowing I wanted another baby and would likely deal with these people on some level again someday regardless of my choices). The most egregious incident was that the head nurse on the ward refused to allow my toddler daughter on the ward to see me, claiming "we have rules here." I had in hand a copy of the rules, which stated siblings were permitted on the ward, directly to the family's room, not anywhere else on the ward.
There was no one else on the entire ward (this MTF sees approx. 200-250 births/year) but this nurse (still the head nurse there) insisted my baby was an infection risk. I reminded her that my toddler had already been exposed to my baby during our 36 hours at home after the birth, at which point she rolled her eyes and stated, "OK, fine, she can come in your room...but you can't breastfeed her in that hospital bed." I looked at her like she was insane and walked away (of course I did nurse my toddler in that bed. I didn't nurse both children at once.). I was also told, upon admission "you are not our patient, the baby is. If you need pads, medication, or anything, don't ask us for it. You are not the respoisbility of this ward, we are letting you stay here as a courtesy to Dr. (Pediatrician) who has asked that you not be separated from your baby." I calmly reminded the nurse that I was entitled to care there, had received prenatal care there, etc., and if I should experience any postpartum medical issues, that I most certainly would alert nursing staff and expect to be cared for.
I am again pregnant (12 years time in service, all at West Point). When I showed up at the OB clinic for orientation with the clinic nurse, she scowled at me and said "Oh, YOU'RE pregnant again." I have been treated with stark politeness (and gross misinformation, which I am not protesting in the interest of being civil) by the COL (OB doc) there and most of the clinic staff (he was the hospital deputy commander when I gave birth to my son, so was likely involved in discussions about our admission to the L/D ward instead of the Med/Surg. unit, how we were treated by the staff there, and how we reacted to that treatment). The female civilian doctor is giving me no trouble whatsoever but after 5 years (including non-OB, GYN care) I think she has agreed to disagree with me. She's easygoing.
My current commander is not requiring that I maintain appointments with the MTF, agreeing to accept any guidance from my midwife about profiles, etc. (to be processed through a PCM if anything has to be made "official"). This is in the interest of my physical and emotional well-being, as this commander sees what happens to me after an appointment at this MTF and also knows how I was treated after the birth of my 2nd baby AND hears how I am treated at each appointment.
The SGM of my unit is in contact with the SGM of the hospital, who claims to be appalled by the treatment I am receiving (and I haven't even gone into detail with these people).
I spoke with a Tricare supervisor (on the 877 number...the 4th person I spoke to during that one call) in May, who advised me that
I am entitled to coverage for a homebirth even though I am on Active Duty because the MTF does not offer midwifery care or homebirth, and New York State law dictates that insurance companies pay beneficiaries for services that are not offered otherwise. Since my MTF does not have a midwife on staff nor does it provide an attendant for birth at my house, NY Law states that I am entitled to the choice of my birth attendant and location and I can/should therefore be covered by my insurance provider (Tricare) despite being on Active Duty. I was told I needed a referral for midwifery care from my PCM.
I made an appointment to see a PCM (mine was on emergency leave, I waited 5 weeks for the appointment I did get) and was told "I cannot support this, get your referral from OB" at which point I told her that Tricare required the referral come from a PCM. She was incredibly rude and started spouting off about "safety" and "my ass isn't going on the line for something so ludicrous as this" and on and on, "I had 4 kids at military hospitals, you can too..."
I left in tears (not normal for me, I usually go down swinging). My SGM spoke with the hospital SGM, who advised me to see *my* PCM at her first available appointment. That is next week. I don't think things are going to go any better with her, because there is another woman, a spouse/dependent, who is also working the channels at this MTF and meeting gross resistance (being told she cannot legally give birth in government quarters! I googled to find information about whether that was even possible, and came up with this thread and the amazing post on page 4 about how that is NOT a legal order. Thank you, thank you!). They are apparently "shocked" that there are TWO women at West point who want homebirths. As if we're the only two in the world? Or the first two ever? Or something?
I am being told to seek guidance from the patient rep. at this MTF if I do not get my referral for midwifery care. I have not involved the OB clinic at all but I'm sure they're hearing all about everything. I'm just keeping my scheduled appointments, smiling and nodding when they tell me I "can't" breastfeed my almost 3-year old son or that "homebirth isn't safe" or that my blood pressure is slightly elevated (hmm...I wonder why that could be? It's routinely around 94/70 at the midwife's office...).
I am deeply distressed by the treatment I have received in the past and am currently receiving, and I am even more upset by the treatment my friend is now receiving (she hasn't ever crossed paths with the people who have hassled me, she hasn't even gone to the OB clinic at the MTF at all...her first two children were born at other duty stations). We have the same midwife, who has a billing person and they are both more than willing to go to bat for us here.
I am very scared that, heaven forbid we do require a transfer to the MTF in labor, we will be shown a complete lack of courtesy or professionalism and treated like we're lucky to have them, not like we're entitled to care.
I only want to fight for that which I am legally entitled...but I am not afraid of a fight. I'm expecting to have this baby after Thanksgiving, and will happily, gladly, enthusiastically round up the New York Friends of Midwives, Senator Hillary Clinton, Representative Carolyn Maloney (introducing breastfeeding protection act...not my representative but she does represent NY), anyone who will demonstrate that I am legally entitled to what I ask for, which is freedom of choice in my birth location and attendant and the right to financial coverage for whatever choice that may be.
If you are still with me after my long story, I thank you from the bottom of my heart and seek your counsel. I have consulted all of the resources listed here on this thread (I've been at this for several hours and must get to bed!) except the supervisor at Tricare whose number was provided earlier (though I wonder if she's who I spoke with? I should have written this down.).
I ask you:
Do you know of Active Duty women who have had homebirths (I can't be the only one...or can I)?
Do you know whether they have received Tricare payment for midwifery care?
Does the fact that we are dual-military, and I could theoretically be his dependent, play into this at all as a loophole?
Should I just shut up, avoid any further stress, go on a payment plan with my midwife for the full out-of-pocket fee, and do what I did last time, which is just not have the baby at the hospital? Or is there a fight worth pursuing here?
Thanks in advance for any guidance you have to offer. Or sympathy, for that matter. I'm already feeling like a lost soul in society at large, this whole mess doesn't do anything to make me feel better. What a crappy vibe to have to carry as I prepare my home and my family for the arrival of our new baby.
I totally know what you mean about being treated like a leper.
about it, and another woman went in for a referral and was also denied, I'd bet there was some hospital-wide memo or staff meeting addressing this and now it'll be a big stone wall.
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