I had someone call me three weeks ago saying that she's due at the end of May. I went ahead and scheduled a consult, against my better judgement. I sheduled the consult and the client was 60 minutes late, only coming after she called to see if I was still at the office. I was and agreed to still meet her, thinking something might have come up. At the consult, I gave her all of the paperwork, including how to verify insurance coverage. I asked if she's had any prenatal care and she said no "because we make too much money." But she has insurance? Okay...moving on. We scheduled an appointment for the next week, which *I* ended up needing to reschedule to this week. When I called to reschedule, she told me that she had looked at her calendar and was actually due amost 10 days sooner than she thought.
Today she had a 4pm appointment. She called at 4:45 to see if I was still at the office and I was. I told her to come on in (because she's due and I need to see her and decide if I'm going to take her, even!). She came in and had none of her paperwork filled out, including the insurance verification. I called the insurance because I wanted to settle the financial side of things so we could know how much she needs to pay me.
Then I move on to her prenatal. I had a hard time palpating her baby. Her belly was B-I-G and high, like none I've ever seen before. Her navel was on the bottom side of her belly and everything from her ribs to her pubic bone was HARD, as if she was contracting, but she wasn't. She's a 4th time mom, but it felt like a first time mom with rock hard abs. I couldn't tell anything. So I moved on to listening. All I could find was cord and placenta, until in desperation I listened at the top of her belly near her ribs and found a heart rate of 128. This is the only heart rate I heard, but I heard cord and placenta everywhere. So I move on to measuring, with growing unease. I'm thinking at this point that I probably want her to have a sonogram before I agree to care for her, because I just can't figure out what's going on in there! Then I measure, and she's measuring a whopping 52 centimeters. I think back to when she walked in and sat down: she sighed and asked if I thought this could be twins because she's so big. I laughed it off and said "nah, you have ten pound babies and you're due in a few days, so of course you feel big." But then when I measured and palpated, I realized what she meant.
I talked to her and told her that I'm not comfortable being her midwife unless she sees a doctor for a sonogram and there's only one baby in there. I told her that I've felt twins before (at 36 weeks, not 40) and that her belly didn't feel like that, but it didn't feel like what I'm used to feeling with one baby either. I gave her the phone numbers of doctors I know *can* be mother friendly, because she's had all unmedicated quick births and doesn't want a c-section.
My concern is that they won't take her because she's 40 weeks and has had no prenatal care, though. I'm also concerned that she won't call because she's worried about the money (though she has EXCELLENT maternity benefits). I'm concerned if she does go in and have a sonogram, that they might want to section/induce her ASAP, which she doesn't want. And I'm concerned about sending a client who doesn't understand the concept of insurance or prenatal care to doctors that I *like*. I thought about calling the #1 doctor on the list that I gave her to give him a heads up that I referred someone to him (he's the OB I saw for my own miscarriage a couple of months ago), but I'm not sure if I should do that or not. I did ask her to call me as soon as she talked to them, and I told her to call first thing in the morning and explain that she's due soon and hasn't had prenatal care becuase of a lack of insurance (until January) and that she's concerned she might be having twins.
THIS is why I want a backup relationship. I don't know what to do but I do know two things: I can't do her birth if she's having twins (it's illegal and I don't have enough experience, anyhow!!), and I can't know that she's not having twins until I see a sonogram report. I feel railroaded and "on the clock," though, because she's due MONDAY and just had her first prenatal (with me) TODAY. What if her water breaks tonight or she goes into labor in the middle of the night? Do I tell her to go to L&D, then roll over and go back to sleep and just hope she takes my advise? Do I meet her at the hospital as her doula? Do I go to her house and risk her having twins at home? ACK! None of these is a good option, though I'm leaning toward meeting her at the hospital as a doula.
Today she had a 4pm appointment. She called at 4:45 to see if I was still at the office and I was. I told her to come on in (because she's due and I need to see her and decide if I'm going to take her, even!). She came in and had none of her paperwork filled out, including the insurance verification. I called the insurance because I wanted to settle the financial side of things so we could know how much she needs to pay me.
Then I move on to her prenatal. I had a hard time palpating her baby. Her belly was B-I-G and high, like none I've ever seen before. Her navel was on the bottom side of her belly and everything from her ribs to her pubic bone was HARD, as if she was contracting, but she wasn't. She's a 4th time mom, but it felt like a first time mom with rock hard abs. I couldn't tell anything. So I moved on to listening. All I could find was cord and placenta, until in desperation I listened at the top of her belly near her ribs and found a heart rate of 128. This is the only heart rate I heard, but I heard cord and placenta everywhere. So I move on to measuring, with growing unease. I'm thinking at this point that I probably want her to have a sonogram before I agree to care for her, because I just can't figure out what's going on in there! Then I measure, and she's measuring a whopping 52 centimeters. I think back to when she walked in and sat down: she sighed and asked if I thought this could be twins because she's so big. I laughed it off and said "nah, you have ten pound babies and you're due in a few days, so of course you feel big." But then when I measured and palpated, I realized what she meant.
I talked to her and told her that I'm not comfortable being her midwife unless she sees a doctor for a sonogram and there's only one baby in there. I told her that I've felt twins before (at 36 weeks, not 40) and that her belly didn't feel like that, but it didn't feel like what I'm used to feeling with one baby either. I gave her the phone numbers of doctors I know *can* be mother friendly, because she's had all unmedicated quick births and doesn't want a c-section.
My concern is that they won't take her because she's 40 weeks and has had no prenatal care, though. I'm also concerned that she won't call because she's worried about the money (though she has EXCELLENT maternity benefits). I'm concerned if she does go in and have a sonogram, that they might want to section/induce her ASAP, which she doesn't want. And I'm concerned about sending a client who doesn't understand the concept of insurance or prenatal care to doctors that I *like*. I thought about calling the #1 doctor on the list that I gave her to give him a heads up that I referred someone to him (he's the OB I saw for my own miscarriage a couple of months ago), but I'm not sure if I should do that or not. I did ask her to call me as soon as she talked to them, and I told her to call first thing in the morning and explain that she's due soon and hasn't had prenatal care becuase of a lack of insurance (until January) and that she's concerned she might be having twins.
THIS is why I want a backup relationship. I don't know what to do but I do know two things: I can't do her birth if she's having twins (it's illegal and I don't have enough experience, anyhow!!), and I can't know that she's not having twins until I see a sonogram report. I feel railroaded and "on the clock," though, because she's due MONDAY and just had her first prenatal (with me) TODAY. What if her water breaks tonight or she goes into labor in the middle of the night? Do I tell her to go to L&D, then roll over and go back to sleep and just hope she takes my advise? Do I meet her at the hospital as her doula? Do I go to her house and risk her having twins at home? ACK! None of these is a good option, though I'm leaning toward meeting her at the hospital as a doula.
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