How am I going to have this baby?!? ***Update: Post #24***

[veganjoy]

I'm 30 weeks pregnant, haven't chosen a midwife for my homebirth, am completely without insurance, and I've begun to wonder when I should get concerned.

The midwife I was about to choose just informed me that family matters will make her unavailable when I'm due. I've interviewed several others, and have a few more appointments lined up. Everyone says I'll "just know" the right one, but although they all seem wonderful and capable, I haven't felt any were right. Do I keep looking, or just make a decision?

Every MW I've talked to requires backup care with an OB, in case of emergency or transfer. That's fine, but I can't get insurance through DH's job until November. At that point, I'll be due within days, and no doctor in their right mind would take me as a patient. I applied for Medi-cal, but DH makes way too much money for us to qualify. Do I just pay exorbitant out-of-pocket fees?

A UC would help me avoid the OB requirement, but I don't feel comfortable with a UC (neither does DH). And in any case, in the event of an emergency (c/s, or even transfer or breech baby; MW's can't deliver breach in my state), I'd be sunk in out-of-pocket medical bills. Of course, I don't anticipate any of those problems, but on the off chance that something happened...

Is there something here I'm just not seeing? Right now I feel like I'm out of possibilities, and I've got no idea how this baby is supposed to come out of me!

[LittleBrownDog]

I wonder if any of the MWs you're considering know any OBs that would be sympathetic to your situation? I think most OBs have a few OBs they prefer to work with as their back-up. Maybe you could have one appt with them now but they could defer billing until your insurance kicks in? Of course I'm probably living in la-la land on the deferred billing bit... Ugh, what a sucky situation! Good luck!!! Wish I had better suggestions!

[Momma Aimee]

Every MW I've talked to requires backup care with an OB, in case of emergency or transfer. That's fine, but I can't get insurance through DH's job until November. At that point, I'll be due within days, and no doctor in their right mind would take me as a patient. I applied for Medi-cal, but DH makes way too much money for us to qualify. Do I just pay exorbitant out-of-pocket fees?

given that the MW require this --

when we birthed with a CNM it was understood SHE had an OB back up (who did end up deliering Theo) and if anything happened HER back up dococtors were the ones called. we never saw her back up OB, and were not clients of that OB or on his case load .. it was just understoad that in an emergency that is who would be called.

so -- would it be the same for you -- whatever Doc backs up THAT MW would be the emegency OB? so it is jsut that there has to be one, not specifically taht you have to find it?

and if that is the case, and you were seeing the MW anyway either 1. you might not ever have to be that OB's client, it would jsut as in our case, be he or she who the MW called and at least 2. the OB might be willing to see you Nov 1 which is a Thursday as you would already be a client of the MW?

Be careful -- in our case -- insurence was supposed to pay 80% of teh CNM but as the OB did the acutal birth (forcepts) she could not change for the birth and insurence paided nothing.............. i tell you this because IF the OB does get called in and do the birth, he or she will be the one billing for the birth, so check that they are on your network or at least that your insurence will cover at 80% for out of network provider.

Same concern with a hosptial -- if you have to tranfer make sure the MW had a resltionship (good one not jsut a relationshipo) with the hosptial in your plan as that is where you will have to go. Check that her back up OB has priviallges there to avoid ending up alone in ER with the luck of the draw.

i hate to bring all the gloom : but i want to help make sure you don't run in to any HUGE bills after teh fact that you were unaware of ... a emergency hostpial tranfer could be an outragous amount fo $$$$$$.

other than that -- i'd say after you meet all you can -- you just have to make a decision ....

Aimee

[Marlet]

Not in your ddc but saw this on new posts. A lot of practices are ok with postponing billing until your insurance kicks in. Maybe call the various back up ob's with the midwife/ves you are considering and explain that your insurance kicks in in Nov. etc. We had to do that with DD1's birth.

[sorteep]

so your ins kicks in Nov 1st?? if things got "weird" you could go to ER for del if you HAD to and you should have coverage?? right?? or could you maybe have one appt with an OB so you would have officila back up for the MW and just pay that one visit out of pocket?? maybe and hope hope you stay PG until nov?? just in case?? don't know.. I am sure it will work itself out though.. things usually do,, hugs

[GinaRae]

Wow, I am so sorry, Mama! Tough stuff. And time is dwindling.

I would definitely find out if you actually have to see the OB (I don't) before really freaking out.

Also, I KNOW how you're feeling about the MWs not being quite right. I am going thru that now. They're okay, but wish I had someone I was ga-ga over like everyone else!

[Isaac'sMa]

Tough indeed. It's getting close!

Are you looking at CNMs only or at CPMs/DEMs too? CPMs/DEMs *usually* have lower fees so it might not be as much of a burden to pay out of pocket, but there might not be that many of them around depending on your state laws. Have you tried posting for suggestions in FYT? PP there might be more familiar with exactly how to get around certain legalities where you are.

[kathteach]

Veganjoy, you are in West LA, right? I am too. If I have you confused with another vegan mama I apologize. Have you heard of AIM? You might be able to qualify for it but you need to act fast b/c they don't take you after 30 weeks. Maybe you could use AIM until your regular ins. kicks in.

http://www.aim.ca.gov/english/qualify.html

I also wanted to let you know about the Westside Pregnancy Resource Center. Please let me say first I am very prochoice and not religious so when I first went I was afraid it would be a bunch of holy rollers throwing antiabortion propaganda at me and trying to convert me. It wasn't like that. The women were Christian but didn't talk about that with me. My problems were not financial but when I went to visit them they made it really clear that if I did have financial difficulties they had resources/programs they could let me know about and even offered to help me with the paperwork. The woman I worked with was Debe (pronounced Debbie) and was very, very kind.

http://www.wpclinic.org/

I am sorry you have to deal with this. I will be thinking of you. Please keep us updated.

[brooklyn_warbler]

you have lots of good advice here, joy, so i won't echo all the suggestions. but i do think that talking to whichever midwife you choose about this, and if necessary talking to the backup ob should help you figure out what to do. you will have insurance by november, so that's a first step! my midwife doesn't bill til after the birth as well so i think OtherMother'n'Madre is right in this instance.

anyway, i have faith it will all work out & just wanted to send my love & support!

[veganjoy]

Thank you all so much for these replies; having actual constructive ideas is v. helpful right now!

Originally Posted by Momma Aimee

when we birthed with a CNM it was understood SHE had an OB back up (who did end up deliering Theo) and if anything happened HER back up dococtors were the ones called. we never saw her back up OB, and were not clients of that OB or on his case load .. it was just understoad that in an emergency that is who would be called.

This would be great, provided I could get some kind of insurance to kick in and cover them--but I couldn't be sure about this. I don't want to choose a MW based on what backup OB insurance would cover, particularly because I'd probably never use the OB at all. But you're right, hospital stuff needs to be covered somehow. I guess, worst case scenario: I could just go to whatever hospital was in my HMO or network in case of emergency. They would have to admit me, even if it was to the ER.

Originally Posted by Isaac'sMa

Are you looking at CNMs only or at CPMs/DEMs too? CPMs/DEMs *usually* have lower fees so it might not be as much of a burden to pay out of pocket

I'm interviewing both, and really have no preference. Cost there isn't such an issue (I've budgeted over $4000 for a MW), I'm more concerned with the possibility of a $30,000 hospital bill in case of emergency.

kathteach, yes, I'm in West LA. I think the folks at Medi-Cal put through an AIM app for me automatically--that would be really helpful. Thank you so much for the WPRC recommendation; it looks like I could easily get an u/s there if a MW suspected the baby were breech.

When it comes down to it, I think my fear is that I'll need to transfer, or have a c/s, or that the baby will arrive pre-insurance. Ideally, I'd be free from this, and just pour the money I would have spent on insurance into chiropractic, accupuncture, etc. and trust that my body would be prepared to give birth. But there's still the chance I could require intervention. I'm just not sure about the line between optimism about a good birth and responsibility with regard to other possible outcomes.

ETA: Just discovered that AIM is out; we don't fit the income requirements, and I need to have lived in CA for 6 months (I've only been here one).

[Momma Aimee]

what is your actual EDD?

This is your first -- first tend to be late anyway .....

HOPE

[GinaRae]

Here's another thought too. I believe no ER in the country can turn you away if you don't have insurance. Would that be the same for the L&D wing?

As sucky as it would be to have a $30,000+ medical bill, it's not the end of the world either. You sign up immediately for a payment plan monthly and if you falter and go to collections - again, not a huge deal.

So while it's scary and no you definitely do NOT want to swallow the costs of an emergency, it's not the end of the world. I'm currently paying off thousands of dollars of old medical bills and no one has hauled me off yet. It just gets paid on when it gets paid on and they don't turn you away for services there (especially if it's in collections).

[veganjoy]

Originally Posted by Momma Aimee

what is your actual EDD?

I've actually got 3 on record: November 16, 19, and 20. So...sometime around there? Yes, I'm going to be praying like mad that it's not pre-November. But good news: October 28 (or so) puts me at 37 weeks, which means I'd be full-term and could still deliver with a MW.

Originally Posted by GinaRae

Here's another thought too. I believe no ER in the country can turn you away if you don't have insurance. Would that be the same for the L&D wing?

As sucky as it would be to have a $30,000+ medical bill, it's not the end of the world either.

Gina, you're right. This is the worst thing I could imagine, and while it's not great (I'm a stickler about not having debt of any sort), there are definitely worse things that could happen!

[Dee-Groovy]

One more suggestion: would it be possible to reduce your income or assets so you can qualify for Medicaid/Medi-cal? In my state they need proof of one month's income, then they check up on it about 6 months later but I'm not sure you have to provide proof. I know of women who have done both approaches. One worked with her boss to reduce her hours/income for a month. Another had her DH transfer the title of his car to his dad, which reduced their assets enough to qualify. I know these sound a little sneaky but you may as well exploit the loopholes if they're gonna try to drop you through one. Good luck mama!

[LittleLlama]

Yes, try for the medicaid!!! We went through a lot of hoops (you've seen the story) but it's the only way for us. You may automatically qualify for your hubbys insurance already pregnant though since there are a LOT of situations where individuals cannot qualify but it's fine in a group plan. Something to look into anyhow.

[veganjoy]

I agree about the loopholes; even the Medi-Cal caseworker suggested making purchases to lower a bank statement. Unfortunately, we don't have any assets (we rent, and our car is--generously--worth $500). On the salary side, DH's new job just started last week, and to meet the salary requirements, he'd have to cut back to about 15 hours per week!

It's odd having too much in some ways, but not enough in others

[Momma Aimee]

Here's another thought too. I believe no ER in the country can turn you away if you don't have insurance. Would that be the same for the L&D wing?

I know, here, all the hosptials have sings up that you can not be truened away if you are in labor -- no discussion of ER vs L/D.

With your EDD so late, I would not be too stressed about going before Nov 1 when you gt insurence.

[Dee-Groovy]

Originally Posted by LittleLlama

You may automatically qualify for your hubbys insurance already pregnant though since there are a LOT of situations where individuals cannot qualify but it's fine in a group plan.

Another great suggestion. Hopefully you hadn't though of it? :

[brooklyn_warbler]

Originally Posted by veganjoy

It's odd having too much in some ways, but not enough in others

i hear you! my husband and i are both phd students and we don't get insurance with our fellowships, and those fellowships are a serious, laughable pittance. we went to apply for free new york state insurance but our income was $19 over the limit/month. $19!!

so i didn't have insurance last year when i was hospitalized for a bad kidney infection -- the good news is that i got the bill, which was 6K for my overnight stay, applied for financial aid, and got it reduced to $300! that goes to show you how little we make. but, in other words, gina is right -- no hospital can turn you away, even if you don't have the means to pay for your care.

when i got pregnant we had to buy nys low-cost (since we weren't eligible for free) insurance for me. i hate the insurance situation in this country, but that's neither here or there right now, i guess! luckily child insurance has higher income limits so our bubs will be covered...unless this new bush bill to cut free insurance for children (ny and a couple of other states have notoriously generous free plans) goes through in the next year! then we're screwed. gotta love it!

[GinaRae]

I don't want to say this in case it stresses you out, but you should be prepared. I don't know for sure what California laws are, but there's a chance insurance you get in Nov will give you problems over the pre-existing condition. Insurance considers pregnancy to be a condition or disease basically.

We had problems with ours telling us that despite the fact that they weren't allowed to consider it a pre-ex. cond. (I think!) and despite the fact that we were on the insurance for 5 months!!!

So just try and be prepared and relaxed and take it as it comes so it doesn't cause a huge amount of stress that could hurt you/baby.