Midwives and blood work???

[mamachiquita]

I am working with a midwife for our pre-natal and post-partum care as well as our homebirth. However, she does not do any of the pre-natal blood work so I have had to see an OB to get that done. Is this what everyone else goes through or is it just me? Do most women who work with midwives not get the blood work done or do they get it done by an independent lab or something? I was a little ticked off that I had to go through a huge long appointment and orientation with this OB (well, CNM that works at the hospital) just to get my pre-natal tests done. Luckily, our insurance does pay for the OB so its not like we had to pay for it. But, why do midwives require the blood work but not include this service in their fee, and why do you have to see an OB to get it done? I would have rather avoided that whole scene and just gone to a lab or something. Please help clarify this for me, those who have been there....

[Carolinamidwife]

We do blood work for our clients. Whether or not a midwife does bloodwork may depend on the legalities in your state. Of course, there are clients who don't want any bloodwork done anyway,

Amy

[mamachiquita]

Geez, I didn't want any blood work done but that wasn't an option for me. My midwife wants to see proof of blood type, rh factor, rubella, hepatitis surface antigen, etc. Luckily, she does perform the hemoglobin check and glucose check at 28 weeks as part of her service. I'm just kind of dissapointed that I had bring an OB into the whole picture. I don't think that any homebirth midwives here that I checked with did prenatal blood work as part of their service. It must vary a lot from state to state, I guess. I have even heard of midwives in other places not requiring any blood work, but I wasn't lucky enough to find one of those.

[pamamidwife]

If your mw is illegal, then she most definitely will not have lab privileges.

Most mws that are legal have lab privileges, so they can order their own labwork. However, if doing it through an MD will enable it to be covered by insurance, I'll have them do that.

I do like an initial set of bloodwork - mainly to see how the iron levels are, what the blood type is, etc. Most of the time, this is required by law (along with Hep B antigens, Syphillis screen, and Rubella immunity), but it depends upon the state.

[TrishWSU]

My mw did the bloodwork herself, then sent it to the lab. She told me one of the reasons was to check levels of something, b/c if they are too low, then a homebirth can be risky due tothe possibility of losing too much blood. Once was for the glucose test, but I didn't have to drink that nasty sugary stuff. She just had me fast fo r10 hours (not hard, it was over night) then came over first thing in the morning to take a blood sample. Again, I guess it's just the differences in each state.

[kerikadi]

My MW does do bloodwork but I choose to go to my GP because insurance pays that bill and will only cover the MW bill out of network so I get a $4.00 bill instead of a $100.00 bill.
You don't need to go to an OB for this bloodwork, any GP will do. My GP has a practice with other doctors and PA's - I have found PA's much more patient, understanding and less condescending so you may want to give that a try. I can't imagine going to an OB even just for bloodwork. I am able to be honestly with the PA about no U/S's, no doppler and birthing at home - she thinks is great.

Keri

[Sustainer]

My midwife doesn't "require" bloodwork, but she does like it, so I had it done, because I like her. I had to go to a CNM at the hospital for it. My midwife is working illegally so does not have lab access.

[EmmaJean]

I really think that this varies by state. In AR, midwifery is very regulated and so there are lots of tests that are required. Part of the requirements of having a HB MW is that you have to have an official back-up person--either a doc or CNM. You go to them 3 times for "risk assessment". At the first, you get lots of blood drawn and they do all the regular tests, the second, you get the glucose screen (required), and at the third you get your second "risk assessment" with all the tests and an "all clear" to go ahead with the planned HB. Sounds like fun, don't it?! So here, the actual MW who attends the birth doesn't do any of the testing, besides testing urine at monthly prenatals. So unless the MW is unliscenced and practicing outside the system, this is how it works.

So here, I can just blame the system for the pain I have to go through. I'd rather forget the whole thing, but then I really want the presence of a skilled MW at my birth. It's worth it in the end to have a satisfying birth!

BTW, when everyone on this thread is saying "mw" I wonder if some of these mw's are CNMs or are they all lay/liscenced/certified/etc mw?? Just curious. They are completely different breeds (at least for me). I'm finding that my back-up CNM is really more like an OB than I'd like, but still a step up from a real OB!

[girliemama]

It depends on a couple of things. One is what state you're in. In my state, only the CNM's will do blood draws and such. The rest make you see an ob. In other states, you can find a CPM who does her job without fear. (IMO, if you won't do your job because you're afraid of being arrested, find another line of work) I went through a lot of frustration finding a homebirth midwife who wouldn't make me see an ob or call 911 for something they should be able to take care of easily themselves. I wonder, though, why you weren't just sent to a lab? An ob appt isn't necessary for a blood draw, unless you midwife isn't able to order bloodwork.

[jenoline]

It's interesting to read this thread. When I was interviewing midwives for my upcoming homebirth, one said initial labwork was required (but I had to go to a doctor to get it done - lay midwifery is illegal in NC), another said it really didn't matter, and another said that "It's good to have, but I don't require that you get it done". That is the only part of the prenatal care that they can't do. Also, the initial bloodwork provides proof of pregnancy, which I will need to obtain the birth certificate.

Trying to figure out where I was going to get it done was a pain! I called the local health clinic (another mom who had homebirths said she went there for her bloodwork). They told me that they did not accept any insurance, and since I had insurance I'd end up paying all of it out of pocket, so I shouldn't (actually she said "couldn't" but that's not really accurate) go there. I called by general practitioner/family doctor and asked if they could do initial prenatal bloodwork - they said "No, we can't do that"! arrgghh...That really surprised me. I'm sure that if I went in with an unknown problem they could take a blood test and tell me that I was pregnant, you know? And, like some of you said above, and GP should be able to do this. SO...I returned to the birth center where I had my first baby, pretended that I was going to deliver there again, and went to 2 prenatals and had my bloodwork done (still need to order a copy from them). It's really annoying , and I hate the deception.

It occured to me recently that possibly I could go to a lab independantly and ask for the bloodwork to be done. Does anyone know if this is possible? Or do all labs require a doctor's order? I don't feel like I'll be able to return to the birth center with any subsequent children , which means I'll have to find another OB to get labwork done. It's very annoying.

Jennifer

[EmmaJean]

Jennifer, I think it could definitely be possible. Just call them up and see what they say. All they need is a tech to draw blood. Although you might need a doc's order to get it done. I'm sure everywhere is different. Good luck!

[Carrieanders]

My MW (certified direct entry) does all her own bloodwork and sends it to a lab. If I didn't want to do it through her, I could go to an independent lab. I can't imagine why you had to go to an OB?:

Carrie, planning HB #3 in April/May 03

[Justice2]

What if I took all of the records from my previous birth? I want NO bloodwork done. Would previous test suffice?

[jenoline]

I think that would depend completely on the midwife. Some of the midwives I interviewed did not require bloodwork, some did.

Also, in NC I need proof of pregnancy to obtain a birth certificate. That either means a blood test confirming the pregnancy or a notarized statement by your pastor (or another "official of the state") stating that you were pregnant. Since I don't attend church, I needed the blood test.

Hmm...I just reviewed an email one of the midwives sent me. If all you need is proof of pregnancy, you may be able to go someplace like Planned Parenthood just for a pregnancy test.

[mamachiquita]

Wow, it's really interesting to see what you've all gone through in relation to this issue. My midwife is a CNM and is completely legal. My husband "thinks" that she briefly mentioned that she could do the initial labs, but it would cost extra and that is why she recommended that I go through a CNM at the hospital to get it done. This way, it is covered by my insurance. My midwife isn't completely strict on getting all of the tests done (like chlamydia, AIDS, etc.), but she did want to see proof of blood type, rh factor, antibodies, etc. Unfortunately, none of this information is available to me from my previous pregnancy because it was done at a military facility in another state and it was basically just in the computer system. Because of all of these crazy privacy acts, it would be very difficult for me to obtain these records because we have sinced moved and I never signed a release that allowed me or another provider to access this info at a later date. Anyway, I just wish that we didn't have to get another party involved to get this stuff done, but we did and the labs have been drawn and hopefully it should be smooth sailing from here. My midwife does the 28 week glucose test and the hemoglobin check so I shouldn't have to see another provider for any other tests. I think that more midwives should include their lab services in thier upfront fee, as most of us get them done and don't want the hassle of going somewhere else to get them. I can understand the issue with lay midwives and midwives practicing illegally, for for a CNM who is practicing legally I don't see why labs should be extra, particularly those that are required. I feel sorry for those of you that have to do the three visit thing with an OB to get the "all-clear" for a homebirth. I would by wary of them trying to find some reason why I wasn't fit for a homebirth. I was so paranoid that the CNM that I saw at the hospital would try to rock the boat that I didn't tell her that I was just using her for her lab services, even though my midwife recommended me to her because she has received referrals from the hospital midwife in the past. Of course, I will tell her that I won't be seeing her again when I go back to get my results, but I wanted to make sure that all of my results came back first. Yes, I don't trust the "system" very much, can you tell??

[EmmaJean]

Laurie, it should be relatively easy for you to get access to your medical records, even though it's military (I'm a former military wife). Just call the hospital, talk to the records room, and ask what you need to do to get a copy of your records. If you think some info is on the computer, be sure to ask for that too. It might be as easy as faxing them a letter from you requesting them and your signature at the bottom. The only thing is that it can take forever, but they are YOUR records! Well, they belong to the military, but you're fully intitled to copies. They do it all the time! It might save you some blood tests. Good luck with all this!

[mamachiquita]

EmmaJean, in response to your post, yes, I probably could jump through a bunch of hoops to get my prenatal tests from my last pregnancy, but I'm more than certain that it would be more work than its worth right now. Before I left that base they explicitly told me that if I wanted to get copies of labs that I had done I should get them right then or otherwise it would be nearly impossible to get them. I hadn't planned on getting pregnant again at the time so I didn't even think to try to get copies of those labs. I'm not up for a huge argument with them, either - I have already gone through that with my insurance company regarding paying for my homebirth and that stressed me out enough. With all that said, I have had my prenatal labs drawn at the hospital yesterday so I might as well just use those. I needed to have my thyroid checked, too, since I am hypothyroid and need to have that monitored. At least I won't need to go back to another provider for any more labs or anything, though, and that is a relief. The less medical we get with this pregnancy, the better!

[mattjule]

I had a CNM in CA and she drew blood herself and sent it to a lab. I have a CDM in CO this time and she, too, draws blood and sends it to a lab. Both included lab in the fees, although with my first one I had to pay $25 for each lab on top of her fee, like a co-pay of sorts.

I just want to say that with CNM's it depends on the person. Our CNM wasn't like an OB at all. But it is hard to find a CNM willing to do a HB without OB backup. In CA it is the law that any CNM has to work with an OB, only in my town no OB would come near a HB so I had to sign a waiver that said I understood she was not under OB supervision. We wanted a MW that wasn't antagonistic towards the medical establishment. I didn't want a midwife who hates doctors with me if I was transported. I also wanted the assurance that I WOULD be transported if the situation warranted it. We have a direct entry this time because we can't find a CNM who does HB. But she has the same attitude, which I appreciate.