Question on Back-up Plans - Mothering Forums

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#1 of 10 Old 09-17-2014, 10:07 AM - Thread Starter
 
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Question on Back-up Plans

I was just curious, if you had a home birth, how did your "back-up plan" for in case something came up that your midwife required you use the hospital for?

I just found out the hospital my midwife works with has gone out of my insurance network as of last month. I am not sure how big of a deal this is, as it is 35 minutes from my home and I live 2 blocks from a hospital so this is where we were planning on going in case of an emergency anyway.

I guess I am not clear what the advantage of the preferred hospital is. Any thoughts on that?

She did mention if I am breech she would send me there for a scheduled C-Section. She also said she would transfer me there if I requested an epidural or said I was too tired to go on and she thought is was safe to spend the 35 mins in the car to get there. That way my labor could continue with someone she knew instead of a stranger at the closest ER.

What was your plan?
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#2 of 10 Old 09-17-2014, 01:19 PM
 
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Maybe I don't understand the situation entirely, but if I'm reading this correctly, that sounds like a little bit of a red flag.

There have been far too many cases where midwives drove their patients past nearby hospitals simply because they didn't want to get yelled at by docs they haven't worked with before. That's not an acceptable reason to delay emergency treatment.

If you're scheduling a c-section, of course, there are a lot of reasons why a slightly less convenient hospital would be a better choice. In any kind of transfer situation, though, I'd want a really good explanation for why she wants you to go 35 minutes instead of 5 minutes.

Again, I could be missing something here. But I'd definitely discuss this in detail with her and figure out the reasons that she's recommending the hospital that's further away.
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#3 of 10 Old 09-17-2014, 02:08 PM - Thread Starter
 
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Thanks, I see her next week so I'm going to bring this up. She wanted me to have an initial appointment there in order to "get in their system" and when I called is when they told me they are no longer in network for me. So going there is not an option as I'm not going to incur some giant $100,000 ER bill that my insurance won't cover.

I am not sure about it being a red flag...the first midwife I interviewed had a similar arrangement, but her back-up hospital was even further away and we thought it would probably take an hour for me to get there. She also recommended 1 appt with that Dr so that he wasn't meeting me for the first time performing my emergency C section.

My state requires CNMs to be supervised by a doctor, so this may play into it?
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#4 of 10 Old 09-17-2014, 02:24 PM
 
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Originally Posted by Yogini108 View Post
Thanks, I see her next week so I'm going to bring this up. She wanted me to have an initial appointment there in order to "get in their system" and when I called is when they told me they are no longer in network for me. So going there is not an option as I'm not going to incur some giant $100,000 ER bill that my insurance won't cover.

I am not sure about it being a red flag...the first midwife I interviewed had a similar arrangement, but her back-up hospital was even further away and we thought it would probably take an hour for me to get there. She also recommended 1 appt with that Dr so that he wasn't meeting me for the first time performing my emergency C section.

My state requires CNMs to be supervised by a doctor, so this may play into it?
Ah, yes, I think I misunderstood this. (That being said, I still might not understand it entirely--- I never had my coffee today!) It sounds like she has everything pretty well managed. "Getting in the system" sounds like a good idea, as does at least meeting the doc who (might?) treat you if you have to transfer.

I would want to go through every possible transfer situation with the midwife (and my insurance company) and make sure that everyone is on the same page.
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#5 of 10 Old 09-17-2014, 10:17 PM
 
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We have the little hospital nearby and the big hospital 1 hr away. Which one I would go to (for anything) would depend on what I needed. My (planned, not actualized) home birth would have been with a midwife who doesn't have those kind of backup arrangements- like, in writing- no one does here, it's how the regulations are. I see you specifically mentioned non-emergent reasons for when she would advise going further away- and I think it boils down to "admitting privileges" ie her back up has admitting privileges there, so they would have your records, youd be pre-registered, you'd go in directly to OB (not the ED) and, yes, know the OB. So to get the same at your in-network place, you'd have to do like concurrent care with a local OB, or a consult, which I think a lot of OBs aren't willing to do but is worth looking for b/c all the above mentioned things are nice perks but not like deal breakers for safety reasons.
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#6 of 10 Old 09-17-2014, 10:54 PM
 
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It is because if she does not have authority at that hospital, she can not deliver you or have much to do with it. Midwives, have hospitals that they have privileges with. They can not just walk into any hospital and aide their patient. So if you go to the closer hospital, she will not be able to be your midwife. But there would be a chance that if you went to the hospital that she has privileges at, then she might be able to (depending on the situation of course).
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#7 of 10 Old 09-18-2014, 08:36 AM - Thread Starter
 
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Thanks for the input. I'm upset about all this since I researched it and they were originally in network for me when we hired the midwife.

Since I am now 26 weeks, I am not sure if I will be able to find an OB to work with me at one of the closer hospitals. My gyno from years ago is there, but it's been 2 years since I've seen him so he has not cared for me during my pregnancy. I'm worried that if I call one of them up I'll just get a giant lecture about how awful they think home birth is.
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#8 of 10 Old 09-18-2014, 02:14 PM
 
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Would SHE be able to attend the birth (not just support, but catch the baby) if you transferred to her preferred hospital? That's not too common but cool when it happens (although moot point for you I guess).
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#9 of 10 Old 09-22-2014, 11:46 AM - Thread Starter
 
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Would SHE be able to attend the birth (not just support, but catch the baby) if you transferred to her preferred hospital? That's not too common but cool when it happens (although moot point for you I guess).
No, she wouldn't be able to. I would be transferred to the care of the hospital based midwifery group or the OB on call, depending on the reason for transfer.
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#10 of 10 Old 09-22-2014, 12:01 PM
 
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It's all a question of hospital privileges, in an emergency you should go to the one nearby. But if it's not a life-or-death emergency but a need for hospital intervention, then go where she should be able to continue your care.

You might want to look a little closer into the hospital nearby. With a lot of insurance, there is a cap on the amount you pay for an out-of-network hospital trip in the case of an emergency. Like if you were on vacation in another state and broke your leg. It will still be expensive, but most insurance covers after a certain dollar amount. Mine caps at $5,000 for out of network emergencies.

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