Anyone have experience with Park Nicollet/Methodist hospital re: giving birth? - Mothering Forums

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#1 of 10 Old 12-30-2008, 02:27 AM - Thread Starter
 
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I am just wondering what your experience was. I was recommended to an OB by a lady at church who I liked but now, due to some rare pregnancy related things, I have to go to the perinatal clinic at Methodist. I am not as happy there as I was with my OB and I am just wondering if anyone else had anything to share regarding care there and/or giving birth at Methodist. So far our insurance has covered 99% of our costs because this system is a preferred provider for us so I haven't looked at other health systems to see what our insurance would cover but I am open to hearing about good experiences people have had elsewhere. Thanks

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#2 of 10 Old 12-30-2008, 12:21 PM
 
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I gave birth at Methodist Sept. 07. I had a completely natural birth and, for the most part, my birthing plan was respected. I had no medication, not even an IV port or anything. I had a specific birthing plan (if you want a copy I can share it with you) and it was respected. In the birthing plan, I asked for a nurse who was comfortable and enjoyed helping a mother choosing a natural labor and delivery. I got a nurse that typically works with the midwives--and she choose for herself a natural delivery after medicated delivery (just as I had). She was with the whole time (cause I came in "late in the game") and it was a good experience.

I'm going to be giving birth there again in late spring. My only complaint came from the nursery/baby care after birth (I had complete rooming-in, which they encourage--I mean more of dealing with the nursery nurses who come in your room and want to do stuff)--but now I know how to address it. We're leaving the hospital as soon as I am ready (a couple hours at most). We had a hard time getting out of there, even after we specifically said we wanted to leave at 24 hours. I've talked with my kiddos' pedi and gotten "permission" to leave early (as long as there's nothing seriously wrong, obviously)...and I implied that I would leave AMA if they (the hospital/nurses/on-call doctors) pulled the crap they pulled to try to get us to stay, like last time (made-up jaundice issues, delayed newborn screening).

Know EXACTLY what you DO and DO NOT want and practice and prepare asserting yourself. We didn't vaccinate (and do not vaccinate at all) at birth, so we had to sign a waiver. We didn't do vitamin k, so we had to sign a waiver. My son was born 9 pounds, 1 ounce, and they freaked and demanded a series of blood sugar tests--I let them do three (they wanted between 5-7)--so when I started declining them--they asked me to sign a waiver. I will not do the newborn hearing test again, if it goes as the last one did. The nurse thought it was more important to get the test done than my kid's comfort.

HAVE A BIRTHING PLAN! And be prepared to sign waivers!

EDIT: I should say that I used the park nicollet OBGYN department...and I love my OB...I WANTED a homebirth this time around, but my husband isn't comfortable with it--so we came up with a compromise--I leave the hospital as soon as I'm ready--within hours...the pediatrician is on-board, I have to talk to my OBGYN...cause "pre-approval" for that kind of thing goes better than springing it on them!
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#3 of 10 Old 12-30-2008, 02:12 PM
 
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i gave birth at methodist, but i didn't have an OB. i used the midwives at park nicollet and they deliver you at methodist. i was going to make a birthplan, but the midwives had a standard one and it was 99% what i wanted. i aimed for all natural, but ended up induced with pitocin (my water broke and i had no progression) and then had an epidural. i HIGHLY recommend the midwives. if you have any inclination to natural birth and if you are a low risk pregnancy, i think it'll be a much lower key affair than seeing an OB.
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#4 of 10 Old 12-30-2008, 02:30 PM
 
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I'm a labor and delivery nurse at Methodist, so I can answer some of your questions.

I think my first recommendation would be to see one of our midwives---if you don't have a medical issue that risks you out of seeing them, hands down I'd suggest it. They offer more support, are much more flexible, and you won't have to deal with any residents. That being said, I've seen wonderful, unmedicated births, and I've seen very managed (or mismanaged) births at Methodist.

In general, I recommend it as a hospital setting. Especially compared to other hospital settings. I think that having the midwives on staff has contributed to being more open minded and supportive of less interventive care. Just as in any hospital environment, you're going to come up against protocol (like mrsfatty did) and be prepared to firmly, but kindly stick to your guns if there are things you'd prefer not to do.

But, just so you know, it doesn't really matter who your OB is in the clinic when you get to the hospital unless she/he is on call that night. So, whatever plans you make with them, won't necessarily be implemented at Methodist. OR go with a family practice MD--they attend the delivery of their own clients. That's why I suggest the midwives. You see whomever is on call for them too, but overall they are typically less interventive.

mrsfatty-- just to let you know, some of those things are out of the nurses' and mds hands. The PKU test for example is a lab draw and if the lab is running behind, it's very difficult to get them done in a timely manner because the test is such a "low priority" test and so if STAT or ASAP labs need to be drawn, they get done first, or if there are many babies discharging that need to be drawn, it takes awhile. It is an optional test however, and could be done at a follow up visit. A good nurse should also be honest and open with what is causing the delays.

The other thing I'll mention is that unfortunately, in the hospital setting, your pediatrician does not have the power to discharge a baby unless he or she has examined him/her. That will be at the discretion of the pediatrician on call that day (and some are fine and some put up a fight). I would caution you about leaving AMA due to cost--most insurance companies will not cover the hospitals stay if you leave against medical advice.

All these things are why I am planning on home birth. I respect and admire many of colleagues, but the protocol is frustrating to get around. And as the nurse, I'm often in the position of being between the protocol and the patient.

ETA: I see now that you say you have some rare pregnancy thing, which I assume means you're now seeing a perinatologist? For High Risk Pregnancy? In that case, the midwives wouldn't be an option.

Mama to P. born at home 10/09, and W. born in the hospital 2/13

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#5 of 10 Old 12-31-2008, 03:30 PM
 
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have you checked into abbott at all? they're good for high risk pg/delivery i hear.
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#6 of 10 Old 01-01-2009, 01:48 AM - Thread Starter
 
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Thanks for all the good feedback, it sounds like if we make a birth plan they will stick to it so that is reassuring. My mom will be there too (if, God willing, everything goes ok with the rest of the pregnancyn and we get to have a natural birth like we want) and she is a OB/L&D nurse so I think she will help us be assertive too. I just feel kind of 'on my own' all of a sudden since I can't see the OB I was seeing and I am not that comfortable with the perinatologist I have seen. Even though I knew I wouldn't have my OB for the delivery I was just more comfortable with the idea of him following my pregnancy. I would LOVE to see a midwife but I don't think one would take me unfortunately
I have a bleeding disorder which the perinatologist said shouldn't be a concern until delivery (maybe not even then we hope) and we found out 2 weeks ago I have tumor on my placenta, I posted about it in the April 2009 DDC. As of last week the baby looked ok and is growing well and the tumor is on the borderline of where it might be a problem or it might not. We are praying that the tumor (a chorioangioma technically) doesn't get any bigger and that it won't affect the baby. I am just hoping if we get to term without any complications that we can still have a good birth experience, i.e. no drugs, minimal intervention, etc.

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#7 of 10 Old 01-01-2009, 04:03 AM
 
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Originally Posted by cileag View Post
mrsfatty-- just to let you know, some of those things are out of the nurses' and mds hands. The PKU test for example is a lab draw and if the lab is running behind, it's very difficult to get them done in a timely manner because the test is such a "low priority" test and so if STAT or ASAP labs need to be drawn, they get done first, or if there are many babies discharging that need to be drawn, it takes awhile. It is an optional test however, and could be done at a follow up visit. A good nurse should also be honest and open with what is causing the delays.

The other thing I'll mention is that unfortunately, in the hospital setting, your pediatrician does not have the power to discharge a baby unless he or she has examined him/her. That will be at the discretion of the pediatrician on call that day (and some are fine and some put up a fight). I would caution you about leaving AMA due to cost--most insurance companies will not cover the hospitals stay if you leave against medical advice.
I'm not trying to be a jerk--so please don't read this that way:
The nurses and on-call drs and pedis WERE dragging their feet. They waited until the last moment to try to do things. I told them the exact hour I was going to leave--whether they were done or not. One hour before I was going to leave they told me they wanted to do the hearing test.

I was cooperative and not confrontation at all, at first. I went with. The first ear was fine--the second ear was showing up as a problem (I can't remember the exact wording the computer came up with)--but she said she didn't want to put that in the record, that she wanted to try again and again. My son was getting very agitated (and hungry). She said she wanted him to have a pacifier. I said I wasn't allowing pacifiers, so I didn't cause breastfeeding issues (artificial nipple introduction within the first few days of birth RUINED my breastfeeding relationship with my first son, and I had to exclusively pump for 18 months--and I WAS NOT wanting to do that again--so I was ADAMANT about not using ANY artificial nipples AT ALL). I asked if I could breastfeed him while he did the test--cause that would do the same thing (calm him down and he'd be sucking). She said no. Fine. I said I'm not allowing pacifiers. THEN SHE ARGUED WITH ME--and was trying to FORCE ME TO USE A PACI, and said that pacifiers have NOTHING to do with the success or failure of a breastfeeding relationship. And then made a snide comment to a fellow nurse about "some mothers," as if I couldn't hear her. I asked if I could take a couple minutes to calm my son down--I took three minutes to nurse him and shush him and he was fine. Set him in the bassinet thing (cause she said I couldn't hold him) and she kept trying for almost an HOUR--and he was continuously upset. And she was continuously complaining about how unreasonable I was being about no pacifiers. I finally told her I didn't care if it came up as "bad" or "not hearing" or whatever the crap it said. It was what it was, and there's nothing we could do about it. And it's something I'll deal with with my regular pediatrician, if there ends up being a real problem. She asked for one more time. I conceded. It came up as fine or hearing or whatever.

THEN, I pick him up (he's crying at this point cause she was yanking on his ear and being really rough with him--his ear was a little misshapened at this point, from birth it was that way--it still has a unique structure to it, but it's "normal") and start breastfeeding him and she makes a comment with a sort of face to the nurse she made the "some mothers" comment to, "doesn't he look a little yellow? I'm going to get the (whatever you call the skin flasher dealie that takes a general estimated bili through the skin)." It said a 6--she does a dramatic, freaking out, hysterical voice--"That's so high! I don't think you guys will be going home tonight! We have to do more testing!!! Call the pedi right away!" I gave her a look. The "I'm not stupid" look. I said, "really? What's your 'cut-off' number for bili?" She said she didn't know, but, a six, that was bad! I told her I was comfortable with a six and that I would be more than happy to follow up with my regular pedi within two days (cause, come on, park nicollet is a busy place, gotta give the st. louis park pedi department a choice of two days) to check his levels again. I also told her I was having a home-care nurse visit (our insurance covers a visit within a certain amount of hours after birth)--so she could check it then as well. And if those numbers were "bad" we'd be more than happy to come back--if there really is a problem. But I'm not staying here for a six. I know the symptoms to look for. He's not yellow to me. He's peeing. He's pooping. He's eating. He's not lethargic. I know the symptoms to look for and I know a bili range I'm comfortable with." She goes to say, "well I'm calling the pedi and we're going to do a blood test and you need to give him formula." To which I said, "we're leaving in 15 minutes, if you can arrange that in the time you have left, that's fine, I will consent to a heel stick for bili and you can call me with the results. And under no circumstances will I give my son formula (we've never given either of our kids formula--my first son's severe jaundice resolved with photo therapy and feeding on demand--and I think his was caused by vit k--and my second son didn't have vit k and wasn't showing ANY of the jaundice symptoms that my first had at this point AT ALL)." She huffed at me as I left--and magically, we were serviced VERY QUICKLY. The pedi on-call magically appeared. The lab techs finally came. The doctor tried the scare tactics as well...and my husband and I were exhausted and we were on the verge ama...and then the pedi said she'd call us, after we told her we'd come back if there REALLY was a problem. But that to us 6 was no reason to stay. We wanted to rest at home and we were leaving. When she called us, everything was fine, just like we thought...

SO....long story short...when I give birth in the spring...three strikes and your out with the hearing test--period. and ama sign-out if they try the jaundice thing again. and I will be speaking to a charge nurse if I get treated like I did by that nurse in the nursery doing the tests.

Why talking to my pedi about my plans in advance? Well, I wanted a homebirth--that made my husband uncomfortable--but giving birth in the hospital and leaving when I was ready was a good compromise. We've talked about what we're comfortable with for my condition and the baby's condition. I shared my plans with my pedi (good communication with your doctor is great) and she shared the on-call/policies and how to get around it and get cooperation this time (she was annoyed that the nurse/oncall pedi made ANY sort of fuss about my second son's bili levels). She explained the time in the middle of the night when no one would be AT the hospital but I COULD call in a pedi from home if I really wanted to...she was ok doing the newborn screening test in office (instead of at the hospital)...she was ok seeing my newborn on short notice (within 72 hours of birth)...talking to the pedi is important for scheduling reasons and just to maintain a healthy level of communication, honesty, and trust on both sides. She was thrilled with my "plan"--and even encouraged me to sign out ama under certain circumstances (we of course talked about certain ones we BOTH agreed we'd stay for). She was comfortable seeing us if we did sign out AMA.

And you're right--you get whoever is on call (for OBGYN and for PEDI)--but, they see all your medical records, because park nicollet has a great system that keeps everything in one place--so the on call doctor can see the notes my doctor puts in the records.

As to your comment about leaving AMA:
Quote:
leaving AMA due to cost--most insurance companies will not cover the hospitals stay if you leave against medical advice.
That is a lie. That is a falsehood to scare patients and parents into not signing out ama. It is ILLEGAL for insurance companies to deny coverage for leaving against medical advice. Why? Because as patients and members of insurance groups, we are in charge of our medical decisions. Insurance companies cannot make medical decisions for us. They can set ahead of time what they will and will not cover in their explanation of benefits--and they must cover it if you meet the requirements (ie if you choose an in-network hospital--they have to cover at your in-network rate)

If what you're saying is true, then all my well-child visits shouldn't be covered, because we don't vaccinate. Not vaccinating is against medical advice--yet, all the well-child visits are covered. If what you're saying is true, then all my waivers mean nothing (declining vaccinations, vit k shot, eye ointment, glucose sticks, breastfeeding instead of formula, etc.) and they shouldn't cover my stay. But, that would never happen because INSURANCE COMPANIES CANNOT DICTATE YOUR CARE. They can decide AHEAD OF TIME, in the explanation of benefits, what they will cover, but everything else is up to us. If doctors ran the show (instead of patients) insurance companies wouldn't be able to afford covering anyone.

Everything is about consent.

I can choose to sign out myself and my child ama if I so please. Sure, you may threaten the whole insurance thing (which is a lie), you may threaten cps...but it is not unreasonable for parents to be in control of their children's health care. I don't think that me signing out my kid ama, if the hospital doesn't comply with my timetable (which my pedi assured me there should be no problem, if I had a similar birth to my second son's), is unreasonable. I am still under medical care (I will have a home nurse the next day, and I will see the pedi within 72 hours)--so it's not medically neglectful. I think that any reasonable person can see that I'm choosing to do what's best (going home to rest, nursing my second child, taking care of my newborn, taking care of myself in the COMFORT OF MY OWN HOME with the support of my medical team).

OP: Don't be afraid to have clear boundaries and set limits and be prepared to assert yourself! You don't have to be a brute about it (I was polite, except for at the end with the whole bili thing--I got rude and short because I was frustrated that I had been berated for 30-45 minutes--and I couldn't take it anymore). You can be firm and polite at the same time. You CAN get what you want from birth, if it goes all according to plan! Be prepared for any obstacles that may come from your condition--and know how you want to handle it AHEAD OF TIME--cause after birth, you'll be tired and emotionally taxed--having a plan when you're as clear-headed as you can be is important. COMMUNICATE with your medical team so they're not surprised by your expectations.



Again, I'm not trying to attack you, nurse from Methodist--just had a bad experience after birth with the staff with my second child's birth...and think you are wrong when it comes to ama information. Sorry if I came off harsh-that's not my intention...
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#8 of 10 Old 01-04-2009, 01:07 AM
 
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mrsfatty,

No offense taken. The baby room nurse was completely out of line. I'm sorry it was such a frustrating discharge experience for you. You sound like a very well educated, informed patient.

And it sounds like you have a very cool pediatrician willing to come in if needed. I just wanted to point out to the OP that in general most hospital decisions are made by those on call, because we have some folk who come in with very different expectations, and I think the key to a good hospital experience is knowing what the protocols at that hospital are and knowing which battles you want to fight. I'm also really glad that the ped went over the protocol with you--again, it's not something I see parents very prepared for and that's when it's frustrating. I wish more of them did that.

About the AMA thing, you're right about everything in the hospital being about consent--as a doula, I remind my clients about that frequently--however, (and maybe not as often in maternity/newborn situations), there are times when medicaid/medicare won't cover AMA--especially in regard to re admittence later on. I've had surgical patient have issues with that before. I haven't checked about private insurance or how frequently it occurs in the maternal/child setting. I certainly don't ever use it as a threat--and it's absolutely inappropriate to do so, but I do like my patients to be aware that in some situations, it's an issue.

steedalyn, good luck with your birth. I hope your birth goes smoothly.

Mama to P. born at home 10/09, and W. born in the hospital 2/13

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#9 of 10 Old 01-05-2009, 09:58 PM - Thread Starter
 
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Thank you for the feedback. I am hoping if we have a birth plan well written out and are assertive enough it won't matter who the Dr. is at the birth and hopefully the nursing staff will be supportive. I so wish I had a MW though.

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#10 of 10 Old 01-06-2009, 03:19 AM
 
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mrsfatty,

No offense taken. The baby room nurse was completely out of line. I'm sorry it was such a frustrating discharge experience for you. You sound like a very well educated, informed patient.

And it sounds like you have a very cool pediatrician willing to come in if needed. I just wanted to point out to the OP that in general most hospital decisions are made by those on call, because we have some folk who come in with very different expectations, and I think the key to a good hospital experience is knowing what the protocols at that hospital are and knowing which battles you want to fight. I'm also really glad that the ped went over the protocol with you--again, it's not something I see parents very prepared for and that's when it's frustrating. I wish more of them did that.

About the AMA thing, you're right about everything in the hospital being about consent--as a doula, I remind my clients about that frequently--however, (and maybe not as often in maternity/newborn situations), there are times when medicaid/medicare won't cover AMA--especially in regard to re admittence later on. I've had surgical patient have issues with that before. I haven't checked about private insurance or how frequently it occurs in the maternal/child setting. I certainly don't ever use it as a threat--and it's absolutely inappropriate to do so, but I do like my patients to be aware that in some situations, it's an issue.

steedalyn, good luck with your birth. I hope your birth goes smoothly.
Sounds like you're a good health care provider, cileag!

I now get what you're saying about AMA...that if you leave ama and then have to COME BACK, insurance (medicaid/medicare) won't cover...but you don't know about private insurance...I'm pretty sure private insurance would have to...but I'm not authority on that...I thought you were saying that if someone gives birth, then leaves ama, that birth wouldn't be covered (which is NOT true)...but, I do see the problem in having to come back...although, even if someone is discharged properly, something can go wrong--like postpartum bleeding becoming excessive after a stay or infection or something...that I'm sure insurance would cover, because that's a "normal" complication that can happen regardless of time frame...but I don't know that for a fact. I've just had people try to tell me that if I leave ama, my birth won't be covered, which isn't true...I mean, for my upcoming birth, I'm going to leave early, and I'm going to try to do it with the cooperation of all involved, but if needed, I'll leave when I want to and not be worried about whether I"m covered or not...

Yeah, discharge was awful last time--but I've communicated with my doctors better and now know what I need to do to get out when I want to get out.

And I'll add that the nurse in the room during labor and delivery (well, the room has TONS of people pile in when you're delivering) was AWESOME...but the doctor on call (who I met for just a few moments beforehand) was even better. There was a moment when the nursing staff (but not the nurse who had been working with me and really read my birthing plan) was trying to get me to lie flat on my back for pushing and telling me I "needed" to have my feet on the foot rest things...and I argued (while in craziness, cause transition hit me hard and pushing and transition seemed to happen simultaneously) that I was going to do it how my body wanted to do it...when the nurse (again, not the one I had been working with during labor) went to argue with me again to follow "protocol" the doctor (who only skimmed my birthing plan and who didn't know me at all) told her to leave me alone and that I was fine the way I was now...if I needed to move later, we could move later--and I ended up giving birth off the side of the bed (sort of) while laying on my side (which seemed to make the nurses, not the one I was dealing with--cause she worked with midwife patients, so I'm sure she was used to it...but the other nurses that came in at the last moment--very uncomfortable)--but I'm glad the doctor allowed me to birth how I needed to instead of forcing me into a position that didn't feel right to me.

Having a good birthing plan. Rehearsing assertiveness. Being prepared for waivers. Overall, Methodist was a good place to birth in--I'm feeling good about the compromise--I mean, I still want a homebirth, but I feel like I can still be "in charge" and get the privacy and such that I want/need at Methodist.

Sorry to go on forever...just coming near to birthing time again...so, I'm thinking about past births more.
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