Care providers - venting

What do you look for in a care provider?

I am very frustrated with my situation. I have had one hospital birth and two homebirths with my previous babies. My homebirths were amazing and easy and wonderful and I had (and still have) the hardest time accepting having a hospital birth with these twins. My current Doctor was supportive of me having a homebirth previously and I had done labs and previous visits with him just in case I needed medical transport to the hospital and he was great as an emergency back-up but he isn't what I like in a primary care provider. I feel like every visit is assembly-line check-ups with no real dialog. He doesn't seem to care what I have to say, he is just down to business and moves me and moves me out as quick as he can.

Because I have worked in the obstetrical field for 9 years I am pretty informed and confident with my options and choices...but my pregnancy isn't some 'professional' experience for me. At the end of the day I am just a woman who wants to be nurtured and supported by my birth team throughout this pregnancy. I have confidently made my decisions every time before and walked away from care providers I didn't feel supported me 100%. Unfortunately, this go around I feel a bit boxed in. My husband is military and the insurance situation is really unyielding on who I can and where I can deliver this go around. My homebirth midwife who I love wont deliver us at home and so I feel like I have no real options.

I know I can negotiate and advocate for myself through the system, but I still resent all the limitations around me for compatible care providers and hospitals. I see so many places and Dr.'s that have very patient friendly practices and just wish the Dr's and the hospitals here would open up as well. Sigh....anyway...thanks for listening.

Heather

 

If you are limited by insurance what about hiring a doula. My best friend is a mid wife but she started out as a doula. They can provide the personal touch that is sometimes missed by doctors. You can interview the doula to make sure you find a good match. Will your mid wife deliver at the hospital? That way you can use the mid wife but in the hospital setting.

I loved my OB. He had the best bedside manner of any doctor I have ever had and I have had many. I spent two years with him being treated for infertility so I knew him pretty well by the time I got pregnant with the boys. I saw him weekly during my pregnancy due to my high risk and complications. So having him in the operating room was extremely comfortable (c-section). He even stopped by to see the boys daily while they were in the NICU.

 

What about a midwife in the hospital, as a midpoint? Twins are more high risk so then you have the hospital setting and back-up doctors, but midwife supporting your entire birth and different mentality about it all than many doctors have. I did have a dr I loved when my twins were born. But I loved having a midwife for a couple of my other births.

 

Tricare really needs to get with the program and provide better maternity care. I don't think I've ever had a good experience with them. I had to compromise on what I wanted because of Tricare and living in a rural area, but overall it was okay. I had a healthy baby at the end of the day and that's what matters. Good luck!

 

I haven't had a birthing experience with twins yet and I know that it will be different than it was with my oldest but I honestly didn't see a lot of the doctor until the very end of my labor. She'd check in every once in a while to see whether I should be pushing or not but the main person that got me through the delivery was the nurse. I know Tricare probably still limits you greatly but if you have options of which hospital to go to, I would look for a strong nursing staff in L & D. You can combine that with the previous recommendations of having a midwife or doula in the hospital with you.

 

I definitely recommend having a doula or advocate with you, especially for a twin pregnancy. They will pull the 'twins are high risk' card right left and center in the hospital and it can be quite hard to advocate for yourself in a hospital in the throes of twin labor-thats where I was and it was a horrible experience unfortunately.

 

Because I am a doula you better believe I'll have one! LOL Infact, at my last birth, I had three doula's! My homebirth midwife, who is a CNM will be attending as my primary doula. She wont do the homebirth, which I understand, but she and I are close and so she wont leave me just because she can't be my PCP. She worked at the military hospital here for 15 years before she branched over as an independent homebirth practitioner and so she knows the hospital and many of the staff who are 'old timers'. I know she'll be a huge support, but I still don't like being rotated between 15 some odd Dr's and delivery with whoever happens to be oncall. I really want dopler monitoring rather than EFM if the babies are doing well, As long as babies are both in a cephalic position then I want to deliver in the hospital bed rather than the OR table, and I know this may be strange for a lot of you but I am just speaking for myself and honestly I just don't want any pelvic exams. I have issues with them and find them pointless over half the time especially for a multigravida with a good medical history. I am used to having that be respected...it is hard to change to fit someone else's policies once you've done it your ideal way.

If all goes well with the pregnancy then I have the option of being seen by the midwives at the end of the pregnancy and during labor. No guarantees though of course.

Sounds like we have some military wives here. Hi all!

Thanks for letting me vent.

 

I think there's nothing worse than a lack of control in this situation. Although my last 2 births were in a hospital it was just my husband, my midwife and myself in the birthing suite which was quite nice and had an awesome shower! I saw an obstetrician the other week who said as he considers the risks after 34 weeks too great with mono/di twins he would just schedule me for a c-section then. I have enjoyed both my labours and births and felt so supported in making my own choices but that made me feel like a sick patient! Luckily my midwife disagrees with him and is finding me someone else so we can at least give these guys a chance to come when they're ready!
You have a real advantage in knowing the system where you are and having the confidence to advocate for yourself and your babies.

 

Oh yes, many of us here can relate even if we're not in the military system. My twin birth was at home with a fantastic midwife, but I didn't find her until 30 weeks along when I had taken too much gruff from my OBs. Who were the best I found. I remember our pregnancy and birth as magical times, but there was that aspect of shock and anger in there too. I couldn't believe how little choice I had in my care, and the comments OBs made to me. Some prize ones I personally heard: "I won't do anything I'm not comfortable with," "the longer the birth plan, the more certain the c/s," "you'll have to qualify to be ambulatory!!!" And then of course "fetal death" as the answer for why I couldn't ever deviate from the standard playbook. "Fetal death" when I didn't book my 3 hr OGTT test fast enough. Different advice from different docs.

You certainly know more than I did when I was pregnant, so hopefully you're already ahead of the curve.

But I can still sympathize with your venting! You're not alone!

 

I had a midwife in a Tricare hospital. At Ft. Carson (at least in 1994) all normal deliveries were assigned to a midwife. There was a supervising doctor, but the midwives handled everything so long as nothing oiut of the ordinary happened.

 

I had such a wonderful experience with my OB, so it saddens me to hear that not all OBs are supportive. She never mentioned a c-section, so it never crossed my mind. She only glanced over inducing, so I didn't concentrate on it. The norm for her was a vaginal birth. So I went into labor naturally and had both vaginally. I wish more OBs were like that.

 

I don't have much to offer b/c I've never been through a pregnancy before, but I know military medicine and insurance. Is your husband officer or enlisted? The reason I ask is because when I was under the military insurance I was under Tricare Standard (you pay a little bit more for it, but to me it's worth it) and Military Officers Association of America's supplement called Mediplus. It costed about $35/quarter and they picked up the 20% that tricare standard didn't plus at the end of every year I'd get my print out from CVS of what I paid out of pocket and submit that to mediplus and they would reimburse me for what came out of pocket with the pharmacy.

The reason I say all of this is b/c you can always go under tricare standard and have the supplement and be under the care of an OB of your choosing, as long as they're in the network --- and if you're in a military area you'll be hard pressed to find someone who DOESN'T take it.

I only know of MOAA Mediplus, however I'm sure there is a supplement out there for enlisted families too.

I hope things work out for you!

 

I opted for Standard so that I wouldn't have to worry about insurance authorizations. I fired my Dr and am shopping for new one....well I am still going to him until I find a new one, but I know I wont delivery with him. I am hopeful that there is a practice that will work out well for me. Standard makes it so much easier. Thank you for the tip about the supplimentary insurance. I am going to look into that.

 

Moonangel, you're more than welcome, if you need the website and forms I can pm them to you. I have a lot.of health issues myself and it would have been horrible had I been on prime bc of the doctors I was able to see, they helped me tremendously with my health, military health care is awful!