Monday, May 26, 2008

birth providers: wwyd?

i could use your opinion or advice or reality check or something. i've thought around this situation so much i'm thinking in circles. this post is prob going to be too long too, as i sort things out.

so, i am on my husbands tricare insurance. it is military insurance, as he is currently on active duty. there is a huge military medical hospital near me (i'll call it army clinic--original huh ) where active duty and dependents give birth. the funny thing is, i have a history with this place even before my current involvement in it; i happened to spend 2 mos rotating there in L&D full time as an elective in nursing school. there are pros and cons to this place.

pros: it is completely, 100% covered. every lab, every test, every IV, every everything. all of the births i witnessed there were professional, and even the ones with unexpected turns of events were handled well. they also have a level III nicu, where i also spent time, and which i was impressed with.

cons: if i deliver at army clinic, there is no opportunity to meet the staff who would be present at my delivery ahead of time. none. there's no way even to narrow the universe of people it might possibly be. whoever will be with me that day or night is whoever is on duty that shift at army clinic. if my delivery crosses shifts, then the personnel that i've gotten to know the previous 12 hrs shifts as well. i have always known this about the army clinic, both because it was that way when i rotated there, and because they told us about it in 'orientation' . but, to be honest, it didn't bother me as much before, because i think part of me never thought i'd make it this far. now that i'm about halfway there, i'm starting to think i might make it the whole way. thus, the newfound concern.

another con about army clinic is they do things their own way: for ex, i could not get an NT scan through them at all, so i had to pay out of pocket for one through another provider.

what i'm worried about: what worries me is the instrumented vaginal delivery. as odd as it sounds, i'm really not worried about a planned c-sect. i have confidence that whoever is my provider is proficient at c-sections. further, i have a bicornuate uterus so my risk for c-sect is higher in the first place. i've made peace with that along time ago. frankly, i'm just going to be happy to have a real live baby, the planned c-sect doesn't bother me. in fact, if i could just plan a c-sect right now i wouldn't even have an issue. the vag delivery where nothing goes wrong doesn't bother me either. what worries me is the worst case scenario: the stuck baby, the crash c-sect, the bottoming out heart rate, the dystocia, the forceps, the vacuum, the episiotomy, the 4th degree tear, the retained placenta etc. etc. etc. THOSE are the situations where i want to be able to be able to concentrate on nothing but myself and SB, where i want to take for granted that my provider is skilled and qualified, and has done thousands of these before and i'm in good hands. in short, i want to be able to trust my provider so that in a worst case scenario, i don't also have to worry that they might not know what they're doing. its sorta like what nicole said in her thread, she trusts her doc to make the right call re: her induction. i want to do that too...but i have no opportunity to do that because i can't meet anyone ahead of time. instead i have to trust the institution that whoever is there when i'm there knows what they're doing. i feel like it's alot different to trust a whole clinic than to trust one person or even a group of people.

so, i wrote an email to my old ob-gyn whom i've known for-EVER and who has known me for-EVER and who did my laparoscopy. i have utmost trust in her. the problem is, her practice doesn't take tricare. i called the hospital where she delivers and they do take tricare, i just have to switch the version of tricare that i have. if the hospital didn't take tricare, i couldn't even contemplate this switch because it would just be too expensive. but they do. her flat fee is $3200 which includes prenatal appts, vag or c-sect delivery, and postpartum care. it's a significant discount from what she generally charges. labs/sonos are NOT included.

pros: trust is not an issue. i know her. she is very good, very skilled, very experienced. if she busted out the forceps, i would not worry that my babe would end up with a mashed skull. i know she would never cut a senseless episiotomy. she would always treat me with dignity and respect.

cons: $3200 is a LOT of money for us right now. especially when that seems to be a floor, not a ceiling, as what if i need extra labs/a sono at the end for some reason? money would suddenly become a huge factor in the delivery, where it isn't now. plus, i'm spending on what is essentially a luxury item. it's not like i don't have care and would have to pay for the delivery no matter what. i have full coverage, and would be not using my coverage (wasting it) and then paying out of pocket for sort of the same service. it's not money i have to spend.

there is one more option. i could ask her to recommend to me someone within the tricare network that delivers at this other hospital (not army clinic) that takes tricare. then i could try to meet everyone in this other practice in the next 20 wks to try and get comfortable with them. it would cost alot less, but i don't know if i can meet and get comfortable with someone or someones that fast. i'm sorta under the gun as i only have 20 wks left. i would have thought of all this before hand, but i really just wasn't sure i'd make it this far.

thanks for making it this far through this rambly post. now, wwyd?


Lori said...

I think I would go with the 3rd option.

Then the 2nd.

I rely a lot on intuition. What does yours say?

Bean said...

Ugh -- sorry you're faced with such a situation, also sorry that I don't have any helpful advice to give. I guess if you would feel ALOT more comfortable AND if you can afford it, going with your former doc sounds like a nice option. Also -- wooohooo you're 20 weeks, 1/2 way there! Congrats!

Geohde said...


Oh, I'd flap about in a circle changing my mind at 5 minute intervals and fret up a storm!

Yeah, not useful, I know, but honest :)


Meghan said...

ohhhh...that's a hard one. I'd probably go with door #3, if that is a possibility. And like Lori, if that didn't work, I'd probably cough up the dough (or more realistically, swipe the credit card) and go with my former doctor. I think you need to do what is going to make you most comfortable.

Doesn't it suck that our medical decisions come down to money??? so freakin unfair

In and Out of Luck said...

Hmm. I think I'd try to talk through my concerns with both providers - ask your clinic specific questions about their experience in the feared "what if" situations, and ask your trusted OB what she thinks of said clinic. I know at times I've paid large amounts out of pocket to assuage what was basically groundless infertile worry, and in retrospect I wish I'd asked the trusted (and expensive) doctor straight out: are you better? What's the reputation of less-expensive clinic? Would I be medically better off with you or are they just as good? Sort of use the expensive person as sounding-board or therapist and get their blessing - IF they have it to give - on the clinic, and interview the clinic to see if their answers to you are satisfactory.

dmarie said...

Holy crap! I had no idea you are preggers!? I've missed a lot. Congrats!!!

Becky said...

If that is just the flat rate it can go up A LOT!! You never know what will happen in the next 20 weeks. With my first daughter I developed high blood pressure at 23 weeks.. I was at the perinatologists and my regular OB more that one time per week for ultrasounds and Non stress tests to monitor growth and all that. If that was your case it would be very expensive. I would probably try number 3 to see if she has someone good to reccomend and if that doesnt work out I would probably stick with Tricare. The cost of stuff is just too expensive!!

Becky said...

oh wait.. what about something like you went with the tricare... but hired a Doula (I have no clue how much they cost) BUT take her to your appointments and then there will be someone to feel comfortable with at the delivery since you dont know what dr will be there.