Stupid pregnancy venting

[ktgrok]

My insurance companies told the doctors they wouldn't pay for elective c-section before 39 weeks.

 

I had a bad feeling about #4. I'd never experienced it before and I thought it was fears associated with pregnancy hormones. I was right to be worried. As it turned out, things were a mess internally, and I was lucky the baby was okay. Trust your intuition and stand your ground.

 

True. But I bet advanced maternal age, or risk of cord prolapse due to baby's position, could be used to justify it as a medical situation rather than elective. The doctor just has to write it up that way. 

[Murphy101]

True. But I bet advanced maternal age, or risk of cord prolapse due to baby's position, could be used to justify it as a medical situation rather than elective. The doctor just has to write it up that way.

And the fact that I'm not being given a choice to not have a c/s due to previous one rules out the entire premise of it being "elective" anyways.

[maize]

38 weeks isn't always safe, I have a nephew born at 38 weeks whose lungs were not mature-- he had to be life flighted to a major hospital as the hospital where he was born was not adequate (maybe did not have a NICU?)

 

I do think OP should listen to her gut though.

Edited September 14, 2016 by maize

[ErinE]

True. But I bet advanced maternal age, or risk of cord prolapse due to baby's position, could be used to justify it as a medical situation rather than elective. The doctor just has to write it up that way.

I was AMA and carrying breech with regular contractions but no dilation or effacement. The doctors (my attending consulted the others in the practice) said it was likely the insurance company would refuse to pay before the 39th week because I was not, technically, in active labor.

 

ETA: I was admitted early to the hospital because my contractions wouldn't stop without intervention. I was given medication to stop the contractions, but I still felt very wrong. I was going to be discharged twelve hours before I was due at the hospital for surgery prep. I convinced the doctor to let me stay another night. Words like long drive, uterine rupture risk, injury to baby, etc. helped. My attending doctor told me that if it was his choice, he would deliver me early, but a national, well-intended push to deliver full term babies overruled individualized care.

Edited September 14, 2016 by ErinE

[Murphy101]

38 weeks isn't always safe, I have a nephew born at 38 weeks whose lungs were not mature-- he had to be life flighted to a major hospital as the hospital where he was born was not adequate (maybe did not have a NICU?)

 

I do think OP should listen to her gut though.

Did they do it knowing that though? There's no reason they can't do a bioscan the day before to check for baby breathing, organ function and so forth. It's not exact, but it does give some indication of lung function.

 

I wouldn't do an early c/s without being sure my baby was ready and likely to be healthy. Or healthier than if we didn't do it bc of course sometimes it can't be avoided.

[Bluegoat]

She sounds like a bit of a twit.  The fact is that some doctors are not particularly logical. 

 

My approach would be to decide which approach I want to take in terms of worrying about labouring or not, and go with it, regardless of what she says, because clearly that is based on bubbles in her guts and nothing more.

 

It does sound to me that she has cut it close schedule wise.  I scheduled my 4th section a few months ago, and in the end I asked for it to be moved closer, so it is one week ahead, which I feel is a good place given I don't seem to go early.  And for me, I actually am not overly worried about labour being a problem if it should happen. I was more worried about the baby being younger than they had thought and it being a problem with a very early section.

 

It sounds to me like you reasonably think you could go into labour earlier than the section, so the question there I think is, do you think that is something to worry about medically or not?  If not, it doesn't matter so much, but if you do, I'd really insist on making it a bit earlier, and be really pressing about what the heck she thinks making it that late.

 

However - about the fear thing - I think it's normal to start to have a lot more irrational fears about things like that as one gets older and it can be very powerful.  So I would not necessarily take those kinds of gut feelings at face value without other things to support it, I think it can cause problems as well as prevent them.  I would tend to try and think about what might help to alleviate irrational fears.

[prairiewindmomma]

Would going OB-GYN shopping at this stage still have you delivering at the same hospital?

 

The first hospital I VBAC'd at had no anesthesia staff on hand.  I had a crisis and it was a wreck, as it took half an hour to get someone in.  I started driving to a hospital an hour away instead as my labors aren't precipitous and they had dedicated L&D anesthesia on hand 24/7.  

 

If you can't switch hospitals, can you have a chat with the charge nurse on L&D and with anesthesiology separately as to what their game plan is given your previous history? Sometimes forewarned is forearmed, and if your ob hasn't already sent your chart over and started those conversations, that might be another step you could take.  Odds are that if you're at a small hospital, they remember you and your story from the last go-round.

 

ETA: If there is no anesthesia on staff, once you feel first labor pangs, you could call in to L&D and they could call in anesthesia on your way in so that you're arriving at the same time. That could easily save you a good chunk of time of getting checked in, getting evaluated, them calling your ob practice, and then finally calling anesthesia in.

 

Edited September 14, 2016 by kbeal

[Murphy101]

These are NOT small rural hospitals. The small one delivers 300 babies a month. The big one, that I'm going to this time, is nearly 650 a month iirc.

 

The problem last time was at a different hospital and it wasn't that they didn't have anesthesia on staff, it was that they didn't have enough and that they had no clue how to handle a crisis surgery need.

 

The hospital requires an appt with anesthesia in advance of pre scheduled surgery, so that will happen next week regardless. They basically just make you watch a video explaining that yes there are dangers and you sign a form saying you accept the risk. And filling out paperwork about medical history and such.

 

I have a choice of three hospitals, one is the previous cluster mess event - so no thanks. Another is closer by 10-15 minutes and much smaller, but the OBs there are only there pt and most of them have their full practice at the third option which is the biggest one and the one my OB is through.

[Guest]

38 weeks isn't always safe, I have a nephew born at 38 weeks whose lungs were not mature-- he had to be life flighted to a major hospital as the hospital where he was born was not adequate (maybe did not have a NICU?)

 

I do think OP should listen to her gut though.

And I've had a 37 weeker with 10/10 on his apgars, right along with a 42 weeker who barely looked or acted post-date at all. It really just depends! I'm not usually a fan of induction or elective surgery, let alone early induction or surgery, but history plus gut feeling is an older mom tips it for me. I usually advise women to wait unless there is distress or a compelling reason to induce like a pre-existing condition, but it's not always the best advice compared with being proactive to avoid complications.

[FaithManor]

Murphy, I would like to personally verbally spank your OB.

 

What an ego!

 

I am worried for you and hope you get your section two weeks in advance.

[LMD]

I'm sorry you're having to deal with this Murphy, and I'd be worried too.

 

Can you put it in dot points to bring to your next appointment? Like, scenario 1 - schedule cs later. Pros- closer to due date. Cons: early labour, breech complications, fast labour, history of cord prolapse. Scenario 2 - earlier cs between 38-39 weeks. Pros - controlled cs environment with adequate prep time. Cons - slightly elevated risk of xyz.

 

Maybe seeing the scenarios side by side in black and white, and having to go through each point with you (and a support person!) will help her see the risk analysis from your point of view - as a specific patient rather than just a general statistical scenario.

[ktgrok]

Well, i'm glad to hear you are at least delivering at a different hospital! And I think 38 weeks is totally reasonable. But I do think it's probably hospital policy that you are fighting, more than this one doctor. 

[Guest]

Well, i'm glad to hear you are at least delivering at a different hospital! And I think 38 weeks is totally reasonable. But I do think it's probably hospital policy that you are fighting, more than this one doctor.

But I can't imagine those rules apply to an over-40, multiple c-section patient.

[ktgrok]

But I can't imagine those rules apply to an over-40, multiple c-section patient.

 

Yes and no. Multiple c-sections, yes. ACOG says the risk of rupture with 2 isn't much different than with 1 c-section, so before 39 weeks still wouldn't be a medical issue on that alone. BUT, advanced maternal age, maybe. I think the guidelines for that though are also 39 weeks for induction/csection but could be wrong. 

 

But a doctor could push it, absolutely. 

[Murphy101]

Well, i'm glad to hear you are at least delivering at a different hospital! And I think 38 weeks is totally reasonable. But I do think it's probably hospital policy that you are fighting, more than this one doctor.

Omg yes. Even if we're willing to return to that hospital, my dh can barely drive past it 5 yrs later without turning pale. He would freak out if I were delivering there.

 

I do think it's a combo of the dr and hospital and insurance policy. (To be clear, I don't have insurance, I'm paying her cash at each appt, but she still has malpractice insurance and other factors to consider I'm sure.) I am going to this dr bc she comes repeatedly and highly recommended. But one of those recommendation is a woman a few years older than me who even had mild placental bleeding and the OB still would not induce her before 39 weeks.

 

For all the scare tactic hype about previous c/s and being AMA, the actual guidelines don't change for when it is best to induce or schedule elective c/s.

Edited September 15, 2016 by Murphy101

[BooksandBoys]

And I've had a 37 weeker with 10/10 on his apgars, right along with a 42 weeker who barely looked or acted post-date at all. It really just depends! I'm not usually a fan of induction or elective surgery, let alone early induction or surgery, but history plus gut feeling is an older mom tips it for me. I usually advise women to wait unless there is distress or a compelling reason to induce like a pre-existing condition, but it's not always the best advice compared with being proactive to avoid complications.

I had a 36.5 week baby (urgent c-section, extremely low fluid, breech). Apgars 9/10. He had some difficulty establishing nursing, but figured it out.

My other two were 41 week VBAC (10/10) and 40.5 week VBAC (9/10). They had difficulty establishing nursing too, but figured it out.

Who knows?

[Murphy101]

Yes and no. Multiple c-sections, yes. ACOG says the risk of rupture with 2 isn't much different than with 1 c-section, so before 39 weeks still wouldn't be a medical issue on that alone. BUT, advanced maternal age, maybe. I think the guidelines for that though are also 39 weeks for induction/csection but could be wrong.

 

But a doctor could push it, absolutely.

Most Drs here do push it to be honest. Way more than I'd ever be comfortable with. One of the reasons the c/s rates can be high is Drs using very frivolous excuses to do it, even early.

[macmacmoo]

first was born on his due date.

 

Second was a still birth due to cord accident at 38 weeks.

 

third they me induce at 38 weeks, because I couldn't bare the thought of spontaneous labor.

 

fourth they told me at the first appointment that sure 38 week induction is fine. At 36 weeks the midwives informed me that based on current recommendations none of the OB's would sign off on a 38 week induction how about 39 weeks? I cried. I have no idea what strings the midwife pulled in the end i was induced at 38 weeks.

 

That was two year ago. So while with the first the OB would have happily signed off for a "convenience " induction (DH was deployed and dates were fuzzy), things have changed and I think they really don't want to do anything planned before 39 weeks anymore.

Edited September 15, 2016 by macmacmoo

[ktgrok]

Most Drs here do push it to be honest. Way more than I'd ever be comfortable with. One of the reasons the c/s rates can be high is Drs using very frivolous excuses to do it, even early.

 

Here too. They SAY 39 weeks before "elective" inductions. But really, why would you be having an "elective" induction before 40 weeks anyway? If you are doing it, you have some version of a medical reason, so if that have that reason they can schedule it whenever they want. And do. I'm on a birth group on Facebook and plenty of women are being induced or having s-cections between 37-38 weeks. 

 

In other words, they saw they had a problem (too many c-sections, way too many babies ending up in the NICU, even if only for a day or two) and changed the policy. In some areas, they took that seriously and are following the policy to change those outcomes. In other areas (mine) they are not...it's just something on paper to help with their accredidation/insurance/etc. It hasn't changed policy. 

 

And it seems with the OP's doctor, they not only changed the policy, they are unable to realize when it should and shouldn't apply. 

[Bluegoat]

Part of the problem with this though is that the idea of the "elective" c-section isn't really as clear-cut as many people think.  And I think that is true even in the minds of the hospital staff at times.

 

 

[MotherGoose]

I actually did say I wanted a biophysical instead or at least maybe do it every other time. So a NST last week, a biophys this week, NST next week... and she flat out refused to order one saying it was not any better than a basic NST and costs a lot more. When I stated the reasons I thought it would be more informative, she said she was the one that has delivered hundreds of babies and went to med school. She made it worse because she always talks really super cheerfully and bubbly. I feel like a heel bc the more sunshiny she gets the more I want to smack her.

Is this your 12th delivery? Surely you know a bit about it. I would not expect baby #12 to wait to come until 39 weeks 5 days, and I would surely expect him or her to come quickly.

[MotherGoose]

first was born on his due date.

 

Second was a still birth due to cord accident at 38 weeks.

 

third they me induce at 38 weeks, because I couldn't bare the thought of spontaneous labor.

 

fourth they told me at the first appointment that sure 38 week induction is fine. At 36 weeks the midwives informed me that based on current recommendations none of the OB's would sign off on a 38 week induction how about 39 weeks? I cried. I have no idea what strings the midwife pulled in the end i was induced at 38 weeks.

 

That was two year ago. So while with the first the OB would have happily signed off for a "convenience " induction (DH was deployed and dates were fuzzy), things have changed and I think they really don't want to do anything planned before 39 weeks anymore.

They don't. My ob was going to be out of town for the magical 39 and a half week day, and I wanted to do it at 39 weeks 2 days or something but the hospital had a fit over it and wouldn't allow it. She said she was wink wink willing to report some contractions or some minor issue to push the envelope after I got to 38 weeks or maybe it was 39 weeks. Advanced maternal age wasn't enough (I was 40). You had to have some sort of medical reason. Fortunately ds cooperated by sending me into labor at 37 weeks and I had not scheduled but intended (not emergency) c s.

ETA sorry I had dates wrong. With last dd they did it at 38.5 weeks, now it's 39.5

Edited September 15, 2016 by MotherGoose

[Murphy101]

I got it moved a few days earlier, but that's it unless some problem comes up. My OB said any scheduled c/s more than a few days before due date has to be reviewed for medical need by a panel at the hospital before it will be approved. Supposedly she can't get anything earlier approved unless she trumps up a genuine medical problem, previous c/s and AMA do not count.

 

I switched to a different OB in her office who, in theory, will be able to schedule it at least a few days earlier than her. I should hear back soon with confirmation of new scheduled date. I hope.

 

In other news though, baby girl is now head down in typical my baby fashion by pressing her spine against mine and folded her knees up against my belly button. And she had a growth spurt with an estimated gain of 1.2 pounds in a week instead of the typical approx 1/2 pound expected.

 

Still no name though. 😆

[ktgrok]

How are you feeling about things? Do you feel any better knowing she is head down now? (even if posterior isn't ideal, at least the breech issue is moot now)

[Murphy101]

How are you feeling about things? Do you feel any better knowing she is head down now? (even if posterior isn't ideal, at least the breech issue is moot now)

Meh. Mostly I want a nap. A 3 week long nap.

 

I'm pessimistic about whether any of this is accurate and still waiting to get actual confirmation about my new scheduled c/s date and to meet the other OB. It would not surprise me to discover that oh we forgot, and oh that day was full and oh ... Until sure enough she gets the date she wanted from the start bc she never made any effort to change it anyways. The OB seems to totally disregard any of my concerns or opinions, whether it's because she genuinely feels her "hands are tied" (her words) or because she just thinks anyone on their 11th birth is a de facto moron is a toss up.

 

I do feel slightly "safer" about her being head down. Most of my babies were posterior and delivered with the accompanying back labor. It's not fun, but it's familiar terroriory for me. Of course, she could decide to flip any which way between now and delivery too.

[Guest]

Yay to the moving positions but boo to your OBs. I'm praying for you!

[wendyroo]

My OB said that there was no way he could schedule an induction before my due date.  So instead he changed my due date. :huh:   

 

Baby had measured big on an early ultrasound and I was measuring big in the third trimester, so we decided that I had my dates wrong (I didn't) and we shifted the due date by a week and scheduled an induction on my new earlier due date.

 

Wendy

[wintermom]

Hugs to your Murphy. So sorry you're going through this stress. Hope everything proceeds well and baby is patient and stays put until that scheduled c/s.  Are there things you can physically do to help delay an early labour, such as bed rest? That may be an alternative to bumping up the c/s date. 

[Murphy101]

My OB said that there was no way he could schedule an induction before my due date. So instead he changed my due date. :huh:

 

Baby had measured big on an early ultrasound and I was measuring big in the third trimester, so we decided that I had my dates wrong (I didn't) and we shifted the due date by a week and scheduled an induction on my new earlier due date.

 

Wendy

Yeah. Dh said just that. Let's just change her due date then. No go.

[Murphy101]

Hugs to your Murphy. So sorry you're going through this stress. Hope everything proceeds well and baby is patient and stays put until that scheduled c/s. Are there things you can physically do to help delay an early labour, such as bed rest? That may be an alternative to bumping up the c/s date.

2 weeks before due date is usually not considered "early". Once a woman gets that close to delivery, purposely thwarting progression can do more harm than good if it does anything at all. Even trying to induce non invasively usually doesn't work unless baby is ready anyways.

[EMS83]

I switched OBs at 41 weeks with baby #1.  What you relate in reply #6 would have me out the door and calling every other office in town, and making sure they didn't share delivery shifts with her at the hospital.  >.<  

 

I don't know what to tell you usefully, though.  I'm sorry.   :grouphug:   I hope of course that everything goes smoothly, but don't ignore your gut, either.  I know that's hard trust.  I go back and forth with myself too.

[ktgrok]

What about a planned induction, can they do that sooner? Just wondering, since baby is no longer breech. Although I know a lot of hospitals won't do induction on VBAC patients. (Although ACOG says only cytotec is contraindicated, not pitocin)

[Katy]

IME, an "feeling of impending doom," is a genuine medical symptom, and if you show up at a hospital having a panic attack that something is wrong and baby girl hasn't been moving as much as usual, at the very least they'll do a comprehensive exam, and if you can work yourself up into a genuine panic attack and bring your blood pressure up a bit, they'll do an emergency caesarean. 

 

Not that I'm telling you working yourself up into a panic is safe for either you or baby girl. Instead, I'm saying that if you have that feeling, make sure that the doctor not only understands it, but writes it in your chart. 

 

Describing that I felt that something was very, very wrong and that I knew something was bad, worse than anything I'd ever had before, got me admitted for observation once, and they found something seriously wrong.  Describing that feeling and getting admitted to a hospital probably saved my life.  So if that intuition comes back...  forget the doctor and just go to the hospital or birthing center.

[Murphy101]

IME, an "feeling of impending doom," is a genuine medical symptom, and if you show up at a hospital having a panic attack that something is wrong and baby girl hasn't been moving as much as usual, at the very least they'll do a comprehensive exam, and if you can work yourself up into a genuine panic attack and bring your blood pressure up a bit, they'll do an emergency caesarean.

Lol. If only I could! I have very LOW blood pressure. It's why I want to nap all the dang time. When I'm stressed and upset, it got to a whopping 80 over 50.

 

Apparently I don't know how to have a proper panic attack. Even during my crazy c/s last time my blood pressure didn't get very high.

 

Not that I'm telling you working yourself up into a panic is safe for either you or baby girl. Instead, I'm saying that if you have that feeling, make sure that the doctor not only understands it, but writes it in your chart.

Short of grabbing the chart and doing it myself, I'm not sure how dh and I can be any more clear. Her general attitude was there was nothing she could do about it so might as well shrug it off.

 

Describing that I felt that something was very, very wrong and that I knew something was bad, worse than anything I'd ever had before, got me admitted for observation once, and they found something seriously wrong. Describing that feeling and getting admitted to a hospital probably saved my life. So if that intuition comes back... forget the doctor and just go to the hospital or birthing center.

My experience has been about 50/50 with medical staff. It tends to be either an immediate sit up and take notice thing they pay attention to, or utter and complete disregard until they have some concrete data to consider.

 

Dh is very much in the take notice camp, so at least I'm not saddled with a husband who won't take me serious. Which would probably be more helpful if he wasn't in another state 5-6 days of the week.

[Bluegoat]

2 weeks before due date is usually not considered "early". Once a woman gets that close to delivery, purposely thwarting progression can do more harm than good if it does anything at all. Even trying to induce non invasively usually doesn't work unless baby is ready anyways.

 

I think there is a difference between twarting progression and being careful to avoid things thatwould encourage labour.  One of the things that seems to trigger labout is the placenta no longer being able to keep up, so if you can put less stress on it, it might help.  And avoiding trampolines.