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-   -   Update! What comprises "unnecessary" prenatal care? (http://www.diaperswappers.com/forum/showthread.php?t=1444089)

KelseyH 09-16-2012 07:11 PM

Update! What comprises "unnecessary" prenatal care?
 
Backstory: When I was pregnant with DS, I was on Medicaid, so I had what I assume was industry-standard prenatal care with my OB, including a glucose test (I have an excellent diet... This seemed really unnecessary to me, not to mention absolutely disgusting) and a barrage of tests for STDs and things like Down syndrome and other abnormalities - that the OB said he "had" to perform because of my insurance. I refused to see the results, but didn't agree with doing the tests to begin with. (NC does require certain STD tests for pregnant women on Medicaid, which is fine - I was more upset about the testing of DS).

This time around, we are no longer on Medicaid - we now have a HDHP through Aetna Feds. So, in addition to the fact that there are some aspects of "standard" care that I don't agree with, we have to pay for EVERYTHING until we reach our deductible (several thousand dollars). Then, of course, Aetna covers everything 90/10, but it's still a substantial bill that we're going to sustain.

SO, what I want to know is - what is absolutely unnecessary as far as my prenatal care goes? We do want an ultrasound at/around 20 weeks so we know the baby's gender, but outside of that... What do they really NEED to do? I had labs drawn last week and I was a little uncomfortable - like, do they really have to do that? BUT I don't have enough medical knowledge to be comfortably assertive and say NO to something. I do know that I want to skip the glucose test, and any tests on the baby since that wouldn't change anything anyway, but outside of that, I don't know what I can "safely" refuse.

I'm not a high risk pregnancy at all - DS and I were both totally normal. Well, aside from the fact that I gained 41 pounds, yuck (my goal this time is 25-30 max). I delivered vaginally after 18 hours of labor, induced by breaking my waters. I had an epidural for the last 4-6 hours of labor and one dose of pitocin sometime after my epi was administered. Don't know if any of that's relevant... But anyway. I've done research online and the line between necessary and unnecessary seems VERY blurry, especially depending on the "crunchiness" (if you will) of whoever's opinion it happens to be. What do YOU think?

L&A'smommy 09-16-2012 07:27 PM

You might sit down and talk with your OB. There were certain tests that my last two OB's required or they would drop me as a patient. If it will be several thousand $$$ have you thought about a midwife HB or birthing center ?

s@hmommy 09-16-2012 07:32 PM

Re: What comprises "unnecessary" prenatal care?
 
subbing. We have the same type of plan and are ttc.

mommyinthesun 09-16-2012 07:47 PM

Re: What comprises "unnecessary" prenatal care?
 
Idk...

Im on medicaid. I was offered all of the testing, but only did the basic blood test for HIV/blood typing/rubella immunity and a vaginal culture (I knew I had bv and an std test isnt harmful imo.) I turned down the genetic/"screening" testing and there was nothing else said about it.

The only other "testing" done is the urine dip each time I go in. I accepted a level 2 ultrasound to look for a specific birth defect that my son was born with, but that was offered for my personal comfort anyway.

A 20 week ultrasound isnt really about finding out gender. Its to check for proper formation and growth. The gender is the "unnecessary" part of it ;)

Just know that YOU are in charge. If it doesnt feel right, or if you dont see it as beneficial, dont do it. Dont be afraid to question the reason for things your doctor may find "necessary."

Christylkeller 09-16-2012 07:48 PM

Re: What comprises "unnecessary" prenatal care?
 
I definitely think *necessary* prenatal testing/care is very subjective. I always opt out of the early screens, but I do get an early u/s and another one at 20 weeks. I also choose to do the GD testing because that is about my health and my babies health. I was told by a previous care giver that even though I was having a c/s I still had to do the GBS test which was very puzzling since the baby wouldn't come into contact with that area at all. The provider I have this time is so laid back and hands off. She didn't do any blood work or an internal at my 1st visit since I had just had all of that done last year with the pregnancy that I lost. She will do the blood work when I have my GD testing done later in the pregnancy.

I think you need to find out what is the *standard* testing/care and then decide what you feel comfortable omitting. Know why you don't feel it is necessary for those tests and be able to articulate that to your DR. And be prepared to find a provider that is willing to listen to you and not pressure you into things that really are unnecessary.

pester 09-16-2012 08:15 PM

Re: What comprises "unnecessary" prenatal care?
 
I would ask what testing they want to do and then discuss the reason behind it. I do a 20 wk us because it gives me peace of mind for having a home birth. This is the only US I do. Blood work is helpful depending on what they are testing. So ask. Are they checking for a disease or are they checking how your body is working. I never had an internal untill I was in active labor. And then I only had two. One when my midwife showed up at my house and wanted to gauge where I was at to see if she should stay. I was 5 cm she stayed and the next hours later and I was a ten. Of course this all depends on the course of your pregnancy.

The best advise I can give you is to ask questions. Ask why do you want to do xyz. Keep in the back of your head that a LOT of medicine is CYA for the doctors. It's the way the system is set up. Do they want to do x for your sake or to cover themselves if something goes wrong in the future. You know that you don't care if your baby say has down syndrome so you won't get mad at the doctor if you have a downs baby and they didn't test for it so you can say no to routein testing for that.

krismark0 09-16-2012 08:19 PM

I would love to skip a lot of testing too, but I know a lot of it would get me dropped as a patient if i refused such as the gestational diabetes and group beta strep. I will just go along with that stuff. I refused all testing to detect genetic abnormalities though.

ButtRpies 09-16-2012 08:27 PM

Re: What comprises "unnecessary" prenatal care?
 
Well, the BD (birth defects) tests aren't "necessary" but most OB's highly recommend them (so you're prepared when baby's born or ... if you so choose).

We buy our own insurance and you're going to hit your deductible when you give birth; since you're using an OB and not midwife I'm assuming you'll be delivering in the hospital. You'll hit your deductible.
I don't know what your deductible is but ours was $1200/person, $3000/family and then 90/10 after deduct. All said and done; we paid out of pocket $2400 for the prenatal care and birth in the hospital- and that was WITH an epidural AND switching from an OB to a midwife at 20 weeks (the midwife was cheaper BUT since we were switching midway, it was the same as if we stayed with the OB-I just HATED my OB and had to switch).
They treat the birth as individual expense. Ointments for the eyes, heel stick, circumcision, and anything post birth to just the infant is the baby's deductible/family. That's where ALOT of the difference in your cost will be. If the infant has problems post birth and is in NICU or something like that. We didn't have any problems but we circumsized (which they charged $400).
Hope that helps a little bit.

KelseyH 09-16-2012 08:29 PM

Quote:

Originally Posted by L&A'smommy
You might sit down and talk with your OB. There were certain tests that my last two OB's required or they would drop me as a patient. If it will be several thousand $$$ have you thought about a midwife HB or birthing center ?

I don't know *exactly* how much care will cost us, but our deductible is at least that much. There are no birthing centers in our rural area - I actually researched it, and we'd have to travel 1.5-2 hours away and I'm not even sure if they are considered "in-network". Out of network medical raises our deductible by two thousand more. Coupled with the fact that my husband works 90 miles away and I wouldn't have anyone else available to drive me to the hospital if I was in labor, that makes for a dangerous situation (IMO) if I am minimum 3 hours away from a birthing center.

And I'm absolutely not comfortable with a home birth. I had my epidural and liked it, and haven't decided yet if I want to go med-free with this birth or not, and home birth is a HUGE leap beyond that for me. Plus my husband is an EMT and is fairly/very uncomfortable with the idea. I think it would take a lot to sway him, if I could even be convinced to begin with.

Quote:

Originally Posted by mommyinthesun
A 20 week ultrasound isnt really about finding out gender. Its to check for proper formation and growth. The gender is the "unnecessary" part of it ;)

I get that... But that's the only part I'm really concerned with! Haha :)

Quote:

Originally Posted by pester
The best advise I can give you is to ask questions. Ask why do you want to do xyz. Keep in the back of your head that a LOT of medicine is CYA for the doctors. It's the way the system is set up. Do they want to do x for your sake or to cover themselves if something goes wrong in the future. You know that you don't care if your baby say has down syndrome so you won't get mad at the doctor if you have a downs baby and they didn't test for it so you can say no to routein testing for that.

This was worded in a way that made a ton of sense to me! Thanks so much! I will definitely sit down with my doctor when I go back in a couple weeks and have a more in-depth discussion about what he thinks needs to be done & why. :)

L J 09-16-2012 09:17 PM

You should absolutely be straight with the doctor as far as cost being a concern. Put it in terms he can accept, and don't give the impression of being a hippie natural birth movement advocate and wanting to refuse stuff just for the heck of it. (I am one of those, at heart, but it's not in your best interest for a doctor to think that.)

That said, I told my doc that I wanted as little done as possible, while still making sure the baby was growing properly. I was high risk, seeing a high risk OB, because of previous full term stillbirth.

We skipped all of the genetic testing/screening.

He was required by law (?) to test for HIV. He insisted on the GBS and the Glucose tests, even though he agreed up front to no antibiotics if I was GBS+.

And, other than the biweekly BPPs, that was it. No pap, screenings for anomalies.


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