Okay, I am pregnant and I want a home birth. Since a home birth and the midwife's prenatal care is not covered by my insurance, she suggested that I get my prenatal care with a covered provider to save money (since my insurance pays 100% of it). I have called several places, and they all tell me they don't want to do the prenatal care if I'm not going to give birth with them.
So I'm wondering if this is worth fighting or not. I'm still trying to find a provider (just emailed my midwife, and waiting to see what she comes up with), and have left a message with my primary care provider (a regular family practice MD) to see if she would be willing to do the tests and listen to the fetal heartbeat and so on. It's my third pregnancy, and really I'm not too worried about it, other than that I have been known to get bladder infections and yeast infections and low iron (though if I would just start taking my blackstrap molasses, that last one wouldn't be a problem), and I like to hear the baby's heartbeat, so I don't really care who does it. I just don't want to be forced into a hospital birth with all the risks of unnecessary interventions and 1/3 chance of having a C-section (most of which, as I understand, are done for the convenience of the OB's).
My husband thinks the providers I have talked to are being discriminatory, and are only thinking of the money they will lose if I don't give birth with them--that's the most expensive part of the whole deal.
So if my doctor says she doesn't want to do the prenatal care, and if the midwife doesn't know of a provider who takes my insurance, then should I talk to my lawyer, or what? Any ideas? My home is in Estacada, so anywhere from Sandy to Gresham to Oregon City to Clackamas, even eastern Portland, would be fine. And if you have a recommendation, it has to be female. Even after two births, I still can't be comfortable with a guy seeing me down there (and so far, only my husband has, since midwives caught my first two).
Thanks so much!
You've had some good advice. My doctor consulted with the OB in her office (it's a "medical home" or building with several doctors of different specialties), and he said he would take me. However, since I am very uncomfortable with having a guy OB (I've only ever had midwives and nurses), they recommended me to a woman's health clinic nearby. The clinic is still within my network, so insurance will cover it. When I call, I won't tell the receptionist that I'm planning on a home birth, just that I'm pregnant and need prenatal care. I'll have to tell them at some point, because my midwife will want to see test results and such. But I figure I can always mention that if there were complications, they would be familiar with me already when I showed up at the hospital.
Hi, L.,
I've had two home births in Vancouver. I did all my prenantal care with an OB... I just don't tell them I am going to do a homebirth. I tell them it's a thought, but I'm still trying to make up my mind. Just go thru all the motions as if you are going to deliver with them, in a hospital.
If you want to talk more, feel free to PM me.
:) Good luck to you Mama!
A doctor does not have to see you, there is nothing a lawyer can do about it. If you are having an emergency and go to an ER, than yes, they have to treat you, but they do not have to accept you as a patient just because you want them to when there is not an emergency. I can understand a doctor not wanting to be your OB if they will not be delivering, they may fear that with that loss of control at the end, if something goes wrong during the birth you may come back on them with some kind of malpractice suit. A good midwife/birthing center should be able to do all those tests and listen to the heart beat. If it is a matter of your insurance not covering it, than you have to make the choice to pay for it.
No they don't have to take you and it has nothing to do with money but liability.
Ok - a couple of thoughts. First, no - don't call a lawyer. The providers aren't being discriminatory, they're simply declining to see you. A doctor can do that. So you don't have a case if you want to claim discrimination.
Second - why are you telling them that you want to have a home birth? It doesn't change the care they'll be giving you during your third trimester, so why do they need to know? I understand that you want to be honest, but there's no reason to even bring it up... especially since in the event of an emergency, you WOULD use their services.
I say this as someone who planned for a home waterbirth and ended up with an emergency C-section at the advice of my awesome midwife who realized that it would provide the best outcome for my daughter. She drove with us to the hospital and stayed the entire time. Not the birth I wanted or planned for, but it couldn't be helped.
I would call Portland Ob at Good Sam. I had Dr. Tim Dooley, and I really like him a lot, but my daughter was delivered by Dr. Sang and she was absolutely wonderful. The PA there is really nice too. I would schedule the appointment and go in and talk to them, don't do it on the phone because the office staff are fielding calls and don't really know the doctors' opinions if you explain the situation. My doc and Dr. Sang actually fought for me NOT to have a C-Section, but I ended up having to have one anyway. (She was too big and in distress). I really like them and I think they take most insurances. The phone number is ###-###-####. The weblink is http://www.pogapdx.com/. I hope they can help you. I can also recommend my PC, but she is St. Helens and it would be a drive, but I think she would be happy to help. Good luck, if I can help more, please let me know.
It's not about discrimination or how much money they lose from your delivery. It's about their malpractice insurance and their liability. Your doctor is protecting her license and her practice.
Even if that weren't the case, your doctor is still allowed to make this sort of judgment call and refuse to treat you. Would you threaten to call your lawyer if you wanted to see a new doctor who was not taking new patients because they had a full docket and you were disappointed and felt they were "discriminating" against you? Or if you threaten with your lawyer because you went to a Catholic hospital that states in their policies that they won't perform certain procedures yet you want them to perform one of those certain procedures anyway?
only one question: do they have to know that you're not going to give birth with them?
You cannot sue a health care provider because they refuse to see you. You could check with your county clinic to see about prenatal care.
You could also just call and schedule an appointment without necessarily telling them that you won't be using them for the birth. Then, when you get close tell them that you've decided on a homebirth with a mid-wife. I don't know how ethical that is, but it would probably work.
Why would you tell them that you are having a home birth? If that really is the problem in getting care, I would just leave that out. No provider can force you to give birth with them, even if you have seen them for the entire pregnancy....and it's always good to have a backup, just in case.
So find a doctor or nurse practitioner that you are comfortable with and just don't talk about your homebirth plans. I mean even women who do birth in a hospital can change providers at a whim, or move halfway through a pregnancy and end up giving birth somewhere else, so it really should not be a big deal!
BTW you DH is right, any doctor that will not see you for prenatal care because you are not planning on giving birth with her is just interested in your money... though I do wonder if maybe the office people misunderstood you when you called? Maybe they though you were asking that the doc attends your homebirth?
In any case: good luck!
Hi L.,
I think I know what's going on here. I learned a lot about how insurance companies handle billing for pregnancy and birth through some unfortunate wrangling I did with my insurance company after one of my home births. For some reason, health care providers and insurance companies have decided that when it comes to pregnancy, they don't charge for each individual office visit. The charges for the prenatal visits and the birth are bundled together and billed after the birth. This means that whatever provider you're with for the birth, gets to bill for the whole bundled package. So they do not want to see you, because they won't get paid.
But, you don't really need a prenatal visit. You need one visit, to establish care and after that all you need is someone to prescribe the necessary labs (your midwife should be listening to the baby's heartbeat at prenatal visits). A primary care physician could do this.
My midwife would just tell me what labs tests she wanted me to have done, I would tell the doc and they would order it and send the results to my midwife.
Perhaps if you phrase the question differently, you will get a different answer. Tell them that you do *not* need prenatal care, because you have a midwife who is providing prenatal care, but that you need someone who will prescribe tests (lab, ultrasound) as needed. When they know that it's just this limited thing you're asking for, they may be more apt to say yes.
*Just to reiterate: You *have* prenatal care- that's what your midwife is doing for you. You just need someone who can order labs that your insurance will pay for. It's a fine point, but definitely the answer can hinge on it.
Sounds like you have the plan I would just ask for the care & not tell them about the home birth.
My daughter had her lab tests thru a doctor in the Providence Medical Clinic@ 48/NE Glisan. I don't know his name but you could call the clinic and ask. But the midwife provided the prenatal care.
Her delivery was at home with a midwife and was covered by her insurance.
