17 weeks and still no appointment

I'm 17 weeks into this pregnancy, and still haven't gone to the doctor
yet. I'm having trouble getting insurance and don't know what to do
about it. I make too much for medicaid, but my employer doesn't offer
insurance. With all our money going into bills, how can we do this?
Any suggestions? Will a OB still take me on as a patient this far
into it? Am I gonna have trouble finding one who WILL take me once I
get some type of insurance do you think?

apply for a discount at the local hospital.. someone should know who to
point you to.

Tori

--
Bonnie 3/20/02
Xavier 10/27/04
"Jenny" wrote in message
...
I'm 17 weeks into this pregnancy, and still haven't gone to the doctor
yet. I'm having trouble getting insurance and don't know what to do
about it. I make too much for medicaid, but my employer doesn't offer
insurance. With all our money going into bills, how can we do this?
Any suggestions? Will a OB still take me on as a patient this far
into it? Am I gonna have trouble finding one who WILL take me once I
get some type of insurance do you think?

Jenny wrote:

I'm 17 weeks into this pregnancy, and still haven't gone to the doctor
yet. I'm having trouble getting insurance and don't know what to do
about it. I make too much for medicaid, but my employer doesn't offer
insurance. With all our money going into bills, how can we do this?
Any suggestions? Will a OB still take me on as a patient this far
into it? Am I gonna have trouble finding one who WILL take me once I
get some type of insurance do you think?

I would start seeing someone ASAP. I would probably
also consider midwifery care. A midwife who does home births
or freestanding birthing center births will often charge a
flat rate (probably somewhere between $2000 and $4000, with
most having a sliding scale based on ability to pay) for
the entire package (prenatal, birth, postnatal). If you
end up having to pay out of pocket, that's *much* cheaper
than what you'd be out with a hospital birth, and as safe
or safer given a normal pregnancy. If you do happen to
find insurance, it may cover out of hospital birth, in
which case you'd really be in luck. Some OBs also have
flat rates, but these typically don't include the
hospital fees, which can be pricey.
Most midwives who do out of hospital births
would probably be happy to see you for prenatals now
at a reasonable rate or would be willing to work out
a payment plan.
Also, if your employer offers a medical savings
account, you could use that to spread payments out over
the course of the year (using pre-tax dollars) if that
helps.

Best wishes,
Ericka

"Jenny" wrote in message
...
I'm 17 weeks into this pregnancy, and still haven't gone to the doctor
yet. I'm having trouble getting insurance and don't know what to do
about it. I make too much for medicaid, but my employer doesn't offer
insurance. With all our money going into bills, how can we do this?
Any suggestions? Will a OB still take me on as a patient this far
into it? Am I gonna have trouble finding one who WILL take me once I
get some type of insurance do you think?

You should be able to find a caregiver if you want one... some will offer
payment plans, etc. There are also often low-income clinics which will
provide basic prenatal care, etc. and charge either on a sliding scale or
not at all. If you show up at the hospital in labor, they'll catch your
baby, period, and you can ultimately pay them as little as $10 per month
until the cows come home.

Personally, I'm planning a homebirth, with midwife backup but probably
unassisted. Our costs should be minimal since we're bartering with the
midwife. If we weren't, I would probably pay her a few hundred to be on call
for me, and a heck of a lot more than that if she attended the birth. It
takes a lot more responsibility on my part, but at the same time, I didn't
really have a "real" prenatal visit until something close to 22-24 weeks,
then another at 32 weeks, and at that, there wasn't much we really *did*.

Also, the income limits for medicaid are often higher when pg--170% of
poverty line rather than poverty line or not available at all when not pg.

Although the usual "expectation" of prenatal care is that you go in once in
the first trimester, once a month or so in the second trimester and more
often as you get closer to delivery, the fact of the matter is that very
little of what is done in prenatal care is "absolutely necessary" in every
case. I personally feel that prenatal care is what you do to take care of
yourself during pregnancy. Here's how I've approached it:

Ultrasounds, believe it or not, are optional. There's no demonstrated health
benefit to baby for getting a routine ultrasound--often when they pick up on
a problem, they end up delivering baby sooner, and so you get more
complications of prematurity in exchange for fast action--and it works out
about even. Personally I think the stress of knowing about a problem ahead
of time is far more difficult than assuming everything is okay until proven
otherwise, but then again, I'm an optimist at heart. We did an ultrasound at
11 weeks because I was bleeding and wanted to know if the pregnancy was
still viable (it was) because I'd had a miscarriage earlier in the year, but
we kept it short and to the point--discovered baby was indeed alive, that
everything looked normal with a cursory scan (5 minutes, tops) and I've not
had another one because nothing in the pg has warranted it. At 11 weeks, if
we'd discovered that baby was *not* okay, or had found the bleeding was
coming from the placenta, there would have been actions we would have taken
at that point. There hasn't been any reason since to do an ultrasound.

Listening to baby's heart: Before 24 weeks, even if they don't find a
heartbeat and something is wrong, there's not a whole lot they can do about
it. If your tummy keeps getting bigger and you start to feel baby moving by
22 weeks or so, you've got a safe bet that baby's got a heartbeat. After 24
weeks, the value of the information is limited, and again, if baby kicks you
on a regular basis, you've got a good idea that it's still got a heartbeat.
The only time baby's heart has been listened to during this pg was when I
was very very sick and went in to get treated for lung stuff (which turned
out to be whooping cough). And that was more for their benefit than mine--I
was too sick to really object at that point. But baby had been kicking
merrily so it wasn't really relevant to my feeling of baby being okay.

Blood pressu I do keep track of this myself, at home or in the grocery
store, because I know that for me, if my bp goes up, there are specific
things that I can change to bring it back down. But I didn't even bother
checking until I *did* get sick--it went up when I was sick, went down
rapidly as I got the acute problems under control, and has stayed down
since.

Belly growth: A normal visit after 20 weeks will usually involve measuring
from the top of the pubic bone to the top of the uterus (the "fundus"), and
"on average" the number of *centimeters* equals the number of weeks pg. If
the rate increases faster than 1 cm per week after that, they start
wondering about twins. If it's slower, they wonder if the baby is growing
enough. Personally, if I'm pg with twins, I don't want to know until they
come out (I'm not, if the US is to be believed...lol!) and most women who
*are* pg with twins get a pretty good idea of it either from rapid growth,
bizarre kicking all over, or the priceless "The left side is hiccuping and
so is the right, but they're not in sync." If baby is not growing enough,
there really is NOT a lot they can do about it except take the baby early,
which is of arguable benefit--as then you not only have a small baby, but a
premie as well. Plus, size estimates, whether from measuring, palpating
(feeling with hands) or ultrasounds, are notoriously inaccurate. I measured
"average" but midwife and doc both, with my daughter, said she was 8-9
pounds at 36 weeks. She was 7 pounds 11 1/2 oz at 40 weeks 3 days. My
neighbor was recently told at 38 weeks that her baby was "about 4
pounds".... and he was 7 pounds 12 ounces when born 5-6 days later. In any
event, I don't measure my belly more than noticing that my pants fit more
snugly or my shirts ride higher. Nevertheless, my belly grows.

All the blood tests, etc. There are an awful lot of "screening" tests
ranging from tests for iron levels, tests for various immunities and
diseases, tests to see if the baby might maybe possibly have some dire
problem. There are pee tests--it's a common ritual to go to the doc, pee in
a cup, then they dip a strip in the cup and see what colors it turns.
Interestingly enough, the midwife I work with says she no longer bothers
with the pee tests "as a routine" because the problems it picks up are
"late" markers and show symptoms in other ways, earlier, in the vast
majority of cases. I had her do one pee test on me shortly after I got sick
and my bp shot up, just to make sure there wasn't more going on than just
being sick causing my bp to rise. But that was 100% normal, and we haven't
bothered since. I didn't do the AFP because when it comes up with a red
flag, a huge percentage of the time (95% IIRC) there is nothing wrong. I
don't need the stress. I've never been anemic in my life, so iron tests
aren't a worry for me. I've been tested 6 ways to Sunday for STD's before my
current monogamous relationship, so I'm not worried about those. My blood
sugar runs ridiculously normal to low, and I had my dad do a home glucometer
reading 1 hour after eating on two separate occasions and came up with
numbers so absolutely *fine* that he isn't asking me about it anymore (he's
diabetic.) In other words, I know my body and although I've had illness
this pg, the underlying fundamentals that make a pregnancy healthy or not
healthy are solid. Whooping cough and the stomach flu aren't about
"fundamental unhealth", they're about having two college students and a
middle schooler in my life.

So what is my prenatal care?
1. I take care of my underlying health so that chronic problems are in
control and I'm fundamentally decently nourished. This means that my asthma
is under control, I take vitamins every day, I eat plenty of protein,
veggies, fruits, drink lots of water, avoid eating foods that make me feel
lousy (i.e. deep fried stuff) and get lots of rest.

2. I pay attention to my body, and if I get sick and need medical help, I
get it. Although I've seen the midwife twice for the pregnancy and seen one
doctor about the pregnancy, I've been to other doctors for the whooping
cough, a chiropractor to get my back adjusted, etc. Every time something
"medical" comes up, I get it taken care of and reevaluate what kind of
screening might be warranted to make sure it hasn't caused problems for the
pregnancy. So when I got sickest with whooping cough and my bp climbed, we
did what we needed to do to open up my lungs and fight the disease
(antibiotics, bronchodilators) and my bp came back down. If it hadn't, I
would have had to look at what other action I could take to help it come
down. When I broke a rib, coughing, we knew that suppressing the cough and
easing the pain (with codeine) outweighted the risks of the drug, so I took
codeine for a few days to reduce the trauma to my rib from coughing and let
me sleep.

3. If I'm curious or worried about something, I go find answers about it. I
was worried when I was coughing so hard that my membranes might
rupture--called the OB's office and they reassured me that while it is
possible to break membranes when coughing, it's not particularly likely (I
broke a rib, instead!), especially not in my case, where I was
well-nourished and had a history where in labor the last time, my waters
didn't break until 8 cm.

Anyway--I'm now at 34 1/2 weeks and do plan on visiting with the midwife at
36 weeks to see how baby is lying (I can't always tell) and do some
positional changes if baby is breech or posterior. Other than that, we'll
play it by ear. Birth is hard work, but not something I'm afraid of, and
I'll only call the midwife in if I feel like I want her there. If I feel
something is wrong that the hospital can help with, I'll go in. The only way
I'd do pain meds is for a c-section or other surgical intervention (and no,
I'm not macho about pain, I just don't see childbirth pain as in the same
class of pain as other kinds of pain. It's finite, temporary, and has a
great reward.)

Incidentally, even *with* insurance, I estimate that our likely cost on a
hospital birth will end up in the range of $5000+. Follow some of the
hospital charges threads here--there's a *LOT* of wiggle room in charges.
Avoiding some of the standard practices (like postpartum medications for a
normal vaginal birth) may give you some room to negotiate the price lower.
Some hospitals will do a set fee.

With midwives, many will charge on a sliding scale, take payments, etc. Some
take Visa. A midwife may come to your house for prenatal visits, stay with
you through labor, clean up after the birth, etc. Most midwives carry
oxygen, medicines to slow bleeding after the birth, and they have a ton of
experience in both keeping birth normal and recognizing early when it's
going away from normal. If you do a homebirth with a midwife for money
reasons, just realize that it's not a "second best" choice--indeed for many
of us, homebirth is the first choice. I've met few people who have had both
a homebirth and a hospital birth and preferred the hospital birth. Most who
have had both will never voluntarily go back to hospital birth without a
darned good medical reason. Safety-wise, homebirth keeps up well with
hospital birth--because while there are more treatments in the hospital,
they carry risks as well as benefits. Most routine interventions in the
hospital are overused, and thus there are problems that happen in the
hospital that don't happen at home. In other words, things can go wrong
wherever you birth, it's just that which things are more dangerous depend on
where you are. Certain things the hospital does better. Certain things the
hospital makes worse. Statistically, if you look at planned homebirth with a
midwife and planned hospital birth with low-risk women, it comes out about
even, risk-wise.

If we weren't bartering with the midwife, I would expect to pay between
$1800 and $3000 for a midwife's "full" services, prenatals and all. With the
"lite" schedule we're doing, the trade I'm giving comes to about $700 for
several prenatals and on call for the birth. If things happen such that she
ends up spending a huge amount of time with me during and/or after the
birth, we'll probably cough up some money on top of the trade.

Ultimately though, even if the hospital were the cheapest option, I'd rather
pay a midwife and stay home, or just stay home, than go to a hospital to
birth. But it all boils down to what *you* need to do to balance the money
worries, etc.

Once baby is here, things that make it cheaper include:
Cloth diapering (if you don't have to pay "by the load" coin op for laundry)
with prefolds, pins and nylon covers.
Breastfeed.
Make your own babyfood.
Don't assume you "need" all the gadgets and stuff--I find a couple good
slings substitute well for most of the "keep baby occupied" gear. We have a
crib but won't use it most likely.
A good carseat is important. Everything else we get second hand, including
baby clothes. Yard sales are a great resource, as are friends, family,
neighbors, church. Ebay, even, though you have to be careful there on price.
If you sew, you can make your own baby clothes, diapers, etc. and save a LOT
of money in some cases.

Every so often I go down the "baby aisle" at the grocery store.... and
realize there's not a darned thing there that I really *need*. Babies just
don't have to be that complicated or expensive. Now, once they're old enough
for music lessons, it's a whole new ball game... g

Jenrose
dd age 11 1/2
baby twofoot coming March 2005

Jenny wrote:
I'm 17 weeks into this pregnancy, and still haven't gone to the doctor
yet. I'm having trouble getting insurance and don't know what to do
about it. I make too much for medicaid, but my employer doesn't offer
insurance. With all our money going into bills, how can we do this?
Any suggestions? Will a OB still take me on as a patient this far
into it? Am I gonna have trouble finding one who WILL take me once I
get some type of insurance do you think?

I'm not an expert on this, but I was under the impression that
in many states at least, folks who ordinariliy wouldn't qualify
for public insurance would qualify for maternity care, and the
same or a related program would cover the baby for a few years.
Anyone know more?

Emily
DS 5/02

On Mon, 24 Jan 2005 20:44:07 -0800, Emily
scribbled:

Jenny wrote:
I'm 17 weeks into this pregnancy, and still haven't gone to the doctor
yet. I'm having trouble getting insurance and don't know what to do
about it. I make too much for medicaid, but my employer doesn't offer
insurance. With all our money going into bills, how can we do this?
Any suggestions? Will a OB still take me on as a patient this far
into it? Am I gonna have trouble finding one who WILL take me once I
get some type of insurance do you think?

I'm not an expert on this, but I was under the impression that
in many states at least, folks who ordinariliy wouldn't qualify
for public insurance would qualify for maternity care, and the
same or a related program would cover the baby for a few years.
Anyone know more?

Yes, more people will qualify for medicaid for maternity only
benefits, but there is still an income cap to qualify. It's pretty
generous, though.

Nan

I've never been anemic in my life, so iron tests aren't a worry for me.

Totally agreeing with you on the unnecessary tests and whatnot, but I did
want to point out that before this pg, I'd never been anemic either. With
my first pregnancy, my iron was excellent both at the first appointment and
at the 28-week check. This time, despite the same diet and all as the first
time, my iron was fine at the beginning, but low at the 28-week check. Not
low enough to risk me out of homebirth if it didn't come up, but low enough
that I was considered anemic, and the midwives wanted me taking a supplement
for my own comfort. I had noticed that I was tired and sluggish, but I
attributed it to a busy time preparing for Thanksgiving and Christmas, plus
normal third-trimester and mom-of-a-toddler tiredness. But it was my iron.
I started taking a supplement (Vitron C, once or twice a day, per my
midwife's recommendation), and it made a huge difference very quickly --
much more energy and everything. As of 36 weeks, my iron is back up to
normal, though the midwife says it's fine to keep taking it once a day,
which I'm planning to do until after the lochia stops and all. That's not
to say a test would have been absolutely necessary, just that had they not
tested, I wouldn't have assumed there was any reason to think I could change
the sluggishness.


--
-Sara
Mommy to DD, 2 3/4
And Someone Due 2/05

Nan wrote:
Yes, more people will qualify for medicaid for maternity only
benefits, but there is still an income cap to qualify. It's pretty
generous, though.

Also, some states offer another medical insurance service for those who are
over that limit. for example in California, the program is called aim, and
there is a monthly lost cost payment to blue cross/blue shield, plus a small
apointment co-pay, but substanstially cheaper than regular insurance fees.
If the original poster wants to tel us the state they reside in, I'd be
willing to google

Laurel
--
Birthmom to Bj 4-12-96
mommy to Juliet 4-13-02
and someone new due 8-14-05

"NotMyRealName" wrote in message
news
I've never been anemic in my life, so iron tests aren't a worry for me.

Totally agreeing with you on the unnecessary tests and whatnot, but I did
want to point out that before this pg, I'd never been anemic either. With
my first pregnancy, my iron was excellent both at the first appointment
and at the 28-week check. This time, despite the same diet and all as the
first time, my iron was fine at the beginning, but low at the 28-week
check



Argh.

Here's the deal. If you look at iron levels and compare them to outcomes,
women with "anemic" levels (i.e. between 8 and 10) have *better* outcomes
statistically than women with "normal" levels of 12+. In fact, it would be
worriesome if your iron levels DID NOT DROP at 28 weeks--because it would
indicate your blood volume had not expanded appropriately.

If you don't feel "anemic" (fatigued easily beyond "pregnancy normal", pale,
wan, etc...) then mild anemia is not only not a problem, it's a Good Thing.

Anemia, btw, does not make it more likely for someone to bleed during a
birth--it just may make recovery take a little longer.

And for as sick as I've been, I'm *still* not feeling anemic.

Jenrose

"Jenrose" wrote in message
news:1106662117.ab5bd7b91b1df68231a9f0e821f85b72@t eranews...

"NotMyRealName" wrote in message
news
I've never been anemic in my life, so iron tests aren't a worry for me.

Totally agreeing with you on the unnecessary tests and whatnot, but I did
want to point out that before this pg, I'd never been anemic either.
With my first pregnancy, my iron was excellent both at the first
appointment and at the 28-week check. This time, despite the same diet
and all as the first time, my iron was fine at the beginning, but low at
the 28-week check



Argh.

Here's the deal. If you look at iron levels and compare them to outcomes,
women with "anemic" levels (i.e. between 8 and 10) have *better* outcomes
statistically than women with "normal" levels of 12+. In fact, it would be
worriesome if your iron levels DID NOT DROP at 28 weeks--because it would
indicate your blood volume had not expanded appropriately.

If you don't feel "anemic" (fatigued easily beyond "pregnancy normal",
pale, wan, etc...) then mild anemia is not only not a problem, it's a Good
Thing.

Anemia, btw, does not make it more likely for someone to bleed during a
birth--it just may make recovery take a little longer.

And for as sick as I've been, I'm *still* not feeling anemic.

For #1 I wasn't anaemic at 17 weeks. At 36 weeks my score was 6.8. As it was
my first I didn't realise that the tiredness I felt wasn't pregancy normal.
My main drop in iron seems to be after about week 30, but I'm only going by
how I felt.
Debbie