Third prenatal checkup.
Sep. 15th, 2008 12:18 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
rivkaWhen you're not a first-time mom, midwife visits really sail right past. I think I was in and out of there in fifteen minutes, and I didn't feel particularly rushed.
I met the other new midwife today, a very (!) young Orthodox woman named Bayla. In comparison to the other new midwife, Kate, she seemed more laid back and less by-the-numbers. For example, when I saw Kate at 14 weeks I hadn't started gaining weight yet, and she mentioned that "we like to have you gain 10 pounds by 20 weeks." At the time I was frazzled enough by the spotting and everything that I didn't challenge the idiocy of that statement, although in retrospect I wished I had.
Today, my weight was still right where it's been for the last 10 weeks. Bayla pointed that out, and I explained that I hadn't gained much with Alex (lost 7 pounds, then gained 15) and that I'd still had an 8-pound baby. She asked if I was nauseated and vomiting. I told her I felt fine, but didn't have much of an appetite. She asked me if I thought I was eating well-balanced meals with enough calcium and protein, and when I said yes, she just said "Okay!" and moved on. No mention of "10 pounds by 20 weeks," which at this late date would be impossible anyway.
We listened to Niblet's heartbeat, sounding incredibly strong and sure on the Doppler. Anterior placenta or not, now that my belly has popped the heartbeat is easy to find. I've reached the mathematically cool stage in which the size of my belly (from the pubic bone to the top of the uterus) in centimeters is equal to the number of weeks pregnant I am.
My blood pressure is an impressive 90/66. I'm not spilling any protein or sugar. I don't have any swelling or weird stuff going on. We're going to keep an eye on the pain in my side and back, where my scoliosis scar is. It's been a bit worse since my belly popped, but not at intervention-level yet. Bayla said I could call any time and ask for a referral to physical therapy - I don't have to go through an orthopedist, yay.
There was a med student present for the visit - apparently they rotate through the midwives' office to see some prenatal and well-woman care. What a great idea. It got me thinking about the things, big and small, that I love about the midwifery model. The big things, of course, are the focus on low-intervention births, trusting the birth process, and providing intensive support throughout pregnancy and birth.
But there are little things, too. At my midwives' office, the scale is in the bathroom. Pregnant women weigh ourselves in private, and give the number to the midwife in the consultation room. We also test our own urine for sugar and protein, in private: there are Dixie cups and test strips in the bathroom, and a chart for comparing the test strip result. These are small differences, but they do increase my sense that (a) my dignity is respected, and (b) I am an intelligent person who can be trusted with my own health care.
I met the other new midwife today, a very (!) young Orthodox woman named Bayla. In comparison to the other new midwife, Kate, she seemed more laid back and less by-the-numbers. For example, when I saw Kate at 14 weeks I hadn't started gaining weight yet, and she mentioned that "we like to have you gain 10 pounds by 20 weeks." At the time I was frazzled enough by the spotting and everything that I didn't challenge the idiocy of that statement, although in retrospect I wished I had.
Today, my weight was still right where it's been for the last 10 weeks. Bayla pointed that out, and I explained that I hadn't gained much with Alex (lost 7 pounds, then gained 15) and that I'd still had an 8-pound baby. She asked if I was nauseated and vomiting. I told her I felt fine, but didn't have much of an appetite. She asked me if I thought I was eating well-balanced meals with enough calcium and protein, and when I said yes, she just said "Okay!" and moved on. No mention of "10 pounds by 20 weeks," which at this late date would be impossible anyway.
We listened to Niblet's heartbeat, sounding incredibly strong and sure on the Doppler. Anterior placenta or not, now that my belly has popped the heartbeat is easy to find. I've reached the mathematically cool stage in which the size of my belly (from the pubic bone to the top of the uterus) in centimeters is equal to the number of weeks pregnant I am.
My blood pressure is an impressive 90/66. I'm not spilling any protein or sugar. I don't have any swelling or weird stuff going on. We're going to keep an eye on the pain in my side and back, where my scoliosis scar is. It's been a bit worse since my belly popped, but not at intervention-level yet. Bayla said I could call any time and ask for a referral to physical therapy - I don't have to go through an orthopedist, yay.
There was a med student present for the visit - apparently they rotate through the midwives' office to see some prenatal and well-woman care. What a great idea. It got me thinking about the things, big and small, that I love about the midwifery model. The big things, of course, are the focus on low-intervention births, trusting the birth process, and providing intensive support throughout pregnancy and birth.
But there are little things, too. At my midwives' office, the scale is in the bathroom. Pregnant women weigh ourselves in private, and give the number to the midwife in the consultation room. We also test our own urine for sugar and protein, in private: there are Dixie cups and test strips in the bathroom, and a chart for comparing the test strip result. These are small differences, but they do increase my sense that (a) my dignity is respected, and (b) I am an intelligent person who can be trusted with my own health care.
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no subject
Date: 2008-09-15 05:11 pm (UTC)Oh good. The "where is the elusive Niblet heartbeat" game was getting pretty old, I think.
Go Team Niblet.
no subject
Date: 2008-09-15 05:23 pm (UTC)Also, I only gained 6 pounds with my first pregnancy, just a few ounces more than the baby himself.
So glad for yet another sterling progress report on Mr. Niblet!
no subject
Date: 2008-09-15 06:47 pm (UTC)Midwifery does seem to be a good model, from what I've heard (I haven't done extensive research into the subject, because, well, I'm not at that point in life.). It's good to hear more about it from an experienced perspective.
no subject
Date: 2008-09-15 07:31 pm (UTC)My midwives are independent practitioners who don't have to answer to doctors, and that makes a big difference.
no subject
Date: 2008-09-15 07:52 pm (UTC)Mary is a midwife in the national health care system, and has several run-ins with doctors about her patients, and also gets offered jobs in independent midwifery practices. I'm not sure if it's a realistic portrayal of the goings-on in British health care, but she was definitely more of a patient advocate and promoted whatever they wanted birth-wise.
no subject
Date: 2008-09-15 06:56 pm (UTC)My OB appointments always went like this: "Hmmm, you haven't gained weight since last time; are you eating enough?" Me: "I feel like I never *stop* eating." Her: [cheerfully] "Okay then!" and she would move on. Every. Single. Time. I think I had a little spurt at the very end that *might* have gotten me up to 15 pounds total. I did have an extra U/S or two, to make sure E was growing properly, which she was.
no subject
Date: 2008-09-15 07:07 pm (UTC)N.
no subject
Date: 2008-09-16 06:19 am (UTC)no subject
Date: 2008-09-16 10:14 am (UTC)no subject
Date: 2008-09-16 03:32 pm (UTC)We always get these stories here about how much health care costs in the US and I was wondering...
-Stephanie
How U.S. health care works, at least for our family.
Date: 2008-09-16 04:36 pm (UTC)Like most Americans, I have group health insurance through my employer. In other words, my employer negotiated with some insurance companies to offer health insurance to all employees at the same price. My employer pays part of the cost and I pay part of the cost.
Every year, my employer distributes a book that describes all the different health plans they support, and explains what each plan covers, what copayments each plan requires, and what our monthly contribution would be for each plan. We then choose which plan we'd like to sign up for. Other people are not so lucky - their employer has one plan, and it's take it or leave it.
I am lucky to work for an employer (the State of Maryland) which offers excellent health benefits at an affordable price. I pay $210 a month for health care & prescription drug coverage for me, Michael, and Alex. My employer pays for the rest of the cost of our insurance policy. Their contribution is $960/month for our whole family. When the Niblet is born, the cost of the policy, and my share of the cost, won't increase - that's the price for two parents + all kids.
There are cheaper insurance plans. We've chosen this plan because it covers absolutely everything we may need, and has few out-of-pocket expenses. We normally pay a $15 "copayment" to go to the doctor, but prenatal care is 100% covered with no copayment, so I don't pay anything to go to the midwife. I don't pay a copayment for lab tests. I think I have something like a $100 copayment for hospital delivery, and that should be about it for my out-of-pocket prenatal expenses. If I get physical therapy, there will probably be a $10 copayment per session. Prescription drugs cost me $5-$15, depending on how expensive the drug is.
Each member of my family has a "primary care doctor." We had to choose one who participates in our insurance plan; in practice, this wasn't difficult because we use one of the nation's biggest insurers and nearly every doctor participates. Michael and I see a family practitioner as our primary doctor, and Alex sees a board-certified pediatrician. Any kind of specialty care we need - for example, when Alex had to see a cardiologist and an ophthalmologist - needs to be approved by the primary care doctor in order for insurance to pay for it. However, prenatal care is not considered "specialty care" - I could refer myself without going through my regular doctor, and my midwives can refer me for additional treatment without the regular doctor having to sign off on it.
I think my midwives bill in one lump sum for all prenatal care + delivery. I don't really know how much that adds up to, because my insurance company pays it. Ask me again after the Niblet is born, because I'll get a copy of the bill.
Health care in the US is incredibly expensive, and we don't necessarily get better care for all the extra expense. It's a messed-up system. My profoundest hope is that Obama will be elected and will fix the health care system, because as it is, it's steadily getting worse.
Re: How U.S. health care works, at least for our family.
Date: 2008-09-17 09:33 am (UTC)If you add up what you are paying to the insurers each year (incl employers contributions), do you end up using the entire amount?
What would happen if you lost your job (!hypothetical!!) and it took you a few months to find another? Does the plan trickle along for a bit or are you just cut off?
My partner and I are trying to sprog (my first) and I am also finishing my PhD, so your blog is of great interest. I hope to work in academia, and am wondering if I should be looking for jobs in the U.S or not. Everything I read in the media makes it sound like a hellish place to live, especially for a lefty intellectual type, so I am looking for some balance.
I really have to stop watching Michael Moore films though.
cheers, Stephanie
Re: How U.S. health care works, at least for our family.
Date: 2008-09-17 09:35 am (UTC)Re: How U.S. health care works, at least for our family.
Date: 2008-09-18 01:50 am (UTC)No way, that wouldn't make economic sense at all. If the average family, in an average year, used enough health care to equal their insurance premiums, the insurers would go out of business.
But if I had to have my appendix out, or if (god forbid) the Niblet spends a couple weeks in the NICU (neonatal intensive care unit) after birth, or even if Alex breaks a bone on two different occasions, as preschoolers tend to do... those things get expensive FAST. You need insurance (in an uncivilized country) to pay for expensive stuff that develops, not necessarily to pay for regular health care expenses.
My coworker developed pancreatic cancer, I guess it was two years ago now. She had five or six hospitalizations, including one that lasted more than six weeks. She had more surgeries than I can keep track of. She had two long courses of chemotherapy and a course of radiation. And she probably had hundreds of high-tech scans and specialist visits and so forth. In the 18 months she lived after diagnosis, our insurer probably spent hundreds of thousands of dollars on her care. But her insurance costs stayed exactly the same as mine.
What would happen if you lost your job (!hypothetical!!) and it took you a few months to find another? Does the plan trickle along for a bit or are you just cut off?
Well, if I lost my job, we would go on health insurance benefits from Michael's job. If we didn't have that option, there's a plan that lets you continue with your previous insurance program by paying the full premiums yourself. (Not so easy, as you can imagine, if you have just lost your job!)
The real problem comes if you don't get re-employed, or you want to be self-employed, or you work for an employer who doesn't offer health benefits. (Any academic job in the US should come with health benefits, so that wouldn't apply to you.) Then you're stuck with the individual market for health insurance, in which instead of buying insurance as part of a group deal for people with the same employer, you shop for your own personal (or family) policy.
In the individual market, insurers can deny you coverage (if, for example, you have ongoing health problems) or charge you unbelievably large amounts. The individual market is a good deal for young healthy people, but not for anyone else.
There are state and federal programs for poor people, people who are so disabled that they can't work at all, and elderly people. There are a lot of holes in coverage, though, especially if you are a member of the working poor or a poor adult without children.
Everything I read in the media makes it sound like a hellish place to live, especially for a lefty intellectual type, so I am looking for some balance.
I am fairly happy in my everyday American life, although I've never lived in another country so I suppose I have nothing to compare it to. What the general atmosphere is like depends heavily on where you are and what social circles you move in.