help me think this through: choosing a hospital (long, sorry!)

[megs4413]

So I posted before that I was not happy with the hospital I was at recently during this pregnancy. We moved to this area less than two years ago and since I really wasn't expecting to become pregnant, I hadn't done any research or put any thought into what OB/Gyn I was using. Because my issues start so early in pregnancy, I just decided to see the doctor I was seeing for my Gyn stuff. Obviously, that was the quickest way to an appointment. Unfortunately, I have not been happy there. I switched to another doc within the practice and she's definitely better, but I truly don't think the hospital is going to work and they only deliver at 3 hospitals: 1-the one I was unhappy with as an inpatient (they cannot monitor heartrate on the maternity floor, which is ridiculous because many of my pregnancy issues are heart-related, how on earth could I DELIVER there?) 2-the one that one of my few friends here is currently in a legal battle with because the anesthesia nurse made a mistake after her hernia repair that put her in a COMA (no way in heck I'm delivering there. my friend very nearly died.) and 3-the hospital NO one recommends. It has a terrible general reputation.

So....this OB practice simply isn't going to work for me. This has been so stressful and everyone I know here personally is fine with the hospital that won't work for me (because of my cardiac issues.) So, I'm not getting anywhere asking people I know. I'm seeing a perinatologist at a very well-respected hospital that is much further away from me in a few weeks for my level II scan. I am thinking about choosing that hospital or another near it that has an equally stellar reputation.

here's the problem: 1) I have to find an OB who will take me on despite being nearly halfway through and being on home health currently and 2) I have an appt this week with my current OB and they're going to want another installment payment...I've already paid the a TON (which they are going to owe me back, because they ran the numbers before I'd hit my deductible and since then I've been in patient twice and have been on home health for more than a month...when they submit the global bill in the fall, I will have long ago hit my deductible and probably OOP max)

So, I sort of need to figure this out this week before I see the OB again. They won't see me without me paying the bill. It's about $400 for this installment. I'm afraid if I hand it over, they will take MONTHS to give it back to me.

What do I do? Does anyone think I have a shot at finding an OB to take me on at this point? Anyone done something like this? I'm just so overwhelmed. Help! TIA!

[Tondi G]

I've never done something like that but I know a few people who have switched mid way through a pregnancy because they were not happy with the care they were receiving. I think the hospital situation makes it very reasonable for you to need/want to make a switch. Hope you can get it all worked out.

can you call the Perinatologist office and ask for a referral to an OB/Gyn who works in the hospital they are affiliated with?

[sarahsthreads]

I think you can definitely find another OB halfway through. I switched at 24 weeks with DD2 when my OB was clearly paying lip service to being supportive of my trying a VBAC.

How far away is the stellar hospital? We're 20-25 minutes (assuming no traffic) from our hospital, and in hard labor it felt like the longest ride of my life, I wouldn't want to be further than that.

Is it possible to get recommendations for OBs that deliver at the stellar hospital through the perinatologist?

Sarah :)

[megs4413]

I think you can definitely find another OB halfway through. I switched at 24 weeks with DD2 when my OB was clearly paying lip service to being supportive of my trying a VBAC.

How far away is the stellar hospital? We're 20-25 minutes (assuming no traffic) from our hospital, and in hard labor it felt like the longest ride of my life, I wouldn't want to be further than that.

Is it possible to get recommendations for OBs that deliver at the stellar hospital through the perinatologist?

Sarah :)

I'm finding that the docs are not wanting to sway me to change practices. I don't know if it's some sort of ethical thing or what. The home health company refuses to even say what hospital they like the best. It's so strange. I am hoping the peri will weigh in, but I can't bank on it and I need to make the choice before I've met the peri (3 weeks from now)

[AngB]

Might not help you, but my MFM practice does deliveries (or can/will manage pregnancy with an OB.) Can they just deliver you at the hospital they practice at? Or at least I would ask them for a new OB recommendation.

If you are being seen by a peri regularly, are the OB visits pretty redundant? (I had weeks where I would go see my MFM, eat lunch, then go see my OB or vice versa.) If that's the case, I would probably just cancel your ob appointment. The new OB office will hopefully get you in quickly.

[megs4413]

Might not help you, but my MFM practice does deliveries (or can/will manage pregnancy with an OB.) Can they just deliver you at the hospital they practice at? Or at least I would ask them for a new OB recommendation.

If you are being seen by a peri regularly, are the OB visits pretty redundant? (I had weeks where I would go see my MFM, eat lunch, then go see my OB or vice versa.) If that's the case, I would probably just cancel your ob appointment. The new OB office will hopefully get you in quickly.

Actually, this is the first pregnancy that I'm NOT seeing a peri regularly. With DD, I saw the peri and had the redundant OB appointments, but the OB delivered. With DS, I saw the peri only and the peri delivered. That was back in St. Louis and if I was still there my peri would be taking care of me with no OB middleman. But here, I don't have a peri and you can't self-refer. the OB has to refer you for the specialized care and so far my OBs seem to think they can handle things EXCEPT for this level II u/s (because of defects diagnosed in utero with my other children) so I'm only seeing the peri for the u/s. If everything looks fine with the u/s, I have no reason to believe the peri will want to see me again at all and of course, I'm hoping that the u/s looks good. So what I want to do is find am OB who will take me and delivers at the two good hospitals that have peris on staff (the hospitals my OB delivers at do not have peris which is why I have to drive so far to see a peri for this u/s)

[scrooks]

Might not help you, but my MFM practice does deliveries (or can/will manage pregnancy with an OB.) Can they just deliver you at the hospital they practice at? Or at least I would ask them for a new OB recommendation.

If you are being seen by a peri regularly, are the OB visits pretty redundant? (I had weeks where I would go see my MFM, eat lunch, then go see my OB or vice versa.) If that's the case, I would probably just cancel your ob appointment. The new OB office will hopefully get you in quickly.

I was going to say the same thing but apparently this is not an option. I am sorry you are going through this with such a stressful pregnancy. Can any of your friends recommend an Ob?

[TxCat]

How far away are the "good" hospitals that you are considering driving to? I feel like 30 minutes would be my personal max. that I could feel comfortable with, but I know people who've done 45 minutes as well.

Personally, I'd look to change practices. I'd start by calling the MFM that you have the ultrasound with - call the office and find out if they deliver their own patients or if they are consultants only. If the MFM that you are specifically scheduled to see doesn't deliver, perhaps there are other MFMs they practice with that do deliver. So, I'd start there, and if that doesn't pan out, start calling around to the other practices that deliver at the hospitals that you are looking at. People definitely change OB practices even mid-way through 2nd trimester, but the faster you do this, the better.

[megs4413]

How far away are the "good" hospitals that you are considering driving to? I feel like 30 minutes would be my personal max. that I could feel comfortable with, but I know people who've done 45 minutes as well.

Personally, I'd look to change practices. I'd start by calling the MFM that you have the ultrasound with - call the office and find out if they deliver their own patients or if they are consultants only. If the MFM that you are specifically scheduled to see doesn't deliver, perhaps there are other MFMs they practice with that do deliver. So, I'd start there, and if that doesn't pan out, start calling around to the other practices that deliver at the hospitals that you are looking at. People definitely change OB practices even mid-way through 2nd trimester, but the faster you do this, the better.

right about 30 minutes. If worse came to worse, I live literally 3 minutes from the hospital I was originally going to deliver at here.

[pb&j]

I'd definitely ask the peri (or his/her nurse) for a referral to an OB who will deliver at a stellar hospital. I'm not clear on the specifics of your insurance and why you can't self refer, but with your existing health issues and prior issues with pregnancy, I'd push really, really hard to get the doc you want at the hospital with all the bells and whistles. You are your own best advocate.

I'd drive an hour for a great doctor and hospital. Of course, there are only two hospitals in a 30 minute radius of me, so that's my frame of reference.

[sste]

Some MFMs in particular will let you have a partial "co-manage" model. So you choose stellar hospital and OB/MFM that delivers there as your primary caregivers. *But* assuming you can't get the same OB/MFM to deliver at second-choice nearby hospital you have an OB/MFM at that #2 hospital. You see that second MFM/OB a few times throughout your pregnancy to get to to know them a bit, get yourself in the system, and the deal is that you will only go to second choice hospital/MFM/OB in an emergency.

Obviously everyone needs to be told and onboard. But if you are a high risk case your physicians should want you to have a close by option and IMO it is better not to run in completely cold at the mercy of whomever is on call at close by hospital.

Also, have you gone to the heart rate monitoring hospital and asked what is up. Are they just monitoring and delivering you in a nearby ICU? I can't imagine they offer no monitoring, I have never heard of such a thing!

[mikala]

I'd definitely ask the peri (or his/her nurse) for a referral to an OB who will deliver at a stellar hospital. I'm not clear on the specifics of your insurance and why you can't self refer, but with your existing health issues and prior issues with pregnancy, I'd push really, really hard to get the doc you want at the hospital with all the bells and whistles. You are your own best advocate.


I agree with this I really needed to feel safe during my labor for everything to progress well. If you're anything like me the stress of feeling like you aren't sure if you can trust the provider or hospital could exacerbate any complications. If you can't get a recommendation from the specialist I'd brainstorm other groups that might have a good pulse on great local providers.

You might also have luck talking to local doulas. I switched providers midway through pregnancy based in part on recommendations from my doula and others I interviewed. They all frowned when I mentioned my original OB group and almost unanimously suggested a different practice that was much further away but in retrospect worth every second of that drive.

Best of luck!!

[anonomom]

Don't be concerned about switching docs halfway through. With DD2, I switched practices/hospitals at 38 weeks. The "new" hospital was 35 minutes away and much more downscale than the "old" hospital, but a much better fit in terms of how I and DD were treated.

Wish I had some suggestions on how you could find a new OB. Maybe call the office that's doing your ultrasound, explain the heart issue (and why that makes Hospital #1 unsuitable) and see if they can direct you elsewhere?

[Liziz]

You may also want to try looking on the website of the stellar hospital and seeing if they have a physician referral service. All major hospital chains in my area, including the one I work for, have a line like this -- you tell them what type of physician you're looking for, and what area of town you'd prefer the practice be located, and they give you a list (or a few options) of physicians that have privileges at their hospital.

[megs4413]

Some MFMs in particular will let you have a partial "co-manage" model. So you choose stellar hospital and OB/MFM that delivers there as your primary caregivers. *But* assuming you can't get the same OB/MFM to deliver at second-choice nearby hospital you have an OB/MFM at that #2 hospital. You see that second MFM/OB a few times throughout your pregnancy to get to to know them a bit, get yourself in the system, and the deal is that you will only go to second choice hospital/MFM/OB in an emergency.

Obviously everyone needs to be told and onboard. But if you are a high risk case your physicians should want you to have a close by option and IMO it is better not to run in completely cold at the mercy of whomever is on call at close by hospital.

Also, have you gone to the heart rate monitoring hospital and asked what is up. Are they just monitoring and delivering you in a nearby ICU? I can't imagine they offer no monitoring, I have never heard of such a thing!

It was honestly baffling to me, too. I was inpatient there in early April with dehydration and tachycardia. They put me in an antepartum room, but had to move me immediately because they don't have the ability to use telemetry on that floor at all. So, I had to go to a med/surgery floor which made me really uncomfortable for several reasons, not the least of which was being wheeled past rooms with contact precautions because of infectious disease patients. Not where I wanted to be. I guess they would put me on a monitor in my room during L&D but no one would be monitoring it but me. I'm not comfortable with that.

If I bring this up to my doc she will likely suggest the hospital where my fried was almost killed. It might be irrational, but she really scared me off the place.