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Pregnant + very confused - any advice appreciated

Pregnant + very confused - any advice appreciated

Old Nov 10th 2017, 1:26 am
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Default Re: Pregnant + very confused - any advice appreciated

Originally Posted by British_in_Brooklyn
Thank you.

I've read about the internal wand and I have to say that it has been bothering me, but from what I can tell, it's not optional.
Everything is optional, and don't let anyone tell you otherwise!

At this point you have plenty of time to educate yourself on different aspects, and some of the key ones would be C-sections, and whether you will allow yourself to be scheduled for one if the baby doesn't arrive on a schedule convenient to the hospital - having a C-section will affect your health and your baby's, and will likely impact any future pregnancies you have too, and another one is whether you want an epidural.

I am sure I would be pounced on if I tried to persuade you either way as I am not qualified to pass an opinion based on experience, but suffice to say there are women who have strong opinions on both sides of the issues I mentioned above, and many others.
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Old Nov 10th 2017, 1:55 am
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Default Re: Pregnant + very confused - any advice appreciated

I don't believe the internal ultrasound is standard everywhere. Both my ultrasounds at 10 weeks and 19 weeks were the "regular" kind. Like the UK they only do 2 ultrasounds unless there is a problem or the baby is stubborn and they can't do the measurements.

One difference to the UK was being sent for a glucose test about 25 weeks to test for gestational diabetes. I believe in the UK they only have you do this if you are high risk. You drink this sweet stuff (tasted like flat fanta) and then wait for an hour and have your blood taken.

I had an epidural and ended up with a c section (stubborn big headed baby and 5 ft 2 me didn't mix well), so my out of pocket costs were higher. Nothing unmanageable though.

It's a crazy time but don't spend too much time stressing about insurance. Make sure your doctor is in network and you like them and their nurses. Keep in mind that often the doctor isn't actually around much when you are in labour and only is there to deliver.
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Old Nov 10th 2017, 2:15 am
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Default Re: Pregnant + very confused - any advice appreciated

I have been an L & D nurse, director women's services for the past 30 years and now teach it too.

You have the right to refuse any treatment offered, this is true pregnant or not.

The "wand up the bits" is a vaginal ultrasound and is used in the first trimester of pregnancy for accurate dating of your pregnancy, especially if you are not sure of your dates. An early vaginal ultrasound is very accurate. You can't get the same accuracy with an early abdominal ultrasound. The uterus does not become an abdominal organ until the 2nd trimester, so abdominal ultrasound is pretty useless early on

Choose a pediatrician before you deliver. If you don't, you will get the "on call" physician, who you won't know, and then you'll still have to find a ped anyway.

If you want an epidural, choose a hospital with 24 hr OB anesthesia coverage. You really want this option anyway (Anesthesia available). The standard of care for an emergency cesarean is 30 mins from when a cesarean is "called" to the time of incision....or as we call it "decision to incision" time. Some hospitals have anesthesia docs on call at home. They only have to be "readily available" You don't want to wait 30 mins in an emergency if you or baby get in trouble and need a stat or emergent C/S.

Ask your OB/GYN what their Cesarean rate is. The National rate is about 25% of first-time mums who will end up with a C/S - Some OBs practice defensively (very litigious area in the US) and have higher rates. In my experience elective cesareans are rare, Induction of labor is not, usually at 39 weeks. You can refuse this too. Most of the women's health advocacy groups are pushing for women to go the "full 40" meaning 40 weeks- your due date before any interventions like an induction occur.

If you want your baby with you 24/7 in the hospital, choose a hospital that offers "couplet care" You can find out this info on the hospital website, Most have pages devoted to options that are available for the expectant parents.

HTH

Last edited by DebzinUS; Nov 10th 2017 at 2:30 am.
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Old Nov 10th 2017, 2:23 am
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Default Re: Pregnant + very confused - any advice appreciated

Originally Posted by ellie_gbr

One difference to the UK was being sent for a glucose test about 25 weeks to test for gestational diabetes. I believe in the UK they only have you do this if you are high risk. You drink this sweet stuff (tasted like flat fanta) and then wait for an hour and have your blood taken.
Yes, at 28 weeks, a Glucose Tolerance Test (GTT) is standard for all women. A fasting blood sugar is drawn, you drink a 50g Carb drink, and then blood drawn again after one hour. if the labs are normal, you are done, If you fail this - a three hr GTT is completed - gestational diabetes is diagnosed if the 3 hr GTT is abnormal.
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Old Nov 10th 2017, 3:03 am
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Default Re: Pregnant + very confused - any advice appreciated

Congratulations is probably the first place to start.

As for the doctor bits, you have two doctor hunts coming up shortly: an OB/GYN to help you with the delivery, and then a pediatrician to deal with the newborn.

Finding a doctor should include a few questions:

1) are they in-network with your insurance. This can lead to some lower costs.
2) are they allowed to practice at the hospital that is your first choice for delivery. Where do you plan to deliver--i.e. what is near to your house, easy to get to, convenient for work, etc.
3) is your pediatrician allowed access to the hospital too. Pediatricians visited our kid within the first few hours of birth so you'll need one with visitation rights or you may have to use the hospital's on-call pediatrician for the first few days (not a big deal).
4) the online reviews are kind of like restaurant reviews--someone has a bad day, misses an appointment and suddenly that doctor is 'the f#@$ anti-Christ of medical care" or something. Just take it with a grain of salt.

I'd make a list of a few OBs and visit them. You'll probably be visiting them frequently (I think we had monthly checkups every month and then every two weeks toward the end) so you might want somewhere closer and convenient to your home / office.

I should note your baby, if born here, will be a US citizen automatically. While this comes with some benefits it will also have some requirements they will have to meet in the future, such as registration for military conscription and paying taxes (along with bank account reporting requirements) no matter where they live in the world (i.e. you move back to the UK, they still have US tax filing requirements). On the plus side they can run for President of the USA one day.

FWIW our first child cost $54 dollars out of pocket total. The first OB visit had a copay ($25) but only the first one. The hospital had a copay ($25) and I got bored so I flipped on the TV in the hospital ($4). Everything else was covered. Our second one ran a bit more.
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Old Nov 10th 2017, 2:51 pm
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Default Re: Pregnant + very confused - any advice appreciated

I was in your position 9 years ago! There are many things to take into consideration, including whether you want a natural birth/home birth/birthing center experience. If you want to go the more crunchy way, then you would want to look into midwives. If you prefer to go the medical route, then before you decide on an OB/GYN, you need to figure out which hospital you want to deliver in. Many middle-class families in Brooklyn do not want to deliver in Brooklyn hospitals (although I heard good things about Methodist in Brooklyn) and opt for the better know Manhattan hospitals. You then pick an OB based on where they have delivering rights and your insurance. I would recommend going on maternity ward tours: check out Methodist in Brooklyn and then maybe one or two Manhattan ones. St. Luke's Roosevelt, Mount Sinai, Lennox Hill, NY Downtown are popular ones (I delivered at Beth Israel, but I think the maternity ward is closed).

And - Congratulations!!!
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Old Nov 10th 2017, 3:36 pm
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Default Re: Pregnant + very confused - any advice appreciated

Kate, when you mention midwife I'm assuming since both you and the OP are New Yorkers, you don't mean the traditional midwife that sees you at home or in her home/office for all your prenatal visits, does your glucose testing and sends you to the hospital for your ultra-sound and ultimately is the only one, plus assistant, in your home at the time of the birth.

The above is exactly what my daughter had for her last two births. A midwife and at home delivery.
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Old Nov 10th 2017, 3:48 pm
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Default Re: Pregnant + very confused - any advice appreciated

Originally Posted by Rete
Kate, when you mention midwife I'm assuming since both you and the OP are New Yorkers, you don't mean the traditional midwife that sees you at home or in her home/office for all your prenatal visits, does your glucose testing and sends you to the hospital for your ultra-sound and ultimately is the only one, plus assistant, in your home at the time of the birth.

The above is exactly what my daughter had for her last two births. A midwife and at home delivery.
You're right that it's not a midwife in the British sense. In New York, midwives tend to be attached to practices which will have a obstetrician but are very low interventionist. Many of them are covered by insurance but will only see very low-risk patients. The births will either be conducted at their birthing centers or at home with no epidurals. I was too old to be considered very low-risk.
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Old Nov 10th 2017, 8:58 pm
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Default Re: Pregnant + very confused - any advice appreciated

In my experience elective cesareans are rare, Induction of labor is not, usually at 39 weeks. You can refuse this too. Most of the women's health advocacy groups are pushing for women to go the "full 40" meaning 40 weeks- your due date before any interventions like an induction occur.
I agree with this! My doctor wanted to induce me as soon as I reached my due date and I said no, I want to wait a week so got induced at 41 weeks. This goes to show that you can say no!
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Old Nov 10th 2017, 11:49 pm
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Default Re: Pregnant + very confused - any advice appreciated

Have you looked into hiring a doula? That's where I'd start. They can then guide you knowledgeably through the rest of the process.

I haven't given birth in the US but have given birth three times in the UK. I found even with the lower intervention rates there it was still important to be well informed and aware that you can refuse procedures.

I was classed as high risk for my third birth and the hospital wanted me cannulated and strapped to a monitor on a bed. Instead I spent my labour snoozing in a birthing pool, gave birth on a birthing stool, and was back home with a healthy baby 9 hours after having arrived.
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Old Nov 11th 2017, 3:48 am
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Default Re: Pregnant + very confused - any advice appreciated

Congratulations

Depending on your medical plan they may pay for a midwife or an OBGYN.
If you insurance company website is hard to navigate, call the number on the back of your insurance card.
Once you find out where you are going to have your baby, you should be able to get an estimated out of pocket cost of having a baby.
Once you know that approximate cost, I would recommend putting probably 50% of that cost into either HSA, FSA or LFSA. This is probably open enrollment time for you.
Your insurance company may use someone like castlight.com to find in-network providers.
Depending on your company, you may get help from HR. I would certainly inform HR now because they have to provide certain provisions depending on the State.

Doulas can be useful, ours was not that helpful.
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Old Nov 11th 2017, 3:02 pm
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Default Re: Pregnant + very confused - any advice appreciated

Originally Posted by penguinsix
4) the online reviews are kind of like restaurant reviews--someone has a bad day, misses an appointment and suddenly that doctor is 'the f#@$ anti-Christ of medical care" or something. Just take it with a grain of salt.
I would agree , but with one exception - https://www.healthgrades.com

Yes, take the patient reviews for what they are worth - not much. However, Healthgrades also provides physician information such as privileges (which hospitals they can practice at), What medical School and residency program attended, and any sanctions, lawsuits, speciality board certification. Many physicians add their philosphy of care. Hospital information is also available. The hospital information is pulled from outcomes that are reported to the Centers for Medicare and Medicaide Services (CMS).
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Old Nov 11th 2017, 4:31 pm
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Default Re: Pregnant + very confused - any advice appreciated

Originally Posted by mrken30
Congratulations

Depending on your medical plan they may pay for a midwife or an OBGYN.
If you insurance company website is hard to navigate, call the number on the back of your insurance card.
Once you find out where you are going to have your baby, you should be able to get an estimated out of pocket cost of having a baby.
Once you know that approximate cost, I would recommend putting probably 50% of that cost into either HSA, FSA or LFSA. This is probably open enrollment time for you.
Your insurance company may use someone like castlight.com to find in-network providers.
Depending on your company, you may get help from HR. I would certainly inform HR now because they have to provide certain provisions depending on the State.

Doulas can be useful, ours was not that helpful.

It's http://www.castlighthealth.com/ not castlight.com. They also have helpful reviews if you health provider uses them.
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Old Nov 11th 2017, 8:28 pm
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Default Re: Pregnant + very confused - any advice appreciated

Originally Posted by Psyman
Consider just going with a midwife rather than an OBGYN. I believe if you were back in the UK you'd almost certainly be seeing a midwife rather than an obstetrician. Some states seem to think they are some kind of alternative medicine and so don't allow hospital privileges, but maybe NY does allow them to deliver at hospitals. I think overall they encourage a less invasive, more natural birth. We used a midwife twice with both kids being born in a hospital.
Thank you I've looked at that option. I've spent the past 24 hours doing *a lot* of research. I think I'm going to go with an OB/GYN just in case there are complications. We definitely want a more natural birth, though.

Originally Posted by Weeze
It wasn’t optional with mine, I tried They try and distract you a lot with “oh won’t it be nice to be able to see your baby for the first time” etc. I also think I had 3 or 4 HIV tests over the course of my pregnancy. What can I say. Texas must think pregnant women have a very exciting life.
I've read about the insane amount of tests. I'm extremely needle-phobic, so that'll be interesting!

Originally Posted by Pulaski
Everything is optional, and don't let anyone tell you otherwise!

At this point you have plenty of time to educate yourself on different aspects, and some of the key ones would be C-sections, and whether you will allow yourself to be scheduled for one if the baby doesn't arrive on a schedule convenient to the hospital - having a C-section will affect your health and your baby's, and will likely impact any future pregnancies you have too, and another one is whether you want an epidural.

I am sure I would be pounced on if I tried to persuade you either way as I am not qualified to pass an opinion based on experience, but suffice to say there are women who have strong opinions on both sides of the issues I mentioned above, and many others.
Thank you about the "optional" advice. I'm not very good at standing up for myself, so I'm hoping to find some magical courage in the next few weeks. We will see! I am already trying to tell myself that it's for the good of the baby if they want to do these things, but it's also hard when they do things here that are considered risky in the UK, such as PAP tests during pregnancy. It's hard to argue when you're being told my a medical professional what they think is best. I'm really not keen on a c-section unless it's an absolute emergency, but again, not sure if I'm strong willed enough to demand that!

Originally Posted by ellie_gbr
I don't believe the internal ultrasound is standard everywhere. Both my ultrasounds at 10 weeks and 19 weeks were the "regular" kind. Like the UK they only do 2 ultrasounds unless there is a problem or the baby is stubborn and they can't do the measurements.

One difference to the UK was being sent for a glucose test about 25 weeks to test for gestational diabetes. I believe in the UK they only have you do this if you are high risk. You drink this sweet stuff (tasted like flat fanta) and then wait for an hour and have your blood taken.

I had an epidural and ended up with a c section (stubborn big headed baby and 5 ft 2 me didn't mix well), so my out of pocket costs were higher. Nothing unmanageable though.

It's a crazy time but don't spend too much time stressing about insurance. Make sure your doctor is in network and you like them and their nurses. Keep in mind that often the doctor isn't actually around much when you are in labour and only is there to deliver.
Thanks. There is a huge chance that I'm really over-thinking things. I'm anxious at the best of times and I'm sure the hormones aren't helping one bit. I think I've managed to find a hospital I like that is in-network and my insurers have told me that there are in-network doctors there, so I have my fingers crossed that I'll find someone when I call on Monday morning. I think I will be quite chilled about availability of doctors because I think that's quite common back home in the UK - you go to hospital and you get the doctor on call at the time. I'm okay with that. I think they must be suitable to have practising privileges at that hospital? Or at least, I hope so!

Originally Posted by DebzinUS
I have been an L & D nurse, director women's services for the past 30 years and now teach it too.

You have the right to refuse any treatment offered, this is true pregnant or not.

The "wand up the bits" is a vaginal ultrasound and is used in the first trimester of pregnancy for accurate dating of your pregnancy, especially if you are not sure of your dates. An early vaginal ultrasound is very accurate. You can't get the same accuracy with an early abdominal ultrasound. The uterus does not become an abdominal organ until the 2nd trimester, so abdominal ultrasound is pretty useless early on

Choose a pediatrician before you deliver. If you don't, you will get the "on call" physician, who you won't know, and then you'll still have to find a ped anyway.

If you want an epidural, choose a hospital with 24 hr OB anesthesia coverage. You really want this option anyway (Anesthesia available). The standard of care for an emergency cesarean is 30 mins from when a cesarean is "called" to the time of incision....or as we call it "decision to incision" time. Some hospitals have anesthesia docs on call at home. They only have to be "readily available" You don't want to wait 30 mins in an emergency if you or baby get in trouble and need a stat or emergent C/S.

Ask your OB/GYN what their Cesarean rate is. The National rate is about 25% of first-time mums who will end up with a C/S - Some OBs practice defensively (very litigious area in the US) and have higher rates. In my experience elective cesareans are rare, Induction of labor is not, usually at 39 weeks. You can refuse this too. Most of the women's health advocacy groups are pushing for women to go the "full 40" meaning 40 weeks- your due date before any interventions like an induction occur.

If you want your baby with you 24/7 in the hospital, choose a hospital that offers "couplet care" You can find out this info on the hospital website, Most have pages devoted to options that are available for the expectant parents.

HTH
Thank you so much for all this info. I'm really not keen on the wand, so want to avoid it if possible. I will try to find the courage to express that if offered it. But I also don't want to feel like I'm not doing best by the baby by not having it! So many decisions to make. I'm really hoping to not have to have a c-section unless I really have to, medically. The hospital I've chosen has private rooms with the baby in the room (for an additional out-of-pocket fee), as far as I'm aware. I'm sure I read that. I will read again though. Thank you again.


Originally Posted by penguinsix
Congratulations is probably the first place to start.

As for the doctor bits, you have two doctor hunts coming up shortly: an OB/GYN to help you with the delivery, and then a pediatrician to deal with the newborn.

Finding a doctor should include a few questions:

1) are they in-network with your insurance. This can lead to some lower costs.
2) are they allowed to practice at the hospital that is your first choice for delivery. Where do you plan to deliver--i.e. what is near to your house, easy to get to, convenient for work, etc.
3) is your pediatrician allowed access to the hospital too. Pediatricians visited our kid within the first few hours of birth so you'll need one with visitation rights or you may have to use the hospital's on-call pediatrician for the first few days (not a big deal).
4) the online reviews are kind of like restaurant reviews--someone has a bad day, misses an appointment and suddenly that doctor is 'the f#@$ anti-Christ of medical care" or something. Just take it with a grain of salt.

I'd make a list of a few OBs and visit them. You'll probably be visiting them frequently (I think we had monthly checkups every month and then every two weeks toward the end) so you might want somewhere closer and convenient to your home / office.

I should note your baby, if born here, will be a US citizen automatically. While this comes with some benefits it will also have some requirements they will have to meet in the future, such as registration for military conscription and paying taxes (along with bank account reporting requirements) no matter where they live in the world (i.e. you move back to the UK, they still have US tax filing requirements). On the plus side they can run for President of the USA one day.

FWIW our first child cost $54 dollars out of pocket total. The first OB visit had a copay ($25) but only the first one. The hospital had a copay ($25) and I got bored so I flipped on the TV in the hospital ($4). Everything else was covered. Our second one ran a bit more.
Thank you also for the really informative reply. I will consider all of those points. I have noticed about the reviews that they are either 5 stars or 1 stars and the 1 stars are VERY angry, capital letter, reviews. The stars on my insurer's website seem a little more accurate. With regards to the child being an american citizen, I'm trying to not stress about how it might complicate things for him/her later in life. My husband seems to think it'll be okay. I'm the worrier! Hopefully having two passports will offer more flexibility than inconvenience. We're prepared to pay more but we want it to be because we're getting more and not because we've made mistakes along the way & thanks to all the useful replies here, I think we'll be able to skip a few of the mistakes we might have made.

Originally Posted by kateinbrooklyn
I was in your position 9 years ago! There are many things to take into consideration, including whether you want a natural birth/home birth/birthing center experience. If you want to go the more crunchy way, then you would want to look into midwives. If you prefer to go the medical route, then before you decide on an OB/GYN, you need to figure out which hospital you want to deliver in. Many middle-class families in Brooklyn do not want to deliver in Brooklyn hospitals (although I heard good things about Methodist in Brooklyn) and opt for the better know Manhattan hospitals. You then pick an OB based on where they have delivering rights and your insurance. I would recommend going on maternity ward tours: check out Methodist in Brooklyn and then maybe one or two Manhattan ones. St. Luke's Roosevelt, Mount Sinai, Lennox Hill, NY Downtown are popular ones (I delivered at Beth Israel, but I think the maternity ward is closed).

And - Congratulations!!!
Thank you!! I think I want a combination of hospital birth but as natural as possible. I don't think I'll be considered low-low risk, but I'm aware that anything can happen even when things are considered low risk. I think I've chosen a hospital in Manhattan that seems to be covered by our insurance. i am calling them first thing Monday morning. I didn't realise that nothing was operational over the weekend with regards to appointments. Thank you again for the advice.

Originally Posted by ellie_gbr
I agree with this! My doctor wanted to induce me as soon as I reached my due date and I said no, I want to wait a week so got induced at 41 weeks. This goes to show that you can say no!
I'm hoping to find the courage to say no if I need to! I think at home they wait for 2 weeks past the due date before offering to induce?

Originally Posted by kins
Have you looked into hiring a doula? That's where I'd start. They can then guide you knowledgeably through the rest of the process.

I haven't given birth in the US but have given birth three times in the UK. I found even with the lower intervention rates there it was still important to be well informed and aware that you can refuse procedures.

I was classed as high risk for my third birth and the hospital wanted me cannulated and strapped to a monitor on a bed. Instead I spent my labour snoozing in a birthing pool, gave birth on a birthing stool, and was back home with a healthy baby 9 hours after having arrived.
Yes, I've researched doulas. I'm not sure if they're right for us but I will do more research, especially since I'd like the birth to be quite natural if possible. I'd never heard of them in England, but it's nice to know they're an option here. Wow, 9 hours after birth is amazing! Go you!

Originally Posted by mrken30
Congratulations

Depending on your medical plan they may pay for a midwife or an OBGYN.
If you insurance company website is hard to navigate, call the number on the back of your insurance card.
Once you find out where you are going to have your baby, you should be able to get an estimated out of pocket cost of having a baby.
Once you know that approximate cost, I would recommend putting probably 50% of that cost into either HSA, FSA or LFSA. This is probably open enrollment time for you.
Your insurance company may use someone like castlight.com to find in-network providers.
Depending on your company, you may get help from HR. I would certainly inform HR now because they have to provide certain provisions depending on the State.

Doulas can be useful, ours was not that helpful.
Thank you! I've had a few chats with the insurers and I've just realised that the info they gave me yesterday was for the wrong hospital, so hoping to try to contact hospitals instead and check with them that they take our insurance. I didn't realise that we had to check that both the hospital and the doctor were covered, but we're aware of that now. It's a learning curve!

Originally Posted by DebzinUS
I would agree , but with one exception - https://www.healthgrades.com

Yes, take the patient reviews for what they are worth - not much. However, Healthgrades also provides physician information such as privileges (which hospitals they can practice at), What medical School and residency program attended, and any sanctions, lawsuits, speciality board certification. Many physicians add their philosphy of care. Hospital information is also available. The hospital information is pulled from outcomes that are reported to the Centers for Medicare and Medicaide Services (CMS).
Thank you. I've discovered that there is certainly more information online about each doctor here than we have access to at home, so I am trying to do as much research as possible. Some of them even have youtube videos!

Originally Posted by mrken30
It's http://www.castlighthealth.com/ not castlight.com. They also have helpful reviews if you health provider uses them.
Thanks, I'll take a look!

Thank you SO, so much to everyone who has replied. I feel much more informed now. Still terrified, but getting there. Hopefully by mid-week next week I'll have an appointment in the pipeline. You've all been a huge help.
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Old Nov 11th 2017, 10:06 pm
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Default Re: Pregnant + very confused - any advice appreciated

You can absolutely refuse any tests that you do not want to have. For my second child (after I had learned a little):

I refused all internal exams during pregnancy until labour.
I refused an induction unless they could show me through a non-stress test that it was medically indicated (the test showed that baby was perfectly happy, and I subsequently went into labour by myself).
I refused all prenatal diagnostic tests other than ultrasound.
I refused continuous fetal monitoring during labour - instead, I had intermittent monitoring and spent much of my time during the later stages of labour in the shower.

Just make sure that the obgyn you choose is on board with your decisions and will support you. I had to really push to avoid an induction, but I absolutely 100% knew that their due date was off by at least a week - I knew the precise date that we had started trying for a baby (i.e. stopped using contraception) so I knew that my due date was, at the earliest, August 8th (short of a contraception failure, of course, but that would have been highly coincidental). They had me down for August 1st based on an ultrasound at 11 weeks with a +/- 8 day range and they really, really, really wanted to induce when that date came and went.

Basically, unless there is reason to suspect that your baby may be in danger, stick to your guns. Don't be an arsehole about it, and you'll more than likely find that they're perfectly willing and able to accommodate you. However, if you don't say anything, you'll find yourself having all kinds of invasive tests, narcotics, an epidural, IV and catheter, and an induction if you go at all past your due date. All of these things increase the risk of a caesarian becoming medically necessary.
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