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Question about using midwife and OB


Forum: July, August & September 2012 Playroom

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  #1  
November 16th, 2011, 10:24 AM
krisb's Avatar Member
Join Date: Mar 2011
Location: Baton Rouge, Louisiana
Posts: 29
My friend is pregnant with her first, about 6 weeks along, and her first OB appt is Dec 9. The doctor is making her see a midwife on this date & then schedule another appt with the actual OB weeks later. They haven't mentioned doing an ultrasound either.
Anyone know why they would do this? And wouldn't there be an extra cost to use both?
She has never said anything about using a midwife.
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  #2  
November 16th, 2011, 11:27 AM
palmetto_moon's Avatar Mega Super Mommy
Join Date: Jul 2009
Posts: 4,657
If it's within the same practice (a midwife who practices with an OB) then no there should not be any additonal cost. Insurance companies are billed "globally" for obstetric/maternity care and so they are going to pay the practice a set fee for all of your ob appts and birth. Certain things do cost extra such as a C-section or extra ultrasounds but typically it doesn't matter who you see in the practice at a given visit...it doesn't change the cost (in this setting at least).

A certified nurse-midwife is basically akin to a nurse practitioner, meaning they can see patients and write prescriptions. They can in many places, also do vaginal deliveries and most everything else (except for surgeries or a few other procedures). Many OB's have patients see a nurse or midwife first and then see the OB at say 12 weeks or something. That first appt with the nurse or midwife is usually a screening appt...perhaps a pap smear, other screenings for various infections or diseases ect is done at that time. Paperwork is also often completed at these appts.

In the practice I go to, I am able to schedule my first appt with my midwife at anytime after finding out I'm pregnant. Then, at 12 weeks I must have an appt with the OB. After that, I can go back to the midwife for the remainder of my appts and have her deliver my baby, or I can see the OB for my appts and have her deliver, or I can mix it up and see them both at various appts and just take whoever is on call to deliver the baby. If at any time during my pregnancy I become high risk or need a C-section, then of course I'll need to see the OB exclusively.

As for ultrasounds, all places do it differently. Some do a dating ultrasound fairly early in the pregnancy to confirm dates, while others offer only one at about halfway through the pregnancy. It all just depends on the office and the provider.
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  #3  
November 16th, 2011, 11:38 AM
Mega Super Mommy
Join Date: Apr 2010
Location: MN
Posts: 4,865
With my last pregnancy I saw my OB and a nurse practitioner. I saw my OB for the first appointment, and all of my appointments from 37 weeks on, but saw the NP for the in between checks. It was no additional cost, because they were part of the same office.
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  #4  
November 16th, 2011, 11:44 AM
krisb's Avatar Member
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Location: Baton Rouge, Louisiana
Posts: 29
Thanks, I just thought it was weird for them to send her to a midwife first- without her ever mentioning she'd like to use one.
I go to a specialized Woman's Hospital so I'll see my OB every time, but she is seeing an OB at a general hospital. I guess that's how they do it there.
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  #5  
November 16th, 2011, 11:54 AM
Mega Super Mommy
Join Date: Apr 2010
Location: MN
Posts: 4,865
Yeah, I think it is a bit strange she isn't seeing her OB right away since he'll be the one delivering, I assume? But like you said, different places have different policies.

Oops! Just realized I assumed her OB is a man. I guess because mine is. Meant s/he.
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  #6  
November 16th, 2011, 12:28 PM
krisb's Avatar Member
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Location: Baton Rouge, Louisiana
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Yea she says she's seen this OB for 7 years now, so we don't know where the midwife came from. She's hoping she'll get the same info as her OB would provide for her- and not have to wait even longer for the official OB appt.
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  #7  
November 16th, 2011, 12:44 PM
JessicaW's Avatar Super Mommy
Join Date: Aug 2011
Location: Central Jersey
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I think midwives are growing in popularity because they are cheaper and often safer. With health care costs up so much, we may be entering a time when low-risk women who previously saw an OB every appt now sometimes see a midwife instead. I'm not sure if this is what is at work or not but I think Angela makes a good point that providers are paid in a lump sum for maternity care, so it may make sense for the practice to send her to a midwife if she is low risk.

Regarding the u/s, I think a lot of people don't get them until 20 weeks.
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  #8  
November 16th, 2011, 01:13 PM
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I think it depends on the practice. At mine, I will almost always see a NP or a midwife. The midwives also do the majority of deliveries, except for high risk and of course c-sections.
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