Author Topic: Trying to have a baby in flyover country  (Read 2431 times)

MillCreek

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Trying to have a baby in flyover country
« on: February 15, 2017, 08:59:33 AM »
https://www.scientificamerican.com/article/maternal-health-care-is-disappearing-in-rural-america/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+ScientificAmerican-News+%28Content%3A+News%29

It is getting more and more difficult to find a provider to deliver your baby and a hospital to do it in.  Lots of reasons for this: OB is a money-loser for hospitals, lack of reimbursement and the typical provider does not want to live out in the sticks.
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MillCreek
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Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
You are one lousy risk manager.

Kingcreek

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Re: Trying to have a baby in flyover country
« Reply #1 on: February 15, 2017, 09:34:10 AM »
yup.
Not planning on any babies but if we were it's a 50 mile drive to a hospital that does OB. I don't know how many are "emergency" births at the local one or the one 20 miles away.
This has been the situation for a few years now.
What we have here is failure to communicate.

Perd Hapley

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Re: Trying to have a baby in flyover country
« Reply #2 on: February 15, 2017, 09:59:51 AM »
I guess it's their fault for being deplorable people that no one wants to live around. If they just hang a few rainbow black lives matter flags, that'll solve things.
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BobR

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Re: Trying to have a baby in flyover country
« Reply #3 on: February 15, 2017, 10:29:57 AM »
There is also malpractice claims. According to an article I saw there is better than a one in ten chance of an OB having a claim filed against them (11% or so). That comes in around #7 of the top 10. The biggest problem is not where they fall in the top 10 but where they fall in amount paid per claim which is probably in the top 3 (SWAG).  My wife's GYN gave up the baby catching part of her practice because of the soaring cost of malpractice insurance.

bob

Perd Hapley

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Re: Trying to have a baby in flyover country
« Reply #4 on: February 15, 2017, 12:14:04 PM »
Quote
...student loan forgiveness for ob-gyn work thereā€”a benefit that is currently offered for dentists and primary care physicians in some underserved communities.

Isn't that the premise of Northern Exposure?


yup.
Not planning on any babies but if we were it's a 50 mile drive to a hospital that does OB. I don't know how many are "emergency" births at the local one or the one 20 miles away.
This has been the situation for a few years now.

It's interesting that the media seems more concerned with the "shortage" of baby-killing facilities in the fly-over states.
"Doggies are angel babies!" -- my wife

MillCreek

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Re: Trying to have a baby in flyover country
« Reply #5 on: February 15, 2017, 12:44:17 PM »
Isn't that the premise of Northern Exposure?

It was, and the program continues to this day.  The major problem with the loan forgiveness programs is that as soon as the provider has worked off the debt, which typically takes 3-5 years, most of them head out to the big city.  We just started a new medical school in Washington state, as part of Washington State University.  The students will be rotated through various rural settings, and it is hoped that some of them will subsequently set up practice there.  One of the major barriers for these rural programs is a lack of jobs for the spouse/significant other.  If the spouse/significant other cannot find a job in their field in the given rural area, that is a strike against the provider moving there.
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MillCreek
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Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
You are one lousy risk manager.

KD5NRH

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Re: Trying to have a baby in flyover country
« Reply #6 on: February 15, 2017, 02:19:19 PM »
The biggest problem is not where they fall in the top 10 but where they fall in amount paid per claim which is probably in the top 3 (SWAG).

Sounds like yet another negative effect of insurance companies playing the short game.  (Paying out a claim they could beat because it's cheaper than going to court right now, ignoring the fact that it encourages more shaky suits in the future.)

makattak

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Re: Trying to have a baby in flyover country
« Reply #7 on: February 15, 2017, 02:27:35 PM »
Sounds like yet another negative effect of insurance companies playing the short game.  (Paying out a claim they could beat because it's cheaper than going to court right now, ignoring the fact that it encourages more shaky suits in the future.)

There's also risk aversion. Show a jury a picture of a child with a birth defect (or the actual child) and claim it's the doctor's fault.

It's a roll of the dice as to whether the sympathy card gets the plaintiff far more than a settlement would have paid.

This is one issue where I don't think the current jury system is well situated to dispense justice.
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So do all who live to see such times. But that is not for them to decide. All we have to decide is what to do with the time that is given to us. There are other forces at work in this world, Frodo, besides the will of evil. Bilbo was meant to find the Ring. In which case, you also were meant to have it. And that is an encouraging thought

MillCreek

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Re: Trying to have a baby in flyover country
« Reply #8 on: February 15, 2017, 02:30:38 PM »
Sounds like yet another negative effect of insurance companies playing the short game.  (Paying out a claim they could beat because it's cheaper than going to court right now, ignoring the fact that it encourages more shaky suits in the future.)

Speaking as the person here who actually does this for a living, I can tell you that when it comes to healthcare malpractice cases, they are vigorously defended.  I routinely spend tens or hundreds of thousands to defend a case that could have been settled for $50,000.  It is not in the best interests of the provider or the insurance company to get a reputation for paying nuisance settlements.  Having said that, healthcare staff make errors all the time, and when those errors reach the level of provable malpractice that cannot be successfully defended, you should look to settle the case.
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MillCreek
Snohomish County, WA  USA


Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
You are one lousy risk manager.

zahc

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Re: Trying to have a baby in flyover country
« Reply #9 on: February 15, 2017, 02:38:16 PM »
I heard also that rural areas have growing numbers of drug abuse complications, and that's one of the reasons as well,

Hospitals are actually not needed to birth babies, and the concept of births as a 'medical' issue requiring treatment per se (rather than possibly being needed for complications) is a relatively recent one, even in the US. I have 3 babies so far, and have yet to step foot in a hospital. If hospitals get more expensive and distant, I expect some market elasticity to kick in, and some people will just go back to having babies for free.
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makattak

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Re: Trying to have a baby in flyover country
« Reply #10 on: February 15, 2017, 03:39:04 PM »
I heard also that rural areas have growing numbers of drug abuse complications, and that's one of the reasons as well,

Hospitals are actually not needed to birth babies, and the concept of births as a 'medical' issue requiring treatment per se (rather than possibly being needed for complications) is a relatively recent one, even in the US. I have 3 babies so far, and have yet to step foot in a hospital. If hospitals get more expensive and distant, I expect some market elasticity to kick in, and some people will just go back to having babies for free.

Part of THAT is also risk aversion. Yes, the birth is probably not going to have complications, but IF there are, you're already in a hospital.

From personal experience, pregnant women tend to be more than a little risk averse.

(To note, our last child's birth DID require hospitalization for my wife- she was preeclamptic. Thankfully, she and the baby came through with no problems, but I was mighty glad we were already set for the hospital.)
I wish the Ring had never come to me. I wish none of this had happened.

So do all who live to see such times. But that is not for them to decide. All we have to decide is what to do with the time that is given to us. There are other forces at work in this world, Frodo, besides the will of evil. Bilbo was meant to find the Ring. In which case, you also were meant to have it. And that is an encouraging thought

Perd Hapley

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Re: Trying to have a baby in flyover country
« Reply #11 on: February 15, 2017, 04:19:29 PM »
I heard also that rural areas have growing numbers of drug abuse complications, and that's one of the reasons as well,

Hospitals are actually not needed to birth babies, and the concept of births as a 'medical' issue requiring treatment per se (rather than possibly being needed for complications) is a relatively recent one, even in the US. I have 3 babies so far, and have yet to step foot in a hospital. If hospitals get more expensive and distant, I expect some market elasticity to kick in, and some people will just go back to having babies for free.

I'm not saying don't have your kids at home, but that seems like a time when you really, really want to have a hospital close by.
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lee n. field

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Re: Trying to have a baby in flyover country
« Reply #12 on: February 15, 2017, 04:33:47 PM »
I heard also that rural areas have growing numbers of drug abuse complications, and that's one of the reasons as well,

Hospitals are actually not needed to birth babies, and the concept of births as a 'medical' issue requiring treatment per se (rather than possibly being needed for complications) is a relatively recent one, even in the US. I have 3 babies so far, and have yet to step foot in a hospital. If hospitals get more expensive and distant, I expect some market elasticity to kick in, and some people will just go back to having babies for free.

My daughter has had 3 at home, with the aid of a midwife.  Which is illegal in Illinois.
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makattak

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Re: Trying to have a baby in flyover country
« Reply #13 on: February 15, 2017, 04:35:44 PM »
I'm not saying don't have your kids at home, but that seems like a time when you really, really want to have a hospital close by.

I should also note that our situation was one that would be dangerous and frightening in the situation from the article (no birthing hospitals nearby). She didn't feel right one night and called the on-call doctor. She said, effectively, "You're probably a little dehydrated. Drink some water and check in tomorrow." (She wasn't totally off-base, my wife had been into the office literally the day before and her numbers had all appeared fine, though there was a little question about the competence of the nurse who took her BP.)

She went into the office first thing in the morning and after checking her vitals, they told her to go straight to the hospital, which was 5 minutes away.

In a circumstance where the hospital (or the obstetrician) is 50 miles away, she'd have been in a much worse position.
I wish the Ring had never come to me. I wish none of this had happened.

So do all who live to see such times. But that is not for them to decide. All we have to decide is what to do with the time that is given to us. There are other forces at work in this world, Frodo, besides the will of evil. Bilbo was meant to find the Ring. In which case, you also were meant to have it. And that is an encouraging thought

sumpnz

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Re: Trying to have a baby in flyover country
« Reply #14 on: February 16, 2017, 09:57:41 PM »
4 kids.  Not a one born in the hospital.  2 were born in the bath tub at free-standing birth centers, 1 in the car on the way to a free-standing birth center (with the bath tub filling), and one at home in our own bath tub.

Jocassee

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Re: Trying to have a baby in flyover country
« Reply #15 on: February 17, 2017, 10:41:31 AM »
4 kids.  Not a one born in the hospital.  2 were born in the bath tub at free-standing birth centers, 1 in the car on the way to a free-standing birth center (with the bath tub filling), and one at home in our own bath tub.


Mine is a mostly-unresearched opinion, but I do wonder if midwifery is what is needed here. Decentralized, home based care. Obviously some mothers are still going to need hospital care if they have risk factors. But midwives can identify those as well and help moms know when to head to the hospital.
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Re: Trying to have a baby in flyover country
« Reply #16 on: February 17, 2017, 11:23:49 AM »
Wife needed an emergency c-section for the oldest.  It was a mess... almost 16 hours trying to induce labor, water broke after the first four, cervix messed up, went to OR, and the cord wrapped around his waist, wife started hemorrhaging, doc got it under control damned quick, and they were both fine.  Second son was a c-section by our choice.  Didn't want a repeat mess.

Our house is 15 minutes from the hospital.
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sumpnz

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Re: Trying to have a baby in flyover country
« Reply #17 on: February 17, 2017, 12:24:40 PM »
Something like 70% of births do not need an MD, hospital, etc.  The reason midwifery isn't more commonplace is that most women want those services, and providing them has become the accepted norm.  That is neither inherently good nor bad. 

There are a lot of upsides to "natural" childbirth vs the medicated version that is so popular today.  But, as Chris pointed out, there are some (~30% - which is a huge number) that still require that medical intervention.  But for those that don't need that, midwifery can save substantial money, and result in a faster/easier recovery for mom.

sumpnz

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Re: Trying to have a baby in flyover country
« Reply #18 on: February 17, 2017, 12:29:47 PM »
My understanding is that in New Zealand pregnant women by default go to a midwife for their care.  Only those that meet certain higher risk profiles are referred to Ob's. 

However, that is because with their socialized medical system they are needing to ration care on some level to constrain costs.  Midwives are far cheaper than Ob's.  I'm not in favor of forcing that setup on all women, but the fact that midwives are banned entirely in some states, and massively restricted in others should change.  Making it more available as an option would be the best way to go.

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Re: Trying to have a baby in flyover country
« Reply #19 on: February 17, 2017, 03:15:51 PM »
https://www.scientificamerican.com/article/maternal-health-care-is-disappearing-in-rural-america/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+ScientificAmerican-News+%28Content%3A+News%29

It is getting more and more difficult to find a provider to deliver your baby and a hospital to do it in.  Lots of reasons for this: OB is a money-loser for hospitals, lack of reimbursement and the typical provider does not want to live out in the sticks.

It cost about 5000 to get my first daughter whelped.  She and my wife remained inpatient for observation for three or four days, due to my wife testing positive for a strep thing.  There were no complications.
I had a HSA at the time, and the bills came to me.
This was in 2002.

I expected it to be much higher.
7-11 was a part time job.

MillCreek

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Re: Trying to have a baby in flyover country
« Reply #20 on: February 17, 2017, 03:31:53 PM »
I am the first to admit that because of what I do for a living (dealing with healthcare disasters), when we had our two children, it was in a tertiary medical facility with an OBG in attendance and me reading each panel of the fetal heart monitor as the printout came out of the machine as a backup.  I have seen way too many cases during L&D in which the feces hit the fan, even with an ostensibly low-risk birth. 

This, however, is my own paranoia.  I think that midwives are just peachy, and they are extensively used here in Washington state.  My enthusiasm for midwives is limited to an actual nurse midwife in a birthing center or hospital.  Washington state also allows for lay midwives with a considerably lesser degree of training and they usually do home births.  I personally would not use a lay midwife nor a home birth, again because of my background.
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MillCreek
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Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
You are one lousy risk manager.

makattak

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Re: Trying to have a baby in flyover country
« Reply #21 on: February 17, 2017, 03:37:48 PM »
I am the first to admit that because of what I do for a living (dealing with healthcare disasters), when we had our two children, it was in a tertiary medical facility with an OBG in attendance and me reading each panel of the fetal heart monitor as the printout came out of the machine as a backup.  I have seen way too many cases during L&D in which the feces hit the fan, even with an ostensibly low-risk birth. 

This, however, is my own paranoia.  I think that midwives are just peachy, and they are extensively used here in Washington state.  My enthusiasm for midwives is limited to an actual nurse midwife in a birthing center or hospital.  Washington state also allows for lay midwives with a considerably lesser degree of training and they usually do home births.  I personally would not use a lay midwife nor a home birth, again because of my background.

Even without the experience you've had, I was doing the same with the heart monitor.

I also noticed that EVERY time we've had a child, the staff was rushing about dealing with several other births. Our 3rd child went so quickly, they had to pull the doctor out of a C-section to deliver her first. (and they got there just in time)

Our second child they induced because my wife was trending towards preeclamptic. They put her on the pitocin and then left for some time. When my wife told me she felt like she had to push, we had to get the nurse in there who quickly turned off the drip and ran to get a doctor.

In neither case did I feel they were incompetent, but I could tell maternity wards are (at least in my experience) very busy. A good father needs to be alert and watching out for the mother and the child, in all circumstances.
I wish the Ring had never come to me. I wish none of this had happened.

So do all who live to see such times. But that is not for them to decide. All we have to decide is what to do with the time that is given to us. There are other forces at work in this world, Frodo, besides the will of evil. Bilbo was meant to find the Ring. In which case, you also were meant to have it. And that is an encouraging thought

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Re: Trying to have a baby in flyover country
« Reply #22 on: February 17, 2017, 04:29:12 PM »
My wife had an outstanding obstetrician.  She was the head of OB at her hospital, had a huge amount of experience, was completely supportive of my wife's preference for lack of any unnecessary intervention, and had an amazing bedside manner.  She was absolutely determined to be on hand to deliver our children (even though she had several other competent docs in her practice).  She didn't have to do much more than catch the baby both times, but I'm very glad the best, most capable OB in the county (and maybe the state) was on hand if something had gone wrong.

Both of my sisters (and lots of folks in our circle of acquaintances) are militant about home births.  This despite the fact that my younger sister's midwife let her go a couple of days after her water broke before delivering her first child.  Her daughter got a severe infection and ended up having to spend several days in the hospital on antibiotics.  On one of her girls the midwife nearly missed the birth entirely because she was out smoking.  Several of the midwives I've met have also really pushed crystals and herbal remedies. 

While I know there are good midwives and bad doctors, I wouldn't consider changing the choices we made even to save a few bucks.

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Re: Trying to have a baby in flyover country
« Reply #23 on: February 17, 2017, 05:01:23 PM »
All I know about Norwegian medical practices I learned from Lilyhammer, but aren't midwives part of the standard medical process there for pregnancies? As in, they are a part of hospital medical staff and the woman gets one assigned to her?
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MillCreek

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Re: Trying to have a baby in flyover country
« Reply #24 on: February 17, 2017, 05:46:09 PM »
All I know about Norwegian medical practices I learned from Lilyhammer, but aren't midwives part of the standard medical process there for pregnancies? As in, they are a part of hospital medical staff and the woman gets one assigned to her?

This is a common approach in many European countries.  The midwives have hospital privileges, do the prenatal care, delivery and post-partum care, and have physician backup when necessary.  OB and FP handle the high-risk cases.
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MillCreek
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Quote from: Angel Eyes on August 09, 2018, 01:56:15 AM
You are one lousy risk manager.