Why Is Blue Cross raising rates in California by 39%?
Perhaps it's because Blue Cross is a very bad business manager when it comes to paying for births.
Blue Cross could cover homebirth midwives at in-network rates and pay about $6000.
Or they could insist that in-network rates only apply to hospital births, where they pay
$15,000 to $40,000 for a birth.
Call Lilian at 303-831-2088 to encourage Anthem Blue Cross to upgrade their policy
for better business and better birth.
Explain legal status of dems in GA
Explain protocol
Explain booklet
Explain birth supplies
Give and discuss diet sheet
Returned diet sheet
Met father
Explain contracts
Returned contracts
Explained birth certificate info
Digital Pager instructions
La Leche Info - 681-0142
Obtain copy of labwork
Circumcision
Eye prophylaxis
Vitamin K
Genetic screening
1 hour challenge for gestational. diabetes
Transport info
Pediatrician info
Siblings-Children at Birth video
Siblings- support person
Explain midwife backup
Discuss RhoGAM & titers
Childbirth classes
Emergency numbers posted
Postpartum care- Doulas
Initial Discussion
_____Client Info and Consent Form discussed
_____Fees determined
_____Insurance form sent in
_____Diet Discussion/supplements
_____PNV rx?
_____Labs ordered
_____ Referrals (WIC, genetics, DSHS, etc.)
First Prenatal to 19 weeks
_____ STD screening desired?
_____AFP discussion
_____AFP ordered?
_____Diet review
_____Supplement review
_____ Exercise/Fitness
24-26 weeks
_____Discussion of 28 week labs
_____ Begin discussion of childbirth classes
_____Need library books?
28-30 weeks
_____Labs done
_____RhoGAM given, if needed
_____Review Preterm Labor sheet
_____Signed up for classes?
_____Diet review/ Ca+/Iron
32-34 weeks
_____Order birth kit
_____Start working on birth plan
_____Discussion of GBS
_____Discussion of prep tea
_____See videos?
36-37 weeks
_____Meet Debbie (my birth assistant)
_____Birth Supplies ready
_____Perineal Massage
_____Prep tea provided
_____Baby treatments/tests discussed
_____Need circ info?
_____Begin birth control discussion
Method selected ___________
38+ weeks
_____Discuss/provide pp tea or sitz
_____Finalize contingency plans
OB Group __________
OB Hospital ________
Peds Provider ________
Peds Hospital _________
_____Finalize plans for PP care
_____Fetal movement counts
_____Arrangements for peds care
Newborn Care Provider. Pediatrician vs. FP___________________
Childbirth Classes: options: one day, series, refresher, sibling
Doulas, labor support, labor attitudes
Labs: anemia, gestational diabetes
Family planning: Options: __________________________
Circumcision:
Fetal Movement/Kick Counts
___________________________
___________________________
THIRD TRIMESTER
Braxton Hicks
Danger Signs, When to call
Breech Tilt
Tubal Consent
Signs & Symptoms Labor/When to Call
GBS/vaginal culture @ 36 weeks, anemia labs
Perineal Massage
Birth Preferences/birth attitudes, visualizations
Postdates Management, NST, AFI & 41 weeks
Postpartum follow-up, support
Preparations for parenting
________________________________
Hospital-Based Protocol
Routine prenatal appointment:
A prenatal in my practice entails the "clinical stuff" which usually doesn't
take very long...pulse, Bp, urinalysis. I ask them if they've gained weight.
I ask them how the baby is doing, how it is moving, how active, when, etc.
I ask them if they have headaches, bleeding, unusual discharge, edema,
nausea or vomiting. I have them to lie on the sofa, feel the baby, teach
them the position, listen to the heartbeat, measure the fundus. We talk
a lot about nutrition, especially if something is amiss, BP, sugar, low
iron, etc, or if they haven't had a very good weight gain, or if I suspect
that they don't have access to good food. We talk about natural alternatives
for yeast infections and exercises and nutritional solutions for common
problems. We talk about the family, children, husband. Sometimes problems
in relationships come up. We discuss concerns about friends and relatives
hostile to homebirth. At the first visit they have filled out an info sheet,
and if it has unusual things on it, abuse, rape, stds, etc, we talk about
that. With first time moms, i usually order blood work and find out blood
types, etc. We get other lab work done as necessary throughout the pregnancy.
I do one vaginal exam before labor, at 37 weeks, mostly to familiarize
myself with the client, and to get her use to my touch. I often don't do
one for repeat clients at all. That exam is in her own home on her bed,
because we do our home visit at that time. Everyone attending the birth
comes to that meeting, can ask questions of us, etc, and we can make sure
birth supplies are in order. Throughout prenatal care we talk about her
wishes and desires for the birth, how she envisions herself giving birth,
why she wants a home birth, what she expects of her midwives, etc. We discuss
and instruct perineal massage, breastfeeding, and any other questions or
concerns the couple may have.
I see my clients once a month until the 28th week, then every other
week until the 37th week, then every week until the birth, more often if
there are any problems. I'm sure I'm leaving out critical stuff. Prenatals
last about an hour. I do many or most in the client's home. Many of the
midwives I work with have the couples come to their home or office.
Here is the AP checklist I use, which I got from NACC. I like it because
it's pretty inclusive of most everything.
Continuous Quality Improvement Program for Birth Centers
Client Health Record Checklist
Name:
Orientation:
INITIAL VISIT
Draw Labs
AFP
Genetic Counseling, if indicated
Give diet history
Students
Appointments, phone contact
Consent forms discussed
Financial contract signed
Insurance forms signed
New OB pack
Self-care
Danger signs: UTI, bleeding, abdominal pain, cramping, headache
Habits: smoking, ETOH, drugs
Exercise; sexuality
Discomforts
Early pregnancy classes
Met partner
Registration Log/Bulletin Board
SECOND VISIT
Review lab results
Review diet history
Fetal development
AFP drawn
Consent forms signed
20-28 WEEKS
Give pediatrician letter
GTT scheduled/drawn
RhoGam scheduled/drawn
PTL signs
CB class Sibling class
Discomforts
Breastfeeding
OB visit scheduled
30-32 WEEKS
Hct
GBS
Danger signs: cramping, ROM, headache, visual changes
Circumcision
Labor support
Supply list
Fetal movement counts
Braxton-Hicks contractions
OB visit completed
Nipples/breast cups
Peds letter returned
34-36 WEEKS
OB chart review
Review call system
Directions to home
Records to hospital
Emergency childbirth
37-38 WEEKS
Signs of labor
When to call
Newborn prophylaxis
Complications classes
Early Home Care class
Circumcision choice
Birth plan
40-42 WEEKS
PP support
Breastfeeding
Ready for baby
Post-dates routine
NST
36-Week Home Visit for Homebirth Clients
The Birth Plan meeting at 36 weeks gestation is an opportunity for the
woman and her family to be together and talk over any housekeeping tasks
before the big day. It is also a time for the midwife to see the
woman in her own space, know where the spare towels, the coffee, the bathroom
and laundry are, work out the quickest route to the woman's house and generally
focus on the imminent birth. It is a family occasion and often the
couple have invited significant other people to the birth plan so that
they might ask questions and give their support to the family.
