Weird Hospital Practices - Insurance Issue

KittyMisha

So I have Kaiser Permanente insurance. For those who aren't familiar with Kaiser, they run differently than many other insurance companies. Specifically, all Kaiser doctors work in Kaiser facilities (called campuses) and follow Kaiser policies. As a patient you can choose which campus you prefer to use and switch between doctors at that campus if necessary, but that is all the say you have. All tests/labs/specialists etc are conducted at the campus as well, and if a service isn't available at one they will send you to another where it is. There are no out-of-network providers, and if you need a hospital you must only use Kaiser hospitals, which are also located on Kaiser campuses.

So, that being said, Kaiser has an interesting policy on OBs that I have recently learned. Specifically, your OB will almost never be the person who delivers your baby. Instead, the L&D has a rotating staff of OBs present, and whoever happens to be free when it's time for you to push is the person who catches your kid. The only way you will have the doctor who has been treating you through your whole pregnancy is if they happen to be doing a rotation that day and happen to be available at that moment.

Now, this will be my second child and I'm pretty calm about the process, but this still makes me a bit uncomfortable. If something were to go wrong, it would be much easier for me to feel confident taking advice from someone I know and trust than from a total stranger. I think I would be freaking out if this were my first kid.

I don't know, maybe it's just me. Thoughts?

violajack

I'm at a rotating midwife practice. I was lucky my midwife was on during my labor, but her shift ended and an ob I had never met before caught my baby. She was pretty awesome though, so it was really no big deal to me. My husband was there holding one leg, he announced the sex, he cut the cord. The nurse and ob were there to make sure the medical side of it went right and they did their jobs well and stayed mostly out of our way. The ob talked me through delivering the placenta and some stitches, but I had an epidural and was so enamoured with my baby that I didn't really care. I knew going in that I would get whoever happened to be on rotation in addition to a student since it's a teaching hospital, so I was prepared. I wrote a short birth plan and she talked over it with me, but at every point she said oh that's how we do it anyway, so I was confident that their standard care would match my wishes anyway, making me even more comfortable.

chase16

That's actually really similar to military health care. I've seen the same nurse midwife for every appt, but odds are if I deliver at night or on a weekend it'll be someone totally different (whoever is on duty). I've never met any of the OBs working at the hospital (which has the clinic inside it).

I'm not overly concerned by it though.. Technically in the military you have a "primary care manager" with whom you're supposed to see for all routine stuff, but due to the sheer number of people they have to see, this rarely happens, and usually you see whoever is free. I'd be more bothered if I want so used to it .

MallardDucky

General practices are similar. 2 out of 3 of mine I never meet before. You pretty much get who's on call

Raclla

That sounds standard.  Even a one-man doctor's office can't be on call 24/7.  There's no way to guarantee you wouldn't have your baby while he was on vacation or sick etc.

My practice has five docs.  I think.  Most of my friends use this practice, so I've heard about almost all of the OBs.  My doctor didn't deliver DD, but the doc who did also delivered my BFs DD.  I loved him just as much as she did.  

You just get who you get when it's time.

If you're actually scheduling induction or a RCS, then you can actually plan on having your same OB.

Sarafar4

My OB practice has 9 doctors. Throughout my pregnancy, they rotate your appointments to try to get you to at least meet everyone, but honestly, some if them I've only seen for ten minutes. So far, though, I've liked them all except for one so I'm hoping he won't be the one who is on duty when I finally deliver. I don't think it's weird at all to want someone you are comfortable with by your side. I think it's more strange that your insurance/hospital doesn't really give you that option at all!

Jules_Shamblin

There are about 10 OBs that practice where I go and they do rotating shifts at the affiliated hospital so who knows who I'll get. I'm fine with that because it is a really great office and I've met most of the doctors and liked them.

My only concern is that one of the OBs is my best friend's father-in-law. He's partially retired now and only practices part time but on the off chance that he would be the one on call, that might be a little awkward. He does always make the top doctors in the city list though so even though it would be awkward, I'd be in good hands.

herecomesthesun

It's not a weird practice at all. I've got a doc that prefers to keep his patients his patients but if this kid comes late... It will be the on-call doc in his practice. I'm preparing myself that it would be someone else because that is a possibility.

Raclla

To add:

After 40w4d, I only saw the delivering doc for about 30 minutes.

The person that catches the baby has very little involvement in the overall course of the pregnancy.

KittyMisha

Well there you go, I guess this is a more common practice than I realized. With my first, my OB was on call for whenever I went into labor and she was the one who delivered DD. (Fortunately it was about 8 PM on a Monday, so not too bad for her.) I guess that's the unusual practice after all, and I was just spoiled because it was all I knew.

On the plus side, Kaiser has both docs and midwives available at all times, so that's pretty neat.

Hilee18

My practice does the same I work routinely with 2 and have worked briefly with the 3rd. The old perinatology practice I worked at had the same premise. It makes it less likely you are going to get rescheduled for your appointments which I like alot. 

rockyrollgirl

I have Kaiser and was fine with this.

Pinkalana

It was not an insurance issue but I didn't get to have my doc deliver my #2 baby. I went into labor on a Friday night, walked into the hospital at midnight. I just had to have the doc on call. They checked me and said, yep you're in labor. They took me back for my csection. Then I recovered so quickly and was discharged on Sunday and my doc never saw me until my 6w post partum appt. I even went to the on call doc to get my staples out. It was not my preferred option but it all worked out great. The on call doc was fabulous. It was a great experience.

KittyMisha

potterowl said:

I have kaiser too and this is something I really like about kaiser. Instead of having a doctor on call who had to come in for you and wants to leave soon, you have a doctor who has a scheduled hospital shift and is there no matter what. We did hire a doula so I would have someone there who I know. And I have heard it is really the nurses who you spend more time with.

That's a good point and something I didn't consider. It is nice to know that no one will be pushing for medical interventions just so they can be home for dinner.

I have thought about hiring doula, but they're pretty expensive and my maternity leave will be cutting into my finances, so I'm not sure it's possible.

tamarar5

That's exactly like my practice. I get to see the same practitioner all the pregnancy (a big and nonnegotiable issue for me) but whoever is on call, delivers.

mamasarahx2

Yep, standard.  For what it's worth, I had Kaiser during my last pregnancy and echo everyone else - the actually delivery moment is a small part of the entire pregnancy.  I had an OB who I loved but really, really loved the midwife that was on when I was laboring.  The Kaiser hospital I delivered at was way above the curve with a lot of more progressive, mom/baby-centered practices and was "baby friendly" so a great start for us with breastfeeding.  Hope you have good experience also.

PecanSam

The practice I go to, you get whoever is on call, even for a scheduled c-section. With my first, I happened to get the midwife I really liked but ended up needing an emergency c-section and got my OB, so I was very excited about that. I would love to have my OB again but with the date I have now, I won't.

My practice also makes sure you see at least everyone at least once in the practice before you deliver. Ever since, it was decided I had to be a c-section this time, they have been keeping all my appts with Drs only and no midwives.

BeachM

There are 7 OBs at my practice as well as a handful of other doctors/NPs/PAs who deal only with the gyn side of the practice.  They try to rotate you through all 7 so you meet them during pregnancy, but you get who is on call during L&D.  I think I can probably pick who I'd like to schedule my RCS with though, I'll find out at my appointment today.  They are also not the only practice with hospital rights where I'll deliver, but it's not my understanding that I'd end up with an OB from another practice.  I will, however, have to use the hospital pedi to deliver #2.  Last time there was a pedi on call from the practice we were with.  I wish our pedi could be there (I've known her since childhood), but it's not an end of the world thing for me.

Same thing at a different practice and hospital with DS1 too.  One OB at the office made the call for induction, another OB sectioned me, and then I was discharged by a 3rd pedi from the practice.  I had my follow up appointments with the OB who did my c/s.  It was all fine and it's really the nursing staff who makes or breaks your experience.

sarahg8r

I think this is pretty standard. There are 5 OBs in my practice...the only 5 who serve my hospital. So I have a 1 in 5 chance of getting my actual OB. I'm not concerned.

workmm01

My OB in a private practice told me she delievers about 50% of her patients. It does kinda freak me out, but not much I can do about it.