Having never had to go to MFM (aside from for the NT and A/S scan) I don't think I fully understand what the line is. People have asked if I'm being seen by a high-risk doctor when I explain the SCH but I don't think any of us with that are (at least because of the SCH) because there's nothing anyone can DO about it. Anyways, I wonder if this is so unique/specialized that it would just be the MFM ordering the labs instead of your OB? It does seem worth asking. Is she at a practice with multiple doctors where they're conferring on this? That would make me feel better.
@kvh22 I wondered if the MFM doc might just have more experience/education to know maybe what types of tests to do, access to better labs, idk that kinda thing maybe? My understanding is they have more training as well as more training in pregnancy complications, specifically.
@kvh22 I don’t know what the line is for MFM either. I think my friends who have had GD have just seen their regular OBs and added a nutritionist. That seems like a more serious condition than what I have going on, especially since I don’t have clinically significant antibodies. And there are 3 OBs and 2 NPs at the practice I go to. But the young one got put in charge of this issue- and I wouldn’t be surprised if it’s because I’m traditionally a pain in the ass patient.
@kvh22 you typically get referred to MFM if you have specific thing that may be beyond your OBs scope of knowledge. Sounds to me like this would fit that definition.
I see them because I have a combination of AMA and insulin resistance. While my OB is super knowledgeable on AMA, they help address the possible complications that can come from the combination of my 2 circumstances. Mostly the effects of my insulin resistance on my pregnancy.
Of course my doctor said my order would be in the system at the hospital and the lady at the blood bank would know about me if there were any questions. Nope and nope. It’s been a total Charlie Foxtrot here and I’ve been waiting for them to figure it out and come get me for an hour.
On a different note, yesterday I caught up with some women from my local mommies group for DD. They all have newborns and the one with the 17 day old had a very relevant birth experience. Apparently she only had to push for 4 minutes and baby was out, and I don’t know if the quick delivery had anything to do with it, but when her placenta detached, her blood didn’t stop flowing and she lost 30% of her blood. They asked her permission to give a transfusion, but she opted out. I guess it was borderline danger zone?? She had no complications with her first delivery, so this was unexpected. And now I’m definitely feeling more worried about this whole blood thing since that actually happened to someone I know in real life.
@poshspice That sounds like a spontaneous occurrence that likely wasn't related to a quick delivery. I pushed for five minutes with only two contractions for DD2 and there was no complication, or concern for one either. However, a spontaneous incident like this would probably make me more anxious too if I were in your situation, and I'd want to be prepared.
@imrachellea I’m glad to hear that wasn’t likely related to a quick delivery! But yeah, I’m definitely freaked out a bit since she had no complications with her first and this scary thing happened with her second.
@poshspice have you specifically asked to be referred to an MFM? I don’t know how your insurance works so no clue what coverage/costs would be. But I see MFMs as my regular OB group and they’ll do my delivery. Im not saying you need that obviously but in terms of where the “line” is, it seems like there’s some wiggle room. If you want a more expert opinion, you should get it!
@poshspice have you specifically asked to be referred to an MFM? I don’t know how your insurance works so no clue what coverage/costs would be. But I see MFMs as my regular OB group and they’ll do my delivery. Im not saying you need that obviously but in terms of where the “line” is, it seems like there’s some wiggle room. If you want a more expert opinion, you should get it!
This 100%. It sounds like you are unsure that your OB is knowledgeable on this issue. If I was in your shoes I would demand to be seen by MFM before it went any further.
@anonellis I have not specifically asked to be referred to a MFM. I feel like I mentioned this somewhere, maybe not in this specific thread, but we are on a HDHP with a $10k Deductible and OOPM. So we'd be paying whatever the negotiated rate is per appointment (likely $100-$300 each office visit). Our plan resets on Jan 1 like most people's, so since we're definitely paying the $10k next year for the birth, all the expenses after Jan 1 are basically moot, but I'm trying to keep costs down before the end of the year.
@chucksmom15 Do you have as shitty of a health plan as we do? It also costs us almost half our mortgage in premium every month in addition to the giant deductible/OOPM.
@poshspice wow, how is a health plan that expensive and also that bad?! I have no advice but I'm so sorry you're dealing with this and I'm sorry insurance is being sucky too. Hopefully you can get in to MFM after the new year.
Yikes! That is a high deductible! I agree MFM is not cheap. If I was in your shoes I would wait until after the new year too. Sorry you are having to deal with all this.
Yup. In case anyone is wondering, this is a typical finance industry/Wall Street plan. And the company only pays as much as they’re legally required to, which is barely anything. On top of everything I thought prenatal appointments would be 100% covered (like preventive care), but those are billed like office visits 😭. DH has had crappy expensive plans since he started working. I used to have a super nice plan when I was working FT before I got KU with DD. Somehow we decided we’d make it work with me being home full time instead... and then I got a part-time work-from-home job when DD was 8 months old and they just laid me off at the end of October. 😭 Have I mentioned that here? It’s been rough. I’m debating going back to work full time, but we don’t have daycare and I’d really want to be home with this new LO at least 6 months before going to work. And DD never took a bottle even when I would be gone for hours, so that’s definitely a worry for this time around, too.
Sorry that hat turned into a bunch of word vomit. I guess a lot of things have been stressing me out lately.
@poshspice if you've mentioned it, I missed it. I'm so sorry. That's crappy. I think I'm going to end up sitting on my license for the next year because I am having a hard time finding anything while pregnant and our life is BUSY. We could use the money (can't we all?) But I have no idea what I'd do at this point with no experience, no residency. So, I feel you, but I'm sorry.
@poshspice I missed it too, I'm so sorry! How stressful! H is a software developer at a tech company and we're really lucky they pay all but $250 for prenatal+delivery. They're not great with DS's therapy stuff, we've had to get a second insurance to helo cover that, but they are good with the pregnancy stuff
@poshspice wow! I'm sorry your insurance sucks. I had a hdhp with a hsa and paid $0 in premiums for myself with a $5000 OOPM ($1500 deductible). DH also has a HDHP with a $9 premium and slightly higher OOPM and deductible. We added DD to mine and my premium went up to $64/month. Your plan sounds nuts. DH's office is moving so they're giving them better benefits to try to mitigate retention issues with increased commute times. As of Jan 1, were getting on a better plan but I didn't think our HDHP options were bad before, and I went through one pregnancy on it. Our companies both contributed to our HSAs.
Your plan to minimize costs until Jan 1 is perfect, IMO. I hope the above doesn't make you feel bad. You seemed legitametly curious and we've both had experience with HDHPs. DH is in defense and I'm in tech, at a company competing for engineering talent with the likes of Google, Facebook, Apple, etc.
@poshspice I am by no means questioning what you said about your coverage, but I thought that the ACA required prenatal visits to be covered like preventive care and have $0 OOP costs? Was this the case with DD1?
@kvh22 no don't worry about it, my career for the past 7 years has been in insurance, and I have seen the best of the best plans. I had an amazing plan once upon a time! But we are used to the ultra shit plans in DH's industry. The company he works for is small, unfortunately, and he also doesn't even earn a salary. He's on a commission only pay structure, so it's feast or famine at our house. It really sucks. Most normal (non-finance) companies care about their employees and want to pay the full premiums for employee-only level coverage for the "crappier" HDHP plans while offering nicer "buy-up" (where EEs pay more) plans. It tends to help them mitigate costs and keep people happy. But not in DH's industry.
@knarlytaurus as I mentioned above, my career has been in insurance since 2011. I have seen pre-ACA and the changes caused by ACA. So, the ACA did change A LOT of things for the better (and worse), but plans that have existed before ACA have legally been "grandfathered in". Assuming companies don't make *material* changes to their plans, they can keep their ridiculous stipulations (like Home Goods refusing to cover birth control). At least that was my understanding when I was still in the trenches.
@poshspice at makes some sense--I am by no means even close to being very knowledgeable about health insurance,but the grandfathered plans make sense I saw a reference to it on Healthcare.gov, but I guess I didn't realize to what extent plans had been grandfathered. That super sucks and it's crazy that we still have such a gap between people and their coverage, especially for prenatal care. Good prenatal care just helps everyone in the long run (and appears to lower overall health care costs in the long run). I'll bet all of our friendly neighbors to the north must be really happy that they don't have to deal with this.
@kvh22 no don't worry about it, my career for the past 7 years has been in insurance, and I have seen the best of the best plans. I had an amazing plan once upon a time! But we are used to the ultra shit plans in DH's industry. The company he works for is small, unfortunately, and he also doesn't even earn a salary. He's on a commission only pay structure, so it's feast or famine at our house. It really sucks. Most normal (non-finance) companies care about their employees and want to pay the full premiums for employee-only level coverage for the "crappier" HDHP plans while offering nicer "buy-up" (where EEs pay more) plans. It tends to help them mitigate costs and keep people happy. But not in DH's industry.
@knarlytaurus as I mentioned above, my career has been in insurance since 2011. I have seen pre-ACA and the changes caused by ACA. So, the ACA did change A LOT of things for the better (and worse), but plans that have existed before ACA have legally been "grandfathered in". Assuming companies don't make *material* changes to their plans, they can keep their ridiculous stipulations (like Home Goods refusing to cover birth control). At least that was my understanding when I was still in the trenches.
I’m also a medical laboratory scientist (like @meatballs37) and I used to work at a big blood bank doing this sort of testing. First off, meatballs had an amazing and informative post and she clearly knows her stuff. Second, I’m surprised that lab called it a day at ‘multiple antibodies or an antibody to a high frequency antigen’. Generally speaking, we’re pretty aware of which antibodies cause problems in pregnancy (it’s one of the big reasons why they were discovered and investigated in the first place)- so there is a good chance you don’t have one of the problem ones. The high-frequency antibodies aren’t usually a problem themselves, but labs and physicians need to be cautious about whether they ‘hide’ clinically important antibodies’ reactions. It’s less likely you have a ton of bad antibodies if you haven’t been transfused a lot in the past, but it’s not in you or the baby’s best interest for labs and clinics to make that assumption and move on- hence the scary messages from the physician.
I do recommend following up with a MFM doc when you’re able to (so sorry about the insurance situation ), they should be better equipped to communicate with the transfusion service to track and judge what should be done ahead of time, and plan for delivery. The big plus side is that this isn’t new ground at most larger hospitals or with experienced OBs/MFM doctors.
Best of wishes for your pregnancy, and that you just have some stubborn, irrelevant antibody making everyone’s day busier than it needs to be.
@DuchessOfCambridge couldn’t agree more! I called the insurance company today to ask more questions about the crappy coverage and even the rep I spoke with was kind of horrified at the lack of prenatal coverage.
@lin0442 thank you so much! I actually had another test run at the hospital this weekend (type and cross ??) so I’m hoping that will provide more clarity.
Hello. Just thought I would pop back in since I saw there were so many more posts. It really does sound like labcorp has no idea what they are doing. Which in part doesn’t help your OB make educated decisions on your screen. I am still not sure I agree with your OB on starting to bank blood so far away from delivery. Especially when blood is only good for 45-60 days.
I’m glad they are rerunning the type and screen again. If I had to guess, they won’t find a clinically significant antibody. Which really means they shouldn’t make you bank blood at all. But still make sure you have a type and screen drawn before delivery to ensure they can crossmatch some donor ones. We have people who have a positive screen and when we run the panels to figure out what it is and we get nada. Then we just crossmatch the blood all the way through Coombs and it’s fine to give. No banking necessary.
Either that or you have a warm auto antibody. But your DAT was negative, so most likely not. This also won’t cause you any issues receiving donor blood if you need it.
Im sorry you are still dealing with what sounds like incompetent health care providers. If it makes you feel any better. We have a good amount of deliveries between our two major hospitals and it is quite rare for us to give blood to mothers.
I’m also sorry your insurance blows. Mine is somewhat similar. I feel like we are going to be paying medical bills for the rest of our life.
@poshspice Good! Hopefully the hospital will be a bit more experienced with IDing antibodies for the type and cross. FWIW, moms banking blood for themselves was extremely rare at my facility, we only really ran into it with one OB patient who had a *very very very* rare and dangerous problem, in which case it was an early donation that got specially frozen so it’s good for 10 years.
It’s generally better to have your blood already inside of you. Most OB transfusions are one or two units, so taking that out ahead of time within those couple of months is usually a little counterproductive.
Also a fun fact- it’s almost always bad practice to have family members (*especially* SOs/partners) donate for you, so please laugh at your OB if she suggests it.
@lin0442 the only people we have ever had to bank for themselves at our two hospitals are jehovas witnesses. We don’t even off the option to freeze RBCs. I imagine most places don’t.
I feel bad for @poshspice with all the run around she is getting.
@lin0442@meatballs37 Thanks, ladies. I feel sorry for myself, too! Haha. I keep getting automated emails from my health provider’s system saying I have new test results, and yet no one from my OB’s office has called me to discuss yet. I’m hoping they’re just consulting with the hematologist/amongst themselves to decide what to do. I can’t see any of the comments they can see in the test results section, so I still have no idea what’s going on. 🙄
So, not much new to report. The hospital was also unable to identify my antibodies, so my blood has been sent along to the Red Cross. Of course no one in my OB's office told me this until I reached out to them.
Something that struck me as odd was that the email my OB sent me said they ruled out "cold agglutinin" as the cause of the positive antibody test. No one told me that was even being considered, so that's kind of annoying. I looked up the symptoms of cold agglutinin and they include low iron tests (mine were normal), blue hands and feet, joint pain, dizziness, dark urine, jaundice and many other things that I have not experienced whatsoever. I'm kind of really annoyed they're going to waste our money having tested for this when no one has bothered to ask me if I'm having any kind of symptoms.
Anyway, we're still just waiting to see if the Red Cross can identify my antibodies...
tagging @lin0442 and @meatballs37 just to see if you ladies have any thoughts on this!
@poshspice Ah, I’m sorry they weren’t able to give a solid answer to you! At least now you’re on the hospital’s radar.
To answer about the cold agglutinins- a lot of the people that have them don’t have many symptoms, or only have weak ones, but they end up rearing their head in certain types of lab testing- especially blood banking. (Some people do have crazy strong agglutinins that cause what you were reading about.)
When it’s being tested in the lab, blood is cooler than it is in your body, so when someone has a cold agglutinin, little clots can form in the tubes used for testing and can essentially give a false positive in the lab. If that blood is then warmed to body temperature ahead of time and there aren’t any other antibodies, it will turn into a negative screen. Ruling out a cold agglutinin helps the lab make sure that they aren’t going to *always* get a positive test before moving into a more extensive and unnecessary (and costly!) workup- or sending it out to the Red Cross.
@lin0442 that is really interesting and it makes much more sense why they tested for that now. WebMD made it seem like symptoms would be super obvious. Thank you for your thoughts on this!!
Re: Positive Antibody Screening
I see them because I have a combination of AMA and insulin resistance. While my OB is super knowledgeable on AMA, they help address the possible complications that can come from the combination of my 2 circumstances. Mostly the effects of my insulin resistance on my pregnancy.
On a different note, yesterday I caught up with some women from my local mommies group for DD. They all have newborns and the one with the 17 day old had a very relevant birth experience. Apparently she only had to push for 4 minutes and baby was out, and I don’t know if the quick delivery had anything to do with it, but when her placenta detached, her blood didn’t stop flowing and she lost 30% of her blood. They asked her permission to give a transfusion, but she opted out. I guess it was borderline danger zone?? She had no complications with her first delivery, so this was unexpected. And now I’m definitely feeling more worried about this whole blood thing since that actually happened to someone I know in real life.
@chucksmom15 Do you have as shitty of a health plan as we do? It also costs us almost half our mortgage in premium every month in addition to the giant deductible/OOPM.
Sorry that hat turned into a bunch of word vomit. I guess a lot of things have been stressing me out lately.
Your plan to minimize costs until Jan 1 is perfect, IMO. I hope the above doesn't make you feel bad. You seemed legitametly curious and we've both had experience with HDHPs. DH is in defense and I'm in tech, at a company competing for engineering talent with the likes of Google, Facebook, Apple, etc.
https://www.healthcare.gov/preventive-care-women/
And this:
https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-get-pregnant/
It looks like the various screenings are covered, but maybe the office visit is not? That would be pretty fucked up, though.
@knarlytaurus as I mentioned above, my career has been in insurance since 2011. I have seen pre-ACA and the changes caused by ACA. So, the ACA did change A LOT of things for the better (and worse), but plans that have existed before ACA have legally been "grandfathered in". Assuming companies don't make *material* changes to their plans, they can keep their ridiculous stipulations (like Home Goods refusing to cover birth control). At least that was my understanding when I was still in the trenches.
I’m also a medical laboratory scientist (like @meatballs37) and I used to work at a big blood bank doing this sort of testing. First off, meatballs had an amazing and informative post and she clearly knows her stuff. Second, I’m surprised that lab called it a day at ‘multiple antibodies or an antibody to a high frequency antigen’. Generally speaking, we’re pretty aware of which antibodies cause problems in pregnancy (it’s one of the big reasons why they were discovered and investigated in the first place)- so there is a good chance you don’t have one of the problem ones. The high-frequency antibodies aren’t usually a problem themselves, but labs and physicians need to be cautious about whether they ‘hide’ clinically important antibodies’ reactions. It’s less likely you have a ton of bad antibodies if you haven’t been transfused a lot in the past, but it’s not in you or the baby’s best interest for labs and clinics to make that assumption and move on- hence the scary messages from the physician.
I do recommend following up with a MFM doc when you’re able to (so sorry about the insurance situation
Best of wishes for your pregnancy, and that you just have some stubborn, irrelevant antibody making everyone’s day busier than it needs to be.
@lin0442 thank you so much! I actually had another test run at the hospital this weekend (type and cross ??) so I’m hoping that will provide more clarity.
I’m glad they are rerunning the type and screen again. If I had to guess, they won’t find a clinically significant antibody. Which really means they shouldn’t make you bank blood at all. But still make sure you have a type and screen drawn before delivery to ensure they can crossmatch some donor ones. We have people who have a positive screen and when we run the panels to figure out what it is and we get nada. Then we just crossmatch the blood all the way through Coombs and it’s fine to give. No banking necessary.
Either that or you have a warm auto antibody. But your DAT was negative, so most likely not. This also won’t cause you any issues receiving donor blood if you need it.
Im sorry you are still dealing with what sounds like incompetent health care providers. If it makes you feel any better. We have a good amount of deliveries between our two major hospitals and it is quite rare for us to give blood to mothers.
I’m also sorry your insurance blows. Mine is somewhat similar. I feel like we are going to be paying medical bills for the rest of our life.
It’s generally better to have your blood already inside of you. Most OB transfusions are one or two units, so taking that out ahead of time within those couple of months is usually a little counterproductive.
Also a fun fact- it’s almost always bad practice to have family members (*especially* SOs/partners) donate for you, so please laugh at your OB if she suggests it.
I feel bad for @poshspice with all the run around she is getting.
Something that struck me as odd was that the email my OB sent me said they ruled out "cold agglutinin" as the cause of the positive antibody test. No one told me that was even being considered, so that's kind of annoying. I looked up the symptoms of cold agglutinin and they include low iron tests (mine were normal), blue hands and feet, joint pain, dizziness, dark urine, jaundice and many other things that I have not experienced whatsoever. I'm kind of really annoyed they're going to waste our money having tested for this when no one has bothered to ask me if I'm having any kind of symptoms.
Anyway, we're still just waiting to see if the Red Cross can identify my antibodies...
tagging @lin0442 and @meatballs37 just to see if you ladies have any thoughts on this!
To answer about the cold agglutinins- a lot of the people that have them don’t have many symptoms, or only have weak ones, but they end up rearing their head in certain types of lab testing- especially blood banking. (Some people do have crazy strong agglutinins that cause what you were reading about.)
When it’s being tested in the lab, blood is cooler than it is in your body, so when someone has a cold agglutinin, little clots can form in the tubes used for testing and can essentially give a false positive in the lab. If that blood is then warmed to body temperature ahead of time and there aren’t any other antibodies, it will turn into a negative screen. Ruling out a cold agglutinin helps the lab make sure that they aren’t going to *always* get a positive test before moving into a more extensive and unnecessary (and costly!) workup- or sending it out to the Red Cross.