pre-eclampsia and military doctors
sarahtx57
member
hi everyone. we are stationed here in San antonio and we are about to start ttc #2. I had severe pre-e with my son and he was born 5 weeks early but I feel, because of the care I recieved at the base hospital they were partially to blame for some of his issues(was stationed in alaska at the time) I will never know, but I have my theories.
#1) Should I request an off base specialist?
#2) How do I do this? Do I need to change to prime or standard..I don't even know what we have now..we got to the mtf for everything I guess. maybe just need a referral? I need to see an ob/gyn or pcm to discuss ttc and just check a check up anyway.
I just would feel much better if I could see someone who specialized in this. I'm afraid I'll just be pushed aside at the base hospital and I've sort of heard awful things about wilford hall. Is anyone here in san antonio and had a baby I could talk to about the care?
Thanks!!
Re: pre-eclampsia and military doctors
If you are seen at an MTF you are on Prime.
I would start by seeing the OB/PCM at the MTF and discussing your concerns and your previous history. If your provider there feels that you need care from a specialist they can refer you out in town. If your provider at the MTF blows you off you should go see the patient advocate at the MTF and request (demand) to be referred off base to receive adequate care (this is only going to work if you are already pregnant, they are not going to refer you for a pregnancy related condition until the concern is immediate).
With a referral from your MTF you will continue to receive Prime coverage while seeing an off base specialist.
If you don't want to deal with the hassle of getting/demanding an off base referral OR you are continually denied that referral, then you always have the option of switching to Standard. You will have co-pays and you may be responsible for a portion of your labor/delivery costs (the story on this seems to vary, you shouldn't have a huge hospital bill or anything, but you will have a nominal per day charge for hospital stays related to labor/delivery). You will also not be able to switch back to Prime for at least a year. Your new child will still be able to be added to Prime after you deliver, it just has to be done in the regular time frame (30 days? 60 days? can't remember) and no one else from your family (other children) have to switch to Standard when you do if you don't want to switch them.
This 100%. Tell the MTF OB you would like to be referred to a high risk doctor straight away. My experiences with MTF's have been horrible. Both DD and I are on Prime, but see off base doctors and we always will. I've never had a problem getting the referral, but I have had to get the forms from the PA.
Darn Bump ate my response. Grrrr!
I understand where you've been. I developed HELLP Syndrome at the very end of my pregnancy and had to deliver my son by emergency c-section. He ended up in the NICU for 12 hours and I was on the mag sulfate drip for 30 hours (of pure hell). Like you, I feel that my OB missed or overlooked signs that could have prevented this from happening, or getting as bad as it did.
That said, I was being seen by a civilian provider at a highly ranked civilian hospital. Its not just MTFs. That said, I would make certain that you are referred to a MFM (Maternal Fetal Medicine) doctor to be followed more closely. Chances are in your favor that you will have a healthy pregnancy, but still.
If you decide to switch to TRICARE Standard, remember that civilian providers must agree to accept the government approved payout --which is paltry, IMO. Some doctors just find that paperwork and hassle not worth it for what they are paid. . . or, they are not accepting new patients. So, finding a highly qualified doctor who takes TRICARE may be a challenge of its own. Not trying to dissuade you. . .
I was on Standard when I delivered my son. Our hospital fees (not including doctors fees) was about $30k. Of that amount, we were responsible for about $60. Standard will cover all of your pregnancy related appointments and services, once the pregnancy has been confirmed. So, you should not have to worry about that, for the pregnancy. But, after your 6 week appointment, and if you get sick with something non-pregnancy related, you will have to pay a portion of the cost (wither 15 or 20% of the TRICARE approved amount).
I would do as a pp suggested. Go see whomever they assign you to for your first appointment. Let them know about your pre-e history and ask how they plan to treat and monitor you. If you are not satisfied with the response, go see the Patient Advocate. Be the (polite) sqeaky wheel!
Good luck and keep us posted!
If the base you are at handles high risk patients, then you will probably be out of luck unless you switch to Standard.
I have had HORRIBLE experiences with military doctors, so I feel for you. Most civilian practices take a urine sample at each appt. to test for protein in the urine. When I was pregnant with DS, the base OB never did. When I had several BH contrax in the 30 minutes that I was at my appt, the OB told me it wasn't a concern. At my childbirth classes, however, the head of the OB clinic was there, and she told me to ignore the doctor next time and head straight up to L&D.
I don't trust military doctors at all. We are currently PCSing, and the base we are going to does not have an OB clinic thankfully. Any future pregnancies will be handled by civilians, and they might suck too, but I will feel a whole lot better about it.
Not to butt in, but as a military physician I am offended that 1) you would think the care of 1 military doc would reflect the care provided by all military docs 2) that being a "civilian" makes you a better doc than being employed by the military (former military physicians are sought after in the civilian world and many civilian docs in military areas are former military/military residency trained) 3) that the care provided by/for others is necessarily better (ie it is NOT indicated by ACOG to test for proteinuria at each OB encounter) 4) you blame your physician for your developing pre-e which is NOT a preventable condition and is ONLY cured by delivery which it sounded as though you required (though I do not know details I admit, perhaps it was a pediatric issue of some nature in which case seeing a high risk OB would not have changed anything). Also, there is no "specialist" in pre-e other than OBs in general, pre-e does not necessarily recur but now you know the signs/symptoms to watch for and will be vigilant. Consider giving your new doc (whoever that will be military or civilian) a chance before judging them. And talk to them about calcium and baby aspirin.
Just wanted to jump in here, because some people have posted some misconceptions on here (not pointing fingers, just saying). I'm an L&D nurse at a military hospital, also a military spouse. There is nothing that can be done to prevent pre-eclampsia, zip, zero, nada. You can monitor for it and watch for it, and treat it with medications like Magnesium Sulfate to prevent eclampsia and hopefully HELLP syndrome from setting in, but the only cure is delivery.
I don't know what happened in your particular situation, however, if you truly had severe pre-eclampsia, then delivery, even 5 weeks early, was the only option to prevent you from getting even sicker. You are at increased risk of developing pre-eclampsia with your next pregnancy, but there is no guarantee you will develop it. That said, with your history, they will probably recommend that you be managed as a complicated OB patient anyway when the time comes. As PPs have said, Wilford Hall/BAMC has specialists and I don't think you would get any different level of care outside the military system than in it.
I get frustrated when I hear things like "I heard awful things about wilford hall..." You will hear awful things about any hospital anywhere if you listen long enough, and because I imagine you mostly talk to military people who only get seen at Wilford Hall, and people talk about their bad experiences more than good ones, that is what you will hear. Take it with a grain of salt. I have worked in the civilian system and I promise you, the grass isn't greener on the other side. The military system might have more volume and you might see different providers, but I promise you that they are adequately staffed and funded, which is not a guarantee at any civilian facility.
nice post mam. thanks
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