MTF OB experiences?
I've been lurking around the 1st trimester and January 2011 moms boards and I keep seeing all of these people complain about their OBs and/or OB/widwife searches (oh, and complaints about not having many options with insurance). I always want to respond with something like "at least you have SOME choices!" But, I really don't want to complain because I've got nothing against Tricare and I'm just grateful to have insurance. I don't have my first real appointment until the beginning of July so I have no experience with our MTF's OBGYN program other than an orientation, lab work, and quick conversation with a nurse.
Anywho, for those of you who received prenatal care and/or delivered at a MTF I'm curious what your experiences have been like.
Re: MTF OB experiences?
i heard so many things about the MTF near me (supposedly one of the best in the country) that i switched from tricare prime to standard... and i dont have to pay anything because regardless maternity care is free... so if you are super concerned about it there is that option
and also before i made that leap i went onto some of the facebook groups for our post and found discussion threads about delivering there and saw too much bad and not enough good. so my decision was made.
At the orientation I went to it was mentioned that we could switch to Standard, but that you have to be there for a year and there have been people who had complications (gallbladder and such) after delivery that they ended up having to pay a lot out of pocket for before they could go back to Prime. It's still an option I guess, just another consideration.
there is a cap of what you are expected to pay out of pocket... like you will never have to pay over 1000, im pretty sure that is the cap. and depending on your husbands rank you actually can switch right back to prime... i think e4 or below... you dont have to wait the full year if your husband is e4 or below
I had a wonderful experience with prenatal care and delivery of my DS at an MTF. I saw a midwife (the same one) my entire pregnancy with DS. I was lucky enough to go into labor on a day when she was the duty midwife and when it was decided that I was in a position that would probably require a c-section she is the one who came to talk to me and we worked through all of the options and made the decision on how to proceed together.
My postpartum care left a little to be desired, I felt very ignored in the hospital and felt like I wasn't given a lot of information about my status or that of my son (although my son was with me all the time, no nursery available), but I think a lot of that was just first time mommy not asking enough, because I know better this time. When they discharged me from the hospital they sent me home with all of the meds one would need if they had a traumatic VAGINAL birth (creams, numbing agents, Motrin, Tylenol, etc) however, I had a c-section and they did not send me home with a narcotic pain reliever. As a first time mom I had no idea that they SHOULD have sent me home with a narcotic, so I suffered through 48 hours of pain (although it was only really bad at night) until my follow up appointment with the postpartum care nurse. When she found out I had not been sent home with a narcotic I thought her head was going to spin, she was LIVID. I immediately got a script (which she had my DH pick up from the pharmacy while we finished my appointment). It was a mixed blessing. Knowing that my pain was only bad at night meant that I didn't take much of the pain reliever at all, I just took it at night for a few days and then I was off the pain meds all together.
I was seen by a civilian OB office for the first 30 weeks-ish of this pregnancy (on Prime Remote) and I am back now with the same MTF that I delivered DS at. I have opted for a repeat c-section based on family history and the reasons behind my first c-section (all having to do with my body and not the size/position of my baby, so they are all reasons that are not variables that will have changed), I was surprised that when I went in to my c-section consultation they OB really seemed to want me to attempt a VBAC even with my other concerns. The didn't tell me I couldn't have a c-section, and they did schedule it, but they made me feel kind of bad about the decision. I am also not excited about the fact that the OB who will be performing my c-section has not even reported to the command yet (and won't until just a few days before my c-section), so I may or may not get to meet him prior to the surgery.
I don't have an issue with my care at the MTF. I am glad to know what I am getting into this time so I will know what to ask and how to be assertive on my behalf (I was prepared to be assertive about what I wanted for DS and all of my wishes were met, but I didn't know enough about what to advocate for ME, I will be better this time).
Yup.
My experience was so bad, DH bypassed the patient advocate and went straight to the hospital commander. We were given a referral to an OB out in town but stayed on Prime. I will never again use a MTF for OB care or pediatric care. Never.
If there is anything about your pregnancy that is not routine, ask for a referral. You'll most likely get it.
This. I had great care at NMC-Portsmouth and would recommend the OBs there to anyone. If we were to PCS to Pensacola, there is no way I would go to that sh*thole of a Naval Hospital. I hate the staff there and would switch to standard in a heartbeat.
Small threadjack, anyone have a baby at Naval Hospital Yokosuka?
Do you live in Japan?
My prenatal care started with a midwife who I was less than impressed with. I went to patient advocacy after I asked her what complications I may expect with the fact that I have a deteriorating hip...she shrugged her shoulders. At 26 weeks I was diagnosed with Gestational Diabetes and was moved to the high risk side of the house where I saw a different doctor everytime I went.
When I went to L&D though it was a completely different story...TOP NOTCH care. It was a wonderful experience with no complaints.
The after care was not what I expected (they did ignore us some but DH was grateful because they weren't in our room constantly so it was nice and quiet).
I did have a frienemy pregnant at the same time and she switched to standard because she wasn't having her baby at some "crappy Army hospital". She had a terrible experience from prenatal onward. Her son ended up in the NICU. As a Standard patient TriCare would only pay for her to stay in the hospital for so many days so when they kept her son longer she had to opt to pay out of pocket to stay with him. Like pp said, you can have a good or bad experience no matter where you go. Just remember that you are your best advocate.
Loved my OB and my whole experience at BAMC/Wilford Hall the first time around. This time around I feel exactly the same (different OB since mine was a chief resident and she transferred), although I haven't delivered yet. Nurses were great, hospital itself was great, and even the lactation consultant was wonderful. Like someone else said, there are good and bad drs in and out of the military (please don't assume all military doctors aren't good, because that just isn't the case at all) . If you see someone you don't like, switch to some else the next time until you find the right fit. I find it tends to help if you are friendly with the appt clerk at the ob clinic (if you don't know any of the drs, they generally can point you in the right direction to a good one).
I think it really depends on where you are. So I agree with pp that said to ask around and see what other people think from your base.
The OBs at my MTF completely, 100%, saved my daughter's life. They were amazing when my water broke and I had no issues getting covered when I got transfered.
I was kind of sketch about going on base for all of my OB stuff, but I figured that I would try it and see.. it was free, so if I went and didn't like it or had a bad experience I could always switch.
We are still Prime and they have yet to deny a claim for anything. She was getting $5,000 shots once a month during flu season and it was totally covered. Her $400,000+ NICU bill and my delivery and almost 2 weeks of bedrest was covered 100%.
I loved the care I got...I had a choice of Midwife team or OB, and I am SOOO glad I went with the Midwife team! We had monthly group meeting of woman who were all due around the same time as me, and I even had one of the Nurse MW's that was with me my entire pregnancy help out during labor and delivery!
I 100% agree with post-pardum care... while the nurses are helpful, they kinda leave you on your own unless you constantly ask for the help. I couldn't meet up with the lactation consultant until right before discharge, but she ended up giving me a double pump to use at home because I am Active Duty, and LO was born early.
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Historically, Military OB care has been atroticious (sp?). Which is why the military lobbyists and advocates fought to get the 2001 law allowing for full coverage under Standard.
And yes, unless your DH is E4 or below, you will have to wait a full year before you reenroll in Prime. But your fiscal year Cat Cap is only $1000 per family and that includes any out-of-pocket pharmacy costs too.
Because of this law, the various Surgeon Generals started putting money towards their MT OB care. THEN the war started and finances dried up. So any updates stopped. (don't expect them to really resume anytime soon).
And just like anywhere else, you are going to find good, bad and horrid care. It is based on the providers, institution, budget and expectations of the patient (you are probably not going to get the same cushy care at an MTF that you would get at a civilian birthing center - so don't compare).
***Please take any of the horrid stories you hear about military carat e and check to see if they happened before 2001. If so, discount them because there has been a good amount of progress before the budget cuts.
Now, I personally disenrolled from Prime for my daughters birth ONLY because I would have to pass the civilian hospital and continue on another 10 miles to the MTF. I didnt want to get caught in a stau.
HOWEVER, most of the civilian population hate hate hate that hospital. I never heard a good thing about them, and yet I had a wonderful birthing experience.
So you never know.
I delivered at a civilian hospital and my delivering OB was fabulous--but my OB of record was AWFUL. Some how, he didn't seem to think my high blood pressure was a problem. . . interesting that I ended up with the most severe form of pre-eclampsia at nearly 42 weeks along! Grrrr. . . So, its often individual doctors.
I had a fabulous Army OB when we were at Fort Irwin. After 6 months of TTC (I am of advanced maternal age, so we had to try for "only" six months before seeking help), the OB I saw knew to refer me out, but continued to follow up with me. We both PCSed before I got pregnant, but I emailed him after I had my son to share our good news. He promptly responded (within 2 hours, if I recall!) with a hearty congratulations.
He was my dear friend's OB for her pregnancy. She was having issues and he took her as his own. He was fabulous. If anyone has the chance to be seen by Dr. Brad Dolinsky, he's great! Last I heard, he was at Madigan at Fort Lewis.
It isn't just my OB experience that has been awful. All of my experiences with MTF have been awful. Let me give you some highlights.
I m/c my first pregnancy. My OB looked at me and said, "Why are you so upset? It wasn't even a baby yet." She not only was rude and insensitive, but she gave me no options. She told me that I had to take Cytotec to m/c. It was one of the most painful and traumatic experiences of my life.
When I was pregnant with DS, I started having BH around 18 weeks. When I was early in my third trimester, I had several during the time that I was waiting for my appt. They always say if you have more than 4-6 in an hour, you should go to L&D. I told the doctor. She said, "Don't worry about it." When I went to my childbirth class, the nurse told me to ignore the doctor the next time and go straight to L&D.
Another one of the OBs told me that I was going to have a premature baby. She had no reason to believe this, but she said it and scared the sh*t out of me. Another told me I was going to have a "tiny, tiny baby" just by feeling my stomach. She berated me because she felt my FT baby should "feel" bigger by that point. She accused me of starving myself and my baby. I was 38 weeks, and I had gained the appropriate amount of weight. Guess what? At 39w2d, DS was born and he was almost 9lbs.
When DS was born, I was having severe chest pains. My heartrate was in the 150s. I was having chest pains during the pregnancy, and the NP told me that they would hook me up to a monitor if it happened during labor. Well, they refused. After DS was born and I was in recovery, the nurse said, "I'm glad that things turned out okay. We were pretty concerned about your chest pains and h/r, but the EKG was not on this floor, and no one felt like going to get it. We were freaked out though because you were in heart attack range."
It's not just OB either. I hurt my neck in 2004. My PCM, on base, REFUSED to do any intervention until 2006. He finally agreed to an MRI. That was 4 more incidents later. Guess what? I had to have my c-spine fused because I had herniated discs. My surgeon, a civilian, told me had they intervened sooner, I probably never would have needed surgery. Instead, I had a surgery at 24 that most people don't get unless they are 50+.
Needless to say, I HATE MTFs.
We are suppose to PCS to Atsugi in late 2010/early 2011.
I know I already said this, but please realize it depends where you are and not all military docs are horrible, in fact many are better and ranked higher in terms of boards scores and program stats than their civilian counterparts. If you are at a huge MTF, you are most likely going to have a better experience with better docs (not saying all the docs are great- there are duds at every hospital in the country). Just like in the civilian world, the bigger and more competitive the hospital, the better residents and staff they are going to get at their location. Think about it.
So it just depends where you are stationed and what type of hospital they have there. If you are stationed somewhere with limited care and there is a major civilian hospital close by, maybe choosing to be referred off base is the best option.
I had a horrendous experience at Madigan. I was high risk and needed a certain medication that the pharmacy would only give me 2 weeks worth of at the time. So every 2 weeks I had to call and request a new RX. Sounds pretty easy but it's not. I was never able to get a hold of the OB that I was assigned too. There were times when I did not take my medication for days on end because of this. My life and my baby's life depended on it. Who knows what caused my miscarriage because they never called me with the results. But all I could think at the time was that it was a result of their neglect. I tried and tried to get a better solution to my problem and no one would work with me or seemed to even care.
After that I switched to standard and went off post. I got pregnant again 3 months later and never paid a single dime for anything including the extra ultrasounds and NST's/BPP's I had done. It scares me to think that Madigan (I'm assuming that's what she was reffering too if she's out of Ft. Lewis) is thought of as one of the best. From all of the experiences I had there, I would never think that.
This is what happened to me!!!!! Never, ever again!
Where does this stuff come from? Do you have access to budget information? Seriously, I swear some military spouses get all worked up about what amounts to gossip. The funding hasn't "dried up," in this economy, the MTFs are the places that have all the money in the world that the civilian hospitals do not. From someone very much on the inside, I can tell you that funding has most definitely not dried up, it is as free-flowing as ever. Obviously, since I am an L&D nurse at a military hospital, I get a little peeved when people bash the care they get, because honestly, I have worked at civilian hospitals and I promise you that we give WAY better care at the MTF, the nurses are better (overall) and we have more of them (because there aren't any budget constraints on staffing). I hate all these individual "I had a horrible experience..." stories. So much of this is personality dependent, I think a lot of the people who have horrible experiences at MTFs would have horrible experiences anywhere because nothing, anywhere is going to meet their expectations, because their expectations are ridiculous. People tell their so-called horror stories on here about their OB care or ER care, or whatever (or I hear them from other wives around post) and I'm like, so what? If they actually had any outside civilian experiences at other hospitals, most of them would find they have the same problems, perhaps worse, outside the military. Nothing that they describe sounds all that horrific. You had to see a bunch of different doctors? So what? Unless you move to a small town in the middle of nowhere, chances are your doctor is not going to agree to be on call just for you to deliver your baby? You think you are extremely high risk and the doctors didn't show enough concern about how high risk you THINK you are? Half the patients who come in think they are high risk are most are not all that high risk, it's actually nice to have doctors who can approach your pregnancy from the standpoint that it is normal, be grateful for it. Your doctor wanted you to VBAC and you didn't want to? Be grateful you have the option, even though it has been determined that is is significantly safer for mom and baby, many civilian hospitals still do not allow VBACs. The OBs are not there to make you feel warm and fuzzy about the choices you make, they are there to recommend the best/safest options based on their knowledge, if they made you feel bad about deciding on a repeat CS, I don't think that is anything to complain about.
IMO, the biggest problem that military healthcare faces is that it is completely free, because that means that everyone feels perfectly entitled to come to the ER every time they have a stuffy nose, or to come in to L&D to be checked out because they vomited twice or had diarrhea. Seriously, people! If you had to pay a copay, would you come in for stupid stuff like that? A lot of the reasons people complain about care at MTFs is because they have to wait a long time in waiting rooms and things like that. If people started using resources appropriately and not abusing them, the waits wouldn't be nearly as bad.
Off my soapbox now, sorry if I offended anyone, and glad that a lot of people in this thread actually had good experiences at MTFs. I appreciate that some on here recognize that there are good and bad doctors both in and out of the military, at least in the military, you can write ICE comment cards about them, that isn't always an option on the outside.
Just because you are an L&D nurse, do not assume that no one else here knows what they are talking abo ut. I am also a L&D nurse. The care WAS just that bad. I'm tired of people being scared into thinking that they will have to pay gobs of money if they switch to standard.
I know all MTF's are different, I just hope the next one we are at is better,
agree 100%
I had a bad OB experience at Darnall at Ft Hood. It wasn't because I was in an Army hospital. It's because my doctor was an_asshole. Nothing annoys me more than sweeping generalizations about military healthcare. You absolutely cannot assume that you're going to get the same quality of care by every single provider at every single facility, military or civilian, that you go to.
I could easily sit around and complain about the OBs on base. My water broke at 25 weeks.. I could totally scream and cry about how they should have seen it coming or done something more or caught it before it happened.
When I went to L/D, I got the 'worst' OB. Everyone hates her. Why? Because she's not nice. She does not explain things 10 times and will tell you whats up, even if you don't want to hear it. She is not a nice, fluffy, "you can do it! keep pushing!" type of doctor. When my water broke, she was the best doctor I could have asked for. She knew exactly what to do and got it done ASAP. She didn't beat around the bush and tell me everything was going to be okay. When I started crying and shaking, she didn't stop to hold my hand. She did her job and saved my daughter's life..
My point is to consider the situation and WHY people say negative things about the care they received.
Actually, when I worked for TRICARE and as a Lobbyist with The Military Coalition's Health Care Committee, I DID have access to the budget information.
I heard that the redistribution of the HMS funds would and did affect the Family Care Initiatives directly from Admiral Cowan himself (Navy Surgeon General at the time).
So I doubt that the information that he gave us was GOSSIP.
As for the funding now, have they (services wide) started back refurbishing the OB centers to be like the civilian birthing centers yet? Because that is what I was talking about - not a disconintuation of OB care all together (rather presumptuous to thing that is what I meant, dontcha think?)
And if you notice from the REST of my post, I stressed that Care (any type of care) is dependent upon so many variables (to include the expectations of the patient herself) that you cannot take what someone else has said as FACT across the board.
I DO believe that TRICARE is one of the best health care programs in our country - no other policy covers as much period and the cost is amazing. And there are horror stories on the civilian side too.
However, OB care HAS been poor in the past, not just gossip or annecdotal but truely studied by both the Associations, GAO and Congress - ergo the 2001 law - something that no one wanted because of the cost. But Congress felt that it was the ONLY way to force the Services to improve the on base care. (again, not gossip, but fact)
I am very glad that there are Providers like you at our bases. You are the reason why we get such good care to begin with.
yeah madigan sucks which is why i switched to standard. because they told me with prime i had to go to madigan because all the guys are deployed so no one is knocked up and they are wide open for appointments.
so i was like oh hell no! no madigan! so i switched to standard and my doctor is in lakewood at st. clare...
and yes... i have heard on numerous occasions that madigan is one of the best mtfs in the country... but they must not be talking about l&d... or parking.
Since I am the only one who mentioned this scenario I am going to address this. The doctor who performed my original c-section and I spoke at length about my options for VBAC and repeat c-section as did me and my original midwife (with my first pregnancy). We talked about all of the factors, we discussed all of the options and after talking to them we (my DH and I) decided that we would go with a repeat c-section for any further pregnancies, even though I am generally a proponent of VBACs, I have done a ton of research and have been instrumental in helping several friends/family members decide to give VBAC a try.
The OB who was pushing a VBAC had never seen me before the c-section consultation appointment. He had NOT read my record (did not know that my previous c-section had been at the same MTF I am currently being seen at) and never asked me a single question about my OB history or my family OB history. The OB I saw never talked to me about the risk/benefit analysis of repeat c-section vs. VBAC for my specific situation OR in general terms. Again, I am not against VBACs at all, I think in many/most cases they are the way to go, but I know that in my case it is not the right decision. I wish that the OB I saw for my consult had really taken the time to consult with me, talk to me about the options the risk/benefit analysis for my situation and discussed with me WHY I feel like a repeat c-section is the right choice for me. I don't feel, even a little bit, like the OB I consulted with really thought VBAC was/is the right decision for me medically and he certainly didn't take anytime to talk to me about it and make an effort to convince me of that at all.
I am lucky that I had a good midwife and OB the first time around and they really talked to me about everything. I am also very lucky that I am the type of person who does a TON of research and who knows how to make an informed and educated decision, because I certainly wasn't given much to go on by the OB I saw for my c-section consult.
I actually said that my OB experience with the MTF was good overall. There were things that were not perfect, but I had a mostly favorable experience or I would not have returned to the MTF to have my second child.
Wow! There are certainly some strong opinions on this! I delivered my daughter at Eglin in February and it was a WONDERFUL experience! I didn't arrive to the area until the end of December and had a few complications that the OB team was on top of. We were referred to a specialist in Pensacola who was great. I saw my midwife for all my regular appointments and because I ended up needing to be induced, she also delivered our little munchkin. I was in for non-stress testing and fetal monitoring twice a week from 32 weeks on and the nursing staff was awesome too. The few OBs that I did see for additional consultation stuff were great and I have zero complaints.
The labor/delivery staff was also awesome. I LOVED my nurse during L&D and the nursing staff on duty during my two days after baby were also great. The pediatrician and pediatric resident were also wonderful and right on top of a few minor issues with my daughter.
My experience was so good that I almost want to get pregnant now so we can have baby #2 here before my hubby pcs-es!!!
The reality is that there are good and bad providers everywhere. My "civilian" provider in Missouri (before moving to the panhandle) absolutely SUCKED...but I knew he wouldn't be delivering the baby so I sucked it up. But, he missed a few really key issues that Eglin immediately dealt with! Hope this helps!!! And good luck!