Delivery before 32 weeks/hospital change

jezebel57 · July 2013

Hi all,

My hospital that my OB and MFM work out of is a level II NICU. I can deliver there after 32 weeks. There are several hospitals about 30 minutes north of that one (an hour from my house) that are level III NICU's. I want to try to be as prepared as possible incase there is an emergency. Does anyone have any experience with this? I'm wondering if I should tour that hospital, send them my records, register with them, etc... just in case? Also am googling and seeing issues with insurance may be a problem?

Just looking for any advice. I obviously have a while but am a planner as much as possible. I am meeting with my MFM next week and will ask them what they recommend as well.

Jez

amd1982 · July 2013

I had this exact same question and concern while pregnant. We ended up having iugr in twin 1 and diminished cord flow to both which caused me to have to see an mfm one hour from our house and deliver at that hospital. It sort of made the choice for me however I was already having second thoughts about delivering at a level II. Nothing against them. It was just our circumstances required a nicu. Here's what i did. We interviewed and spoke with a few of the level II nursery nurses before making our choice. We found out what their capabilities were and where they send the baby or babies if they cannot care for them. We also asked about transporting me to be with the babies if they needed to be moved.

Again we ended up going to a level III because of our circumstances. I can tell you I felt a lot more comfortable. But that's just me. Twin births usually are somewhat planned so I didn't have that worry about going into labor and not making it in time. On the average twin labors are longer anyway. Good luck with your decision! And good for you being a planner. I was the same way.

jezebel57 · July 2013

amd1982:
I had this exact same question and concern while pregnant. We ended up having iugr in twin 1 and diminished cord flow to both which caused me to have to see an mfm one hour from our house and deliver at that hospital. It sort of made the choice for me however I was already having second thoughts about delivering at a level II. Nothing against them. It was just our circumstances required a nicu. Here's what i did. We interviewed and spoke with a few of the level II nursery nurses before making our choice. We found out what their capabilities were and where they send the baby or babies if they cannot care for them. We also asked about transporting me to be with the babies if they needed to be moved. Again we ended up going to a level III because of our circumstances. I can tell you I felt a lot more comfortable. But that's just me. Twin births usually are somewhat planned so I didn't have that worry about going into labor and not making it in time. On the average twin labors are longer anyway. Good luck with your decision! And good for you being a planner. I was the same way.

Thank you! I already talked to my OB about having a scheduled c-section (I would prefer that due to other health issues) and he agreed. I'm just worried incase I end up having PTL before the 32 weeks what would I do. I am considering 2 specific level III NICU hospitals and I believe my MFM works out of the one so that would be much better as i'm sure they would take me with no problem (although I really would prefer the other hospital). I just really don't want to change OB's as I've had this guy as my GYN for over 5 years and really trust/like him. I appreciate you sharing your story with me!

CNYBride05 · July 2013

IMO, you just need to see what happens. There is no predicting and I think it would be silly to make a change now "just in case." Not all multiples pregnancies are high-risk.

I'm also a planner, but this pregnancy, from conception through pending induction, has been a lesson in relinquishing control/realizing that we really have no control over any of this. It's a teaser of what's to come with parenthood.

If you end up delivering early, your docs will be sure to get the appropriate records where they need to be. Try to sit back, relax, and enjoy the ride you've fought so hard to get on

Brummy14 · July 2013

Way to plan in advance -- we didn't. We did all thr tours, planning, etc with the hospital with the Level 2 Special Care nursery -- and I just ended up getting transferred from there to one with a Level 3 NICU when I went into PTL. Luckily, the two level 3 NICUs in the city are in AMAZING hospitals, and I knew I would be in good hands, regardless. Honestly, everything happened so dang fast, I didn't have time to lament not "planning for the worst."

Had I done all of that pre-work, however, I'm not sure it would have made a ton of difference -- the way things went down, I didn't get much (any?) say in who delivered me (I had an emergency c/s), when it happened, or anything. I was just thankful I was able to keep them in long enough to get me to the Level 3 NICU, and get those steroid shots in!

jezebel57 · July 2013

CNYBride05:
IMO, you just need to see what happens. There is no predicting and I think it would be silly to make a change now "just in case." Not all multiples pregnancies are high-risk.
I'm also a planner, but this pregnancy, from conception through pending induction, has been a lesson in relinquishing control/realizing that we really have no control over any of this. It's a teaser of what's to come with parenthood.
If you end up delivering early, your docs will be sure to get the appropriate records where they need to be. Try to sit back, relax, and enjoy the ride you've fought so hard to get on

Thanks! The relinquishing control is hard and I was just worried if I have to all of a sudden get transferred or go to a hospital with a level III how that would work with them having never heard of me.

jezebel57 · July 2013

Brummy14:
Way to plan in advance -- we didn't. We did all thr tours, planning, etc with the hospital with the Level 2 Special Care nursery -- and I just ended up getting transferred from there to one with a Level 3 NICU when I went into PTL. Luckily, the two level 3 NICUs in the city are in AMAZING hospitals, and I knew I would be in good hands, regardless. Honestly, everything happened so dang fast, I didn't have time to lament not "planning for the worst."
Had I done all of that pre-work, however, I'm not sure it would have made a ton of difference -- the way things went down, I didn't get much (any?) say in who delivered me (I had an emergency c/s), when it happened, or anything. I was just thankful I was able to keep them in long enough to get me to the Level 3 NICU, and get those steroid shots in!

I know one can't really "plan" with deliveries of twins, and that's why I'm just trying to do everything within my control now that will make it easier. even if it means just making sure the level III has my insurance info would make me feel better. Hopefully I'll get some good advice from my MFM as I'm sure i'm not the only one to go through this.

CNYBride05 · July 2013

jezebel57:
CNYBride05:
IMO, you just need to see what happens. There is no predicting and I think it would be silly to make a change now "just in case." Not all multiples pregnancies are high-risk.
I'm also a planner, but this pregnancy, from conception through pending induction, has been a lesson in relinquishing control/realizing that we really have no control over any of this. It's a teaser of what's to come with parenthood.
If you end up delivering early, your docs will be sure to get the appropriate records where they need to be. Try to sit back, relax, and enjoy the ride you've fought so hard to get on
Thanks! The relinquishing control is hard and I was just worried if I have to all of a sudden get transferred or go to a hospital with a level III how that would work with them having never heard of me.

Everything works out. I assure you.

Mrs. Alice · July 2013

I was hospitalized for over a month before I delivered at an out of network hospital 2 hours away. The babies then spent 5 out of 10 weeks of their NICU stay in that same hospital. I definitely didn't originally plan to deliver at that hospital since the one we planned on had a level III NICU but only took 28+weeks/1000g+ babies but there was no MFM associated with that hospital. If it so happens that you need care beyond what the hospital you are registered with and is in network with your insurance, insurance will typically give you the same rate as in network if you call them for approval. This is what occurred in our case anyway. I probably wouldn't spend too much time thinking about this but you may want to ask the opinion of your medical providers.

PurpleIris30 · July 2013

I'd probably just start by asking your MFM next week what the practice and procedures are if you deliver before 32 weeks. I bet this will answer a lot of your questions on how it would work, and then you can double check on insurance coverage.

jezebel57 · July 2013

thanks everyone, i really appreciate the opinions... it's so hard to not know the answers to things! i feel like i knew EVERYTHING about infertility and now am an idiot when it comes to being pregnant. it's driving me crazy.

thanks for bearing with me.

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