Fetal Health and Development

Mamas on Bedrest: “Out of Pocket” But In The Best Hands

March 25th, 2013

Hello Mamas,

Last post I shared with you the story of Mama H who is having some pregnancy complications and really needing some answers. So far, she has had to change OB’s and is waiting for her current OB to gather enough information to not only give her a diagnosis, but also a prognosis for whether or not her pregnancy will progress to a healthy child.

I have since heard back from Mama H and learned that she is being treated by one of the best OB’s in her town in India (India, we are getting around!!). As would be expected she is extremely anxious and wanting to know if her baby will survive (If you’ll recall, she lost the child she was carrying a year ago.).

In our last post I reminded Mamas on Bedrest not to be shy about getting a second opinion if their questions and concerns are not being met to their satisfaction. I still hold to this recommendation because I believe that having as much information as possible when making potentially life changing decisions is critical. I am also a strong proponent of not letting money be a deciding factor. Here’s why.

Being that you are on bed rest, it’s safe to assume there is a suspected complication with your pregnancy. You need to see a specialist, but the specialist recommended is $300 and not on your insurance plan. Do you pay out of pocket or wing it? Let’s look at the possible outcomes.

1) You hem and haw, but decide to shell out the cash for the peace of mind. You meet with the specialist and while your condition is abnormal, it does not warrant any major treatment or intervention other than bed rest. You go on to have an uneventful bed rest pregnancy, deliver your baby at 39 weeks (after spontaneous initiation of labor) and have a healthy baby.

Compare this scenario to what could have happened.

2) Mama A is going along in her pregnancy and at what was to be a routine 2nd trimester prenatal visit, her OB recognizes something abnormal. She recommends a Level  II ultrasound. She refers Mama A to a special radiology clinic that does the ultrasound but neither the Maternal Fetal Medicine specialist in charge of the center nor the ultra sound is covered by insurance. When all is said and done, this entire visit will be nearly $750. Convinced She can’t possibly afford the procedure and really “liking” her OB, Mama A decides to stick with her and trust that she will attend to all her needs with no complications.

Mama A goes into labor at 32 weeks. When she gives birth to her son, he is noted to have a loud heart murmur consistent with a hole in his heart that requires major medical attention. The neonatologist who attends the birth mentions that had this abnormality been detected during the pregnancy at the Level II ultrasound, Mama A would have been started on  prescription medication and the heart defect would likely have closed itself. Mama A’s little boy is treated and does go on to lead a healthy normal life. But Mama A’s little boy spent several weeks in the NICU and by the time he went home, Mama A’s family was some $500,000 in debt.*

If Mama A had had the Level 2 Ultrasound and taken medication she may have spent a total of $1000. Now I am not saying that this is a trivial amount of money. But I am relatively sure that Mama A could have weathered $1000 far better than $500,000.

Sometimes the best answer to a situation is not the easiest, most obvious or most inexpensive answer. Sometimes that best answer at the time really hurts and blows your budget to bits. But it has been my experience that to be a “out of pocket to be in the best hands” has always served me well. Everyone has to make their own decisions and I am in no way trivializing expenses (I know debt intimately!!!), but I am suggesting that we all look beyond the monetary for the true value for which we seek.

 

*This is a totally fictitious scenario and Mama A is a totally fictitious mama!!!

Mamas on Bedrest: Worry Busting

January 14th, 2013

I’m tired.

I spent a large part of the weekend worrying about some pending bills, and by the time I sat down to my desk today to address them, the issues had resolved themselves! I had worried for nothing and am now sleep deprived as well. Lesson learned? I’d love to telly you yes, but I have yet to truly kick the “worry habit”.

Worry is such a precarious thing. On the one hand, we all intellectually know that worrying serves no benefit. As the saying goes, “What can you really change by worrying?” I worried all weekend and on Monday morning, the situation had not initially changed. My worrying had had not effect. When things did resolve, all my worrying and not sleeping had been for naught. I tried not to worry, but I have to say, I have a very vivid imagination and I had all sorts of outlandish outcomes for my situation from the mundane to “the boogie man” coming to get me ran through my head. When it really came down to it, I was afraid of the unknown and worried that whatever happened, I wouldn’t be able to handle it.

I imagine that many of you mamas are in a similar situation. I worried with both of my pregnancies as I became pregnant with each of my children following a miscarriage. When I was pregnant with my daughter, my first, I would move around holding my stomach in my hands-as if I could somehow prevent losing the pregnancy in that way. I spent a lot of frantic nights worrying about her and in the end, she was born prematurely at 36 weeks, 6 days.  I cannot say that if I had not worried she would have stayed in longer. No one can say that for sure. But I did go into labor with her and given the information from my previous blog post, I have often wondered if my worry did in fact cause my cervix to ripen, for labor to begin and for her to be born early. But now with a healthy, sassy 10 year old I don’t think it really matters.

But I want to put this out there to you all as a potential worry buster. As I was stressing myself out this weekend and my mind was cooking up all kinds of crazy scenarios, the thing that calmed me down the most is when I confronted my worry head on. When I came into my office this morning, I sat down, looked at my bills, looked at my finances, looked at a couple of other responsibilities and decided to get clarity. I checked my balances on my bank accounts and my bills. I made a couple of calls and found out that I actually had more time than I thought with a couple of items. With that, I only had 1-2 things requiring immediate attention. I then sat down and contemplated what could be moved/pushed back/ borrowed from/etc…And I found that I did in fact have some funds that I could tap in the event of an emergency. With that realization, I felt much better and proceeded to do a few other tasks on my to do list. When I returned to my computer later, funds that I have been awaiting had been deposited in to my account. Now nothing will be late and I don’t have to do the “financial shuffle”.  I worried in vain.

Now you may be saying, “But my baby’s life is at stake.” I hear you. I’ve been there. But worrying won’t help your baby and may quite possibly harm him or her. What I learned from my own most recent experience is that if you can anticipate the outcomes, you can make concrete plans which often alleviate worry. So for example, if you are worried about preterm labor, ask your health care provider at your next office visit what would be the possible outcomes if my baby were to be born today? The information may be hard to take, especially if you are in the 20-26 week range. But knowledge is power and you can at least mentally prepare in the event of preterm labor; pack your hospital bag, plan how you’ll reach your partner, how you’ll get to the hospital, who will take care of your older children, etc… So that you don’t have to ask at each office visit, you can check out websites like WhatToExpect.com and BabyCenter.com. Each of these sites provide week by week information about fetal growth and development.

Some mamas are worried about their finances (boy can I relate!) being on bed rest. If that is the case, sit down with your partner, with your check book, your accounts and see exactly where you are financially. If you anticipate being short for payments, call the providers of services. They will likely work with you if you have an account in good standing. I have found that most providers would much rather have some payment than no payment!

If you are worried about childcare if you are admitted to the hospital (and not already there), seek and secure childcare now. See what help you can get from family and friends, and then supplement as necessary from fee for service sitters.

I think you get the picture. My mother used to tell me that worry is imagination misplaced. I think that there is a lot of truth in that statement. When I was able to ground my fears in reality, I was able to release the fear. And I am not oblivious to the fact that there are some instances where worry is somewhat justified. As you are looking at your situation and your options, there may not be good options. While I won’t say go ahead and worry, I will say that these are the situations about which to put your energy. And always remember, we are here to help with our coaching program for mamas needing assistance or if you need a quick review, you can have a one time 30 minute Complimentary Bedrest Breakthrough Session. Learn about both on our website or send an e-mail to info@mamasonbedrest.com. I also encourage you to use our Facebook Page (for non private items) as the mamas there have come up with some great tips and referrals. And if you still find yourself worrying and anxiety ridden, do discuss your feelings and concerns with your health care provider. You may need to consider consulting with at therpist. Perinatal depression is real and many women suffer in silence. This is extremely detrimental to both mamas and babies! Help is out there, please seek it! Again, if you are unsure, ask your health care provider for assistance.

I hope this helps! Here’ s to not worrying!!

Mamas on Bedrest: Common Sense Isn’t Very Common

September 24th, 2012

My dear friend Renee has a saying that is so apt, “Common sense isn’t very common”.

The first time she said this, we both busted out in laughter and shook our heads at whatever crazy occurrence had just transpired. Since that time, I have said to myself time and time again regarding various occurrences, “Common sense isn’t very common.”

But when I see the lack of common sense in medicine and science it really gives me pause. I recently got a MedScape alert in my e-mail inbox entitled, “Prenatal Diagnosis: What About the Mother?”, and it was a short video commentary by Jack Rychik, MD, Director of the Fetal Heart Program at the Cardiac Center of the Children’s Hospital of Philadelphia. Dr. Rychik was explaining how medicine has progressed to where we can now make diagnoses of congenital heart abnormalities in fetuses as early as 14-16 weeks.  In his video he states,

“Making the diagnosis of congenital heart disease before birth provides multiple benefits. We can offer education to families. We can, most importantly, make a plan. When these babies come to term and they are ready for delivery, medication, care, and management can be offered to optimize the overall outcome for these patients.”

Dr. Rychik goes on to say.

“What we have appreciated of late is that, by offering these fetal echocardiography services and making a diagnosis [of congenital heart disease], we create a potential for maternal stress. In essence, these are mothers who have been given this diagnosis in their fetus but then there are months that elapse before actual management takes place. This is a period of time with potential for significant stress.”

At the risk of seeming snide, can we all give a collective, “Duh!” How can one not realize that if you tell a mother that there is something wrong with her child, she is going to be upset? How can one not realize that if you tell a pregnant mama that there is something wrong (and as serious as a congenital heart abnormality) with her unborn child, that she’s going to be upset? When I read his statement, “we have appreciated of late…” Really?? You’re just getting this?? Once again, common sense isn’t very common.

I am as appreciative as the next person of the advances that have been made in science and technology that enable advances in diagnosis and treatment in medicine. But I am even more concerned that medicine and science have forgotten that for all their ease of knowledge and function, technology and science are being used on and for people. Medicine and science are not just fascinating and interesting disciplines. At their core, and I am speaking specifically about medicine here, they are about improving the human condition. Medicine is (or should be) about making people feel better, easing their pain and restoring them to a state of good health. This should always be the guiding principle whether we are talking about improving the lifestyle of a diabetic, improving mobility and function in a paraplegic or making an early diagnosis and treatment plan for a pregnant mama and her unborn baby. To forget the human element in favor of medical science is a travesty. We cannot lose the human element to medicine.

When I first started Mamas on Bedrest & Beyond, I was (and continue to be) adamant that the focus be on mamas. So often with obstetrics and pregnancy the focus shifts to the baby and mamas seem to be relegated to ‘gestational carriers’. While I don’t believe that any obstetrician or women’s health care provider ever intends for this to happen, many mamas begin to feel secondary within their pregnancies and this becomes even more pronounced when the pregnancy becomes high risk.

The goal with Mamas on Bedrest & Beyond has always been to be a support and resource for mamas. For mamas locally, that can mean home visits to perform personal care services such as grocery shopping, running errands, light housekeeping, etc… For mamas online, that means support via answering questions, social interaction, workshops and webinars and teleseminars.  Having had 2 high risk pregnancies, I know what it feels like to be spoken of in the third person or to have the baby and pregnancy made tantamount with you feeling as if you’re “just there”. We know that you are doing the absolute best that you can and our goal is to provide as many tools and resources as possible so that you can continue your pregnancy as far along as possible.