Alta Bates vs. Kaiser vs. midwife for VBAC/high-risk pregnancy?
I'm taking a job with a new employer, and they offer either Kaiser, or a PPO or HMO plan with another insurance company. I'm trying to decide between them, and the main consideration is whether it would be better to see the perinatal doctors at Kaiser Oakland, or the doctors at East Bay Perinatal Medical Associates (now called UCSF Benioff Children's Physicians) and deliver at Alta Bates. Honestly, I'd prefer a provider who would be willing to consider a VBAC, and even see if I could deliver at a birth center with a midwife (the non-Kaiser insurance plan may cover that), but not sure given my preeclampsia from my previous pregnancy and my age (36) that any birth center with midwives would accept me. The Farm in Tennessee would be ideal, but I unfortunately don't have the money to go there. Would there be a similar place here in the Bay? And any recommendation on Alta Bates vs. Kaiser?
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I had Kaiser. Then at 32 weeks, I switched to Blue Cross and began going to Sutter East Bay Medical Foundation. Despite clearly top-notch doctors, I found my overall care worse than at Kaiser. Scheduling was challenging as the doctors' schedules were full; appointments were expected to be very short; and they were often running behind, leading to long waiting room waits -- all of which sounds minor, but starts to add up when you have weekly appointments. It also felt like it was my responsibility to make sure I was getting the care I needed. (I even had a few moments of worrying I might simply not fit into any doctor's schedule, and then what would I do?) In fairness, perhaps this would've happened when I needed weekly appointments at Kaiser, and/or perhaps it would not have happened if I hadn't switched late -- maybe they would've scheduled me in advance for all those weekly appointments in weeks 37-41.
At Kaiser, the process of getting infertility treatment, being handed off to a regular OB, and getting access to a maternal-fetal medicine specialist to discuss prenatal testingfelt seamless. I felt like they were caring for me at Kaiser -- finding the expert I needed and getting them to call me -- whereas I was having to fend for myself, find the doctors I needed, and leave multiple voice messages via the PPO model. Appointments also seemed to run on time at Kaiser. The only part that was frustrating with Kaiser was getting scheduled for an ultrasound; for some reason, it was hard to get on that calendar, especially as we wanted to do it on the earlier side. Ultimately, we went to their Walnut Creek facility.
I have not heard birth stories from Kaiser, so I can't compare the birth experiences. I can say that at Alta Bates, I had great nurses, as did my friend. Alta Bates has a Level III (highest level) NICU, which was good to know, though we didn't end up needing it. The giving-birth part of my experience felt much more integrated than during prenatal care -- a number of specialists dropped in (e.g., a lactation consultant). Overall, I thought the birth experience at Alta Bates was excellent.
I have been with Kaiser for almost 60 years. They had some bad times in the long past but now they are great. ESPECIALLY in neo-natal issues. I had my baby at 30 weeks and he was in NICU for 5 weeks but everything was absolutely perfect. Excellent care. Kaiser is well-known for their maternity and birth care.
I highly recommend Kaiser. With my first pregnancy I had a PPO plan and a complication-free pregnancy, and delivered at Alta Bates via c-section after a failed induction. The second time around I had Kaiser and gestational diabetes. The OB who provided my prenatal care was supportive of my desire to try for a VBAC and a midwife-assisted delivery, which fortunately worked out beautifully at Kaiser Walnut Creek. I've had pretty positive experiences with Kaiser San Leandro, Oakland, and Union City as well. Good luck!
this is from NYT article April this year http://www.nytimes.com/2016/05/01/opinion/sunday/why-is-american-home-b…
. "Many studies of American home birth show that planned home birth with a midwife has a perinatal death rate at least triple that of a comparable hospital birth. (The perinatal death rate refers to the death rate of babies in their last weeks in the womb and first week outside it.)
The problem is that there are two types of midwives in the United States. The first, certified nurse midwives, called C.N.M.s, are perhaps the best-educated, best-trained midwives in the world, exceeding standards set by the International Confederation of Midwives. Their qualifications, similar to those of midwives in Canada, include a university degree in midwifery and extensive training in a hospital diagnosing and managing complications.
The other, certified professional midwives, or C.P.M.s, fall far short of international standards. One 2010 study of midwives published in The Journal of Perinatology found that home births attended by nurse midwives had double the neonatal mortality rate of hospital births attended by nurse midwives, while home births attended by C.P.M.s and other midwives had nearly four times that rate.
This second class of poorly trained midwives attend the majority of American home births. And yet they are legal in only 28 states; in the rest of the country, many practice outside the law. They used to be called “lay midwives” or “direct entry midwives,” in recognition of their lack of formal medical schooling. That didn’t sound very impressive. In a brilliant marketing ploy, they created a credential — the C.P.M. — and awarded it to themselves. Many receive their education through correspondence courses and their training through apprenticeships with another C.P.M., observing several dozen births and presiding at fewer. How woefully inadequate is this education? In 2012 the requirements were updated to require proof of a high school diploma.
C.P.M.s would not even qualify as midwives in other developed countries.
You're already high risk. Good luck but be very cautious about a midwife.