Obstetric Options in Rural Colorado

If you haven’t already heard the great news, I am having another baby in May.  Yes, Baby6. It shouldn’t be a shock.  We’re Catholic and married and healthy and of child-bearing age.

Finding out that I am having a baby should be very joyful.  Kevin and I are delighted. However, there are two things that have put a damper on our happiness.

First, this is our sixth baby.  While I look at it as God pouring His abundant blessings upon our family, some loved ones don’t seem to have the same opinion.  This hurts.  From the no congratulations at all, to the half hearted congratulations, to the “I hope this  is your last one”, to the “I feel so bad for your other children, they are still babies”, it seems a lot of people have something to say and it isn’t always nice.  This gets to me.  I knew there would be naysayers and that’s why I have been avoiding telling people.  I normally like to tell people as soon as I get that plus sign, but this time I knew that there would be more naysayers and I did not feel like dealing with it.  I have been suffering through the first trimester nausea and tiredness in silence.  I am a very outgoing sharing person and for me to not be able to tell you about my sorrow of sickness and my joy of expecting is quite torturesome.  I have kept it under wraps because of the naysayers.  Although well-meaning, the naysayers are hurtful.  Also, if it is a my-choice-my-body culture, why is having a sixth baby suddenly fall out of the my-choice-my-body realm?

The second thing that has been putting a damper on the joy of expecting is that I wonder where I am going to have this baby.  I will spend the rest of this blogpost talking about obstetric options in Rural Eastern Colorado.  Obamacare was supposed to increase access to healthcare.  You forgot about the Colorado Prairie, President Obama.  I guess I shouldn’t be surprised.  The Front Range and Mountains forget about us, too, so why would the president remember?

My first baby, SonOne, was born at St. Francis Medical Center on the eastern edge of Colorado Springs after a failed home birth.  I remember we found a midwife quite easily.  We spoke to a few and were drawn to two.  We interviewed them both.  It was no-brainer on who to pick.  TheMidwife, as I’ll refer to her here, had had umpteen children of her own, was married for over thirty years, was a Christian who seemed to share our values, etc.  We clicked with her personality-wise, too.  TheMidwife lived in Colorado Springs, but we combined grocery shopping with prenatal appointments.   Although my first home birth failed, I delivered my other four babies at home with TheMidwife.  Those labors all went relatively smoothly and we bonded more with TheMidwife and grew to love her more and more each time.  Shortly after I had Baby5 (Son3) TheMidwife retired.  This means I need to find another obstetric care provider for this baby.  That should be simple.  Let me tell you that here on the prairie, there are few and far between obstetric options.

My first option would be to find another midwife.  Of course I realize that no one would be TheMidwife, but finding another midwife should be easy, right?  Well, wrong!  Actually, it seems that like malls, Wal-marts, and real stores, midwives in Colorado are all concentrated in the Front Range area and a few are scattered in the mountains.  For midwives, real stores and even the state legislature, the Colorado Prairie just does not exist.  “Oh, I’ve been out there,” one said.  “I delivered a baby in Peyton once.” Peyton is right outside of Colorado Springs.  I live maybe 70 miles further east of Peyton.  “Do you live close to Kansas?” While I realize the 37th Parallel is pretty unimpressive, I still live way closer to you than I do Kansas. “Really?” Yes, really.  After calling about every midwife in Colorado Springs and Denver, I actually found four who would be willing to come out here.  That was great.  They all seemed like nice ladies.  No one was TheMidwife.  The problem?  They were all super expensive, about double what TheMidwife charged me.  TheMidwife, because she had known us for so long was pretty flexible on her payment terms, too.  Starting over, I realize I would have to again build a rapport with a new midwife.  I am off the street, or in this case off the prairie. They bill insurance, but after payment and after the birth.  United Healthcare, my insurance company, has a tendency to spazz out.  I don’t blame midwives for not trusting them and wanting their money ahead of time.  I don’t trust United Healthcare either.  I cannot trust them to reimburse.  I just can’t afford the price of a new midwife.  As I said, those four rare midwives who are willing to come out here are DOUBLE the price of TheMidwife.  That’s a lot of cash, cash I don’t have.

My second option would be to see Dr.Denver or his partner Dr.DenverPartner.  They are OBGYNs who practice in downtown Denver.  Once a month each, they come down to the Lincoln Community Hospital in Hugo.  I could schedule my prenatals in Hugo, just ten minutes away.  Labor would be in their affiliated hospital in downtown Denver.  The thought of rush hour traffic in labor after a two hour journey scares me.  I already rode in a car in labor when I had to transport to the hospital for SonOne.  It was torture.  I do not look forward to repeating that experience.   Denver rush hour traffic on top of that? Nope.  That is an experience that I can live without.
Dr.Denver and Dr.DenverPartner are the only two obstetric doctors who come to Lincoln County.  They are both part of the same practice.  I saw Dr.Denver once when I was expecting my second baby, DaughterOne.  I saw him during one of his monthly visits to the Lincoln Community Hospital.  He did my initial bloodwork and first prenatal visit.  Shortly after that visit, I changed my health insurance and Dr.Denver was no longer on the network.  I opted for a different OBGYN who was in Colorado Springs and on the network.  (I was kind of scared during that pregnancy because I had had such a bad experience with SonOne’s delivery.  I doubled up my prenatal care with TheMidwife and an OBGYN. )  I never saw Dr.Denver again. I received a bill from the Lincoln Community Hospital for the copay, which I paid.  A few years later, I happened to check my credit report. There was a negative item on the credit report which up until that point I had been unaware of.  After further investigating, I realized that that negative item was an unpaid co-pay from Dr.Denver’s office.  I had never been to the actual office and was unaware to even expect a bill from that particular doctor practice. TheDoctorOffice had misread my address and I had never received my bill.  The bill was returned to them.  Instead of calling the Lincoln Community Hospital or my phone number which was also on the same paperwork, TheDoctorOffice had simply sent me off to collections. The collection agency had made no attempt to get in touch with me.  Checking my credit report was the first time I had even suspected that the copay paid to the Lincoln Community Hospital was not the sole copay.  Upon doing a lot of investigating and finally learning of the due bill, I immediately paid TheDoctorOffice their $42.  I spoke to Dr.Denver himself who assured me that the information would be removed from my credit report and that the problem was taken care of. I took him at his word.  Over another year after that, I checked my credit report again.  (I have since learned to check it more often.)  The outstanding amount was still showing as outstanding and as a negative unpaid item. What?! That same baby that I had seen him for the initial prenatal appointment that time was potty trained and this lie on my credit report was still there only because TheDoctorOffice staff cannot read an address properly and further cannot properly notate that they received a check.  In our modern society, your credit report is your reputation.  Your credit report impacts jobs, insurance rates and credit worthiness. Dr.Denver failing to correct his mistake is calumny.  I sent Dr.Denver an email (online to his practice) and left him a phone message.  When he called me back he told me that people don’t expect to pay for healthcare and “if you paid” and all this bologna.  No, I had paid 18 months before that and had a printout from my bank’s online bill pay to prove it, which should have been in front of him since I had sent that in the email.  He called me back in a few days and said he investigated, found I had paid (duh) and would reverse his calumny.  No apology.  I did write to the Lincoln Community Hospital CEO to make him aware of the situation.  He was very sympathetic and apologetic, however, it really wasn’t directly under his supervision since Dr.Denver is kind of like an outside contractor with his hospital.  May the CEO’s soul rest in peace.  If I cannot even trust Dr.Denver’s office staff to read my address correctly or even slightly investigate returned mail, how can I trust them to read my chart correctly?  If Dr.Denver cannot be trusted not to falsely defame my character for a total of three years, how am I supposed to trust him to bring my precious new baby’s life into this world? The truth is I don’t trust Dr.Denver and by extension Dr.DenverPartner. They are on my insurance network now.  Even if I had no fear of riding in the car for two hours in labor and then through downtown Denver traffic, Dr.Denver and Dr.Partner are not an option for me.

My third option is to see the nurse practitioner in Limon through the second trimester and transfer to a different obstetric provider later in my pregnancy.  This was my plan, at least temporarily.  I would see TheNursePractitioner and at least get prenatal care until I decided what I was going to do.  I called up the doctor’s office in Limon.
“Hi, this is Laura. I need to make a prenatal appointment with TheNursePractioner.”
“What’s your date of birth?” the secretary-appointment-maker-lady asked.
I told her.
“The first prenatal appointment I have available is…”
I made the appointment.  It was 2.5 weeks from then.  I was getting dangerously close to the point in my pregnancy where I should have already seen a provider.  She assured me that that was the first available.
The day before the appointment they called me to confirm the appointment. “Yes, I will see TheNursePractitioner tomorrow at 11 am.”  I told them.
A few hours later I got another call.  “Laura, you cannot see TheNursePractitioner tomorrow. She only sees low-risk patients, patients up to 32.”
“32?” You remember you asked me my date of birth when I called to make the appointment, right?
I asked if TheNursePractitioner would at least see me to do bloodwork.  Nope.
“TheNursePractitioner is not an OBGYN and you are high risk.”
What? After five babies, I think I got this baby thing down.
Yeah, so apparently since I am at the ripe ol’age of 36, seeing TheNursePractitioner for some prenatal care is not an option for me, either.

Lincoln County is bigger than the state of Delaware.  There is nowhere to have a baby here other than your own home with those rare four midwives who were willing to come out here. The OBGYN that comes here occasionally and delivers in Denver is a liar. TheNursePractitioner that sees mothers for prenatal care won’t see me because I am over 32.

Then I thought, Maybe a birth center wouldn’t be so bad.  A friend of mine had two of her babies in birth centers back east.  Birth Centers are kind of between home and a hospital. They are staffed with midwives.  Sure the closest one is in the Denver area, but maybe if I left early enough, it wouldn’t be so bad.  I could have a water birth.  It’s not like it’s a hospital. Plus, they take my insurance and I wouldn’t have to lay the cost out.  A birth center might be a nice compromise.  Well, wrong, Laura.  Apparently I am a grand multip. I had never heard that word before.  A grand multip is someone who has had five or more babies.  Since this is Baby6, and the Birth Center does not accept grand multips, the Birth Center is not an option for me either.  Just for giggles, I called the Birth Center in Boulder, too, and they also do not accept grand multips.

Sure I could show up in labor at the Lincoln Community Hospital.  My husband was born there back when they delivered babies and he turned out OK.  I could also drive 80 miles or so to Burlington Colorado or 100 miles to Goodland Kansas and deliver at their dinky hospitals, but they are just dippy hospitals in dippy little towns.   If I’m going to drive that far to a hospital, I may as well go to a real hospital.

So that leaves me my last option.  I could deliver at a real hospital at the edge of Denver or Colorado Springs.  I would have to get my prenatal care up there, but that’s not a whole lot different than traveling to a Front Range city to a midwife for prenatal care.  I just dread the thought of traveling in labor.  With a hospital birth, I wouldn’t have to lay anything out. Insurance would cover it all at 100%.  We will have made our out-of-pocket maximum for our plan year (which we always do) and I can have my baby for free.  I can go with a hospital-type midwife, who in the state of Colorado have different schooling and different licensing than home birth-type midwives. They would have to have a less interventionist policy than an OBGYN.  If I go to the hospital-type midwives at the University of Colorado Hospital, I could even still have a water birth.  I still dread the two hour drive in labor, but at least University of Colorado Hospital is on the eastern edge of the Denver area.   This is what I am leaning towards right now.  I have seen a hospital-type midwife there for my first prenatal appointment. The nurse drew blood.  I had an ultrasound.  Everything is looking great.  At least I am receiving prenatal care now.

So, yes, I am expecting Baby6.  Thank you.  I don’t want to hear anything but your well wishes. If you have something that’s not nice to say, just don’t say it.
Every baby is a miracle.  Every baby is a creation of God in His very own Image and Likeness. Every baby has an immortal soul. God has entrusted Kevin and me with another beautiful little one to teach to know Him, to love Him and serve Him in this life so he can be happy with Him forever in the next life.  That is it right there.

I am overjoyed at expecting this new little one, but I’d be lying if I told you I wasn’t feeling shadows in my joy, the shadows of the naysayers and the shadows of the lack of obstetric options.

Update: I switched my birth plan to a homebirth midwife and had the baby at home.


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