Working with a Patient Advocate on a Budget
Patient advocacy can be life-changing for people. You get one-on-one support from an expert in navigating the medical system. Your advocate works for you, not a medical provider or facility. The resources, skills, and unmatched support that a good advocate can offer is as good as gold. There are folks that desire patient advocacy, but find the cost to be prohibitive, so they don’t reach out. Patient Advocacy is an investment, and a good advocate will help you budget your time and resources effectively. Here’s how to make it work:
First, let your Advocate know that you are on a budget before you hire them. This can be discussed in a consultation, or via phone and/or email communications. The business I work with, Lost Coast Advocacy, offers free hour-long consultations. It’s okay to have consultations with multiple advocates to find the right fit for your needs and your budget! Don’t be afraid to shop around. Don’t be shy about asking questions. The Patient Advocate should help you determine how many hours they can offer based on their rate and your budget.
Determine what you are looking to get out of working with an Advocate. A focused, clear objective is always useful. Your advocate can help you decide what your most important needs are, should you require support with that.
Next, create a game plan. What steps need to be taken to get your needs met? What is your role and what is your Advocate’s role in this? Do they anticipate being able to fulfill your desires within the limited timeframe?
Ask for resources! Your Advocate may have an abundance of pertinent resources at their fingertips. Since time is limited, it is crucial to have tools to continue advocating for yourself once you part ways with your Advocate. You can also ask them to help you strategize next steps to take for when you are no longer working together.
As an example, let’s talk through a fictitious scenario. Carmen has a medical history of years of back and shoulder pain from the weight of her breasts. She suffers through the days, despite taking an excess of over-the-counter pain medications and trying remedies like heat, massage, and a myriad of different supportive garments. Carmen has done some research and is interested in a breast reduction to ease her pain and take some stress off her chest and back. She had a consultation with the only plastic surgeon in her area. A pre-authorization was filed with her insurance, Medi-Cal, but was denied on the basis of deeming this breast reduction cosmetic instead of medically necessary.
Carmen does not know what to do next and her plastic surgeon is so overwhelmed with patients that they are neglecting to help her appeal this. She reaches out to a Patient Advocate for help but is worried because she her budget is tight. After discussion with her Advocate of choice, she determines she can afford to pay for 2 hours. She is worried this will not be enough. The Advocate reassures her that they can make this work. They determine that the primary objective is to file an appeal, and get her insurance to pay for the breast reduction.
The Advocate follows through with filing the appeal. They learn that there was insufficient documentation to prove the procedure is medically necessary. The Advocate assists in getting the clinic to take and submit photos to the insurance- it takes 3 phone calls to make this happen! The Advocate also gets medical records that support the claims of years of pain related to the size of Carmen’s breasts. Eventually, the claim is approved and Carmen gets scheduled for surgery!
Carmen’s Advocate sends her resources to prepare for surgery and recovery. Her Advocate also checks in on her after the surgery. Their time together is complete. Carmen got her surgery, and resources to help her now that her time with the Advocate is up. She is relieved and feeling so much better now. The investment and leap of faith was worth it!
In summary: A good Advocate will be honest about what they can realistically support you with in the timeframe that works with your budget. They will provide resources to help you along the way, and for once you are no longer working together. They will help you meet your needs!
Please reach out if you have any questions about Patient Advocacy. We want to help nonjudgmentally, and to support you as best we can. Our role is to help you, and we are happy to do it! Take care.
Birth Plans - Perspectives From a Midwife and Childbirth Educator
Birth plans are a frequently discussed topic in childbirth education classes, in birthing spaces, and even in day-to-day conversations. As your belly expands, so does the curiosity of those around you, and it is not always welcome. That being said, the topic feels nearly unavoidable. So, let’s talk about it.
It’s hard to talk about this in a way that is completely unbiased because, well, we all have our biases and individual anecdotal experiences. My background is as a licensed midwife attending home births and freestanding birth center births. I am also a childbirth educator and initially trained with Lamaze, although that’s not really the model I use to teach childbirth education classes anymore.
First, what’s in a birth plan? This is a non-exhaustive list of topics often in the birth plan: ambiance, support people, pain management, labor and birth positions, fetal monitoring options, interventions such as AROM (Artificial Rupture of Membranes AKA breaking your water) and episiotomy, methods of pushing, who is catching the baby, umbilical cord clamping, newborn medications and procedures, lactation, and more.
Here’s my nuanced take: Sometimes birth plans set people up for failure. There’s a lot to be said about overplanning, underpreparing, and the grief that comes with an unfulfilled plan.
At the same time, I hold true that sometimes birth plans are empowering and result in a very positive experience. That often goes hand in hand with other types of preparation for birth, but not always.
The first half of this blog post with discuss my gripes with birth plans, and pitfalls I have seen over the years. The second half will discuss recommendations for improvement and resources. And, remember, this is my opinion based on my anecdotal experience. It is okay if your experience differs. Informed and empowered choice is most important, above all. My hope is that this information will help you decide what is best for you and your family. My hope is that you will feel more educated and empowered after reading this.
Birth Plans - My Complaints & Cautions
Sometimes birth plans lure people into a false sense of preparation.
It can tempt people to create unrealistic, inflexible expectations.
There can be grief when the plan doesn’t work out as envisioned.
Some providers won’t read them.
Let’s break this down one by one.
Sometimes birth plans lure people into a false sense of preparation.
There are two ways I have seen this play out. The first scenario is that someone, often a first time birth-giver, chooses to forgo a childbirth education class and only makes a birth plan. There are many free templates and examples online that people will borrow to make their own birth plan. One of the issues with this is that people can select preferences that they are uninformed about. This can result in dissatisfaction with their birth experience. Sharing your birth plan with your provider in advance allows them to ask questions and clarify the birth plan that you’ve created.
Creating a birth plan is not the same thing as preparing for labor. The birth plan is meant to be a guide, not a rulebook. Labor is an endurance game, especially if you are birthing unmedicated. It’s not just about knowing what you want, it’s about knowing how to get there. The second scenario that I’ve encountered is someone who truly believes that their birth plan and support people are all they need. These folks tend to be quite confident, and I’ve found that they also tend to be enmeshed in certain social media communities that promote only needing an innate trust in your body to give birth. Trust your body, but also please understand that labor and birth are unpredictable and external forces cannot always control the outcome.
It can tempt people to create unrealistic, inflexible expectations.
It is wonderful to know what you want, and to be assertive about it! It is not wonderful to be inflexible. Maybe you’ve really done their research through a childbirth education class, or other reputable resources. That being said, there can be a trap here, too. Overattachment to a dreamy birth can have emotional and medical consequences.
Delaying necessary medical care because it contradicts the birth plan can be harmful in the short or long term. The stress of deciding whether or not to alter the birth plan is not conducive to the labor process. Sometimes, decisions have to be made quickly. When the birther and their support team are set in achieving the birth plan as written, this can hinder urgent decision making. Changing the birth plan can result in grief that lasts for weeks, months, or years. More on that below.
There can be grief when the plan doesn’t work out as envisioned.
This is by far the most common issue I see with birth plans, and my biggest gripe with them. Having a baby is a unique, special time in someone’s life. There is often a lot of anticipation, nerves, and desires. Some people’s birth plan is simply “healthy parent, healthy baby”. Other’s is pages of wants and needs. Know what you want. Be firm in it. But, please have an open mind. Find a provider that you trust, so if they must guide you away from your original birth plan, you know it was a shared decision made in the best interest of you and your baby.
When heaps of emotions have been piled onto the birth plan, grief is likely to ensue. All the states I’ve worked as a midwife in have caps at 42 weeks gestation, meaning once you hit that point you must transfer care to the hospital. You have the right to decline a hospital induction, but past 42 weeks licensed midwives cannot deliver your baby. This is absolutely heartbreaking when it happens. There have been many times where we did everything possible to put someone into labor: membrane sweeps, herbs, tinctures, foley balloons, nipple stimulation, castor oil, and more! Yet, still, things did not kick into gear. Changing birth locations is a big deal. Grief is normal. That being said, a rigid birth plan doesn’t help. I have worked with clients who were adamant about not transferring to the hospital. When they had to for one reason or another, they had a very hard time coping. Often these folks had not considered how a hospital birth plan would look. They would continue fantasizing about an out of hospital birth, about getting back to their original birth plan.
I have attended postpartum visits where women would cry about their grief in change of plans. I attended a birth of a fourth time mother whose plan was to have the same birth she’d had for her last 3: smooth, quick, and at a birth center. She anticipated her labor to be 4 hours. Once we had reached nearly double that time she began to panic. A vaginal exam determined that the baby was ‘face presentation’ (i.e. head tilted all the way back so their face is the presenting part felt during an exam). It was going to take a lot of work to move this kiddo. She was too overwhelmed and ended up transferring to the hospital for a cesarean birth. Her grief was immense, although she was very happy to have her baby in her arms.
I have attended births of women who were physically strong, who had stamina for physical activity, and who did not see the need to intentionally prepare for labor. The endurance and stamina of physical activity is different than the endurance and preparation required for labor. Once labor started, they struggled. Almost every one ended in a hospital transfer for pain relief. They grieved their experience, and sometimes placed blame upon another person for the outcome.
As a final example, that could apply to any person giving birth, I have seen the grief of necessary medical care infringing upon the golden hour. The golden hour is the first hour of a newborn’s life. The family is bonding, the baby is getting skin to skin and starting to nurse, and it’s peaceful. It’s very good for parent-child attachment, among other things. However, sometimes when babies are born they struggle to “come around”. This often means they need medical intervention and support. What does that look like? Often, it means clamping and cutting the cord instantly, it means taking baby away from the parent to the warmer, it can even result in a longer separation if baby has to go to the NICU. This situation is already painful, even when the baby quickly makes it back to the parent’s arms. If delayed cord clamping, skin to skin, and rooming with the parents was on the birth plan, there can be additional grief that those things went out the window.
Grief is hard. It’s normal. It doesn’t need to be exacerbated by rigid birth plans, though. Resources will be linked at the end of this post. You are not alone.
Some providers won’t read them.
I have seen this primarily with hospital-based providers who are busy and/or whose personal philosophy doesn’t align with individualized care. This is particularly a problem if the plan is overly wordy, or more than one page. I will link some free and cheap templates below. If your care provider is busy and seems rushed, I highly recommend a short birth plan. There are ones that are picture based that work well for these scenarios.
I have seen many folks be immensely disappointed, and sometimes angry, that their provider seems to be ignoring their wishes. Ultimately, there is only so much you can do about that, but it’s still something to be aware of. Try to have your provider review it before birth. If there is a whiteboard in your hospital delivery room, write your top priority preferences on it. You can always request a patient advocate, any time of day if you need additional support. The hospital should always have one on staff, or you can hire an independent advocate that doesn’t work for the hospital (like me!).
Birth Preferences - A Better Alternative
Why Birth Preferences over Birth Plan? Does that slight change in language really matter? Yes, it absolutely does.
Think about it like this. An architect drafts a building plan. She doesn’t prefer it is done this way. She plans it this way, because if built incorrectly the building could be faulty, resulting in negative consequences. It has to be this way.
Now, the architect is going to make another building plan, but needs to check-in on available materials first. She would prefer Douglas Fir, but tailors her plan to allow for another wood type to take it’s place. Having an open mind about the materials allows her to flex and keep going without stress. A substitute would be acceptable, even if not ideal.
Language is everything. When someone plans something for months and it goes awry it is stress inducing. When they have preferences, they can be more flexible.
There is a game I like to play in my childbirth education classes because I feel it really hammers this concept home. Essentially, every pregnant person + their support person gets a small stack of cards with different birth preferences. They are instructed to choose the most important ones to them. Slowly, they must eliminate a preference until there are two left. This game is challenging for folks. It shows them that flexibility is important. Imagine feeling that stress in labor! I find that people are better prepared when confronted with the reality that birth can be unpredictable and requires flexibility.
Preparing for Labor and Birth - A Realistic Approach
I’ve harped a lot on the pitfalls of birth plans, and the idea of a language shift to birth preferences. Now, I want to talk about what preparing for labor and birth actually looks like. Below are some suggestions of places to start.
Grounding exercises (breathwork, hypnobirthing, etc.)
Endurance exercises to tolerate discomfort in labor (hands in ice water, etc.)
Physical movement (Spinning Babies, squats, yoga ball, walking, swimming, etc.)
Hire a doula! They’ll typically do a couple of prenatal and postpartum visits with you to help with birth prep and processing.
Take a childbirth education class! A well-trained instructor can make a huge difference. You should walk away feeling empowered and informed. It’s also a great bonding opportunity with your partner.
Bring in your birth support team! Teach them how to best comfort you. Do you like physical touch? Words of affirmation? Your comfort preferences may change in labor but they may not. Additionally, have you or your doula teach them how to do hip squeezes, rebozo shifting, etc. Teach them now so they can help you!
Practice flexibility. Consider alternative scenarios and how you can be best supported if plans change and your preferences have to go out the window.
Watch a variety of birth videos. Get comfortable with it and ensure your support team have watched some birth videos, too.
Make your list of birth preferences. Share it with your care team. Ask questions. Be informed!
As you gain all this information, trust yourself and your body! Fear can hinder the birth process. Remember your preferences, remember your flexibility, but also remember all the wisdom and skills you have learned along the way. You got this!
Resources
Birth Preferences Templates:
Preparing for Birth:
Boobs & Boos! Alcohol and lactation: Halloween edition!
Lactation and alcohol doesn’t have to be scary! A short, spooky story about navigating this dilemma. Happy Halloween!
It’s Halloween! You always go to your friend’s Halloween party. This year is different, though. This year you have a nursing baby. It’s hard enough to leave your babe behind for a few hours. The stress and confusion of what you’re supposed to do is haunting you. What are you going to do?
“Pump and dump!” the Facebook moms howl at you like a pack of werewolves. “It’s fine! The baby will be fine!”, your mother-in-law insists as she snatches your baby out of your arms and cackles like a banshee. Ok, maybe not quite like a banshee… You’re anxious. All the conflicting information online is making you feel like you have jellied brains. “Argh!”, you shout like a very frustrated zombie.
Having a little alcohol while nursing doesn’t have to be scary. You just have to find the right information and the right support. Hands shaking and with bated breath, you dial up your lactation consult. She answers. You sigh from relief.
Your lactation consultant asks you how much you plan to drink. Bashfully, you tell her that you’ll be having 2-3 drinks and have already ensured you have a safe ride home. The lactation consultant is not judgmental. Instead, she educates you.
“For every alcoholic drink that you have, you should wait 2 hours to feed your baby. Feed your baby before right you go to the party. If you have 2 drinks you should wait at least 4 hours to nurse your baby, and if you have 3 drinks you should wait at least 6 hours to nurse your baby.”
Cold chills run down your spine at the thought of not nursing your baby for 6 hours. You wonder aloud if the painful engorgement from waiting that long will be worth the night of fun. The lactation consultant explains that this is typically when people will ‘pump and dump’. They pump to relieve their breasts of engorgement. But, they have to dump the milk because there is too much alcohol in it. Typically, the amount of alcohol in the maternal bloodstream matches the amount of alcohol in the breastmilk. “Remember”, she says “6 hours is the minimum for 3 drinks, it could take longer for the alcohol to be completely gone.”
What if you mess it up? You quietly decide a poltergeist would be more tolerable than your current dilemma. The lactation consultant warmly reassures you that you’re a great parent, and that it’s a good thing you’re taking some time to have fun, and that you’re doing the right thing by asking questions so you can keep your baby safe.
“I know it’s not what you want to hear, but a foolproof way to shield your baby from alcohol is to avoid drinking”. She is correct that you didn’t want to hear that. You wail and moan like a ghost, turning the decision over and over in your head.
“Do you have pumped and properly stored breastmilk? Or formula? You may be too tired to try to nurse your baby once those 6 hours go by. And, your baby will likely need to eat sooner than that, anyways”, suggests your lactation consultant. Yes! You have both. Your mother-in-law will be staying the night, so she could feed the baby until the morning when the alcohol will certainly be worn off. Then, your little breastmilk vampire can get right back to suckling his alcohol-free milk.
Tearfully, you thank your lactation consultant. You put your costume on, you have dinner, nurse your sweet baby, and then head off to your party! Your mother-in-law texts you occasional updates that the baby is doing well. You have your three drinks and dance the night away among partygoers dressed in spooky costumes. You pump and dump once. It was a great night! Once you get home you crawl into bed and don’t feed your baby from breast until the early morning hours once the alcohol is worn off. All is well. The terror of navigating breastfeeding and alcohol has passed!
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Happy Halloween! Please have fun, be safe, and when in doubt- ask a professional. Lactation doesn’t have to be scary with the support of an expert.