Discharge AMA?

I have a question ... I haven't yet written up our birth story. All things considered it was perfect and beautiful, but there is one issue that I can't seem to reconcile. I am hoping that this community might be able to help me find some answers.

What are a patients rights around discharging against medical advice (AMA) following a hospital birth?

My home birth plan turned into a hospital induction and delivery at a facility that has a 24 hour discharge policy. I wanted to go home after the birth, but they weren't willing to budge and told us that our insurance might not pay if we signed out AMA. We called our insurance and were told they would probably pay, but that we would have to submit the claim in order to find out. We ended up staying the full 24 hours, but it has left me feeling slightly bullied and ignorant about my rights.

I am just wondering what the facts are about the implications of discharging AMA.
Or if others have experienced anything similar.

thanks!

*****
UPDATE:
I contacted the California Department of Insurance with my question, mostly because I want to know my rights in case I ever end up in a different situation and want to leave AMA. Their response is pasted below:

Thank you for your inquiry to the California Department of Insurance (CDI) regarding the referenced subject matter.

The insurance company would have to cover the birth of the child as long as it is a covered benefit. If they refuse to cover the benefit you would file a complaint with the Department of Insurance called an Independent Medical Review.  Your treatment would be considered medically necessary.  The main problem you may have is if you discharge yourself against medical advice any complications that arise as a result of this may not be covered or covered at a lesser benefit level. Some policies may have riders that contain language stating that if you discharge yourself and do not comply with the recommendations from your physician your policy may limit future benefits that pertain to any complications relating to early discharge. Insurance companies have to comply with Federal law and allow women to stay 48 hours after a normal childbirth or 96 hours after a cesarean has been performed. Most complications to the mother and child occur within the the initial two days after delivery and the goal is not to force women to be pushed out of the hospital too soon. I'm sure you are aware of this, but ultimately nothing can prevent you from rejecting medical care or leaving the hospital.

We hope this information has been of help.  If we can assist you in the future with an insurance problem, looking for insurance or provide information you may contact us through the e-mail system or you may reach our Consumer Communications Bureau at 1-800-927-HELP.

Two Months Old

Wrapped up warm in grandmas special quilt

I call you "baby cakes" all the time. Little One came over last week and asked if she could call you 'baby cakes' too. It was beyond sweet.

Your eyes are starting to look green to me. Most days they are greyish blue, but somedays they have glimmers of green.

When you smile, I feel like you DO like me after all.

I love to kiss your little face, on each side of your mouth and the ridge of your little nose. You love my kisses and I love feeling your soft skin on mine.

You have a special scent. I catch myself smelling your head throughout the day.

Your daddy and I are so grateful that you are such a good nurser and grower. You weighed nearly 15 lbs at your 2 month Dr appointment. Its no wonder that my back hurts from carrying you around all day.

Last night, when you were refusing to go to sleep, daddy took you to get a new diaper and never returned. I found you guys at the changing table having an "adult conversation" as daddy described it, about life and diapers and swaddling and sleep.

You don't poop as often as we'd like, and when you do it usually explodes out of your diaper all over your clothes and onto the blanket that you are wrapped in. Your most favorite blanket for blow-outs is the special quilt that grandma made for you. Its been through the wash so many times already that grandma is worried it is going to fall apart. We think you are holding it until we wrap you in grandmas blanket.

*****

I'd be lying if I said I didn't think about the donor more than I'd like. I guess there is a grief about the loss of ML's genetics that just persists. It just does.

I felt bad acknowledging it until now, but I've felt so detached. I was afraid to love you while you grew in my stomach, and thought that I'd be overcome with love when I finally held you, but it hasn't been like that. I am still waiting for those feelings of 'my heart being on the outside' that everyone else talks about.

I want to start taking to you about your story, but I don't know where to begin. I try to bring it up, but just don't know what to say or how to say it.

I haven't cried since you've been born, and, well, that just seems weird to me.

Eight Weeks Old

Baby Q is 8 weeks old today. It feels like he's been here forever, and yet everything is still brand spankin new at the same time.

He is SO much happier thanks to the reflux meds, gas drops, probiotics, and my diet changes. Instead of near constant crying when he is awake, we get times during the day when he is awake and alert and happy.  It helps too that he started smiling at us.

I have made a very conscious effort to slow down our schedule and spend more (ie, all of our) time at home so that we can get to know each other. I am starting to see a few daily patterns for napping and playing. We go to baby class on Wednesday's and Fridays, but other than that I spend most other days in the house following Q's lead. Things seem to be better when I don't mess with his naps or make him wait to eat.

My mom got us this little tummy tub. It is basically a little bucket that babies bathe in. Q loves it! We take at least one bath a day.

Back to Work...
I have to go back to work in April and have such mixed feelings about it all. I actually really miss my job, so much more than I thought I would. I am actually really looking forward to leaving the house and doing a job that I feel somewhat competent at. I would have thought that I'd want to stay home and that leaving my baby to go back to work would be torture. Regardless, I carry our health benefits and my fmla job protection runs out after 12 weeks, so I have to work at least 20 hours / week starting in April.
 
I'd made plans to start back at 20 hours /week for a couple months, which seems like a manageable plan. Ideally I'll be able to work 2 full days in the office and then a few hours from home on the other days. I still need to sort out the details with my boss, but am confident that she'll be supportive. Before I had Q, she suggested that I bring the baby to work. Now that he is here I'm not sure that Q has the temperament for spending the day in the office.

The challenge that I'm facing now is childcare... We'd initially thought that ML would be working from home with a very flexible schedule, able to care for Q while I was at work. Then last month he got called for a contract project working in an office 40 hours week. The contract is for 2 months, with a full time position possibly waiting for him, if things work out well. On the one hand, a full time gig with this firm would be fantastic (providing a steady income and offer health benefits). On the other, it means that we need to make arrangements for childcare.

I'd assumed that we wouldn't need non-family childcare and don't even know where to start looking.

One day at a time

First off, THANK YOU all for your amazing outpouring of support yesterday.
Incredible.
And so so so much appreciated! And so so so needed :)

We actually had a really great day yesterday. Q had a nice long nap in the morning, and then my mom came over to help me take him to the pediatrician. He made a little liar out of us as he peacefully let the Dr examine him and talk with us for nearly an hour. After I explained that he only poops every couple days and blows out of his diaper each time, he even made a nice little normal looking poop while we were in the office!

I realized that one of the biggest challenges that us new parents face is that we have no baseline for normal. As the Dr asked me if Q's poop was normal looking, if he farted more that normal, etc... I had nothing but Q's behavior to base my answer on. I found myself saying again and again "I don't know what normal is."

I had to find examples of what I meant by, he cries "all the time"... like, I try to take a picture or video to send to the grandmas everyday. I try to send a happy picture, but barely have time to grab my camera and snap a few shots before he starts crying again. Unless he is asleep, or nursing, he is fussing/crying and I am cycling thru my baby soothing strategies - all day long.

We determined that what my mom and I described about Q's behavior was in fact not normal and that there was a good chance that he had some sort of gastrointestinal issue going on. Instead of trying one treatment at a time, we decided to tackle all of the possibilities at once and see if there is a chance in Q's behavior. Then we can wean off of the different treatments one at a time, to determine which one made the difference.

1) I started a dairy-free diet yesterday. And thanks to the lovely ladies in the braces bunch facebook page I also discovered the "milk soy protein intolerance" (MSPI) websites and facebook page. Cheese is a staple in my diet, and its going to be a serious challenge to cut it out.
2) We started Q on Axid (for reflux).
3) We started Q on Gas Drops.
4) We started giving Q probiotics.

We see the Dr again in two weeks and will reevaluate things then.

I also made arrangements for Bestie's part time nanny to come over in the morning two days next week so that I can sleep in a couple extra hours. I feel like the sleep deprivation is catching up with me and not helping the situation.

My little piggy sporting man boobies at 5 weeks.
The Dr described his weight gain as "impressive!"

For the record, and my memory, and anyone else who reads this in the future, I wanted to mention a few things:
-the 5 S's have been our saving grace. We are methodical about the swaddle (in a thick blanket), shhhh (via white noise ap on Q's dedicated iphone), suck (preferably on a finger), and swing (via bouncing on the ball). The side laying doesn't seem to help. The other 4, when combined, are golden.
- the yoga/exercise ball is possible the most important baby supply we have. We spend hours everyday on that thing.
- the changing station is equipped with a heating pad and blow drier. Q will usually calm down for a few minutes when placed on the warm table with the blow drier on. We've also avoided diaper rash, possibly because we give him a little blow job (hahaha) with each diaper change.
- I started taking lexapro about 3 weeks ago. I'd been on it prior to getting pregnant, and stayed on it until the third trimester when I weaned off. I'd intended to start taking it the day he was born, but felt so happy that I waited. When we found out ML was going back to work, I figured that things were going to get a lot harder. The happy hormones of those first two weeks had also started wearing off. We knew that I was at high risk of ppd and my husband, mom, and dr are all paying pretty close attention.
- we have both the moby and the ergo, but Q seems to like the moby better. I am getting better at wearing it, and he is getting better at sleeping in it.
- the swing is amazing. Q goes to sleep in it every evening at about 8pm for his first stretch. Then I bring him into our bed. He also takes his first morning nap in the swing. When I suspect he is sleepy I can set him in it still awake and he will immediately relax and drift off to sleep.

Again, thank you all for your amazing comments, and emails. I seriously needed to feel like I wasn't alone in my emotions yesterday and your words meant more to me that I can tell you.

Waaaaaa

Baby Q cries a lot. 

Most of my day is spent transitioning from one soothing strategy to another. ML and I have even wondered aloud "why doesn't he like us?" We try so hard to make him happy, but he just isn't. 

He does have a few periods of each day where he is awake and alert. There is about 30-40 minutes in the morning just after we wake up. and when I'm lucky well have a few other 5-10 minute periods of alert. 

He is generally calm while i am nursing him, which might help explain his extraordinary weight gain of 5 lbs in 5 weeks... the boob is my 'go-to' solution, so Q eats A LOT! 

I know that all babies cry. and I just figured that our is on the fussier side. I figure that its my job to keep trying to make him happy, and that eventually he will outgrow it. but sometimes I wonder if maybe there is something wrong with him. and then yesterday my mom, who knows a lot about babies, said that he thinks we should make an appointment with the pediatrician. She thinks that maybe he is suffering from reflux, or that there is some other reason that he cries so much.  

The things that worry me are: 

- the way that he will be so upset while I am holding him and then stop crying when I set him down (sometimes). 

- the way that he struggles so hard every morning, kicking is legs, and making grunting noises.

- the way that when you hold him, he doesn't cuddle.

- the way that he is so dependent on white noise to soothe.

The other thing that both worries me, and at the same time I know will happen with time, is that I don't have that feeling of being so 'in love' with my baby. I love him. I do. But most of the time it is more of a job than a labor of love to care for him. I am relieved to leave him in the arms of other people, and leaving the house without him is such a treat. When he is crying while someone else is holding him I am just glad to have a break - unlike so many other moms I know who can't help but run to get their baby. 

I felt better yesterday when my mom acknowledged that it is hard to fall in love with a baby who is so fussy. I know it will happen.

I am trying to figure out how to tell the pediatrician about Q. This is all I know. And all I can compare to is what I hear other moms talking about. Its not like he cries when I put him down - I hold or wear him almost all day long. And its not like anything I do consistently helps him stop fussing. We do spend a lot of time bouncing on the big exercise ball - that seems to be effective, when combined with a swaddle, and white noise, and pacifier. I felt pretty lame calling to make an appointment, saying I need to see the dr because my baby cries a lot. But maybe if he can help us figure out how to help baby Q be happier, it will totally be worth it. 

Regardless of what we figure out at the pediatrician, I am going to hire someone to come over and help me a few days a week. Knowing that I'll have someone to hand him off to for a couple hours will keep me sane - and hopefully help me get a little extra sleep.

six weeks old

6 weeks along

Every night when I lay down in bed I compose a post about our day... whats working, what I'm struggling with, what I'm hoping I'll figure out soon... but then in the morning, or whenever it is that I have a chance to write my mind is blank. 

Little Q is 6 weeks old. He is growing like a little weed - gained just under 5 lbs in 5 weeks! He is a champion nurser, and has even started taking a bottle with pumped milk from daddy or grandma so that I can catch a few extra zzzz's every so often. 

So many of the things that I think about are things that I'm not sure I am ready to write about, and I am confident that they will pass with time. Its all stuff about the donor and bonding. Stuff that is not in the forefront of my thinking, but is there, everyday, nonetheless. 

Yesterday I'd invited all of the moms from our parents class over for the afternoon. It was really nice to have company and other new moms to talk about new mom stuff with. Most of them had shared in class that they got pregnant the first month they tried. I finally divulged yesterday that we used IVF to conceive Q. I am always surprised at how little people know about the IVF process. Later in the conversation one of the moms asked if Q looked more like me or ML. I paused and thought about sharing the details of Q's conception, but didn't. I just replied, as I always do, that I think that he just looks like Q. Its been a very effective way at deflecting the question, which actually comes up much less often than I thought it would. 

I'd been planning to go to a postpartum support group this morning, but baby Q is napping and I am afraid to wake him... and even when he does wake if will take me 20 minutes to nurse him and another 20 to drive across town, at which point the group will be half over. Meh.

Sleep remains an issue, more for me than for Q. He is actually doing a pretty stellar job at sleeping thru the night. And by that I mean waking to nurse every 2-3 hours. I am up (out of bed) with him a few nights a week between 4-5 am, but have always been able to get him back to sleep. He starts the night in his swing, which helps me get to sleep alone, and then moves into our bed for his first nursing of the night. I wish that I could ask ML to take him away for the morning feeding before he leaves for work, but I know that he is just as tired as I am and under quite a bit of stress already. I am having such a hard time sleeping when our little guy is asleep. His little noises keep me awake at night, and I find myself laying in bed awake, thinking, more often than I'd like. 

This is really hard work.

doing it wrong

I feel like we must be doing the sleep thing wrong.

Not that it sounds like anyone has figured out how to do it right in the first few weeks, but I really think that there must be a better way than what we are doing.

From the beginning we've said that we will do whatever it takes to get the most sleep. I was raised with a family bed, and figured thats where the baby would end up sleeping, but wasn't opposed to other arrangements. We inherited lots of other hand-me-down places for the baby to sleep - a crib, pack-n-play, bouncy chair, swing, etc, but decided to wait and see how things went before we set any of it up.

The first couple nights I nursed him whenever he fussed, and he stayed in the bed with us. I worried about having any blankets or pillows near him, so tried to set him on the far side of the bed in between feedings. That didn't work so well, so he ended up sleeping on our chests, which also prevented us from sleeping. ML figured out that the poor kid was probably cold, which made me feel awful, but was probably true, so we started dressing him much warmer for bed.

It was near impossible for me to fall asleep or stay asleep with Baby Cakes next to me, as I felt like I couldn't move around at all and every noise he made caused me to wake up. About a week in, someone suggested we move the swing next to our bed and put him in the swing in between night feedings. We tried that and I slept much better, but it was so much harder to get up out of bed to move him back and forth everytime he needed to nurse. And if I botched the transfer back to the swing I had to start over with the nursing. Exhausting. It ended up being easier to just keep him in the bed.

ML figured out how to swaddle Baby Cakes which has been wonderful and really helped him sleep for longer periods of time.

Luckily, we had the nursing figured out. I was able to nurse while laying on my side so we both ended up drifting off to sleep while he nursed, which was great that I didn't have to be fully awake, but made the transfer back to the swing a bit more difficult as I'd often rouse realizing that it was actually time to nurse again. And side nursing is awesome, with the exception that I have to hold my body 'just so' to ensure that my breast is perfectly positioned to Baby Cake's head. Not exactly relaxing.

We then ditched the swing, and tried setting up a baby bounce chair next to the bed. It was easier to move baby cakes in and out of the chair, but still hard to stay awake enough to make the switch after each feeding. We ended up having some success setting him him the chair as we went to bed, but I rarely made a successful transfer back into the chair.

Last week I randomly set Baby Cakes in the swing which had been moved to the living room one evening, and he liked it! It was right before we were going to head to bed, but we were afraid to move a happily sleeping baby. I sent ML off to bed, and I grabbed a blanket and curled up on the couch. I slept better than I have all month! The swing was across the room, and we had the air filter turned on high for the white noise. I didn't hear any of baby cakes's baby sleep noises, and didn't have him right next to me. It was glorious. And the best part is that he slept for 3 hours! THREE! He woke, cried, I jumped up, nursed him, changed him, and attempted to join ML in bed. Baby Cakes started fussing again so I came back out to the living room, set him in the swing and was amazed that he settled right down. I curled up back on the couch and we slept for another 2 hours!

I feel like we must be doing something wrong when a few hours sleep is such an achievement that it is worthy of the level of celebration that it elicited. It felt like a freakin miracle!

We've had a ton of success since then using the swing for daytime naps, and the first sleep shift of the night. Mostly though, baby cakes is sleeping next to me in the crook of my arm, swaddled up, partially under our comforter. I nurse one boob, then we sleep, when flop him to the other side and nurse the other boob, then we sleep, every hour or so.

The weirdest past for me is that I actually feel guilty wishing that I could just leave him in another room for the night. I just want to sleep. in a bed with my husband. peacefully. uninterrupted.  It feels wrong to wish my baby away like that.

I could go on and on about this sleep thing, but it has seriously become the center of my world. I know that there isn't any answer or solution, and that it will get easier, but my god, it is hard.

i licked him

It was shocking.
I was holding this perfect little baby.

I couldn't help but question where in the world he had come from.
How did he get here?
How did he end up in MY arms?

I was struggling to wrap my head around the past 24 hours, thinking about how hard I'd worked to bring him into this world.

This baby I'd thought I'd never hold was looking up at me with clear bright eyes.

Without thinking, I leaned down and licked his little forehead.

He was mine.
I was his.

It was real.

week 3 with baby cakes

Sitting in the rocker with a sleeping baby tucked close to my heart. I've had posts running through my head, there are so many things I want to write about, but its been a challenge to get more than few minutes at a time to work on anything these days.

Baby Cakes is growing like a little weed, gained two pounds in his first two weeks. I swear he feels heavier today and predict that he is going to keep gaining at this pace. Our little porker :)

Parents Place
We went to baby class this week. To our age-based class on Wednesday and to the wee-chant baby singing class on Friday. It was so special. This is at the school my mom started over 25 years ago and still runs today, with the teachers who I've know for decades, where the non-profit I started has funded so many projects. ML and I couldn't even get to the office before we were stopped by 4 different people who wanted to meet our little guy and offer their congratulations. It was so special. Some of them knew the details of our story, and others were just excited to share in the excitement of my moms first grandchild. They'd all been waiting with us on pins and needles for the arrival of this baby who was nearly 3 weeks past due.

ML came with us to the age class, wearing baby cakes in the Moby wrap. We snickered a little when the other women/couples told their "how this baby came to be in your life" stories. Half of the ladies shared that they conceived in the first month they tried. I was glad that ML took the lead in telling our story simply saying that just about nothing has happened according to our plans, but that we are so happy to have little baby cakes with us now.

ML's mom came with us to wee-chant on Friday. It couldn't have been more perfect. ML held baby cakes while both grandma's sat nearby singing sweet lullaby's. Towards the end of class there is time for announcements and my mom officially introduced her new grandson. It was so sweet. I almost lost it during the final song, my heart just exploding with love. Instead I nuzzled my head into ML's neck peeking over his shoulder at our sweet sleeping son.

Visitors
Oh wow, we've had so many visitors come over to meet baby cakes. Everyday. It is so wonderful to have so many people who want to bring food and gifts and blessings. and Yet, we are looking forward to having some quiet time in the coming weeks.

Nighttime Parenting

While we started off with a little guy who was generally happy when awake and willing to sleep for decent 2-3 hour stretches in between feedings at night, things seem to have changed. We are having more periods of fussy during the day and have had a few really long nights where he is awake and unhappy unless being bounced. 

We hadn't made any arrangements for where he would sleep, figuring that he'd be with us in bed for a while. It turns out that sleeping next to a tiny little baby is not so restful for me. I still wanted him close enough that I didn't have to get up to nurse, but didn't want to worry about blankets and pillows getting too close to him. We pulled the baby swing close to the bed and used that for  few nights. It was better, but still hard for me to get him in and out to nurse. We've since set up the little baby papazan chair (hammock style with the vibration) on a table next to the bed. It is working really well. I don't get him back into it after every feeding, but it is helpful to have a safe place for him to sleep so that I can get some deep sleep for at least few hours every night.

The past few nights have been extra challenging. He'll wake up for a nurse and get fussy. I'll spend about an hour trying to calm him, change his diaper, burp him, wrap him in the swaddle, bounce him, nurse him again. Finally I'll pass him off to ML who jumps into action. He's been up for hours bouncing our little boy on the ball in the living room, letting me sleep. I feel guilty sleeping while he is up, but am just so desperate for sleep. And while I know that ML stirs everytime I nurse, I actually have to wake up in order to get baby cakes latched on and set up to nurse. It wasn't until yesterday that the sleep deprivation finally caught up with me. I just felt exhausted.

Recovery
Labor and delivery kicked my butt! Recovery has been much slower than I anticipated. One of the risks of induction is post delivery hemorrhage, which I had, and meant that I lost more blood than normal leaving me feeling quite weak for about a week postpartum. I've been drinking Floridix iron supplement and feeling much better this week. I also had multiple nasty second degree tears requiring more stitches than the dr bothered to count. Instead of a standard perineal tear, I managed to tear up both labia and inside my vaginal walls. Standing and walking put a lot of pressure (and pain) on my bottom, so my upright activity has been basically limited to being around the house. I would really like to start walking soon, but am going to have to work my way up to it. The other big complaint I have is pain in my tailbone. Lounging on the couch is ok, but sitting on anything hard for more than a few minutes is not happening.  I have pain when i stand up from sitting. Walking also seems to make it hurt more.  I'm taking it easy, but feeling a little anxious to start moving around a little bit more.

my iPhone
...is the most awesome device ever! I take about 100 pictures everyday, Send a little video to the grandmas every morning and text daily pics to aunties and friends. I read facebook and email, and can access the internet while confined to my rocker with a babe in my arms.

Dear Baby Cakes - 10 days old

Dear baby cakes,

One week in and I have loved every second of being your mom and being a parent with your daddy. There are so many things that I want to remember about this time, and yet simply 'being present' is so beyond satisfying that I don't want to be distracted trying to capture the moments.

At your weigh-in yesterday you showed off some champion nursing skills with gain of a full pound! in less than a week! You were born at 8lbs 5ozs, dropped to 7lbs13ozs 24 hours later and then down to 7-11 48 hours after birth. Yesterday (at 8 days old) you were back up to 8lbs 11ozs! Breastfeeding has been so natural and easy with your started suckling minutes after delivery and feeding like a pro since. I'd been so worried about the early pregnancy vasospasm's coming back or the awful nipple pain I'd the past nine months. Instead my nipples feel fine, my breasts are producing milk at the perfect speed, and you, my sweet baby, are growing bigger and stronger everyday. I love it.

 With the exception of yesterday, you've been generally happy, with long periods of being awake and alert, carefully studying our faces and listening to our voices. You eat about every 2 hours for 10-15 minutes, fuss briefly for a burp or two, and sleep peacefully for nice long 2 hour stretches. We've got a good thing going because you love to be held and we love to hold you. In fact I'm not sure that we've set you down, other than for a changing, just yet. Between me, your daddy, your grandma, and the steady flow of visitors who are showering us with love and food, there are plenty of arms available to hold your perfect little body.

Nighttime is different, but we are all adjusting well. Going to bed a bit earlier, staying in bed a little longer. We often fall asleep as you nurse, and then you curl up in the crook of my arm to sleep. You are also a fan of sleeping on dads chest. We really like sleeping at night around here, and are so glad that you seem to appreciate nighttime sleep as much as we do.

So many people have come to meet you already. I ordered a little baby book and am hoping that I'll be able to jot down some notes throughout the day so that you can someday read all about the world of love that you have just entered.

I think often about the birth experience that transitioned you from inside my belly to outside my belly. It was more intense than anything I could have ever imagined. I worked so hard, giving you every bit of energy and strength that I had to give.  I thought that I was prepared for the experience, but I was not. Your daddy and grandma were there with us every second, even though I felt like I was in an alternate reality where the only things that existed were you and me, working together to deliver you into this world. While there are some details that are so vivid and clear in my memory, other parts are so hazy. Grandma took a lot of pictures that I've been looking back over. What an incredible 24 hours we shared.

We feel so incredibly lucky to have you here with us. 

love, your foxy mama