So begins our process of getting the insurance covered! As promised, Miriam called the insurance company and they informed her that we need to file for a GAP exemption. Basically the two midwives they offer in Miami-Dade County, one is ill in the hospital until further notice and the other only offers prenatal care and no longer delivers. So I needed to request Miriam to be covered. I called multiple times a day for three days to never get anywhere. So yesterday, we went to their offices. We were in and out in no time and while we didn't get an immediate answer, we found help. The lady who we spoke with informed us that the request needed to come from my PCP. My appointment with him was scheduled for Friday the 13th. However, I didn't want to wait that long. So I called and was able to get an appointment today from someone else's cancellation (thank you God!). I saw him earlier and he's such a gem. Honestly, I haven't had such a positive and proactive doctor in so long! His first concern was my iron levels and we discussed the midwife. He said basically that it's my pregnancy and he will do whatever I want but he legally has to go on record and state that he doesn't recommend it. He said unfortunately home births are either positive or negative and there is not much in between. He said he believes I'm strong willed enough to make this happen but he would hate to see a "what if" happen to me. With that, he had his assistant file the request with my insurance company. I also requested if I could have two more venofer IVs of 200 mg versus four more of 100 mg. It's a hassle to go and costs me a $50 co pay each time. Obviously I want to do what's best for me and the baby but I didn't see how it would make a difference. He immediately sent me to the lab for a CBC to check my hemoglobin just to make sure we were going in the right direction. The best news I received today? My hemoglobin is up to a 10! While it's not great (recommended to be a 12 before getting pregnant), it's a huge step in the right direction. It's also only 1/2 an answer since ferritin wasn't tested. However!!!!! He said that he feels much more confident and supportive of me working with a midwife knowing that my number is going up! He also gave me the prescription to receive 200 mg next week and 200 mg in a month (in March) and then come first week in April to check bloodwork again. At that time I will request he also checks my ferritin. It's also positive because we have to get my hemoglobin to an 11 and MAINTAIN it at an 11 for a home birth to be an option. So we're getting closer to reaching that! However, it WILL drop again between 25-27 weeks of pregnancy so we will all have to stay on top of my levels. I'm pretty sure I'll be receiving even more infusions throughout this pregnancy. BUUTTT if it's going to continue to rise and help me maintain I'm all for it. I know it will have a huge effect on me after birth too. My low iron was such a huge reason that I was so miserable after the twins!!!
For those of you who don't know, here's a simple answer on the differences between ferritin, iron and hemoglobin:
IRON: aka ferrum. Essential ingredient for hemoglobin among other biological functions
HEMOGLOBIN: Protein that is responsible for transporting oxygen. Contains a "heme" group which has iron in it. Hence the name, hemoglobin.
FERRITIN: Protein that stores and carries iron around to wherever it's needed.
So we really need both ferritin and hemoglobin to rise to know we're having a long term impact on my body and my baby. You have to keep in mind too that I had gastric bypass surgery 7 1/2 years ago so rules are slightly different for me than a normal pregnancy. My pre-pregnant ferritin should have been at least 70 before getting pregnant. While pregnant my iron stores are being diluted to half their value until my bone marrow catches up to the demand to create blood for me and the unborn baby. It will take 6-7 months for my bone marrow to meet this demand. Iron deficiency is the single largest cause of prenatal anemia (close to 70%)…. Prenatal iron deficiency leads to low birth weight and premature delivery. It also leaves me at an increased risk of post partum hemorrhage. Infants born to iron deficient moms are themselves at a higher risk of iron deficiency which may result in cognitive damage.
Obviously a lot of what's out there sounds SCARY and it isn't always the case but it falls in with those "what ifs." Sadly I believe my iron & ferritin were this low, if not lower with the twins pregnancy. However I didn't have a proactive doctor and I was educated enough nor advocating for myself. This time around, I'm doing the legwork. With knowledge comes more responsibility but I believe and will continue to believe that God is overseeing this whole process. He will take care of me and this unborn baby and keep us in all the right hands and I will have an amazing testimony that is formed!
I will follow up with the insurance company next week and hopefully get some more answers. Until then, I'm here to answer any questions and help anyone else's process however I can and I'm continuing my own research and care! Enjoy your weekend!
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