Changing Care Providers Mid-Pregnancy
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MICHELE KAZMIER: You are mid-pregnancy and you need to find a new care provider. Maybe your insurance changed, you moved or you are simply unhappy with your current provider. You might be wondering what steps you need to take to do so. I am Michele Kazmier, certified nurse midwife and today we're here discussing have to switch care providers mid-pregnancy. This is Preggie Pals.
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STEPHANIE GLOVER: Welcome to Preggie Pals, Broadcasting from the Birth Education Centre of San Diego. Preggie Pals is your online on the go support group for expecting parents and those hoping to become pregnant. I am your host Stephanie Glover.
We have covered over 130 topics so far, can't believe it. Visit the episode guide on our website to scroll through those topics. Listen directly on your computer through iTunes; download our free app available on the Android, iTunes and Windows Market Places. And be sure to check out our new network app where you can listen to all your favorite New Mommy Media shows on the go. So here is Sunny with more information about how you can get more involved with Preggie Pals.
SUNNY GAULT: We have a couple of different segments that you guys might be interested in. We love to have your submission for this, so the first one is call “Pregnancy Oops” and it is where we are look to you guys to share your funny pregnancy stories that have happened throughout the 9 months, you can submit for that.
There is another one where you can actually “ask our experts” the questions that you have about your own pregnancy because also if you have that question then someone out there has that question as well. You can submit for both of those segments via our website. You can go to www.newmommymedia.com click on the contact link and send us an email or if you want to actually ask the question yourself or tell the story yourself you can leave us a voicemail and that number is 619-866-4775. And we will include it on an upcoming episode.
STEPHANIE GLOVER: Awesome! Thank you Sunny. So let's get started with some panelist introduction. I will go first, like I said, I am Stephanie Glover, I am 33, I am the host of Preggie Pals and also trained childbirth educator, getting certified to teach in hospital. I don't have a due date but I have got 2 little ones. Gretchen is 4 and she was my c-section baby, and Lydia was 2 and she was my VBAC.
LAURA KELLER: Hi my name is Laura Keller, I am 34 years old, I am a childbirth educator, lactation educator and birth doula. I also have a little girl who just turned 2 years old and I had a hospital birth.
STEPHANIE GLOVER: Great! Sunny?
SUNNY GAULT: I have 4 little ones at home, my oldest is 5 a boy, and then I have a 3 year old boy, and then I have twin girls who are almost 2 years old. I don't have any experience with switching care providers. But I did switch with in my own network of providers. I have switched O/B’s but not, I didn't have to get completely out of the system.
STEPHANIE GLOVER: And Michele your mom right?
MICHELE KAZMIER: I am.
STEPHANIE GLOVER: Please introduce yourself a little bit.
MICHELE KAZMIER: Sure, I am 47 years old and I have 3 children, I have an 18, 12, and a 4 years old. My first 2 children were born in the hospital and my third child was born at home.
STEPHANIE GLOVER: Awesome! Well welcome.
SUNNY GAULT: Before we kick off today show, there is a news headline that I found online that I thought was kind of interesting. The title grabbed my attention and it is “can pregnancy stress affect your baby's dental health”. So here is the situation, there was a study that was done in the UK and the results of it claimed that your child can be at an increased risk for dental cavities if mom experiences chronic stress while pregnant.
Now for the study they researched and they studied the data of 716 children as well as their mothers and the kids that they researched were between age is 2 and 6 years of age. All the moms were aged 30 years or older And they found out that if the mother had two or more chronic stress markers they were significantly more likely to have kids with dental cavities, and there were some other findings, some other things in the study for example cavities were more common amongst kids who weren’t breastfed, a lower incidence of breastfeeding was significantly more common in moms with less income.
So the kind of studied multiple things, but the big headline that came out of this was related to your baby's dental health. So I thought we would kind of go round the room and see what you guys thought about this. Like mums to have enough stuff to be stressed about in pregnancy now you have to worry about your kid’s cavity. Stephanie what do you think?
STEPHANIE GLOVER: Well I don't have any cavities in my kids so far, I don't know I feel like there's probably still a lot more that you need to know more about that study. I was probably more stress in my second pregnancy because I felt I had a lot more move in pieces of getting a birth experience I wanted and really making that a priority. But we were just told that Lydia had beautiful teeth, so I don't know yet. I am just not sure.
SUNNY GAULT: Michele what do you think?
MICHELE KAZMIER: I mean I would have to agree with Stephanie that's you know I am not familiar with the study and I do not know much about what they control for during the study. I also think it is important no matter how much stress my mother is under to understand what she is doing to cope with stress and how that is affecting her health. So I would want to know if they added any of those into the study to see if that affected the outcomes.
STEPHANIE GLOVER: Like if there was like a medication maybe or something like that.
MICHELE KAZMIER: Medications but just the overall lifestyle and have the lifestyle was helping them cope with stress, so I would want to know. You know I would want to know the diet exercise, things like that how that were also contributing to it. You know where they make other choices because they were stressed out was that affecting, that was what I would look for. But I am not familiar with the study.
SUNNY GAULT: It says here, I am just looking at the article and it says “what researchers were looking for where biological markers of chronic stress. In order to do this they assess blood levels of high density lipoprotein, cholesterol, Glucose and C-reactive protein and noted blood pressure and waist circumference”. I don't know if that really helps it doesn't really kind of address what you are talking about but that is kind of some of the guidelines that they were using.
Anyway Laura what do you think?
LAURA KELLER: Well I would agree that there are a lot of moving parts and a lot of different factors that affects stress levels and health of the mom and also the health of the baby. So I am sure that being chronically stressed out during pregnancy does have any impact in some degrees on a baby's health, dental and otherwise, so could possibly be one of those factors. I was pretty stressed out when I was pregnant.
STEPHANIE GLOVER: So today we are discussing on how to change care providers mid pregnancy. Join us in the studio is Michele Kazmier certified nurse and midwife. Michele started her career as a navy nurse then when on to work as a NICU L&D and postpartum nurse and then followed her dreams of becoming a nurse midwife and has worked both in hospital settings, home birth as well as birth centre. She now has her own home birth practice called Lavender Moon Midwifery. Welcome to Preggie Pals it is so great to have you.
MICHELE KAZMIER: Thank you Stephanie, thank you it is great to be here, thank you for inviting me.
STEPHANIE GLOVER: Awesome! So Michele many women might not even know that there are options for switching care providers in mid-pregnancy. So it is great to have you here to shed some light on this topic. What are some common reasons why women might need to switch providers during pregnancy?
MICHELE KAZMIER: Well you know sometimes there is the bigger issues where you move and you need to switch provider because you moved to another location, your insurance has changed and so you need to explore other providers because your insurance changes in mid-pregnancy, and then of course there is also as you go through your pregnancy you may change your mind about the actual provider that you have chosen maybe it doesn't match with your ideas of how you would like the pregnancy care and the birth plan to go, so you might change for that reason.
STEPHANIE GLOVER: And I think that is a great topic to because or a great point because some women don't really know that they do have the option to change mid-pregnancy, so we can certainly talk more about that. When it is a simple change in insurance, how may a woman go back in finding a new provider?
MICHELE KAZMIER: Well I think it is really important to take the time first to narrow your choices in terms not just to find out what providers are in network with your insurance or that take your insurance even in an out network basis and maybe even you don't have insurance and you are paying cash. But to narrow that network down based on your actual value system and what you looking for because there are a lot of choices.
And in San Diego especially we have a lot of different providers all with different practices, different values, different settings that day practice in and so you should narrow your choice down first and go from there and then you can start making those calls to find out what matches with you know other things in terms of your insurance. Sometimes if it is an insurance issue you can switch to and out of network provider that will still take a majority you know that still will cover up a majority of your care.
STEPHANIE GLOVER: And I know to, I think a lot of insurance companies would have some sort of websites that will show there providers and network and then I would venture to guess that when you move areas it is probably similar in terms of finding new provider outside of the area.
MICHELE KAZMIER: We are a military family so very familiar with this. The very first thing that I do is trying to get plugged into the birth network in that community. So you will try and find out if there is an actual, online it's very easy to find out if there is a community birth network, you can ask some questions there, families and friends may not be in the area to give you that advice so you know if you can link into family and friends first to ask them that would be great and then you go from there.
But it is nice to find out a network that can give you some actual referrals, people that experienced in the area first and then matched up with insurance. So you have two different things that you have to do to think about when you move obviously.
STEPHANIE GLOVER: Word of mouth so important. Laura when you were pregnant with your daughter, how did you find your O/B initially? The one you started with.
LAURA KELLER: I felt like at that time, I was living in a new city and I didn't have that community yet, so it was really challenging to make that choice kind of not having a lot to go on. So I actually just choose it based on from a list from my primary care provider and it was close to my house.
STEPHANIE GLOVER: I think I choose one, or I was seen a group just for, like I saw a gynecologist. So when I was call for my first appointment, so oh I need to be seen, I am pregnant, Oh he doesn't do that, he is just like menopause and gynecology. So I was like okay well can someone else see me, sure who; I don't know and they just assigned me with someone that they said was sweet and she was. But yeah I just went off like tell me where to go, this is all new to me. I have a feeling that probably all the moms do that.
So I know Laura you have experienced with changing providers in mid-pregnancy, can tell us a little bit more about why you choose to change providers?
LAURA KELLER: Sure well as I mentioned, I initially choose my OB/GYN without really knowing a lot about her and I really wanted to have a natural birth even though I would be giving birth in the hospital, I knew that, I had very specific wishes for my birth and when I started talking about that early on with my care provider she wasn't really all that supportive of it. She was like “well you can try”, like she kind of wasn't on board with my birth plan and my birth wishes.
So she was a little bit more medicalised, did an ultrasound in every single visit, every 3 weeks and this was at the very beginning so after a while I just decided that she wasn't for me and I started doing more research and I ended up switching over to midwife practice where I had midwifery for the rest of my pregnancy it was wonderful. I was really glad I need to switch.
STEPHANIE GLOVER: Awesome! I have experience in this, even though I am the host I am sort of the panelist as well because my first C-section with that very sweet OB ended up in C-section and she was very kind and sweet. She had tears in her eyes just along with me because she knew it was in my plan. But I went really for that VBAC the second time and she was supportive, I was in a group practice so I just didn't know how support of the other doctors would be and she had become a parent since my first birth so she attended I think all most all of them in the first round but I could not be guaranteed that I would get her that's second pregnancy so at 35 weeks has switched to a group of midwives as well.
I am just thankful that it took me at 35 weeks and never looked back. I felt like I was kind of like a rebel. A lot of like a family and friends didn't understand my choice but I knew that it was an option and I never looked back. I actually kept her as my gynecologist because I really do love her but doesn't trust the process with the group setting.
So when you made that decision and you want to go forward and find a new provider what are some questions that you can ask when you are looking around? What do you recommend Michelle with them that kind of initial meet and greet.
MICHELE KAZMIER: Well what you were just talking about just there the process that you went through just switch providers is really important I think for people like keep in mind is that you are really looking for someone that is matching not just you desires because things can change as you go through your pregnancy and obviously during the labor and even postpartum. But you are trying to find someone that is listening to you is in somewhat of a similar value system as you, someone that you feel very safe with.
I often tell clients that they need to first understand what their real desires are for their birth, I mean really explorer it, because sometimes we don't spend the time at the beginning of our pregnancy you really think about that. Certain situations like in your case you were looking for a specific experience because you already had experienced, I think it is harder for first time moms.
But take the time at the beginning of your pregnancy to really explore what you think your desires are and start from there. Take that list and ask those questions that are important to you, not to your neighbor, not to your friends but to you. What really is important for you? The setting may be very important to you, you may be okay with a certain setting and then you explore other things, maybe you are interested in having water at your birth, you want to have a water birth, I mean there is different things that you are looking for. So you need to figure out what your priorities are and then take that too and then ask those questions.
Really important to ask real questions that are important to you at the beginning, because that is how you going to find out if that provider is really respecting you.
STEPHANIE GLOVER: Right, and give you time to research otherwise if they are not right.
MICHELE KAZMIER: Yes, and including you in the decisions. Do they feel like it is important to listen to what you have to say, are they listening and . . . I feel like that is more important than anything.
STEPHANIE GLOVER: I researched and got to a point where I had to put myself in a position with a good team around me and then surrender and I remember feeling like now I am supported with this midwives even if I end up with a C-section again or with some other complications, I trusted my team and I remember that made all the difference.
MICHELE KAZMIER: And you trusted yourself that you actually did your homework and you did the things that work for you and family. But sometimes the situations that you may want or the care provider or settings you want maybe outside, not in your area. You may have to make a big choice to move somewhere . . . there are some people that come to San Diego for certain birth choices or go to the farm. . .
STEPHANIE GLOVER: That is a big decision, yeah go to the farm exactly.
MICHELE KAZMIER: Sometimes you are making that decision because finances are the most important in your family and that is a really important part of the decision making process and that is a big one that I tell clients, they really have to explore that because there are a lot of choices with that and if you make the decisions to pick a certain setting that may not be what was your first choice base on your finances, there are still ways that you can make that setting work for you.
In other words if you have to choose a hospital because the hospital is covered for your insurance and financially it makes more sense. How can you make that setting more of what you thought if you were going to choose an out of hospital setting? How could it match that better for you? There are ways to do that, you just have to really think through the whole process and be comfortable with asserting yourself and be comfortable with telling people what your choices are and not been afraid of that, that's really important.
STEPHANIE GLOVER: I'd like to tell mamma's that there no for politeness when you are in labor.
MICHELE KAZMIER: That is right because during the prenatal care as Penny Senkin often says “ if it is in the prenatal care you don't feel like your choices are respected it is not going to be any different during labor and delivery, in fact you're going to be much more vulnerable at that time. That is a difficult time to make those choices, some people of faced with having to make those choices then, it is better if you can do your homework upfront first and figure out what is going to work for you at the very beginning. If you have to change that is fine and sometimes you will go through process where you have to change.
STEPHANIE GLOVER: And when you have the opportunity to meet with providers to ask this question paper before really deciding to go with them. Do providers charge for this typically? Do you need to be seen as an actual appointment? Or . . .
MICHELE KAZMIER: Most providers offer an initial consultation and there should be that availability, I have heard some feedback from some clients that said that they didn't actually have that option when they switched but there should be an initial consultation arrangement where you can meet with them free of charge, bring your questions, get to know them, that should be for all providers, you should be able to do that and hopefully they are doing that. Because that way you really can get a feel for the practice without already been obligated to physical exams and things like that where you might not need.
STEPHANIE GLOVER: Laura when you were choosing that new provided, did you interview any in between?
LAURA KELLER: I didn't do interviews, I did a lot more research though and I got a lot of advice from other people who I knew who were pregnant or had babies in the area. I tried to look online as well and kind of read reviews and get some information that way. But it was quite challenging, there is not a lot of information out there so I was mostly relying on word of mouth and referrals from friends.
STEPHANIE GLOVER: It is interest because I was referred to two doctors here who have a very wonderful reputation in the VBAC community and I actually had an opportunity to meet with each of them as meet and greet and they weren't right for me. But so many people love them and so I think that what is so important to is to, you know if you get an opportunity . . . and my experience anyway was that I did have that chance to meet with them and ultimately settle in where I think I was supposed to be and I am sure I would have been taking care of with either of those choices as well. I did a lot of leg work with those weeks.
MICHELE KAZMIER: That brings us right back to that same point is that sometimes we . . . it is difficult to assert yourself in those situations. You feel like maybe you're bothering . . . That there is really no place for that when you are making these choices because it is a very big decision. So it's good that it looks like you really explored and even though there were community references they were telling you it works better when you were really thinking, you know really going with your gut which worked for you.
STEPHANIE GLOVER: When we come back we will discuss the process of switching providers, we will be right back.
STEPHANIE GLOVER: Welcome back we're discussing changing providers mid pregnancy, certified nurse and midwife Michele Kazmier is our expert today. So let's talk about the actual process of switching providers. So you found that new provider and you liked to move forward, now what, how do you go about transferring your medical records?
MICHELE KAZMIER: Transfer of medical records is present simple, the provider that you are going to see can give you a release form or can actually do the whole process for you. So once you decide on the provider they would have you fill out the release form and fax it to the previous provider’s office and just obtain your records.
So sometimes especially if it is in an uncomfortable situation for you, if maybe you left previous practice and it wasn't for a reason where it wasn't working out for you. It can be a very simple process. I do encourage clients when they leave a practice . . . if they can spend some time talking to that practice about why they are leaving, it could be helpful for that practice to have the feedback. But if you are not comfortable by doing that this can be very simple. Just the fax of release of records and then you can start the process.
STEPHANIE GLOVER: Laura did you have a chance to give the old office any feedback? Or how did you go about transferring . . . ?
LAURA KELLER: Yeah there wasn't really a moment where I said; O/B we breaking up, I made the decision and basically just had to call the office and get my medical records transferred, so it's mostly just the office staff taking care of that for me and as far as the process of transferring the records it was pretty simple.
STEPHANIE GLOVER: Mine I felt was a bit dramatic because the midwife I think they are cut off for accepting any patience was typically 34 weeks and I met them at a meet and greet and they saw the desperation in my eyes and accepted me a little bit later and arranged for midwife to come in an hour early on clinical so that they could see me but they were essentially like if you can get your records by noon, we have an appointment for you at noon. So I remember having just go to my O/B office and I was calling my doula on the way saying how do I phrase this, this is so awkward.
So I had to go in person and wait for them and that is why you are leaving us, and I didn't know yet I didn't know what the process was, “ I am seeking subsequent care, you know something like that . . . I don't know I had some funny phrase to use and she was like, looking at me kind of . . . So what are you leaving to office, No I am just looking at alternative as well to include with and she is like a okay, and I said but I need those records now . . . and when I made that switch I decided to call my O/B and I left a message and it was just like I don't need a nurse to call me, I need you to, I need to discuss my care.
And she called very alarmed and I just started crying and I was like I don't want to burn bridges, because I love her, and I said can I just keep you as my gynecologist just you know and she said oh I know where you going, your angered hands you know yes, and if you are pregnant ever again I would love to be your O/B again. So I did sort to have to break up with her . . .
LAURA KELLER: I didn't have to but I decided to, for me it kind of was the closer.
MICHELE KAZMIER: I think it was kind of good to do that, I really think it's good again you just exercising that muscle of exerting yourself in your pregnancy is important you know to really just . . . and you also given valuable feedback and I mean she might be really upset, she is probably upset from losing you.
STEPHANIE GLOVER: And she understood to, so I really basically said I trust you but I just don’t know about the other providers and no, not every assurance from you will make me feel better about them because I do not know about them. And you know she was like you know I understand. So it was kind of a nice closer. I think we had our Maternity shot later that day. so I thought it was a good timing so I got to just like be in a different head space for my pictures so I was more serening.
So let's talk about billing because I remember that was a huge kind of a way on my shoulders. I didn't know how it would be handled with what I have to end up sort of double paying in some instances. If we could talk a little bit about the billing side of things and if someone switches provider’s kind of what does that mean on the backend.
MICHELE KAZMIER: Well billing in maternity care could probably be a whole episode. I could tell you that I have learnt that over this last year. But just in the subject of insurance itself, understanding your co-payments and deductible and things like that and putting that aside. The provider that you previously saw should be able to bill separately for those prenatal visits and then your new provider should be able to bill for those.
So it should be shameless, it should be okay. You should definitely be investigating the other portions of it and we have already talked about that. But ones you know that it's going to be a seamless insurance to insurance transition, the other provider you get paid fine and the new provider should an it shouldn't be too much out of pocket expense if you are going that direction from insurance to insurance.
Now if we don’t go that direction and we go to different then that's a whole other segment. And then it can get a little complicated. But if one provider takes insurance they will bill your insurance and she go to a provider that doesn't then obviously you are going to see pretty clearly you know how that is going to work out.
STEPHANIE GLOVER: I didn't even realize before getting pregnant, how much maternity care was even billed. I remember like . . .
MICHELE KAZMIER: Very confusing.
STEPHANIE GLOVER: . . . very is different, you think maybe an OB as a specialist, but I have my specialist bill paid, no maybe on your initial visit but then we'll build up on delivery for everything, you know so I just . . . I remember searching going “ do I have to do anything or are they just going to do the math on that bill” and thankfully to pretty seamless. I ended up actually paying more my second time, but that was just my bad for something I did not open [inaudible].
So is there a cut off in pregnancy I think I mentioned for my group, but is there a cut off for switching providers or is it more sort of on a case by case basis.
MICHELE KAZMIER: There can be a cutoff, it depends on the settings, it depends on the practice but in general you should be able to switch providers all the way through your pregnancy and you should you know be able during labor which I know we might touch base at the end. But in terms of switching for your prenatal care most providers are looking at 28 to 32 weeks some will take to 36 weeks and some providers will take all the way to the end, it just depends.
So it is definitely again if you do your research at the beginning and again it's hard to do and sometimes you do not know what you want at the beginning, you can get a little bit more of an idea. You can start with one provider and then know you have a certain amount of time to switch over to another if you to change your mind. The providers just really want to . . . most do want to build up relationship with you so it's really . . .
STEPHANIE GLOVER: So that is why they really want to cut off just to be able to see you for a bit before handing. . .
MICHELE KAZMIER: There are other reasons but yes that is really important. Especially if you seeking a soul provider practice, for them to have the time to really get to know you it makes it a little tricky if you are coming in at the very end, although you can do it and if you had prenatal care, a lot of providers would take you in close to the end. It depends if you have had prenatal care, now if you haven’t had prenatal care it gets a lot harder. So you have to make sure you had some prenatal care.
STEPHANIE GLOVER: So if you were on that show, I didn't know I was pregnant.
MICHELE KAZMIER: It makes it a little tricky, you can still do it, but again its provider preference, practice preference, everyone has different rules.
STEPHANIE GLOVER: Laura how far long were you when you switched?
LAURA KELLER: I was 20 weeks.
STEPHANIE GLOVER: So right in the middle then.
LAURA KELLER: It was a long process and I learnt more about insurance than I ever cared now, but by that time I switched over I was at 20 weeks.
STEPHANIE GLOVER: So thanks for joining us Michele, for more information about Michele as well as information about any of our panelist, visit our episode page of our website. This conversation continues for members of our Preggie Pals Club. After the show Michele is going to discuss how to switch care providers while in labor. I bet you didn't know you could do that. To join our club, visit our website at www.newmommymedia.com.
LISA DRUXMAN: Hi Preggie Pals, I am Lisa Druxman, Fitness Expert and Chief Founding Mom of Stroller Strides, a fitness program for moms and the babies. I am here to answer some of your most common questions when it comes to exercise in pregnancy and today I am going to give you some good ideas to improve labor and delivery. Now there are some mixed reports on the effects of exercise during pregnancy and on the course of outcome of your labor and delivery. Some studies have honestly shown that it has no effect, yet other shows that exercise has shorter labors and less painful labors.
To me that sounds like a little pretty good incentive. Overall I am going to tell you that the best thing you can do for a better labor is going to be just to exercise consistently throughout your pregnancy. Make sure you're getting cardiovascular training; make sure you are getting strength training. But also think about what are some of the positions you are going to be in during pregnancy. I want to see you doing a lot of squats so that your legs don't fatigue during pregnancy and thinking about hip opening exercises, so a plea squat and actually mimicking some of the positions.
I hope during labor that you are actually not going to be on your back and you are going to be in a lot of standing positions. It will definitely help you getting ready. The other thing is you can work your abdominals during pregnancy; you just can't do a lot of exercise lying on your back. So whether you are doing abdominal bracing or some standing core exercises, the stronger your abs are the easier it is going to be to move that baby down and certainly it is important to be kegeling throughout your pregnancy and honestly you should be kegeling every single day for the rest of your life even after the baby is born. Those strong pelvic floor muscles will help you get the baby out but it is also controlling your body, so you know how to relax your pelvic floor and will help you greatly.
So overall I want to see you exercising throughout pregnancy, focusing on some core strength, focusing on some hip openers and again your pelvic floor and I do hope you have a wonderful fit pregnancy. Do visits www.strollerstrides.com for more information on how to stay fit through pregnancy and parenthood and be sure to listen to Preggie Pals for more great prenatal fitness tips.
STEPHANIE GLOVER: That wraps up our show for today. We appreciate you listening to Preggie Pals.
Don’t forget to check out our sister show:
• Newbies – For postpartum moms during baby's first year
• Parent Savers for parents with infants and toddlers
• Twin Talks for parents with multiples and
• The Boob Group for moms who breastfeed
This is Preggie Pals. Your pregnancy, your way!
This has been a New Mommy Media production. The information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. While such information and materials are believed to be accurate, it is not intended to replace or substitute for professional, medical advice or care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
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