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Monday
Jun272011

Disclosing Homebirth Plans to OB

On my Navelgazing Midwife Facebook Page, I asked:

If you had an OB and had/are having a homebirth, did you tell your OB? What did s/he have to say about it? Have any of you been fired from care for disclosing your homebirth plans?

I asked this because I’ve had a couple of recent inquiries about whether to share their upcoming homebirth plans with their doctor or not. My advice is to explore why you want to tell the doctor. Do you want him/her to be your back-up in case of an emergency? Do you feel that not telling is lying by omission? Do you honestly want to know what your OB thinks about your having a homebirth… whether you’re a safe candidate or not? Each woman has to answer those questions for themselves, but every single one of them also has to be prepared to be dismissed from care if their doctor isn’t too keen on the whole homebirth thing. It might not be fair, but that’s the way it is. For many doctors, even those who might be supportive (albeit, grudgingly), their malpractice insurance might not allow them to speak about their feelings, much less act upon them.

Here's how the women answered my question. No names given, of course.

C: No, I didn't want to deal with any comments my OB would have about my home birth plans. I saw the OB three times in my pregnancy for ultrasound and labs, and my midwife for all the other visits. This time I'm not planning to see an OB at all.

 J: I'm pretty upfront - my occupation is "homebirth midwife" after all. She didn't flinch one bit, although I know she personally is not a homebirth fan. But she gave me the consultation I needed. I like her a lot. She pulls no punches, just tells you what she thinks, no manipulation.

M: I hinted without saying my plans. She apparently never got the memo. After <my baby> was born (planned homebirth with a midwife turned unplanned UC [Unassisted Childbirth]), I called her to say the baby was born. She wanted me to come in right away and "get checked out". When I refused, she pretty much refused me ANY postpartum care (battled thrush, mastitis, depression); didn't matter. She was pissed and though she never dismissed me from her practice, she refused to see me and instead my appointments were with the [mean, nasty, devoid of feeling] CNM.

J: There is only one practice in our area, a family doc, who will knowingly do dual care for home birth women. Even the CNMs will kick you out of their practice if they find out you are having a home birth. Seriously! There is one group of CNMs who will do dual care on a "don't-ask-don't-tell" basis, but the others are openly hostile to home birthers, as are the OBs in our city. Any hint that a woman is considering a home birth and she'll get a discontinue care letter.

K: I sought care from the OB who performed my Cesarean for scar tissue issues, and since I was newly pregnant, but not her patient she wouldn't see me. A week later I got a letter dismissing me from her practice along with a tear-out of the increased-neonatal-death-with-planned-homebirth article. Had a beautiful healing HBAC three months ago. 

L: It was very much our intention to have an OB attended homebirth.

J: Recently, I had a client switch care to me for Out-of-Hospital birth. Then, she got cellulitis/mastitis on day four and her OB took her back, called stuff in, saw her in person when that didn't work and treated her beautifully. I really appreciate that. She didn't have to do that. She could have sentenced my client to the walk-in clinic of uncertain-care.

L: My OB took it pretty well, although he made sure to mention he wouldn't let his own wife or daughter do it, and he asked that I please call him after the birth to let him know that the baby and I both "survived." At a later GYN visit he was very excited to show me an article in some medical journal entitled "What If My Patient Wants a Homebirth?" and how, thanks to me, he has a better answer now if it comes up again. I found the whole experience amusing and I'll probably go back to him for shadow care when we have our next home birth. He delivered my first daughter in the hospital, so I did have a bit more history with him than just random prenatal visits along the way.

M: I was seeing an OB for fertility issues. When I completed the first trimester and was comfortably out of my personal "worry zone" for repeat miscarriage, I let her know that I was switching to a licensed midwife for a homebirth and she supported me completely. She is one of the local favorites for natural hospital birth and midwife backup. We are lucky to have her!

N: I'm seeing an OB but have UC plans, which I most definitely have not shared!

C: My OB used to run a solo practice and is now partnered with two other doctors. He was wonderfully supportive of my unmedicated hospital births when he was the only OB there, but I wouldn't go back to them because I don't know and trust his partners. When I was pregnant with a miscarriage I called to see if I could get in for an ultrasound and was told I would have to schedule the full OB workup at ten weeks in order to be seen in their office at all.

E: With my second pregnancy (first home birth) I told my OB at around 16 weeks. Every visit included a diatribe about the risks of home birth. Finally, at 32 weeks I said 'please make a note in my chart that I don't wish to discuss it any further and if I have to keep going through this I will terminate my care'. It was not mentioned again. With my 3rd pregnancy, the practice already knew my history and was more relaxed about it. My 4th and 5th pregnancies I had no OB care.

P: LOL to the term "fired". Doctors do not pay their patients.

Navelgazing Midwife: I understand, P, but when you can be "dismissed" from their care, it isn't uncommon to consider that fired. It does seem like the only person who can fire should be the woman firing her provider, but The System is twisted enough that women ARE fired from care.

C: I've told my OB for both planned homebirths (the first of which transferred to the hospital). I was offered the same prenatal care as anyone else birthing with his practice (which was still not as wonderful as my homebirth midwife's prenatal care). 

The second time, only had prenatal care I didn't have access to with my homebirth midwife after my first visit to say, "I'm pregnant and having a homebirth, but would like to have a plan B option." The other two visits were for an ultrasound and Group B Strep screening. My OB wished me well and made sure to tell me to not to hesitate coming to the hospital if I need anything.

J: Yes. In 2001 in San Diego. It sucked.

A: My OBs obviously don't recommend it, but they give me care anyway. Though, I am convinced it isn't the same care since they know. I also am monitored by a midwife. So many other women I know that see the same OBs tell me such different stories about how their visits go. I guess maybe they think I get everything I need from the midwife, so don't monitor me as closely. I am convinced they just pick numbers to write in my chart as measurements.

E: I saw an ob a few times -- I specifically drove an hour each way to see the one homebirth friendly ob in my city. I told her and she was cool.

K: I didn't tell my OB face to face, but I did tell the front office I wanted copies of my records because I was considering a homebirth. They let me have them for $1 a page. At the next visit, the Dr. didn't ask me about it so I didn't volunteer anything. I didn't get fired; I quietly fired him. Called the office to cancel the next appointment; they were closed (weird, it wasn't a holiday), so left a voicemail saying I was canceling the next appointment because I has chosen to have a homebirth. I was 29 weeks. I never heard from them at all after that.

C: I saw an OB a few times to do genetic counseling (I was paranoid being Advanced Maternal Age) and never told him my plans to UC.

R: I didn't share with the OB my plans of a UC!

A: It was important to me to co-care, and also to not be lectured. So I did not feel obliged to divulge my birth plans.

J: My former OB has two CNMs in his practice. I mentioned, on the first visit, that I was considering a homebirth. (First pregnancy but had been to him for well visits.) He mentioned that with his practice, I could have a, "home-style birth in the hospital" but otherwise didn't push. At 20 weeks, I switched care to my homebirth midwife. Everyone at his practice was cooperative and I never looked back.

C: I was fired from the practice.

S: I'm from the United Kingdom and I was under OB care, when I told her I was going to have a homebirth she went completely mad! Told me I would have a heart attack if I didn't come into hospital as I had Pregnancy Induced Hypertension. I spoke to the head of midwifery and she was great! In the end, our baby arrived unassisted in our living room. If i would of gone to hospital she would of been born in the car! 

R: Nope she never knew. 

L: It is interesting to read everyone's comments. I have an OB and decided not to see him for prenatal care because I didn't want to risk being ousted OR putting him in an awkward position with the Clinic he's with. So when I needed a script for tests, I saw a local DO who provides parallel care for others as well.

A: In my area, your general practitioner cares for you until around 20 weeks at which point you are transferred to OB care until the end of your pregnancy (New Brunswick, Canada). In a small percentage of cases GPs do deliveries and only transfer care or consult if needed. For my second pregnancy, I advised my GP that I'd hired a midwife for a homebirth, but that I still wanted to see an OB/GYN to introduce myself. I went for one visit with the OB and told him our plans. He reviewed my charts from my previous birth, asked if I was confident our midwife had enough training and told me there was a 99% chance that I wouldn't need him or the hospital. I was totally flabbergasted. He suggested I send in my charts from the midwife after 36 weeks in case I needed to transfer. I wish I could call this OB wonderful on all counts but, I've since worked with him for a few doula clients, he's got some good and bad points, is all I'll say. He also supports placentophagy... go figure!  

L: I planned on having a homebirth; then we ended up seeing OBs. My husband mentioned my wanting to homebirth and the OB said basically "Oh no, you don't want that." Never said anything about it to him again but, tried to find out if there was a practising midwife around - nothing. If I'd said something at nanowrimo write-ins though, I'd have had a better idea (as I found out a year later).

While I didn't homebirth, I really wish I had done what I wanted in the first place - my husband finally ended up talking to his midwife-friend who he'd kept telling me I should contact from that first anti-homebirth sentiment we got; she was there for us and was a whole lot better than the L&D staff - suggested helpful things before they even thought of them. If I were pregnant again, I'd be planning on a homebirth again.

R: I was planning a homebirth w/a CNM (with family doctor back-up) until 27 weeks when an ultrasound revealed twins. I switched to a hospital-based OB group with CNMs and tried to avoid revealing my PRIOR plans -- even though I was no longer considering a homebirth, I feared being treated as a "nutso" and disrespected for my original choice. The doctors already seemed annoyed enough at my lack of early-pregnancy ultrasounds and switching to their practice so late in pregnancy. I needed them to take me seriously and be partners in my care and didn't want to alienate anyone. I didn't even want the nurses in the hospital to know. When we arrived at the hospital at 39w5d with me in VERY active labor and the nurses rushing around, my mom mentioned it and I got upset, even though it clearly didn't matter at that point (the babies were born an hour after I arrived, I don't think anyone even had time to read my birth plan). For reference, my care providers are in the area described by J. above, so the fear of bias wasn't just in my head!

J: I live in Washington State where CNM are licensed to do home births, so when I told my OBs, they were supportive and fine with it. In their practice they employed two CNMs that delivered babies in the hospital. They also told me if I needed to transfer to the hospital to have the nurses page them and they would cover my birth. So I really did have the best of both worlds. I realize that I am in a minority!

Me again.

I had concurrent care with my second baby, my UC baby. I certainly didn't tell the OBs I saw at the military hospital. I got enough crap from them after she was born. They even sent Child Protective Services out to the house to make sure we weren't neglectful parents. No, just really, really hands-off. (Much more so then than I am now!) With my third baby, my military CNMs did know of my homebirth plans with a legal hebamme (German midwife) and were wonderful about it. When my plans changed because my membranes had been ruptured longer than the hebamme could legally keep me as a client, the midwives embraced me as a hospital-birthing mama, promising to make the birth as peaceful as possible. I ended up delivering in the car with a CNM and an OB; I wouldn't consider it "peaceful." Hilarious was more like it.

In a perfect world, we'd all be able to share our whole stories... care would be seamless, whoever we were sitting in front of. It makes me sigh with frustration that women are often forced to either lie or omit information because they might lose an important link in their pregnancy care. I applaud the providers that withstand the enormous pressure to punish and ignore women who are choosing to birth at home. Thank you for your tenacity! I also applaud the women who walk the thin line of another form of Don't Ask, Don't Tell... the kind that can get you kicked out, just as readily as when it was gays in the military. Both are just wrong.

 

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Reader Comments (12)

Thanks for this post. I'm also in the "Don't ask, don't tell" group right now. I have only 1 choice for an OB with my HMO, and I've been told that he "fires" patients for home births, so I'm keeping my mouth shut. Keep in mind that my midwife has been attending births longer than my OB, and home birth is completely legal in this state. Makes me sick to think that we have to lie in order to get the best care for ourselves and our babies!

June 27, 2011 | Unregistered CommenterTina

Why do so many people continue to see an OB if under the care of a licensed midwife? Or is concurrent care just in those situations where a woman is working with an unlicensed midwife or CPM?

I work with a CNM homebirth midwife for my pregnancies and have never seen an OB for any pregnancy-related care. My midwife gives me a referral for the sonos I want at the local hospital, but that's it.

June 28, 2011 | Unregistered CommenterJo

For exactly the reasons you said: They are seeing midwives without prescriptive privileges, either for meds if they need them or for sonos and prenatal testing.

June 28, 2011 | Registered CommenterNavelgazing Midwife

Barb, I'm kind of embarrassed that I hadn't fully-considered this, but I guess I will have to figure it out. My (MD) mom is supportive of my plans to HB, and, as you know, will be with me during labor, primarily as emotional support. But I did realize the other day that she still has one small reservation-- when she asked who my backup OB would be. I kinda looked at her funny, like why do I need one? But then I gleaned she is concerned about what will happen if I need to transfer, not thinking I need an OB for concurrent prenatal care. We didn't really get into it in depth because I'm not even expecting yet, but I realized *I* had just assumed I would go to the nearest hospital and have to deal with whomever is on call. Not ideal, but I hadn't really thought there were (usually) many other options?

Where I am, I can only legally be attended at home by a CNM, who will have script-writing privileges, will carry medications and whatnot, so that's not really an issue. Assuming I stay low-risk, I am not seeing any particular need to see an OB EXCEPT if I need to transfer during labor.

So... what should I do?

I think my mom is concerned about how I will be treated if I go to the hospital during labor as a completely new patient. Well, that is completely understandable*. Of course, since my HB MW will be "legal" and would come with me to the hospital (though she won't have privileges), we at least don't have to worry about that aspect. But I guess I'm not clear that there is any sort of protocol for consulting with an OB while planning a HB... I mean for the sole purpose of "knowing someone" at the hospital, "just in case." In a perfect world, sure, but how would I cobble something like that together in the land of reality?

I figured I would ask the MWs when I interviewed them if they have relationships with any OBs in nearby hospitals? Something like that? At this point, I am planning on having moved by the time I give birth, but since I'm in a big city and will stay here, as long as it's not life or death, I guess I will have some choice of where to transfer during labor, if my MW has a relationship with one hospital but not another. Meaning... like right now, I'm 3 minutes from one hospital, 12 minutes from 2 other hospitals, 20-30 minutes from 2 MORE hospitals, etc. So I may have some flexibility.

IDK... Does any of this make sense? I wouldn't at all mind meeting with a HB/NCB-friendly OB to "touch base" (in fact, that would be great) but having shadow care per se seems silly if I have a low-risk pregnancy-- especially since I'll be seeing a CNM anyway.

Yes, no?

It must be typical for these legal HB CNMs to at least have SOME relationship with SOMEONE in SOME nearby hospital... no? Even someone I wouldn't have to see pre-natally at all, but someone who, when I arrive at the hospital as a transfer, would say, "Oh, that's one of Maria's HB patients (clients)" and not, "Oh, that's one of those crazy women who gets no prenatal care." I mean, the latter could still happen depending on who's on call and whatnot, but I mean, I'm thinking of improving the odds that a transfer would happen with some semblance of smoothness...

Am I making any sense? LOL...


*And might have something to do with the fact that she worked as an ER doc for some time, and probably did see women come in who had not been to an OB during pregnancy for a wide variety of reasons. Though my mom herself is super-respectful, I imagine she saw these women treated in a variety of ways, plus there's always the aspect of having to get up to speed on a "foreign" patient's history.

June 29, 2011 | Unregistered CommenterDreamy

I think this is a pretty easy one, actually.

Ask the CNMs to describe a transport to you.

That way, you will learn where they go, who they talk to at the hospital and also the role they take once there. You can ask how previous transports have gone... have they been received well? Have they ever had nurses or doctors that gave them a hard time? How did they handle it? If they've ever had a hard time, was it the midwives or the client that was punished? What have they done differently to ensure that didn't happen again (if they had any way to change the situation)?

Just hearing about their transports will give you the info you're looking for.

Even when a homebirth midwife has a sympathetic doctor, it would be pretty unusual (impossible around here) to have that doctor have anything to do with the transport, including (and especially) meeting the woman and midwife at the hospital. Even when the client might see the kind and sympathetic doc during the pregnancy... say, for antibiotics or thyroid medication... when she goes in during a transport, she is treated as if she has no doctor.

The Doc in the Box is what the doctor on-call is typically called (on the inside) and transporting women, almost exclusively, get the Doc in the Box. I've been extremely lucky on two occasions when the Doc in the Box happened to be the sympathetic doc who'd seen my client, but that was a total coincidence and we had to make it CLEAR the woman was NOT the doctor's patient even though he seemed to know her better than another walk-in.

Is this helping?

June 29, 2011 | Registered CommenterNavelgazing Midwife

I'm a FB follower, but I didn't see this one, and thought I would share :) I planned a homebirth, and in SC you must see an OB 2 times during your pregnancy and have them sign a waiver at 37 weeks that you are in good health to birth at home. I saw my OB much more than that due to an incompetent cervix that I needed a cerclage for, so I had care with both my midwife and OB, seeing my midwife once during the first 20 weeks, and alternating between OB and MW during the last 22 weeks.

My OB was fully aware of my plans to birth at home from the beginning, but unfortunately, I was his last homebirth patient because of insurance issues, he will no longer be able to help the homebirth patients in my area. We also don't have any more midwives within a 2 hour drive because mine moved :( but thats a whole different issue.

I am very grateful that I saw my OB so much, and was surprised after having all female caregivers with my first 2 children that I felt so much more comfortable with him.... it seemed that he had more empathy? not sure, but he was so supportive of me, and when in the end, I "had" to be induced at 42 weeks (SC law says 37-42 weeks can birth at home, anything outside of that needs OB approval with a BPP and since my MW estimated baby at "a good 9lbs" which he was, 9.5, I wasn't going to risk a csection, so I went with the induction and no BPP), so having such a great relationship with him was invaluable.

He was supportive of my decisions, even the ones he thought were "strange", including delayed cord clamping, no traction or active management of the 3rd stage, I had freedom of movement (with an AMAZING nurse holding the monitors to my belly the WHOLE time, and never leaving my side, even to eat lunch), the pit was turned off when I had a good labor pattern down, I pushed in an upright position, and no one bothered me about an epidural, my AWESOME nurse even told my hubs to stop asking me if I wanted one, I would tell her if I needed one but was doing great, lol!

In the end, I am still very disappointed that I couldn't birth at home, but plan to have my next baby (no clue when that will happen, lol) at home, and I am so very grateful that I got to experience a peaceful birth attended by someone who supported my choices, even though he didn't understand them

July 1, 2011 | Unregistered CommenterBrittney

You know, that makes complete sense to me, and was kinda what I was picturing. Excuse any rambling to follow, but I think my mom's issue is that she supports the idea of homebirth but doesn't quite grasp the logistics yet. I was the one who really introduced it to her and got her researching the major problems with the routine use of modern obstetrics for low risk blah blah blah a few years ago. So we've talked about it quite a bit in theory, and though she was initially skeptical (while she has always been an advocate of NCB), she basically brought HERSELF around by doing a bit of research. But since I am only now about to TTC, we haven't gone in-depth on every single facet of HB yet, and I'm realizing she might not quite "get" it in some respects.

Kind of like my husband, who even just a year ago or so-- after hearing me blab for years, getting 100% behind homebirth, etc.-- said something to me about the doctor I'd see. In addition to a MW. You know, for prenatals and stuff.

Bzuh?

By then he knew a MW wasn't a doula or-- to paraphrase Will & Grace-- a witchy lesbian who waves a stick over you (though maybe we'll get lucky and have one of those too!)-- but he still hadn't QUITE comprehended the whole scenario. I think it's tough when you've only seen one way for most of your life (and most of that shrouded in mystery). Kind of like the OBs who ask how HB MWs rig up stirrups at home, LOL...

Anyway.

She knows that half the time a laboring woman doesn't even see her own OB during birth, and a significant minority of the time a woman doesn't see anyone in her OB's PRACTICE-- and what about a woman who gives birth while on vacation? I'll really have to discuss this further with Mom to see if I can address any specific concerns, because I do know she isn't worried about my not seeing an OB prenatally, so... is she that worried I'll be treated badly? (I'll certainly have one advantage over a vacationing woman, as my care provider will be physically present at admission.) Is it something else? I'll have to see.

But thank you for the help in phrasing the question to potential MWs! That does help quite a bit. :)

July 1, 2011 | Unregistered CommenterDreamy

I'm going for my second HB in march and I plan on getting a back-up doctor this time (I'm in a non-CPM licensing state). fortunately, there is one doc in our area who works with my midwife and I'm grateful that I won't have to deal with flak (although I feel slightly guilty I won't be going to her birth center). I wanted to have the peace of mind that if I needed to transfer care I wouldn't be with just anyone.

July 25, 2011 | Unregistered CommenterMeg

Thank you for this post. I had no clue that this was a 'norm' in OB care.

I saw an OB for my pregnancy up until 20 weeks. I discussed homebirth with him and he didn't try to dissurade us but encouraged us to take a Bradley class. He was supportive. At 20 weeks I switched to a HB midwife, and let his office know that I was pleased with my care and would be back for postpartum care and intended to stay with the practice for general GYN services. After I delivered, I called his office to schedule an annual appointment. The staff welcomed me back. This past Friday I called to see if I could get in for an emergency issue I was having, and he had a staff member call me to tell me I was no longer welcome at his practice, that I should see whoever delivered my baby (does not to general GYN services) or go to the ER, and I was also informed that all further scheduled appointments would be cancelled. I was SHOCKED and had never heard of such a thing.

I also felt abandoned, betrayed, and misled. From the begining he mentioned c/s because I am a small frame. Now I feel like he just wanted to slice and dice me for more money or convienence. I went with my gut instinct to deliver at home, and now knowing what I do know, I am so glad that he was not a part of such a wonderful day in the life of my family.

I thought they had to give prior written notice to patients instead of abandoning them in the time of need? I'm considering writing a letter to the board in my area.

August 1, 2011 | Unregistered CommenterA

Barb, I just wanted to follow up and say that even though I'm not quite TTC yet, I (along with my husband) went ahead and attended an info session held by a local HB MW (CNM). She and her partner don't have privileges, but what they do is the following (hope my terminology is right)...

-For emergency transPORTs, they call 911 and get you to the nearest hospital. Sounds right to me-- pretty sure I want to be in the care of surgeons in a case like that. And I know now where I'll be living, and it's literally 1/2 a mile from the nearest hospital, which is a totally decent one (if interventionist, like most) and does tons of births.

-For non-emergent transFERs-- which are, according to the MW, more than 95% of all of their transfer/ports-- they call around and see who's on duty at various nearby hospitals, and go with the best prospect. They have good professional relationships with a number of HCPs at most local hospitals and will try to get you seen by hospital CNMs if at all possible.

In my case, there will be four nearish hospitals that have CNM practices-- 3 about 20-30 minutes away in different directions, and 1 about 35-40 minutes away. As she said, the vast majority of transfers are for maternal exhaustion/choice (but vitals look good), so 20-40 minutes should be fine in those cases.

Oh, except if baby needs to transfer PP (non-emergent). Then they always go to Children's (NMC) cause it's awesome and ~25 minutes away. That's only come up a couple times, and in both cases the baby was fine (they were just being conservative.

...so... that sounds pretty excellent to me. And like I said, they're CNMs, so no concern about basic meds and such. They can write scripts, carry injectable pit, do heplock infusions for GBS+, all at home.

BTW, Barb, I wanted to thank you for a lot of your recent writing about how to choose a HB MW. I was definitely not on the uber-crunchy "liberal" end of the scale before, but I think I've even become a bit more conservative lately. I was doing some research now that TTC is really imminent, and realized how my thinking has shifted subtly but significantly. There are only 3 for-certain HB MW options where I'm moving to, and posssssibly 2-3 more, but they might be out of range. Before your series, one of the three-- we'll call her "Q"-- really appealed to me, and this other practice-- the one I just met-- seemed like it might be a bit interventionist.

Well, my feelings must have changed. After meeting the possibly-interventionist MW, some of my legit concerns (about a birth story on their site-- turned out to be very atypical) were allayed. I wasn't thrilled that they don't do breeches, but otherwise they seemed perfect practitioners of evidence-based care and empowerment, including some small bits of medical management (although only with informed consent). Very professional.

Then I started researching Q again (because I won't be hiring anyone without speaking to more than a couple of practices!) Well, first of all, there was a bad public review that made her seem waaaaaay too "hands-off," to the point of negligence (keeping in mind she is a CNM with hospital experience, too). It's the Internet, and there are at least two sides to every story, so I will still meet with her, but of course it gave me pause. But then I saw a woman on MDC praising her to the high heavens. Why? Because she attended her HB, despite the fact that she was attempting a HBA2C, her last C-birth was <2 years ago, she had late-onset pre-e, HBP and measured grossly large for dates. Q was apparently fine with her refusing a US (for the large-for-dates issue) on top of all of this.

Now.

That said.

I will still interview her. It's certainly possible that her philosophy is "SOMEONE had to attend this woman's birth, and if not me, she would have gone unassisted. So even if I strongly disagree, blah blah..."

I am not saying that would be my philosophy, but I *might* be able to get with that-- which is why I will still at least speak to her. But if her philosophy is that this client had little increased risk of complications, being high risk is a vast conspiracy, trust birth almost-no-matter-what, I'll happily attend a quadruplet HB, etc., etc.-- well, then... NEXT!

Luckily for me, if the practice I just met with turns out to be the only good option, I think I'll be very happy. They definitely seem aligned with me from a science + consent/respect perspective, vs. being very interventionist or being super "natural"-minded for the sake of being "natural." Like they have no cut-off for postdates, though they do NSTs every couple of days after 41w. OTOH, though everything is always presented as a choice, their protocol for GBS+ is IV abx. They usually do physiologic 3rd stage management, but will do prophylactic pit if there are PPH warning signs. These things, IMO, are very evidence-based and aligned with my thinking. They seem to be all about informed consent and never doing anything without your permission... basically they are about you taking more responsibility along with respecting your rights. Which is awesome AFAIC-- I don't want a HCP that asks me to just trust her (whether medicalized or hippy-dippy) and I WANT to take responsibility for my choices. I don't want to be fed a line of bull from any end of the spectrum-- you know, the whole "Do everything I say and you'll be fine-- hey, it's not MY fault!" flippity-floo.

Anyway! I'm incapable of writing a short comment. But I wanted to say that I appreciated your warning that women planning HBs may not WANT a MW who would take some of these clients on, because it could be indicative of other issues with her practice of midwifery. Or at the very least, of a mismatch between the client's needs and the philosophy of care.

So, thanks. You're awesome.

November 17, 2011 | Unregistered CommenterDreamy

Dreamy: LOVED what you had to say. Please forgive me for not answering in full yet. I'm struggling with clinical depression and it's REALLY hard to form complete, coherent sentences at the moment. I didn't want you to think I just threw your fantastic comment up without reading. I really, really am impressed with how you've pulled in your own knowledge with my added thoughts to "create" the midwife for you. I promise to come back to this when I'm better able to respond. Thanks so, so much for writing it all out. I *know* it will help many, many others.

November 19, 2011 | Registered CommenterNavelgazing Midwife

Thanks for this post... was just thinking about this for my next pregnancy. I had my son at home, with only one visit to a back up family doc- a rare one who did c/s amd provided OB care. He said he wasn't against what I was doing, but recommended against breech homebirth. He would have been my back-up, but he was an hour away-The local hospital was only 15 minutes away, but they were extremely unfriendly to hb transfers... So I'll still have to think about it for the next one and do some research to find a hb supportive OB, but hopefully I'd be able to find friendly back-up. :)

February 12, 2012 | Unregistered Commenterthebirthbug

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