Is is more "responsible" to have backup care?

[aiyasmama]

I'm planning an HBAC for August in NC with an "illegal" MW. I love my MW and trust her and I'm very excited to have a homebirth! But my first baby was born by c-section even though I had planned to be in a birth center...so the specter of transferring is heavy for me. I have the opportunity to get shadow care with a local hospital practice and I'm having trouble deciding if I want to. I have this idea that it is more responsible to have the backup care. But I don't want to do twice the prenatal appointments. If anything goes wrong I want to know that I covered all my bases. But I don't want to open myself up for unnecessary worries, doubts, interventions, etc. by being evaluated within the medical system. For example, we went ahead with doing an ultrasound this week and the doctor said the baby might be too small. I'm not worried that the baby is small, neither is my MW, and I know u/s is notoriously inaccurate in this regard, but it planted a little seed of doubt...and I don't want this pregnancy and birth to be colored by the hospital's culture of fear. Does this make any sense? Any thoughts?

[Veritaserum]

I did shadow care for one of my pregnancies, but it was with a fully home birth supportive family practice doc. In the end when I gave birth at home he was totally cool about it and had told me that if I'd needed to transfer he'd have come to the hospital for me. He doesn't do OB anymore, so I only saw my midwife with the others. I'd get the on-call doc in the event of transport. I'd call around a few hospitals to see what my options were WRT to docs because some are notoriously horrible to home birth transport moms.

You need to do what makes you feel most comfortable.

[MsBlack]

Hmmm, IMO, what would be most responsible would be if the AMA and ACOG were to start supporting all birth choices so that mamas like you don't need to worry about having med care lined up in a friendly, cooperative way, should that med care ultimately be needed.

But no, it is not irresponsible of you to avoid that backup care. In fact, with my HBAC clients, that backup care (whether hb friendly or not) generally seems to be more stressful for the mamas than helpful to anyone. There are exceptions--but because of the likelihood in our region for the docs to be scaremongering and pressure-ful with the moms (esp VBAC, whether or not doc knows of HBAC plans), I usually wish they DIDN'T have that backup. I mean, of course I think homebirth is safest with backup care in place--in an ideal world, anyway--but we don't live yet in that world. In the one we've got, I have yet to see med backup care actually serve any useful purpose for HBAC clients.

[XanaduMama]

I don't think so. If there's an emergency, you'll call 911 anyway and go to the nearest hospital...won't make much difference if you've seen an OB practice, will it?

I also had a HB in NC last year with a fabulous unlicensed CPM whom I trust utterly and completely. Not sure if you're seeing the same one, but you've got to have faith that your MW knows what she's doing and when to worry, and isn't hesitant to call 911 or go to the hospital if there really is an emergency.

I agree that the culture of fear promoted by medical birth will just negatively affect you and your baby, make you doubt yourself.

[DahliaRW]

I wouldn't bother, personally. If you transfer you're not guaranteed the OB you did backup care with anyways, you may just get who is on call. I have never had back up care and never felt it was irresponsible. If a medical condition were to arise pre-birth, I would find a good OB. During birth, I don't think I care because it's going to be bad enough if I have to transfer anyways.

[hikingmommy]

I too am planning an HBAC after a planned BC birth turned c-section. (Any day now!) My MW is "legal", but she is a CPM not a CNM, so she can't prescribe drugs, U/S, etc. It has made a world of difference to me having a non-medical focused pregnancy. It has made being pregnant so much easier, less stressful, and more enjoyable. I trust my MW not to hesitate to suggest I see an OB if something doesn't look right, either during the pregnancy or during the birth, and considering she's been practicing almost as long as I've been alive, I trust her judgment. I know that if I saw a CNM or an OB I'd be subjecting myself to lectures about dangers of VBAC, "trial of labor" (I hate that phrase), etc., which I just don't need. I know if I need to transfer I'll end up w/ whoever is on call that day, but I'd get that from whatever practice I chose anyway. I definitely agree w/ what you're saying about "the hospital's culture of fear". I say don't get parallel care, enjoy being pregnant, hope for the best, and trust your midwife and yourself.

[Beauchamp]

Originally Posted by MsBlack

Hmmm, IMO, what would be most responsible would be if the AMA and ACOG were to start supporting all birth choices so that mamas like you don't need to worry about having med care lined up in a friendly, cooperative way, should that med care ultimately be needed.

I agree. I had a bad experience leaving my OB for my MW. (As in, the OB and her staff treated me badly and delayed sending my records, aside from regularly throwing out their opinions on HB being "dangerous" and "hazardous" ...ACOG....ugh!!!!!!!!) :

Now, our family doc (a D.O., not an M.D.) has no problem with HB at all. I guess if your back up care is HB/MW friendly like Veritaserum had, it would be no problem. But if there is any friction at all...I'd sack the OB.

[trauerweidchen]

We're having our first baby this spring, so I can't relate our experiences to your previous C-section, but early on we did consider shadow care in addition to our wonderful midwife and decided against it for the same reasons others have mentioned. At the end of the day, I decided I didn't want to spend my pregnancy potentially battling with the medical establishment. If I had a doctor in the area who I trusted and could work with, I might have considered it more seriously, but I would have been starting from scratch (I didn't like the NP I was seeing prior to becoming pregnant). I didn't want to mess with two sets of appointments, and I wouldn't feel comfortable lying to them about my HB plans, but at the same time I was afraid I would have trouble being open with them and declining all sorts of tests, etc. If a problem comes up, we'll deal with it. Otherwise, it is SO wonderful to be working with someone who really knows what she is doing and treats this process as normal and healthy. I trust our midwife, as others have said, to tell me if she thinks I need to check something out with an OB or transfer during labor.

As I said, I haven't had your experience, but from things I've read and observed on these boards, I'd personally be hesitant to do shadow care as a HBAC because I think they might pressure you very heavily, especially as you get close to term, to schedule another C-section or come in for induction (which raises the chance of uterine rupture quite a lot). It depends a lot on the care provider you get, though.

That being said, everyone has their own comfort zone and you're the one who has to deal with your pregnancy and birth. Have you talked to your midwife about it? What does she think?

[Burnindinner]

I'm in NC also! Just had a HB in Nov and LOVED IT! Anyway, I did not do shadow care. In looking at the "what could go wrongs", I decided that if it was going to impact labor and we'd be able to do something about it, then we would know in time to transfer. If it was going to go badly wrong, it would do it in the hospital too and we probably wouldn't know it ahead of time anyway. If it were something wrong with the baby, it wouldn't change whether or not we'd go through with the pregnancy, so I decided to skip unnecessary care.

[Climbergirl]

I have an awesome OB (who was on vacation when I had my son) and I am starting to research HBAC. There is a homebirth midwife out here that says my OB is like having a midwife. I am just more concerned about the only hospital in the area the "allows" VBACs and the rules she would be subjected to. She used to even have a midwife on her staff that the pregnant ladies used to see!

IF you were in that case, would you consider doing shadow care?

During the last pregnancy, she really did a lot of encouraging me and she is already aware of my VBAC intentions. What questions should I ask her for doing shadow care for HBAC.

[SublimeBirthGirl]

I don't do shadow care. The stress of it cancels out the benefits for me. I planned for transfer the best I could without a back up.

[maotmsmi]

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Edited by maotmsmi - 5/21/11 at 12:29pm

[RachaelsMommy]

I'm not doing shadow care b/c I don't want to deal with the stress. I don't want to fight to not have tests or procedures.