any advice for getting OB on board with homebirth?

[JenniferLS]

Hi...I just found out that I am pregnant with my third child...and am planning on my FIRST homebirth! I'll be meeting with a midwife soon, but I haven't called my doctor yet. I LOVE my doctor...she did an awesome delivery for my second child (first child was a different doctor). I remember telling her after my daughter was born that I wanted her to deliver all my future children. But my priorities have changed, and I just
can't go through with another hospital stay. I can't stand the feeling of being powerless and not in control and i hate the idea of being strapped down with all kinds of wires and monitors and that STUPID blood pressure thing! UGGHH!!

i don't know how my doctor would feel about me having a homebirth, I'm sure she would try to discourage it...but i would LOVE it if she could be on board and be there for me should any problems arise. Anyone have any advice on how to broach this with my OB? Has anyone had any problems and had to change doctors because of this? i'm only five weeks pregnant, so i don't feel like i need to be in a hurry to call the doctor...i'd like to wait and see what the midwife says.

sorry to ramble...just over-excited!

Jennifer

[Rev1053]

I personally wouldnt say anything. I love my doctor. She is very hippie friendly and has told other people I know if she could go back she would be a midwife. But I dont feel the need to tell her that I am having a homebirth. I saw her early in the pregnancy and she told me to make another appointment and I just never did.

I dont see the need to say anything if I perceive that drama may be started.

[mamabadger]

I hate to pour cold water on your excitement, but most women planning a home birth do not even mention it to their OB. She may be a wonderful OB, but she is an OB, and to most of them, talking about "home birth" is like talking about performing surgery without washing your hands first: there is no up side, only risks. At the very least, I would suggest sounding her out on the subject first, to see how she feels about it in theory.

[meganmarie]

I guess it depends.
1) Will you do your annual checks with the midwife from now on, or do you plan to go back to this doctor for future gyn care?
2) Does your midwife have a backup doc she works with, or would you go back to this original OB if any situation should arise during the pregnancy that risks you out of homebirth?

Because, in general I agree with mamabadger that most women don't say anything and there's no reason to do so if you are never going to run into the doctor again. Women remember their doctors much better than the doctors remember them, just given how many patients they have! I said nothing when I switched from OB to midwife for birth #2 - it was a big mainstream OB practice and I was just another number to them, and never went back.

On the other hand, I could see a scenario where you want to preserve the option of a future relationship with this OB and therefore decide you should have some kind of communication that says "hey I've made this decision, and its not about you - you are great - its about the hospital and its policies - so I look forward to seeing you again for future well-woman care an/or may see you again should this pregnancy turn out to develop complications that require hospital involvement, thanks for understanding"

Not only for this reason, but I think for the purposes of birth advocacy its good for doctors to know about the choices women are making and maybe eventually this doctor could tell the hospital, hey you are losing customers over this stuff, can we make some changes in the experience here. Just another perspective.

By the way, I am a total chicken and if it were me I would totally do this in writing, not live or in a phone call!

[ShwarmaQueen]

I agree with the others. If you want a HB and want to keep a good relationship with your OB, stop scheduling visits and have your HB. Don't worry about explaining, justifying, or getting her on board.

[vegasgrl]

I finally watched The Business of Being Born the other night, and I was so shocked when Abby's doctor was all "GO FOR IT!" to the HB. Anyone have any idea why he was so for it? I had visions of my doc being the same way.

I would like my doctor on board as well; I like him a lot and if I had to transfer I'd like for him to be there. I'm curious to hear from women who HAVE had a good experience telling their OB...

[JenniferLS]

thanks, but one thing...

Yes, truly, if it were my preference, I wouldn't ever let her know I was pregnant right now...In fact, I envisioned that when they auto-scheduled my annual checkup, i would just call and say i can't make at this time!
However, the midwife i spoke to said that I needed to have a doctor as backup who would be supportive of a homebirth. So that's my quandry.
I guess if I don't think my OB would be supportive, I'd just have to go with one that the midwife works with.

And to the one who suggested writing a letter...I'm a TOTAL chicken, too, and that's probably what I'd have to do!

Thanks so much!

Jennifer

[mysticmomma]

However, the midwife i spoke to said that I needed to have a doctor as backup who would be supportive of a homebirth. So that's my quandry.

This sends up red flags for me. First of all, doctors as backups are generally the midwife's responsibility if the state licensing requires it. Secondly, You could probably find 3 doctors in a state that would support a homebirth. If an emergency arises, you go to the hospital. No need for shadow care or a back up. What state are you in?

[Mamatoabunch]

Originally Posted by shwarmaqueen

i agree with the others. If you want a hb and want to keep a good relationship with your ob, stop scheduling visits and have your hb. Don't worry about explaining, justifying, or getting her on board.

ita

[JenniferLS]

Mysticmomma

Hey...i just spoke with the midwife more at length today and we plan on meeting next week. But she said that there really aren't many doctors here at all that support homebirth. She only knows of one that she uses.
So, I think she was trying to encourage me to find one that i would be comfortable with. She said the state does require two OB visits w/standard labwork, etc. She encouraged me to at least talk to my doctor and see if she might be supportive. She thought that I could schedule my initial appointment for physical, etc...to make sure I'm not high-risk and so forth. And then that would count for one of my visits, even if the OB wasn't on board.

I'm just curious...do OBs have you sign some kind of waiver if you want to do a homebirth?

Thanks for your advice! Oh, i live in Louisiana.

[peainthepod]

When I told my OB that I was leaving her care to see a homebirth midwife I was dreading it, expecting some kind of scene. I really liked her but she specialized in high-risk pregnancies and was very much a fan of the medicalized, high intervention model.

Instead of trying to talk me out of it or getting defensive, she just raised one eyebrow and softly said, "You're very brave". Then she offered to be my backup OB if I needed a transfer. :

I do think it's weird that your midwife is claiming you "need" an OB's permission to have a homebirth. I would double-check that with the state for sure.

[fruitfulmomma]

I was pretty much thinking, why does it matter, but I understand some states require a certain number of ob visits. Ours doesn't. I did tell my doctor when I was pregnant with the first one that we were thinking about it and he said something about first time moms having a harder time but said many women in his practice did home births and he had stopped doing births by that point, so it wasn't even really an issue. (He is also okay with us not doing vax even though he doesn't agree.)

Anyway, I've used the doctors on call at the hospital when I've needed them. No big deal, that is what they are there for.

Have you run your OB's name past your midwife? She might know more about whether or not she has supported other women in the area who are using midwifery care.

Also, don't discount all doctors. I Marsden Wagner's work. He is one of the biggest proponents of home birth and of exposing the dark side of maternity care in America.

[GoldmanBaby09]

If you have to see an OB for some aspects of care, I probably would not say anything at all. Go and get your labwork done and leave it at that. As long as your midwife has someone she knows who can be her back up, I think that is enough. And besides, if you do have to transport, and it is a real emergency, you are going to get who you are going to get. If you really feel the need to tell your OB, fine, but wait until you have had the requisite care first. Since you don't know her personal stance, I would hedge your bets in case she has a bad reaction to your choice.

[ShwarmaQueen]

Originally Posted by JenniferLS

She thought that I could schedule my initial appointment for physical, etc...to make sure I'm not high-risk and so forth. And then that would count for one of my visits, even if the OB wasn't on board.

Your MW should be able to determine whether you're high risk...sounds kinda fishy if she wants clearance from a doc. Why would you be seeing her if she isn't comfortable making that call on her own (would signal confidence issues to me).

I'm just curious...do OBs have you sign some kind of waiver if you want to do a homebirth?

I didn't sign a waiver. I stopped doing OB visits at 7 weeks and when they asked to schedule another visit, I informed them I was changing providers. We left it at that. It's really none of their business how your baby is born! Afterall, you are a customer and can take your business anywhere you want!

[Mamatoabunch]

I too do not know why you need a OB visit to determine your risk. A midwife is certainly or should be perfectly qualified to do that. Our state requires one visit w/ backup OB if you are planning a VBAC. I refused, signed a waiver.

W/ two midwife HB prenatal care I have never seen an OB, nor cared to.

[crunchy_mama]

I wanted my ob as a back for birth #2 a homebirth as I don't want to take the gamble in an emergency- as I live in a small town and the rest of the dr's are HORRIBLE. Plus I wanted access to Rhogram. I did not tell him in pregnancy though. I went after the birth(which of course went fine). He didn't even ask any details, just if I tore and I gave a very abbreviated birth story and just made it sound like I didn't make it in time, although I am sure he figured it out- however- the status of lay midwifery at the time was a felony. I am seeing him as well this time and it hasn't even came up- he doesn't seem to care. My plan is the same this time as well. Maybe after this birth I will work up the nerve to ask him if I can just him for the shots. I don't know how I got him on board, we had a good relationship and he is just kind of laid back.

[JenniferLS]

ShwarmaQueen and Mamatoabunch

Hey...i really appreciate your insight here. I'm really new at this. But my understanding from the midwife was that the state requires that an OB (or maybe it could be any medical dr, I don't know) has to see me twice (once in the beg. for all that stuff I mentioned earlier) and once toward the end.

I think there really are only a couple midwives in my area, but this one is
highly recommended...she's an RN and she's been assisting in births and delivering babies for 35 yrs...and she was the first in our state to be licensed as a midwife. She has some pretty numerous credentials and I also have a close friend who used her, so I was going on that recommendation as well.

I still don't know exactly what I will do about my OB, but I'm not in a big hurry. We'll see...thanks again for all the advice...you're very likely to hear from me again as this whole process of planning a homebirth progresses!

Jennifer

[laohaire]

Do you mind disclosing your state?

I am NOT an expert on the various state rules, but am a little familiar with some of them, and I've never heard of a state that required OB visits and labwork. Not saying it isn't so, but maybe if you disclose your state others can confirm if that's indeed the case, or if maybe there's some misunderstanding somewhere.

It just seems really odd all around - odd that your midwife would be making it your responsibility to find a backup OB (I've only heard of either mamas getting backup OBs just for their own reasons OR their midwives have their own due to legislation or their own working preferences, usually the former), and seems like a very tall order.

Of course every OB is an individual; most OBs are not supportive of homebirths but some accept it. Chances are your OB is not going to be thrilled but she might go along with it, who knows. I have reason to be glad I live in MA, though CNMs are barred from attending home births, lay midwifery is alegal (not illegal but not specifically sanctioned). Basically the trick is just to lay low and not make a big deal about it. I did see an OB before I found a midwife (I was spotting and wanted a professional to look at it asap) and he was abrupt and condescending when we were honest about our intentions to homebirth, and poured on the scare tactics.

[JenniferLS]

laohaire

Hey...I said in an earlier post that i live in LA. You mentioned CNMs and yes, they are also not allowed to do homebirths in our state.

It's possible I could be misunderstanding the midwife...I haven't met her in person yet...will meet with her on Wednesday. But she seemed very clear about me needing to have an OB. She did offer the one she uses, but
I think she was concerned about my comfortability about it. I don't know.
I think I've decided to at least try with my OB and see what happens. I'm not doing anything, though, until after I meet with the midwife.

[mysticmomma]

So I'm guessing you are using a CPM. CNM's are not bound by this law. Here is the law

§5311. Initial Medical Evaluation

A. The licensed midwife practitioner must require that the client have a physical examination by a physician and be found to be essentially normal or at low risk before her care can be assumed. The initial physician examination shall include the physical assessment procedures which meet current standards of care set forth by the American College of Obstetricians and Gynecologists (ACOG).