Dismissed from clinic for planned homebirth?

[sunfish21]

I have been seen repeatedly this pregnancy by a CNM at the local clinic (my home birth midwife is 90 minutes away, across state lines, and our insurance doesn't cover the lab she uses). I did this with DD who is now 21 months as well; if I need to transfer someone knows me and I have a local place to get any labs I want done. I was at my "once-every-few-months-visit" last week and was politely told by the CNM that her partner midwives were concerned about me being seen there and the clinic's (part of the Mayo system) lawyer told her that if I was planning a home birth and had transferred my care that I needed to *transfer* my care and not come back. Between what I was told and what I read between the lines the legal people believe that if something bad happens with my home birth that I can come after them. It seems as if the CPM I see is not recognized as a serious, trained professional. This seems ridiculous to me, and I think the CNM (who had a home birth with her own child) agrees. But she also needs her job....I thanked her for any grief she had gotten because of seeing me this long and she said that she never anticipated when she took this job that someday she would be telling a pregnant woman seeking the care of a midwife that she shouldn't come back. I did tell her that while I didn't want to be a problem to her individually I was more than happy to be a problem to be discussed or an issue for the lawyers. If no-one ever rocks the boat then nothing ever changes.

Now I am wondering if I can write a letter to...someone....explaining how unhappy I am with this. I don't believe that a person being seen in another department/specialty would ever be asked to leave the clinic because they also sought out care elsewhere. I don't want to give the impression that I need them--I have the utmost trust in my CPM and don't want to give them the idea that I don't. But I do feel as if this treatment is unfair and would like to ruffle some feathers, while respecting the CNM who is in an uncomfortable position.

Any thoughts or advice? I want them talking about this!

[Xiaohua]

Umm, wow! I don't have any words of advice for you, but I can say that it exactly what I am worried about happening to me! I am also pretty sure I'll have a homebirth, but have been seeing an OB practice for the same reasons you are going to this clinic. I don't know what your legal recourse might be. Is your ins also paying your midwife? If you are paying out of pocket, maybe just keep going to the CNM at the clinic (more regularly than you have been) and not mention the hb plans at all. They would not find out until the birth either way (either you never show up in labor - call it an "oops" hb, or you show up as an emergency transfer). But that will only work if your ins will cover the clinic visits and isn't covering your midwife. No way they'll cover both...

Looking forward to some other replies, perhaps someone else might have actual legal advice for you.

Serena

[cathicog]

this doesn't surprise me at all. Despite the fact(or maybe because of it) that more women are seeing midwives and having hbs, more(maybe most) institutions are being advised by thier lawyers to not see people who are homebirthing. So it isn't an issue of safety per se, but of liability(even though the liability is really with the homebirthing family). I would let this be a warning to people who do have dual care- you might not want to tell the clinic you are planning a hb. This is sad, because they usually get ticked if you don't tell them everything, but then when you do, they drop you! So much for transparency in care! the medical model STILL doesn't trust midwives....or anything out of thier system. I don't know if they ever will. This isn't Europe, and most OBs are looking out for themselves and thier profession. The more things change, the more they stay the same.
FWIW, I had dual care with my first hb, til about 36 weeks. I think they got nervous....I had a fine hb, and even showed the baby off(at 2 weeks) to some nurse friends I had at the hospital I was planning to use as a backup...

[cileag]

I think the issue is that most providers don't like it when you see another provider for the same reason concurrently. Second opinions are typical, but for treatment, you would only go to one MD, not two. It's similar for prenatals/birth. You wouldn't see two CPMs and pick which one you liked when you were in labor would you? I find it frustrating that many of our home birth midwives don't have hospital priviliges---that's what I think would be ideal. Unfortunately, many women are in your position--or where their insurance will not cover lab work/US etc unless ordered by a MD or CNM and so I know many people choose to see an OB, whether covertly or not.

[sunflowergrrl]

I went to a CNM practice until 37 weeks and then switched to care w/ a CPM, planned HB. The CNM practice sent me a certified letter saying they are no longer responible for me BUT would provide emergency care for 30 days.

[caned & able]

That is B.S.

A person can sue anyone for anything anytime anywhere, if you get the attorney to file the case. Such silliness. The judge will toss the case, I am sure, but it is a perceived problem for the CNM.

As for the CPM not being a professional, babies have been delivered by lay midwives or DEMs since the dawn of time, before anyone thought of certification of any sort for that kind of thing. The government has gone over board with certifying every single thing in the last 50 years: child raising is now a profession by people who are not parents, but have child development units; teaching childbirth classes is done by people who have never been pregnant, but are certified; teaching breastfeeding is done by people who have never had a child and have the letters CLC after their names...on and on... so silly. But true.

You will be fine.

[Kirsten]

Originally Posted by cileag

I think the issue is that most providers don't like it when you see another provider for the same reason concurrently. Second opinions are typical, but for treatment, you would only go to one MD, not two. It's similar for prenatals/birth. You wouldn't see two CPMs and pick which one you liked when you were in labor would you? I find it frustrating that many of our home birth midwives don't have hospital priviliges---that's what I think would be ideal. Unfortunately, many women are in your position--or where their insurance will not cover lab work/US etc unless ordered by a MD or CNM and so I know many people choose to see an OB, whether covertly or not.

I agree with this. If you want a homebirth midwife 90 minutes away, then you see the homebirth midwife 90 minutes away. I had two of the three of mine out of hospital (one freestanding birth center and one homebirth) so I do understand wanting that - but if you pick it, you pick it. It seems unfair to "double dip" (for lack of a better term).

The midwives we used were 30 minutes from us, and had hospital priviliges - not at the nearest hospital but one another 30 minutes away (longer during bad traffic times). So depending on how urgent a transfer was, you'd get your midwife with her OB backup (for non-urgent transfers to the far hospital) or whoever was on call (for urgent transfers to the near hospital). I never met the OB backup.

Our CPM could refer us out if we needed any lab work or testing. Yours can't refer out for that?

I think we are lucky to live in (or near) states where homebirth is a choice, and a variety of care providers are within our options. But I think choosing an alternative option but expecting the more traditional options to care for us because it is nearer our home is unfair to all involved - and yes, does put them in a vulnerable position in our lawsuit-happy society (not that you personally would sue, but they can't assume that).

I also am curious as to how two sets of providers gets paid. If CNM is insurance and CPM is out of pocket then I guess that is fair, but if insurance pays both then it seems unfair to the bottom line which eventually raises health care and insurance costs for everyone.

Interesting topic.

[jenneology]

You might want to consider writing and submitting a guest post to Change.org or http://mothersrights.blogspot.com/. Getting some hype and attention could cause the lawyers to back off or at least highlight the unethical nature of such policies (think Joy Szabo).

Perhaps in your local area there is a Women's Law Center that can point you in the direction of some resources to fight this.

You can generally contact a patient representative at the medical center/system you have been working with. You can also write a letter of a complaint to the direction of the clinic.

[sunfish21]

...but if you pick it, you pick it. It seems unfair to "double dip" (for lack of a better term).

I also am curious as to how two sets of providers gets paid. If CNM is insurance and CPM is out of pocket then I guess that is fair, but if insurance pays both then it seems unfair to the bottom line which eventually raises health care and insurance costs for everyone.

(the above was quoted from a pp--I messed up the quotes...sorry!)



I disagree with the statement about if I pick it, I pick it. I am a paying customer--CNM comes out of our insurance (largely) and the CPM is completely out of pocket. I would never drive 90 minutes to have blood drawn when there is a clinic 5 minutes away. I don't see it at all as double dipping--it is my money and I should be able to spent it where I wish.

My main point was that while my pregnancy is the over-riding similarity, the truth is that I have been seeing them for different reasons: one for routine visits, one for lab work and to discuss transfer options (again, I would not be driven to another state in an emergency but would go to the closest hospital here, where the CNM works). I guess it bothers me too that they have knows this was plan since my intake appointment with them at around 10 weeks AND the CNM herself had a home birth---although I know this does not affect hospital policy, and I heard nothing about it until 31 weeks.

I understand that in an overly litigious society this could be a concern for them, but don't I have the right to choose my care?

I appreciate all the comments--this has really been on my mind a lot.

[sunfish21]

Originally Posted by jenneology

You might want to consider writing and submitting a guest post to Change.org or http://mothersrights.blogspot.com/. Getting some hype and attention could cause the lawyers to back off or at least highlight the unethical nature of such policies (think Joy Szabo).

Perhaps in your local area there is a Women's Law Center that can point you in the direction of some resources to fight this.

You can generally contact a patient representative at the medical center/system you have been working with. You can also write a letter of a complaint to the direction of the clinic.

I would like to contact someone; my concern is not throwing the CNM under a bus in my process of making a point. I know her hands are tied which is why I want to address someone else.

Also, we are in a fairly large town/small city so there is nothing like the Law Center you mentioned, but I will check out the website you listed. Thanks!

[Kidzaplenty]

Well, I have been dismissed from several drs for similar reasons. No doctor will see me if they know (or suspect) that I am planning a HB. I just mentioned HB once to my OB (did not say I was planning one) and had a "Find a new doc" letter in the mail within the week.

I am surprised they were even seeing you if you let them know your plans.

I never tell them I am planning a HB now. I just go about my "routine" prenatal care with the docs and plan my HB on the side.

[MegBoz]

Originally Posted by Kirsten

I agree with this. If you want a homebirth midwife 90 minutes away, then you see the homebirth midwife 90 minutes away. I had two of the three of mine out of hospital (one freestanding birth center and one homebirth) so I do understand wanting that - but if you pick it, you pick it. It seems unfair to "double dip" (for lack of a better term).

<snip>
But I think choosing an alternative option but expecting the more traditional options to care for us because it is nearer our home is unfair to all involved - <snip>
but if insurance pays both then it seems unfair to the bottom line which eventually raises health care and insurance costs for everyone.

Well, I personally live in a state where CPMs are illegal. We have ONE CNM, just ONE who attends HBs in all of greater Baltimore and she's very busy. A dear friend of mine called her when she was about 10 weeks along & was told she is fully booked for her due month.

But, thankfully we have illegal, underground, renegade CPMs who attend HBs in Maryland anyway.

HOWEVER, haven't we all heard the HB transfer horror stories? The American medical establishment is hostile to HB... and too often that hostility translates into downright abusive treatment for HB transfer mamas.

Knowing these facts about maternity care in America today, I don't blame a mama in the least for seeking 'shadow' care so that she has care established with an HCP at a hospital in the event that she needs to transfer.

Yes, true, if her insurance paid for both, she would indeed be double dipping. However, the transfer rate for planned HB is not very high - so odds are good she'd never use the hospital anyway. In that case, there's no way she'd have an epidural or CS & her insurance wouldn't have to pay the added expense of the hospital stay (generally at least one night, often 2 nights even for a vaginal delivery.)

All told, an HB, even if 'shadow/dual' prenatal care was provided, will probably STILL cost less than the average hospital delivery (particularlly bearing in mind the nearly 33% CS rate and very high epidural rate.)

Therefore, I think it's a bit unreasonable to blame a HB mama for "double-dipping" and driving up health care costs! That is certainly the least of our problems when it comes to the expense of American maternity care!

This "double dipping" wouldn't even be necessary if we had a system like that in Europe!

• If MWs were respected as the primary care providers dedicated to normal healthy pregnancy
• If the transfer of a HB Mama to OB care when a problem arises is seen as how it is SUPPOSED TO WORK (like a general practitioner transfers to a cardiologist) instead of a "train wreck" and a testament to the danger of HB
• If HB were seen as a legitimate option for all healthy women & insurance paid for it as easily & readily as they did for hospital birth
• If HB MWs were even half as plentiful as OBs

But we don't have that system here in the US. We have a ed up system. So, working within that system, some mama's choose to get "shadow care." I personally blame the system for FORCING them into that situation. I think it's wrong to blame them.