Telling OB

[Salem Lily]

I want a homebirth, but I'm still planning on seeing my OB throughout my pregnancy (personal choice).

My question is: How should I go about telling him about my homebirth plans? What is a typical response? Should I wait until just before my due date or not tell him at all? If I did do a "oops! It just happened so fast," would he still want me to go the hospital afterwards instead of just staying at home and seeing him later postpartum?

I would like to keep a good relationship with my OB, I've seen him for many years and he's been there through some tough times. But I'm also prepared if I can't have that and need to sever ties.

[liberal_chick]

I saw an OB through my last pregnancy in conjunction with a midwife, and I birthed at home.

I didn't tell him. I just didn't show up in labor or schedule a PP check-up (my MW did that at 24 hrs, 3 days, and 6 weeks). I still use that practice, although I've been seeing the NP and not him. He was a UAV, anyway. Dh was ready to sue him for sexual assault after he did my first (and only) cervical exam.

[cileag]

You might get dropped from his practice. Many providers are not able/willing to see patients who are seeing another provider for the same thing---you wouldn't go to two oncologists for example to treat the same tumor. I always advocate telling and dealing with the consequences just out of professional courtesy and respect, but I understand the fear of transfer and not being in the system etc. Other things to consider would be that if your insurance is maybe going to cover your home birth or you at least want to try to get it covered, it is probably not going to want to cover both sets of prenatal visits and might lower your chances of getting money back.

[lunarlady]

I told mine when he asked about my labor and delivery plans. I was maybe 18 weeks along. He actaully was okay with it when I explained that although I planned to deliver at home with a lay MW, I wanted to see him for care and have him on record as my OB in case I end up transferring to the hospital. I will say, however, that I thought his understanding response was a bit surprising.

Around 20 weeks, my MW asked for a transfer of records (bloodwork, ultrasound results) so that really made it clear what I was planning.

He did wait a few visits more, maybe 28 weeks, to give me the "best place to birth is in the hospital" talk, so I had to suffer through that, and he wanted to make sure I would come into the hospital under certian conditions (labor longer than 24 hours, pushing longer than 5 hours, hemmorage, breech presentation). He did tell me that he just wanted me to safe, no matter where I ended up birthing, so I know his heart was in the same place. He also told me a story about a woman who homebirthed, lost a lot of blood, and waited 4 days to come to the hospital. She was very sick, and had to be admitted for treatment. He wanted me to feel comfortable reaching out to him at any time, including right after the birth, if I needed help of any kind. He hasn't brought it up since, so I think he got it off his chest and was fine with it.

My OB is known for being a rather "hands off" labor and delivery doctor with a high % of natural birth and a low c-section rate when compared to other local practices, so that might have something to do with it. And my insurance will absolutly not cover any portion of my homebirth, so I don't have any double billing issues there.

With my last pregnancy, I just fully transfered care to my homebirth MW around 24 weeks (I waited until after the ultrasound), so I just didn't make the next appointment and never went back. But that was a CMW group that I wasn't getting a good feeling from, so a little different.

[Burnindinner]

It may also depend on where in the country you are. Here most home birth midwives can't be licensed, so most practices won't do parallel care. I've been dropped from 2! I saw a family practice midwife for parallel care but risked out of home birth anyway, so it turns out it was good we were seeing her.

Anyway, with the OB's, I told them at an appointment I was planning a home birth and they guided from there - gave me the speech and then said they couldn't also treat.

I would tell, mainly because that way you don't have to do double the number of appointments (pretty pointless), and it may be less expensive that way too.

[laohaire]

I don't have personal experience. Well, actually I do - I visited an OB early on, before I had a midwife, because I was spotting and concerned. I told him of our plans to homebirth and his reaction was so dismissive and full of lying scare tactics that he, ironically, was the reason that DH went from being on the fence about homebirth, to supportive of it.

But that's not analogous to your situation because I didn't have any relationship with him whatsoever. And I assume you like yours because he's good and respectful and so on. I was just going to write and say that based on anecdotal evidence - that is, what I read about here from other women who love their OBs but choose a homebirth, and tell them of their plans - that it really could go either way.

There seem to be about 3 reactions. The least common (but it DOES happen) is real support. I've read a few stories of women whose OBs actually said they thought it was great, sometimes they offer to be a backup.

Then there is the middle-road reaction, which seems to be the most common reaction. The OB doesn't flip out nor offer total support, but reacts more like "well, if that's your decision that's fine, but you should know ____" (insert some concern or scary story or something).

And yes, there are stories about women who had good relationships with their OBs that ended on the day of the announcement.

As a PP said, it's not solely a factor of the OB's open-mindedness alone, but also the legal climate of the area. If the area is a hotbed of midwife prosecution, honestly your OB would have to be crazy to be supportive. On the other hand, if your area is a lot more supportive of midwifery, and midwife-OB relationships are common, then your chances of support are obviously better. I'd also say that it's the climate that matters, not necessarily the actual laws on the books. Midwifery could be, say, alegal both "here" and "there," but "here" midwives are generally allowed to practice in peace, and "there" they are constantly harrassed.

Please also keep in mind that you are effectively telling him "oh, I'm not going to do business with you but someone else! Aren't you excited?!" Um, no. It's a rare person who will sincerely support you taking your business elsewhere. Yes, you will be paying him for your office visits, but I understand it's the actual birth that is the gold ring of fees-for-service.

But it's really up to you whether you want to share the information. You might get a lot of support. But you might get thrown out of the practice. Or, your relationship might not be as good. So just be prepared for any reaction.

[CherryBomb]

I wouldn't tell him, it's not necessary. At the end or whenever you're ready to leave his practice, I'd just say you're transferring care and ask for a copy of your records.

Many OBs will not willing give prenatal care to women who don't intend to deliver with them.

[MonP'titBoudain]

Personally, I would tell him and take the consequences because I want my doctor's respect, so I try to offer respect. That said, around here I would most likely be dropped as a patient. He would be seen as a radical or a rogue within the community to accept the status of "back-up". If for some reason, you have to have back-up care, then you can always play the "oops, it happened at home" card. That said, I had a friend who did this and the OB called DFS on her for endangering her newborn. It's not the most pleasant place to be a midwife or homebirther around here!

[Got_Cloth]

I told my OB at 26ish weeks, with my son. He laughed, as a nervous reaction, but overall supported my choice. He continued to see me. I was able to get my NST's when i went past due. ( personal choice due to having had many pregnancy losses). He was very nice about it. I wound up still being pregnant at 42 weeks and asked to be induced. ( again personal choice, because i was worried about the lack of movement from baby)
When i went in to be induced, he had ordered pit. I told the nurse, that was not going to happen, as i didnt want to be hooked up to IV's all day. He came in, broke my water, let me eat, drink, labor in the tub, and baby was born 5 hours after he broke my water, with no meds at all. He chuckled when we told him we wanted to placenta, and he said "of course you do" but told the nurses how to get it ready for us.
He even was asking my midwife, how she would handle things, so my birth was most like she would have done it. He talked with my midwife, and my family, and almost acted like a midwife during my birth. He was in the room about 3 out of the 5 hours, and he came by to visit the next day, and just chatted with me and my family.
I am now pregnant again, and i am seeing him again. At this point, we are unsure what we are going to do. Birthing with him in a hosptial was not a bad experience. and finances are playing a role in our choice. We are in the middle of bankruptcy, and trying to get back on track, financially, and we have already met our deductable and co insurance for the year, so at this point, everything is 100% covered. It makes it hard to pay a midwife, 3000, when we know there is a chance i will birth in a hospital, because i have complicated pregnancies.

Anyway, i would wait until you are prepared for any answer to tell him. Maybe after your 20 weeks scan, if you are choosing to get one. I had my husband come with me, because i wanted his support. But your doc might surprise you. you never know.