Do you think shadow care is neccessary?

[sellendie]

DH and I are currently TTC #1 and hoping for a homebirth.

My question is in regards to the importance of shadow care from an OB if planning a homebirth. I have read some women's stories of being treated horribly after transferring to the hospital during birth and not having a file on hand because they did not receive OB prenatal care. Is this typical? For those of you that did or did not have shadow care, why or why not?

[mntnmom]

I didn't have shadow care, because only a life threatening emergency was going to get me into the hospital anyway. My earlier babes came fast, so I wasn't really concerned about things like failure to progress and exhaustion by the time I have #4 and #5 at home. In retrospect, if I'd realized homebirth was an option with my first (go you!!), I might have considered having an OB as well as a midwife.

[fruitfulmomma]

I've never had it in any of my five pregnancies. I have also received excellent care from our local hospital during the two times I transported (once during late labor and once while there for a BPP and deciding she needed to be born so we agreed to AROM with the on-call doc). They were also great when I consulted with them near the end of the last pregnancy because I was "late" and wanted some reassurance, after which they were happy to tell me to go home and have a good homebirth when she was ready to come.

OTOH, I have not heard many nice things about another close hospital, although they may be getting better.

[Gena 22]

I did parallel care, and I've got good and bad things to say about it. Mostly good.

As a first timer, I didn't decide on a HB until late in the game. And by that time, I knew my babies (twins) and I were healthy. In some ways parallel care is a confidence booster and good insurance. Insurance in the meaning that if something went wrong we could seamlessly get treatment.

But . . . I never told my OB that I planned a HB. Even without that, going to parallel care requires a thick skin. You'll hear all sorts of fear mongering, at least I did. So that can be a little stressful.

As a twin mom, I considered parallel care a necessity. But I can see advantages to it for any mom. Just don't know if it's worth the trouble.

[dannic]

I have never had a dr's care for prenatals. I can get all the testing I need/want through my mw and if something were to go wrong it would be an emergency.
I think it would be stressful for me to have to continually opt out of treatments, ect.
The only reason I could foresee shadow care as being useful for me is if I had insurance and could get insurance to pay for testing only through a Dr's office.

[47chromosomes]

I would think it would be up to you entirely. I can tell you why we have shadow care. For me, if a transfer to the hospital for any reason becomes necessary, it is important to me to have care providers with whom I have a standing relationship. I would feel very uncomfortable with just anyone managing my care. Our shadow care providers are great, and even supportive of our choice to have a home birth, so I know if we end up in the hospital I will not be belittled or treated poorly. To me, it feels good in advance to know that wherever this little one is born with be a special, supportive event.

If you are TTC you have a wonderful opportunity and plenty of time to find a care provider who will be supportive, or at least not offended, by your choice for home birth. You may interview home birth midwives and ask them for their recommendations of parallel care provider groups who are supportive of women's choices for birth and also who do not overuse medical interventions.

[JessicaS]

I had shadow care and because of a lot of complications risked out of homebirth.

I am scared to think what might have happened had I not had additional care.

I think it is a good idea as long as one can find a good, open minded OB.

[AmaraMonillas]

My midwives have excellent relationships with a team of OB's, and one of my mw's has hospital privileges (which I know is unusual for hb mw's). If she didn't have privileges I could maybe see meeting the OB(s) once, but prenatal care from both would be totally redundant since there is no concern about hostility.

If your mw can legally practice hb in your state I see no reason why you wouldn't have your files with you, or delivered soon after your arrival.

[alegna]

I didn't have shadow care, there are no OBs here who will do true shadow care and I don't see the purpose in having "twice" the care. If something came up, midwives here have OBs they can refer to as needed.

-Angela

[St. Margaret]

I have shadow care I guess; I have been seeing a CNM and OBs that work in a practice, which my insurance sent me to (my only choice! Luckily they are pretty cool). But I'm interviewing HB midwives next week, and that's our plan. This way, all the labs are covered 100% by insurance and I have care providers set up for if I ever have to go in for anything serious or transfer. That way, I know the insurance will pay up if I do have to go in to the hospital (because I know they will try to screw you every chance they get!). Otheriwse, I'll just call and let them know when I've had the baby . It'll be a pain to go into lots of appts at the end, but I figure I'll stretch a few out here and there, and both they and the MWs are super close.

[dachshundqueen]

I think it depends on the political climate where you are.

Here HB's are "under the table." So if you develop complications or are in need of transfer or late pregnancy care without having an established relationship with an OB, good luck. You then have the joy of showing up at L&D with "No prenatal care" and all the rudeness that will bring your way.

I have shadow care as insurance in the event I either develop complications or need a transfer. I am not informing my OB of my intent to HB just I as did not with my last HB. I did show up for my 6 week pp visit after my last HB with kidlet in tow, that was fun. The OB was shocked that I actually did it, but hey, that's life.

Liz

[Kitten]

I don't bother with shadow care. I don't want the stress and pressure of anyone trying to bully me into tests I don't want.

if I need a consultation during pregnancy or risk out of homebirth, my family care clinic attends hospital births. They know I homebirth and aren't exactly cheerleaders, but they respect me. We've been clients there for many years now.

if I transfer during labor I get whoever is on call. I have an hmo and if I got OB care, my only choice is a big OB practice. OB roulette means even if I saw the practice for every appointment, I could and probably would end up with someone I'd never met before.

HB is legal and regulated in my state. My mw would go to the hospital with me and advocate for me and could easily provide any needed medical records.

[etsdtm99]

one of the reasons i wanted to have a homebirth was to not have to deal with an OB (long waits for short appts, someone who didn't agree with my choices and who hardly remembered my name after 3 pregnancies etc.).. i am almost 32 weeks and i have really enjoyed that part, it has been so relaxed - i went to one appt. with my midwifes 'back up doctor' (family physician, does not deliver babies and is over an hour away) so i have a file with her and her name to throw out if i transfer .. that way i have someone who is a doctor and is respected by the hospital staff AND supports my decision.. i don't think there are any OBs around here who will do 'shadow care' without you just lying to them.. if i transfer i will have all the necessary records (gbs test, etc) from my midwife and my midwife will act as a doula and argue with the hospital staff for me, she said she has only ever had one bad experience at the hospital and that involved the nurses being rude to her, not to the parents..

so, if i were you i would find a midwife and ask what she thinks...

[chelle.ra]

as someone who thinks of choosing hb as a socially responsible decision, i would ask you to consider the fact that using an OB should only be done if there is a need to seek higher level of care. if you are blessed to have a healthy pregnancy and there is no indication otherwise, mw's are the way to go! unnecessary use of these high cost specialists cost us all.
once you've met your midwife, i would base my choice on shadow care on her experience with your local hospital and providers. she can likely refer you to someone you'll be able to share your hb with, making any needed extra care easier. our plan was to use the local hospital in an emergency (duh), use the mw's dr contact if needed. i saw our (former) FP dr for our first two prenatals and she was shocked we didn't want an US at 7 weeks, "you don't want a picture?" WTH! so not the right dr for us. i didn't want to have to fight for and explain every justifiable choice to someone every week.
also, i just can't imagine going to TWICE the appointments - bleh!

[annethcz]

I never understood the point of going through 2 sets of care providers. And I really don't understand lying to OBs about planning a homebirth. I chose care providers who would provide the level of service that I wanted, and it worked well for me. If you're concerned about needing to transfer for the birth, it makes more sense to me to hire a MW who has connections to local hospitals/OBs than to seek shadow care.

[St. Margaret]

But not all of us have that option-- in some places there ARE no OBs who will make connections with MWs-- or the one here that did was run out of the hospital on a rail, sadly. In fact, the midwives around here specifically encourage us to just see the practice/OBs covered by insurance for labs early on, and then just drop some appts if we like, in the later days. And without establishing with an OB practice, I'd be opening myself up to having to pay thousands upon thousands of dollars, or worse, if I had to transfer, plus seeing any old OB instead of the pretty supportive ones I've found, plus having to fight even harder in the middle of a transfer to avoid extra interventions they want to give you if you've had "no prenatal care." Plus, the insurance company decided it would pay for the same labs if I go to the OB/CNM practice, whereas it would not pay through a midwife. Not everyone's situation is the same. It's fabulous to have those options, but sadly women's options are severly limited in areas of the US. We used to be lucky here with the one OB in MW's clothing; now we have to protect ourselves from the system, by using it to our advantage. I pay for my insurance, and I'm darn well getting everything I can paid out of it. Luckily the practice I see would never push anything on me or try to stress me out, and anyway I'm confident enough to know when to ignore anyone who's just blowing a lot of hot air.

I think it's great some can just do MWs, but I don't think it's wrong to have backup or shadow care. The system is screwed up, and until it acknowledges MWs as the norm for normal birth, many of us can't afford to ignore it. Paying 4K just to have a normal birth at home, out of pocket, is all we can do!

[sellendie]

Originally Posted by St. Margaret

And without establishing with an OB practice, I'd be opening myself up to having to pay thousands upon thousands of dollars,

Where do the extra thousands of dollars come in by not receiving shadow care?

[mntnmom]

Originally Posted by sellendie

Where do the extra thousands of dollars come in by not receiving shadow care?

If referrals and such aren't handled the "right" way, some insurance companies will refuse to pay the resulting bills.

[sellendie]

Originally Posted by mntnmom

If referrals and such aren't handled the "right" way, some insurance companies will refuse to pay the resulting bills.

I had not even thought of that, I have Blue Cross...has anyone else run into this issue and been denied coverage?

[dachshundqueen]

I am also on BCBS of GA which is yet another reason I have shadow care.

If I need to transfer, there is no guarantee that the doctor that the hospital has contracted with will take my insurance even though the hospital will.

I had the same problem with Kaiser. Kaiser contracted with the hospital, but some of the peds people that saw my daughter (specifically the ped on call and the audiologist who did hearing tests) did not take Kaiser and I got SCREWED. The anesthesiologist didn't take Kaiser either. Not good times.

So, lesson learned, find doctors who take your insurance ahead of time. I'm working on finding a ped that has privileges at my back up hospital so I don't get screwed again should I need to transfer as my regular ped doesn't have privileges there.

If you get transferred, ask each and every doctor/HCP if they take your insurance, because if they don't you're responsible for 100% of the bill till you hit the OON deductible (mine is around $5000 IIRC).

Liz