How do I talk to my OB about home birth?

[thtr4me]

DH and I have finally made the decision to have an HBAC. We interviewed midwives, and decided on a wonderful local midwife with many years of experience, who has quite a bit of HBAC experience. Currently I am still under the care of my regular OB, and would like to continue concurrent care, so that in the event that a hospital birth becomes necessary (outside of an emergency transfer), I have a relationship with an OB at the hospital that takes my insurance. I also want to make sure that I get coverage for labs/ultrasounds, as I have an HMO, and will be paying entirely out of pocket for the home birth.

So, how do I go about talking to my OB about home birth, but continuing care with him as well? Do I bring it up at all? Do I bring it up now (16 weeks at next appt) or wait until later in the pregnancy? Can he legally drop me from care, or ask me to find another OB if he does not agree with my decision (I am in California). I really like this OB, and plan on using him as my regular GYN in the future, and want to make sure that I don't do something that will cause him to drop me from his care.

So, any advice, tips, suggestions would be more than welcome. I will be seeing him next week, and am hoping to be able to talk to him about it then. I also plan on having the VBAC discussion with him as well. I had a VBAC talk with one of the midwives in the same practice, which is what prompted me to stop just dreaming about and researching HBAC, but to get up and do something about making it happen. And the only reason we have not talked VBAC yet, is because I have a history of first tri loss, and his primary focus up until now has been making sure this pregnancy is healthy (which at this point it is).

Thanks in advance and I look forward to your advice!

[turnquia]

Cristina. Congrats I didn't know you were pg!

I would say just be honest with your OB and up front with them. I personally think the only way our system will change is when we start making our plans known. Your OB's response may surprise you. (Mine is ok with twin homebirth... he would prefer hospital delivery since it is twins... but is ok with it). However it could go the other way and he may want to drop your care and have you find another OB. Which is entirely possible and legal as long as your given 30 days notice.

I would discuss with him why you want to HBAC vs VBAC in hospital, why you feel its safe, or safer than a hospital delivery. If he agrees to continue to see you through your pregnancy talk with him about what a transfer would be like with him. Would it mean automatic C-Section or would a VBAC still be an option if things are still able to be done like that.

In the event your unable to find any OB to attend to you for concurrent care. Go to the hospital where your insurance is accepted. Your care cannot be denied period. You may need to disupute an insurance claim later, but that's always able to be disputed. You may even be able to find a family doctor to back up your care for pregnancy and write for U/S and labwork. We did that with DS1.

Good luck!

[homemademom]

Maybe I've read too many horror stories here at MDC, but I can't imagine that discussing my homebirth plans with a hospital OB would go over very well. Can you ask your mw what she knows about this particular OB's attitude?

[turnquia]

Originally Posted by homemademom

Maybe I've read too many horror stories here at MDC, but I can't imagine that discussing my homebirth plans with a hospital OB would go over very well. Can you ask your mw what she knows about this particular OB's attitude?

My OB is totally 100% fine backing up homebirth moms. Provided he can tell they are educated in their decisions and know the risks as well as the benefits. He was leery about it with twins, but was very supportive. He hasn't said a word since our initial visit.

I think really the only way things are going to change is if we are respectful to our doctors as well as them to us. So hiding it, and not being clear with your intentions makes homebirth seem and feel wrong to me. But taht's my opinion. Your doc may surprise you

[homemademom]

Originally Posted by turnquia

My OB is totally 100% fine backing up homebirth moms. Provided he can tell they are educated in their decisions and know the risks as well as the benefits. He was leery about it with twins, but was very supportive. He hasn't said a word since our initial visit.

I think really the only way things are going to change is if we are respectful to our doctors as well as them to us. So hiding it, and not being clear with your intentions makes homebirth seem and feel wrong to me. But taht's my opinion. Your doc may surprise you

I agree, it would be nice to be able to openly discuss this with caregivers, but i think your situation is unusual. I've transferred care twice and neither caregiver (hospital CNM and regular OB/Gyn) was open to homebirth. Ironically, both were very naturally minded in their own professions, but could not get past the location of the birth. It just did not compute and made it automatically "dangerous" to them.

Maybe it has to do with regional differences? Both of the instances I mentioned were in states with legal, but unregulated midwifery. I didn't get such a negative vibe in the one place I lived where state licensure was required. Our ped, for example, was perfectly fine with hb.

[thtr4me]

I did talk to the midwife about this doc, but since there are so many docs in this practice, she is not familiar with him. She has transfered to this hospital, and has been treated very respectfully on the occasions that she has transfered there.

I think I may take things slowly with the conversation. Mention that we are (seriously) considering home birth, ask what his feelings are with continuing my care if I were to pursue home birth, and if he would want to transfer my care to another provider if that is the way we decide to go. I know I have mentioned the word home birth to him before, and I do not recall him being very thrilled about that word coming out of my mouth.

And Amanda, I have been following your progress with your twins, but did not realize you were planning a twin home birth. Congrats on that! You must be just thrilled to be able to birth them at home.

And I will be visiting the family doc at some point to discuss him taking a new patient early next year, and plan on having a very open discussion with him, since he will not have a hospital to visit the baby in . He is a really amazing family doc, and despite the fact that his office is at least 40 minutes from the hospital (and he lives near the office), he visited me and my DS all 4 days we were in the hospital after DS was born.

[turnquia]

Cristina,
The family doc was awesome for me with my DS. He was great and totally awesome with the whole idea. Even if your OB isn't comfy with the idea of backing your care, that's ok it gives you time to look around. When we found out we were having twins my previous OB was handing me info on a C-section right then and there. Um we handed it back and left. They dropped me last pregnancy when we mentioned homebirth.

This new OB was refered to me by a friend who happens to be a midwife assistant. She had a great experience with them. There is a few in the practice that think homebirth is nuts. But they have signed off my care, and only the 2 who are comfy with my plans will see me. even if they aren't on call they will come in.

I'm excited to hopefully be homebirthing two. We're realistic that things could change but as we get closer and closer to term... defintely getting super excited at the though of having them at home.

Good luck with the OB and keep us updated on how it goes!

[msmiranda]

I've read stories from other mamas on this board who were dropped for even saying the words "home" and "birth" in the same sentence in the presence of their OB, when they were just *thinking* about it, much less asking an OB to do concurrent care. Most OBs will see that as opening them up to vicarious liability charges in the event you were to (in their minds, this is the way they think) show up at the hospital as what they refer to as a "train wreck". I would NEVER tell an OB I wanted to see for shadow care that I was planning a home birth. The problem is if you want to have a future relationship with them -- not showing up for your birth only works for one child! I'm sort of having this dilemma myself, though I'm not pregnant right now. Shadow care -- i.e. the possibility of just showing up as if I was never planning a home birth at all and avoiding the possibility of being treated as a pariah at the hospital -- is comforting to me, but I don't like the dishonesty of it. Sigh. If you do talk to him, please let us know what happens!

[laurata]

Originally Posted by msmiranda

Most OBs will see that as opening them up to vicarious liability charges in the event you were to (in their minds, this is the way they think) show up at the hospital as what they refer to as a "train wreck".

This. My Gyn was kindly up front that she "knew" we would be having another home birth for our fourth, and for liability reasons, would not be permitted to provide prenatal care for me. But indirectly, she encouraged me to have another homebirth, so I thought that was cool, even though she couldn't provide care.

[KSDoulaMama]

Hmm... I live in a small town with a limited (very limited!) pool of OB's. Actually, there are three of them. I've heard really bad stories about two of them and everyone seemed to like the third. He is also the least induction-happy and the one with the lowest cesarean rate. Anyway, despite all of that, it is a small town hospital that has a lot of uneducated young parents and only a small handful of mothers who prefer natural birth. The nearest homebirth midwife is 4 hours away. So I wasn't expecting my doc to be thrilled, but I approached it matter of factly. At my second appointment I told him we were also seeing a midwife for prenatal care. He said okay and not much else. Later, when we were discussing birth preferences with him, I told him that as long as everything continued to be healthy and normal, we were planning to birth at home, so these were our preferences for what we would like to happen IF we were to transfer to the hospital. We presented him with a brief and very reasonable birth plan. He read it and okayed it. He really never said much about the home birth, I think because he supported it but wanted to distance himself from it for the sake of liability and his practice. After our successful homebirth, I went to him for my postpartum visit and told him the birth went great, and he said, "Well good... I'm not convinced that the hospital has much more to offer."

So... you never know!

[cileag]

Just another thing to consider is that if you are planning on submitting your home birth charges to insurance, they may not cover them since you've already had coverage for the same visits through your OB. Also, I think the issue with many OBs (aside from the obvious discomfort with the general idea) is that in no other area do you typically see two providers for the same issue---you get a second opinion, but then you pick one person to coordinate your care. What are you going to do if you go to 41 weeks 3 days and your OB recommend induction but your midwife doesn't? Or you have some higher blood pressures and one recommends bedrest, the other induction? You wouldn't take your kid to two different pediatricians for double the well visits would you?

I think that Turnquia is right in that being honest is important, but I completely undertand why most OBs and CNMs that are not ok with dual care--I personally think the solution is giving hospital priviliges to home birth providers, but that's another issue....

[Galatea]

Originally Posted by msmiranda

I've read stories from other mamas on this board who were dropped for even saying the words "home" and "birth" in the same sentence in the presence of their OB, when they were just *thinking* about it, much less asking an OB to do concurrent care. Most OBs will see that as opening them up to vicarious liability charges in the event you were to (in their minds, this is the way they think) show up at the hospital as what they refer to as a "train wreck". I would NEVER tell an OB I wanted to see for shadow care that I was planning a home birth. The problem is if you want to have a future relationship with them -- not showing up for your birth only works for one child! I'm sort of having this dilemma myself, though I'm not pregnant right now. Shadow care -- i.e. the possibility of just showing up as if I was never planning a home birth at all and avoiding the possibility of being treated as a pariah at the hospital -- is comforting to me, but I don't like the dishonesty of it. Sigh. If you do talk to him, please let us know what happens!

Yes to this. Turnquia's experience is very rare. I would go to him for the appointments you want and never mention it.

[lovemyzoo]

I plan on using weather in our location at my edd as a into in to the topic to see what he thinks. Also you can talk to the midwife to see if they know how homebirth friendly the OB is.

[Youngfrankenstein]

I did parallel care and I kept my lips sealed. I went to a group of CNMs and OBs and spoke to the head CNM on the phone and told her my plans. She had delivered homebirths years ago and thought it was "beautiful", but she didn't want me to do it and could "support" it. She has different loyalties now. She has a practice to protect and I could understand she couldn't be on the record telling me to do a homebirth. She told me one of the other mw in the practice had a homebirth. I mentioned that I'd heard she'd had one and she said "Yes" and totally changed the subject.

I said nothing to the other HCP I saw there. They looked at me like I had bugs coming out of my ears whenever I questioned anything.

If you truly want to know what they think, say you have "a friend" who just had a homebirth....send out the fishing line and see what response you get....

[lunarlady]

I waited until my OB asked what hospital I was interested in delivering at. (we have several locally). I was very surprised when he was very calm about it. He understood that I was seeing him in case I had complications with the pregnancy, and I think he was hoping I might change my mind. He made a point that I should feel free to consult him at any time - during pregnancy, labor, or post partum - if I had any issues. Overall, I would say he feels most home birth is very safe, but that big problems occur when issues arise and mom has no doc to turn to. Overall a refreshing and surprising outcome, although I did have to have a half hour talk from him about reasons I should transfer. (meconium in waters, excessive bleeding, etc.). This was only mildly annoying because both I and my mw are well aware of what requires transfer. But he was just doing his job.

My cnmw care group with dd1 dropped me like a hot rock when I said I was doing a home birth, so I do think my current ob's attitude is rare.

[Fly Girl]

I did parallel care with an OB in my first pregnancy. I only did it because I had an HMO and wanted my tests and ultrasound covered by insurance and because it made DH feel a little better. He wasn't very comfortable with my homebirth plans. I had been quizzing my OB at each appointment about his birth practices, telling him I wanted a natural birth and gauging his answers and reactions. He seemed to be pretty laid back and very open to letting me birth the way I wanted to. He even told me that this was my birth, not his, so we could do it my way. So I decided to tell him at my 20 week appointment that I was planning a homebirth. He was definitely taken aback at first. He said he felt like the hospital was the safest place to birth but that I was low risk and would probably do just fine. He continued to see me for prenatals and even pp but he did say that his malpractice ins would not allow him to be my "back up". So I would have to transfer out of his care at some point.
I personally don't feel that you need to be honest with your OB about your homebirth plans. If you want to keep your OB for future care it is probably smarter not to tell. But maybe to can feel him out before you tell him about your homebirth plans.

[MsBlack]

Oh, I do so prefer honesty in all my relationships! It is so much easier, usually--cleaner, clearer...

and we are tallking, in this case, not just about 'homebirth', but about

Homebirth After Cesarian.

and I am thinking, much as I prefer honesty and would want to give anyone the chance to show that they are honestly supportive as well...I just would not go there with an OB. Even a hb friendly ob is unlikely to be completely comfy with HBAC....even if s/he was personally ok with it, I can only imagine their potential for great angst concerning peer pressure and liability, if it ever came out that s/he was supportive of HBAC.

Yeah, maybe you can somehow check out homebirth attitude, vbac attitudes--in some roundabout way, before you ever decide about telling this ob about your hbac plans.

I agree--things won't change until we confront honestly, the things that need changing. But I personally wouldn't put my birth on the line (in terms of good back up care, in this case) toward that cause. I'd be working when I *wasn't* pregnant toward those needed changes. JMO

[MegBoz]

Originally Posted by thtr4me

I think I may take things slowly with the conversation. Mention that we are (seriously) considering home birth, ask what his feelings are

Maybe you could inquire as to his general attitude towards HB and HBAC in particular without cluing him in to the fact that you're considering it.
Just say your sister or your friend is planning an HBAC. You & your DH are a little concerned for her. What does he think? I suspect your answer will be clear immediately.

As for me, I already went to my hospital-based CNM group & told them I'm planning an HB with a a CPM (which are illegal in MD, but legal in our neighboring states.) The MW said, almost dismissively, "Just don't mention the HB until you've had the tests you want." (The CPM couldn't take care of ultrasounds, which is why I went there. I don't want full-on shadow care, just though the 20W anatomy scan.) I thought that was cool. Like, "Don't ask, don't tell." She didn't say anything more about it & she said it in a matter-of-fact tone. No judgment or negativity. BUT- these are CNMs and very NCB-friendly CNMs.

[thtr4me]

Well, I had my appointment today, and did not bring up homebirth at all. I hit him up pretty good with some general VBAC questions, and he was already uncomfortable enough with some of those questions. I could tell pretty easily that the idea of a homebirth would have made his head spin. He kept talking about how the few ruptures that they have had at the hospital, everyone came out fine because they had such a great hospital facility and could respond so quickly to the emergency situation.

And I talked to him about my IV issue (IV's cause me severe pain and burning) to see what we could do as a work around. He was not comfortable with the situation at all, said that an IV was pretty much mandatory (although admitted that I did have the right to refuse), and suggested a meeting with an anesthesiologist in my third trimester to try to find a solution.

So will not be discussing homebirth plans with him until after the fact at this point, and so so happy that I made the decision to hire a midwife. Even my DH could see red flags jumping up at us when talking and agrees that homebirth will not be mentioned in the presence of the OB.

[turnquia]

Originally Posted by thtr4me

So will not be discussing homebirth plans with him until after the fact at this point, and so so happy that I made the decision to hire a midwife. Even my DH could see red flags jumping up at us when talking and agrees that homebirth will not be mentioned in the presence of the OB.

I'm sorry your OB wasn't supportive But I'm glad it reinforces your decision in HBAC even more for both you and DH.

I hope once for the sake of slowly changing people's minds. At some point, maybe even a year after the birth (not the convo I'd want to get into newly postpartum). But that you are able to have a discussion with him about homebirth and its importance to you. Again his reaction may not be favorable, but the more we talk... the more will change.

LMAO I still get looked at like I have 10 eyeballs when OB remembers wer're HBing twins.