HB MW wants me to do shadow care?

[MegBoz]

Sorry so long – but without the details it boils down to:

• Is keeping some degree of a relationship with the hospital-base CNMs (just a few visits) much better than none at all? (Because I will NOT be doing full-on shadow care.)

So I’m really super healthy. Had a complication-free NCB in a hospital with CNMs with DS. My HB MW is a CPM, & they’re illegal in Maryland (although she’s licensed in Virginia). She knows the CNMs where I had DS & they’re relatively friendly to HB- she’s never had problems transferring there.
I wanted ultrasounds, which she can’t do, so I decided to see the CNMs for it & just be honest. When I mentioned it, CNM says,
“Well, just don’t mention the HB until you’ve had all the testing you want.”
“Oh, OK, so after the 20W anatomy screen?”
“Well, don’t you want GD testing?”
“Actually my MW can actually do that.”
“Oh, OK.”

End of discussion. No lecture, no problems.

I tell the CPM this – that I plan to discontinue seeing them after the 20W anatomy scan (assuming of course I continue to be healthy & not NEED a hospital) & she says, “Well, you might want to maintain more of a file there. It just greases the wheels & makes it easy in case of a transfer.”’
Well, I did a quick count, assuming I go to at least 40W (& I went to nearly 42W with DS), that is TWELVE VISITS if I keep it up. No way! Too much time commitment to do 12 more visits with the CNMs on top of the same 12 with the CPM.

But I think she was saying to see them maybe a few more times before birth – as opposed to stopping altogether at 20W.

Here’s the thing, if I see them maybe 3X between 20W & birth (instead of the 12X I SHOULD see them), I’m still not a full “patient” of theirs. I’m still “on the fringe” so to speak. Is having those 3 visits really going to make a transfer situation much better than stopping at 20W? Because I really doubt it.

I’m either full-on shadow care (i.e. don’t mention the HB.) Or I’m honest & I rely on the CPM as my primary care-provider, which is what I want to do. (in which case, if I transfer, I’m a true “HB transfer”)

I think the best thing to do is just ASK the CNM what she thinks (I’ll schedule the apt with the most HB-friendly of the group)- is there any value in a few more apts after 20W? Cuz I’m NOT doing 12 more!

[Galatea]

Well, some hospitals/practices have policies about various tests. Like, if you didn't have some sort of GD test, they will test the baby's blood sugars. Or if you didn't do the GBS screen, you automatically get antibiotics. So it might be worth researching that and just scheduling appointments for those weeks/tests.

[MegBoz]

Originally Posted by Galatea

Well, some hospitals/practices have policies about various tests. Like, if you didn't have some sort of GD test, they will test the baby's blood sugars. Or if you didn't do the GBS screen, you automatically get antibiotics. So it might be worth researching that and just scheduling appointments for those weeks/tests.

Oh, good point! Actually my HB MW does GBS testing, so I'll have that on file. She also does her own GD testing protocol (she sends you home with a glucometer to do it yourself!)

So there wouldn't be anything I wouldn't have done - even if I discontinued seeing them at 20W. I even consented to a pap smear at that 1st visit & blood work (HIV, etc.)

[Galatea]

So would you bring the MW's records with you to the hospital, then? Would they respect those? Or would it be better for the hospital CNMs to have their own tests/records?

My thoughts on my own are that I stopped going to the CNMs after the U/S, b/c if I transfer, it will be for an emergency, and I will go to the closest hospital that doesn't have CNMs and they will probably duplicate every test I had (I also did a 3 day glucometer for GD) but it won't matter b/c it will be a true emergency. Also, the CNMs would be happy to see me for the labor and birth if that was my plan - but they cannot accept me in the middle of labor with a problem.

[MegBoz]

Originally Posted by Galatea

So would you bring the MW's records with you to the hospital, then? Would they respect those?

Yes, my CPM would come to the hospital with the records. Even though she's illegal, she doesn't hide in case of transfer.

As for whether or not they would "respect" them, hm, another good Q! I think they would at this hospital because they're not HB-hostile. Actually, the same CNM I had the above conversation with actually approached my CPM to ask about apprenticing & was considering going into HB herself!

Originally Posted by Galatea

My thoughts on my own are that I stopped going to the CNMs after the U/S, b/c if I transfer, it will be for an emergency, and I will go to the closest hospital that doesn't have CNMs

Luckily for me, this actually IS the closest hospital anyway! It's not all that close, (20 min) considering I live in a densely populated area, but it still is the closest. So that's good!

Originally Posted by Galatea

Also, the CNMs would be happy to see me for the labor and birth if that was my plan - but they cannot accept me in the middle of labor with a problem.

Ooooh, right, I forgot about that! I have to ask - if I transfer in labor for a problem, I don't know if I could see the CNMs or if an OB would have to take over since it was a "problem." Obviously if it were something serious like cord-proplapse that would require a CS, an OB is necessary anyway. But for lengthy labor/wanting an epidural, I don't know if I could see the CNMs.

Ugh, so much to think about! Thanks for your replies! They're very helpful!

[Galatea]

No problem. I stress about this a lot. I am 35 weeks and have not gone to appointments with CNMs since 20 weeks. I like the CNMs and have no problem with their FSBC, but it is 45 minutes' drive from my house and I have 2-3 hour labors, so that is why I HB. It really stresses me, though, that the closest hospital (7 minutes) is the worst hospital with the least-friendly OBs. I hate the local practice with a passion (super-high c-section rate) and so have refused to use them for shadow care b/c I don't want my insurance to give them any money. I just wish that I did have local shadow care so at least they wouldn't know right away that I am a HB transfer and be mean to me. So long story short, you have a pretty ideal set-up!

[cileag]

I would talk to your CNM since mine couldn't technically follow me since I was planning a home birth. While I was indecisive, they could sort of turn a blind eye, which is what they did since I too wanted the 20 week anatomy scan and my insurance to cover it. They also are not supposed to take home birth transfers, although since I work in my hospital as an OB nurse, I was planning on just requesting them and they probably would have been willing to make an exception.

I don't really think that doing 3 or 4 extra visits is worth it--the majority of the relevant information is your labwork, the ultrasound, GBS status and the GD screening. And you will have all those things--including recent BPs, urine dips, measurements etc from your HB provider. As long as you continue to be healthy and low risk, I really don't think you would gain any points for minimally continuing your care with them.

[sattygirl99]

I'm delivering in MD (though with a CNM) and I have not done any shadow care. In fact, I had a 2 month lapse in 'real' prenatal care when my prior MW let me go without warning. In my case, I'm a VBA2C and I would be pressured to have a RCS at 39 weeks.

To me, it's more stress to do shadow care if you're healthy. I had a minor freak out about this just recently, as I am having some issues with BP and protein in my urine if I'm not staying very very hydrated and I was concerned that if my MW suddenly felt the need to induce or send me for a RCS, I don't have an OB. But situations such as that are pretty rare and if you present at the hospital with a true emergency, you're likely to get whoever is there because it will need to be fast. Just my thoughts but I only plan to transfer if it's life or death and in that case, it won't matter WHO does it, just that it gets done.

FTR - I didn't have either the GD or GBS test done.... I had both with DD and they STILL checked her blood sugar every hour for the first 6 hours because my son is diabetic. Since I monitor my own BG at home, I didn't worry about a lab screen. With GBS, I'm not going the antibiotic route regardless... Even in a hospital, I would refuse it this time.

[St. Margaret]

I'm going to do shadow care, b/c I've heard that my insurance co can be kind of crazy about being established and covered. I figure I'll just stretch out appts here and there if I'm feeling overwhelmed by them, but they tend to be so fast and I bring DD along, so we're just hanging out and playing and getting out of the house, and she loves seeing doctors (OB or CNM at this practice) do their thing... the trickiest part will just be not letting DD talk about the homebirth I'll have to start leaving her at home with DH if it comes to that, but I figured I'd just say her friend's mommy had a HB and we watched the video, and let them think it's just a kid being silly. I gotta do what I gotta do to get my coverage in case of a transfer. Silly as all get out, but there you have it. I actually liked how the midwife I picked was supportive of doing that and suggested it on her own, whereas others told me I'd have to "transfer care" the last several weeks. I've just been screwed over too many times by insurance to risk it.

I get that so many appts can be crazy... I've done nothing but go to appts for chiro, acu, PT, etc with this pregancy (sciatica) and yeah, it's getting old, but mostly I like to get out with DD, and this is better than going out to eat

[honeybee]

We are in an unregulated state for hb midwives, so they are not illegal. But I still know of at least one friend who transferred during birth and had "no prenatal care" stamped all over her file, despite having access to the CPM's records, because they did not "count" that. I don't know that it affected the care they received... my friend did not find out until she requested her files much later.

But you have had some "official" prenatal care, at least. I don't personally do any kind of shadow care, and I don't know if it's worth it in any case, but just thought I'd throw that out there.

[mammamo]

I wouldn't be worried so much about what the CNM thinks, I would worry more about what the MD that she works with thinks, because in a true emergency a CNM isn't going to be in the picture

[Comtessa]

Originally Posted by honeybee

We are in an unregulated state for hb midwives, so they are not illegal. But I still know of at least one friend who transferred during birth and had "no prenatal care" stamped all over her file, despite having access to the CPM's records, because they did not "count" that. I don't know that it affected the care they received... my friend did not find out until she requested her files much later.

We are also in an unregulated state. I transferred in labor with my HB MW (CPM), and the hospital literally took her careful records and chart from her and threw them in the garbage. In front of her. She didn't tell me about it until over a year later, which is a good thing because I would have gone on the warpath over it.

I did shadow care with the chief OB at my HMO's practice, and I'm really glad that I did, because he had signed off on my birth plan (which said that if I was there at all, it was because something had gone wrong at home) and put it on file with the hospital, and nobody was willing to gainsay his signature. Now, in hindsight, I probably didn't need to go to quite so many appointments. But he agreed to see me less frequently than he would if he was the only HCP on my pregnancy, since he knew I was getting good prenatal care from my CPM. Even though he "pretended" he didn't know. . Good grief, what I wouldn't give for sensible laws about maternity care in this state.

At any rate, my vote is, go for as much shadow care as you think you can tolerate, because the hospital will treat you better than if you come in with a CPM and no "official" records on file at the hospital.