I'm in a difficult situation and looking for support. I apologize for how long this is.
I have risked someone out of a home birth at 39 weeks for psychosocial reasons. I'm going to abbreviate a lot. Three days ago (Tuesday), my nurse went to the patient's house for her home visit, and she (the patient) wasn't there. The man who answered the door (not the patient's partner) said she'd just run out & he didn't know where she'd gone, and her cell phone was still in the house. (Side note: usually home visits are done at 36 weeks; hers kept getting changed for things out of anyone's control.)
She'd gone to a nearby emergency room (a big one that has a specialty OB triage run by CNMs) with an abdominal trauma. The CNM who saw her told me on the phone that she came to the ER with no shoes (in Chicago in February), no phone, no ID, and no keys (She said she drove, and I don't know how that happens with no keys.) She told the nurse she'd been in a fight, then said she tripped over a dog cage. She got four hours of monitoring, her labs were fine, and she wasn't contracting. I called at about hour 3. The triage CNM told me they offered to call social work several times and she said no. I asked her to transfer me into the patient's room. There was a problem with the phones and she said she would tell the patient to call me. Half an hour later, no call, so I called again and was told she'd been discharged and had just left.
I called her and she said she'd just fallen; yes, she was safe; no, she wasn't in danger. I offered her, of course, to call me later, anytime, if she wasn't able to speak freely. We scheduled for my nurse to do her home visit the next morning.
The visit went without incident-my nurse said that had the events of the day before not happened, she would have thought nothing was amiss. Her partner was asleep downstairs, she yelled for him to come up, and he never did. Later that day, as we pieced together what she (the nurse) saw, and the stories of the patient and the CNM at the hospital, too many things just didn't jive. I called the patients later that night and directly told her, "I am very concerned about abuse." She replied, "I worked for a year and a half in a domestic violence shelter. I understand why you are concerned. I'm not being abused." I responded, "Then all I can do is take you on your word." I said I would be at her house the next day for a home visit. I wasn't quite sure what I was going to do, but I wanted to assess the situation myself before I made any decisions.
All the way to her house I felt that bowling ball in my stomach that we home birth midwives can't ignore. Her partner was there, and I asked her more questions about the details of two days prior. The stories and the sequences got more convoluted, and finally realized the point is not who's telling the truth but simply that the stories weren't matching. I finally just said that I needed to risk her out of a home birth because I have concerns about the safety of her home. When she said I was firing her, I said I was risking her out, as if someone had high blood pressure or too much bleeding in labor. In accordance with our contract, I will accompany her as a doula to her transfer hospital, but in my assessment, a home birth is not safe. She said I was taking away all of her choices, I replied that I was offering her a choice that she didn't like. We went back and forth for 5 or 10 minutes, until I said I need to leave because we're saying the same things.
Through all of this, her partner didn't say much, was on his computer and his phone, and chimed in once in a while, usually repeating something she had just said. He had been to a few prenatal visits and was generally on the quiet side.
When I got to my office about an hour later, my nurse had done some googling and came up with several links that she sent me. Her partner has been in and out of jail since 2002, his most recent arrest being in 2009. Domestic battery, assault with injury to another, and a sex offender charge, among other things. So my bowling ball WAS telling me something. And I don't want to go back to her house. He's never threatened me in any way, and his behavior has never been aggressive towards me or towards her, that I've observed; but this much objective information (his record as well as the events of Tueday) is impossible to ignore.
I've written a letter and plan to send it certified mail first thing tomorrow; it's very short and factual, that I'm risking her out of home birth due to safety concerns, that I will support her in a doula role, and that I will help to expedite a transfer of care.
I'm of course concerned about her safety-but she's been offered help in many ways, from me and from the triage midwife, and says she doesn't need it. She's worked in domestic violence, she KNOWS where the resources are. Now I'm concerned about me and my nurse. I'm afraid of patient abandonment charges, but I'm more afraid for my personal safety.
Sorry this is so long. Thanks for reading, and I look forward to your input.