sad about concurrent care options

[livvie97]

I'm 17 weeks with my second pregnancy.  First was a c-section because of pre-e (long story...I had mild pre-e symptoms (135/95 bp and 300-600 protein in urine, no other symptoms) whole pregnancy, starting at 8ish weeks,  at 37 weeks there was growth restriction so they induced, she flipped in the middle of the night to breach, ended up with a c-section).  All in all I don't think it was anything too traumatic or risky and no one was ever concerned about my life or health or the baby. 

We're planning for a homebirth this time, but were thinking about also seeing a doctor, so we have a relationship with someone (my last ob is no longer practicing in the area) in case i get booted out of midwife care.  But...all the doctors that deliver at our (nice hippie) hospital have bad vbac rates, and think homebirth, while ok for some women, is the stupidest idea in the world for me (and I understand that they don't support it, but they are *vehement* about it for me in particular). I keep trying to figure out why, and they just say I might suddenly get pre-e, or they quote grossly inflated rates of rupture (3%) at me.  nothing that is convincing.

I guess i just want some reassurance that maybe we should just drop the obs, and deal with finding one if and when the time comes.  And that it's not the most ridiculous thing in the world for me to want a homebirth given my history.  We are 10 minutes from the hospital,  with an awesome midwife (in an area with tons of midwives), and my bp and protein will be constantly monitored.  It seems pretty non-controversial.   

I felt like last time my ob at least listened to my thoughts (tried an induction with no pitocin, didn't put me on blood pressure meds, etc.) and the ob's now are all being my worst nightmare.  One actually said he didn't even want to consider seeing me if i am thinking about a homebirth because then he'd have to see me for 30 weeks, but lose out on making any money off the birth.   it's just been a hard week of listening to idiotic ob's, and i need some homebirth encouragement.

[Arete]

I understand where you're coming from--don't you have enough to do without digging through every doctor on earth?  But my first pregnancy led me to the opposite conclusion.  I was VERY confident all would go great and I would have my baby at the lovely local birth center with a trusted midwife, so I didn't bother having any kind of relationship with a doctor.  Long story short, I wound up with the ob on call at the hospital for an emergency c/s.  I had kind of a unique situation--because of a sexual assault by a male pediatrician I have a TERRIBLE fear of male doctors, and I had been promised by my midwives that I would not get one, but when the time came the hospital said this is who we have for you, period.  Bonus: the anethesiologist was a man too.  So that is maybe unusual, but the fact is that an on call doctor can be a monster for lots of reasons.  Next time I will try for a an HBAC with all my might, but I will ABSOLUTELY have a female doctor in my hip pocket, just in case.  And if she disapproves, I'll just lie to her about every one of my plans.   

[happynaturalmama]

Well I was going to suggest just finding an ob, when/if that time comes, but Arete makes a good point.   I wish you luck in finding someone to support you!

[MarineWife]

I did dual care with my last pg, first homebirth. When the OB practice found out I had a homebirth, someone there reported me to CPS. Of course, the allegations were unfounded and nothing happened to me or my children as a result. The investigation was emotionally traumatic and now I have a permanent record with CPS.

When I was pg with my first I saw a CNM in a large HMO practice. When the time came for me to have the baby, I ended up having to have a c-section and just got whatever OB was at the hospital at the time. That's just how it works. Apparently, I got lucky because all the nurses said I got the best around but I had no idea who he was.

This time around I am seeing only my homebirth MW. I'm not concerned about what OB I might get if I end up at the hospital for an emergency. Pretty much, regardless of who your regular care provider is, if you end up with an emergency transfer, you are at the mercy of whoever is on call at the hospital at the time. Even if your OB has a sole practice, s/he has to have back-up OBs so they can get at least one day off a week. KWIM?

If you develop pre-e again, you will probably have enough notice to switch to an OB before an emergency. Then the problem would be if you can find one who won't be hostile toward you for seeing a homebirth MW up until that point. If you can't, you'd just have to be very strong and stand up for yourself and make it clear that not seeing an OB wouldn't have had anything to do with you developing pre-e. As a matter of fact, I would bet that more OB patients develop pre-e than MW patients because, in general, MWs spend a lot more time on prevention and awareness whereas OBs just wait for something to happen and then try to treat it after the fact. That's JMO.

[Full Heart]

Never had a c/s but I have transferred twice (out of 8).  Once was during labor and I had an ob backup who attended me.  He retired and I have not had an ob since.  So last time when I had to transfer to be induced for pih I got who ever was on call and had a lovely ob, it was actually a MUCH better experience than the first time when I actually had care with an OB!  This time I thought about having ob back up and decided against it.  First I am not going to fight for everything that an ob wants.  Second, I am not going to lie to them either.  Most won't see hb patients because of insurance reasons (they can lose their malpractice insurance which means they could lose their business).  I actually was planning a birth center birth that had an ob at it and switched back at 36 weeks to a hb mw.  The ob, who works daily with mws at a birth center, was terrible to me.  Made me realize if I wanted that kind of care I would have sought it out.  I don't want that kind of care so I went back to a hb mw and feel SO much happier.  Oh and a side note, the time I saw the ob this pg my bp was high, all other times it was low.  She had me so stressed out.  See...it wasn't healthy for me lol. 

[dot1]

This is a completely different pregnancy - I don't get why OB's are so up in arms over the idea of a homebirth and the other post about child protection being called after finding out about a homebirth completely dismays me. 

If it were me, I'd go with the provider with who you felt most supported - plenty of research backs that as being a significant factor in birth outcomes!  I had gestational hypertension with my first and low amniotic fluid and managed to delay labour induction to 40 weeks and baby was just fine, full size, full term.  Also hemorraged (no suprise with induced labour and high BP).  At times my BP shot up as much as 170/100, but was generally in the 140-150/90-95 range at the time of birth and mostly in the 140/90 ranges the last few weeks.  I'm going with a midwife this time and she's completely fine with my history and when/if there's a problem she refers to either a GP or OB.  If all goes well with this pregnancy, she's also okay with the idea of a homebirth - we're about 8-10 min drive to a full service hospital with surgical services.  Now my husband...that's a different story!

Anyway, I came across a research article (I can look up reference later if you like) about the actual chances of having a 2nd pregnancy with pre-e if you had it in your first.  Basically, I think it suggested there's a 75% chance of having a completely normal pregnancy but the risk of pre-e is definitely much higher than someone who never had it.

In Canada there is a "Best Birth Clinic" operated out of BC Women's Hospital in Vancouver and they are a group of OB's who are advocating for choices in birth and are also promoting the safety of VBAC/trial of labour as safer than a repeat C-section.  They have a facebook group - just do a search and you should find it and some links to good resources.  They have found women and taped them sharing their stories about VBAC's and other birth experiences.  They've also been involved in promoting midwifery forums discussing home birth safety.

Personally, I'd stick with the midwife in your situation.  It sounds like the OB's are just creating stress when there's been no actual event occur to warrant the alarm this time...someone with a blood pressure history does not need that ;-)   

[Lisa1970]

My bet is that it is not just you and they are just putting up this act to scare you. Ignore them and forget concurrent care. They just want the money for the csect and they want you to have one.

[19spitfire]

I struggled with the same type of issue for my last pregnancy. Eventually I decided to
forgo OB care and just meet with my midwives. I didn't realize that one of the benefits
would be greater peace about having a homebirth. I stopped feeling like my choice was
to be challenged around every corner. I think it was a very wise choice in retrospect. I
had already made the choice to have an HBAC and having those who supported me
around let me learn what I needed to have a good chance at success.

[Arete]

Wow, this discussion is really depressing me!  I thought I had it figured out this time (found an all female practice, so no matter who was on call, I'd be safe) but now maybe she'd be calling CPS on me.  I just don't think I can survive another pregnancy with the prospect of everything culminating in reliving a sexual assault (last time I was close to suicidal over it, for a while).  It seems there is no right choice for me.