dragging my feet regarding shadow care

[labortrials]

So, I'm planning a VBA2C at home with an experienced local midwife.  I had been feeling really good about this decision, but now that I'm starting to see the end in sight, I'm feeling less secure.

At my last appointment I agreed to maintaining my shadow care with an OB.  I had been thinking about breaking up with my OB because he doesn't want to do a VBA2C, and even though he gives great prenatal care, I can't trust that he'd actually show up for me if he's not on call.  I'm not going to push him on this.  And really, I don't want to have a "fake" relationship with a care provider, and there's NO WAY to tell an OB in this town that you plan to birth at home.

But my midwife made a good case for continuing care with an OB in addition to her.  I guess that if I do need to transfer at some point, I'll be treated much better if I don't seem to be a homebirth transfer.  It sucks that my care would be affected by this, and I must say that I'm terrified of needing to transfer and not being treated in a timely manner if something serious is going on or being harrassed or whatever.

However, I just DON'T want to be shopping around for an OB.  And I'm not sure I can deal with people telling me "no."

What would you do?

[jenniro]

Wow, that sucks.  You'd like to think that if you needed a transfer to the hospital, you would be treated with respect because you are a woman in need of care, not a homebirth transfer.  Little rant there, sorry. I agree with the midwife that it is nice to have a relationship with an OB in case of transfer, but I think that is only beneficial if you have an open, honest relationship.  Otherwise, you're showing up the hospital after laboring at home and then telling your OB, "Oh, yeah, I didn't feel comfortable telling you I was doing homebirth, but here I am."  That doesn't seem any better than just showing up and getting whoever is on call, KWIM? 

 Maybe your OB will surprise you.  I don't like shopping around either, so I would probably have an open conversation with my OB.  I would try to be confident and assertive, telling him I am doing homebirth, but I would appreciate his support if I needed a transfer.  If he flat out refuses, then you know, and you can decide if you want to shop around or take your chances.  But you never know, maybe he'll see that you are going to do what you want and he will support what is best for you.  Everything will work out, you'll do great, and won't need a transfer anyway.  GL!! 

[Xerxella]

Honestly, I disagree.  I don't think I would tell my OB, I'm planning a homebirth.  I know what you mean, they would go ballistic.  Just about every OB I've met is incredibly anti-homebirth, especialy for a VBAC!  (Maybe you have the exception, but I'd be surprised.) 

But, I would continue the shadow care.  I'd feel free to skip some of the redundant appointments at the OBs office (call in sick, no child care, forgot, whatever, I'll be there next week).  If you have to transfer, you wouldn't come in and say, hi, I've been trying for a homebirth, but it didn't work, so I thought I'd try you instead.  I'd say, wow, labor came on really fast so here I am, labor started about an hour ago (even if it had been days). 

Have you checked your local ICAN or your tribe?  Maybe you won't have to shop around and they can point you to the doc (maybe docs) in your area who are willing to do VBA2C.  If there isn't one, I certainly wouldn't change. 

But, know that at the end you're probably going to have a struggle on your hands.  Most docs section at 39 weeks.  So, they're going to want to schedule you then.  Try to convince them to schedule up for 41 weeks or at least 40 weeks.  You might have to do some fast talking as the date gets near and that's really tough in the final days of pregnancy.  (This is what happened with my last VBAC attempt.)  Be prepared to say, I want to think about it, I want to get a second opinion, I want to talk to my dh, I want to talk to my second cousin's neighbor who is a podiatrist, whatever.  I'll call you back.  I can't come in that day.  My grandmother died, my uncle died, my cat died.  My car broke down.  I was locked out of the house.  You get the idea. 

I think I'll be doing shadowcare for this pg (which will be a VBA2C) and these are things I've thought of.  But, if I do it my shadowcare will be with the VBA2C "friendliest" practice in the area to keep my chances high. 

Good luck! 

[labortrials]

Thanks gals!

I can't come clean about my homebirth plans because NONE of them will do shadow care for that.  Heck, even our CNM-run birth center hasn't been able to get an OB to serve as backup.

I've heard that there are a couple of OBs who will consider VBA2C; I guess I just don't want to open myself up to the certain obligatory minimum (or maximum) amount of fear mongering about "risks," especially since the obstetric presentation of risk is SOOOOOOOOOO one sided.  One of the docs requires a referral because he's a high risk OB, so it'd mean telling my current OB.  Argh.  And my OB doesn't do VBAmC and doesn't imagine that ANYONE in town does.

So, yeah . . . I could just keep going with my current OB and just drag my feet when he starts pressing me at the end.  It just seems SO WRONG to be having to fight off the medical "machine" when you're trying to gestate peacefully and get ready for imminent birth.  He'll definitely want to schedule a 39w cesarean.  I could probably put him off to 40w considering that my babies just DON'T come early.  After that it really WILL turn into a fight.

Ugh.  I'm just SO HATING THIS!  Why can't it be the way it SHOULD be?!  I feel robbed.

[CookAMH]

Originally Posted by labortrials 

But my midwife made a good case for continuing care with an OB in addition to her.  I guess that if I do need to transfer at some point, I'll be treated much better if I don't seem to be a homebirth transfer.  It sucks that my care would be affected by this, and I must say that I'm terrified of needing to transfer and not being treated in a timely manner if something serious is going on or being harrassed or whatever.

From the conversations I have had with midwives and my doula about this, the hospital *knows* what's up when you come in late in labor. They can figure it out. My approach will be honesty and humility (but firmness in my own desires) and take what comes. It's true that HBAC transfers aren't looked on too kindly, but trying to cover it up could make it worse. Why not just be open?

[Xerxella]

Of course it's up to you, but I would strongly consider the OBs who will at least attempt a VBA2C.  They'll at least give you a chance (even if it's small) for a vaginal birth.  Otherwise, what are you going to tell your doc at 39 weeks?  I don't think it'd be possible to put him off for 2 weeks.  Are you going to tell him you're trying for a home birth then?  Tell him you've decided to switch care providers?  Just stop going and answering the phone?  I think for your own peace of mind you need to have a plan, an exit strategy (at least I know I would). 

And, what are you going to do if you have to come in?  Even if you come in pushing, he'll want to do a c-section. 

Have you considered going to a new care provider and fudging you due date by 2 weeks (saying your lmp was x date so that he would think 41 weeks was actually 39 weeks).  That would buy you a lot of time.  And, if you wait until the 3rd trimester the ultrasound isn't very accurate for dating. 

Isn't it so sad that we feel we have to lie and scheme and plan to get the type of birth we desire?  I'm so sorry you have to go through this.