Is it possible to do self-prenatal care and still birth at a birthing center or hospital?

[Sunshine34]

Hi - I'm a first time mommy-to-be due in March and I've decided to do self pre-natal care.  I truly believe in trusting nature in the miracle of creating my baby and giving birth.  I've read up on the basic pre-natal care and I'm keeping an eye on it all while trying to take a laid back/natural approach to the whole experience.  Ideally I want to check in with a midwife once or twice before the birth and then have the birth at a birthing center. Does anyone have experience doing this?  Do birth centers allow this kind of limited pre-natal care and then birth?  If the birth center option is out, I'm open to having a birth at the hospital but really it's not my first choice.  This may seem like a silly question but can a hospital turn you away if you do not have a relationship with a doc there??  Any input would be greatly appreciated!!!

[dogmom327]

I would be surprised if a birth center would go along with that for liability reasons.  A hospital will of course take you but it will likely be a miserable experience.  You will most likely be treated like an irresponsible parent who clearly risked the safety and life of yourself and your baby.  You will likely be pressured into a great deal of unnecessary testing for both you and the baby.  It's also possible someone at the hospital will call CPS and theoretically they would have a case. Obtaining medical care and oversight during pregnancy is considered to be a basic level of responsible behavior in our society at large.  A hospital is unlikely to be sympathetic to your autonomy.

Having sad all that, I know where you are coming from.  I'm hoping for a very hands off pregnancy this next time around but I'll be using a home birth midwife and we'll be in agreement as to the plan when I hire her.  I honestly can't fathom doing either a UP or a hands off pregnancy and then showing up to a hospital for anything sort of a life an death emergency.  It just wouldn't be well received and would result in all sorts of negative repercussions for both baby and I.

ETA: I should have clarified.  Under a law called EMTALA, a hospital will have to take you if you are in labor but you will be subject to whomever is on call, hospital policy, etc.  Regardless of how strong you are, your birth plan, etc. that will not prevent them from making your life a living hell, calling CPS (for either you lack of prenatal care or your refusal of any tests or treatments, etc.).  Sorry to be so negative but even around here (where home births and midwives are really common), I can't imagine that being well received.

[Kokolove]

Hi Sunshine, I am new here, but having had 2 babies recently, back to back, I am pretty familiar with what kinds of things go along with standard prenatal care.  I have never heard of anyone doing "self" prenatal care.  In fact, I can't think of how it is possible.  How can you test yourself for Group B Strep?  Gestational Diabetes?  Placenta Previa?  I'm sure there are more, but those are the main things I can think of off the top of my head that would be impossible to do on your own.  You really should see someone, at least for those important tests.  Other things, like monthly belly measurements and heartbeat monitoring, you could do on your own or with your partner's help. 

I don't know of any midwife who would take on a patient who willingly refused prenatal care, because she would have no idea what kinds of risks factors are present.  You would likely end up going into the ER, where you wouldn't know anyone and (like the previous poster said) they are likely to call CPS for child neglect.  It is much, much safer for you and your baby if you find a competent care provider who will see you throughout your pregnancy and delivery.

[JamieCatheryn]

I wonder why don't you want to birth at home (barring complications), if you find home best for prenatal care and trust the process of birth? Is that maybe just not a leap you've made mentally yet, accept home birth as possible for you? I had a great experience with a homebirth midwife who I visited for all the regular checkups, but was my partner in keeping an eye on baby's and my health, not in charge of me and not doing anything invasive. At the birth she was the same way. Many birth center midwives may take a similar approach. UP and UC is another option, trusting yourself and the process from start to finish and birth on your own. Unassisted pregnancy and then walking into the hospital without records, they'll take you but make your life and labor miserable out of concern or maybe just to "punish" you. By all means transfer if complications arise though, that's what the hospital is there for, treating serious problems, giving medications, doing c sections.

[JamieCatheryn]

People who do their own prenatal care often use the urine test strips and if there's any warning signs of GD will test blood sugars with a home monitor. Placenta previa can often cause a little bleeding in pregnancy as a warning sign and might be found by listening via doppler. A CDC approved alternative GBS treatment plan is to only treat for it if waters are broken too long, mom gets a fever, or baby is premature. If a mother responsibly performs her own care it's a question of semantics and legalism whether she received prenatal care.

Ignoring the legalism and semantics, the main obstacle to working with a midwife is that suddenly she's taking on responsibility for your case, having hardly spent time with you, having never been responsible for your care so far, having very little familiarity with your body and your personality.

[Magali]

I did it.  I saw a doctor at 18 weeks, 22 weeks and 28 weeks.  I wanted an ultrasound and bloodwork so we took care of that at those appointments.  Also I wanted to do a hospital tour and have a chart.  I ended up being almost 2 weeks overdue so I showed up at the ER for a non stress test.  My doctor happened to be on call at the time and she was also there the next day when I went back to have my baby.  

Where I live you don't have the option of a midwife or birth centre.  My choice was hospital birth or birthing alone about 40 mins away from the hospital (I considered it for about 5 minutes but only half-heartedly because it just boiled down to be waaaaay out my safety zone).  I was realy upset so I did what felt right at the time, and that was mainly self prenatal care and a hospital birth.  So I just minimized the amount of time I spent at the Dr's office really, and did the tests I thought were important. 

The doctor wasn't happy with me at all.   But we didn't get along from the get-go anyway.  It still was a great birth.  All the nurses at my birth were super and respectful of my choices.  Because I didn't discuss my birthing preferences with the doc ahead of time, a couple of things like super duper delayed cord clamping and trying different pushing positions didn't happen.  But, I push my babies out really quickly and easily on my back anyway so that ended up being a non issue.  I didn't take a group b strep test and no one even batted an eye (that I knew of), although I did write in my birth plan that I would take abx under certain conditions.

I'm in Canada btw.  I don't know if the crap I pulled would have been so tolerated elsewhere.  I say "crap" now, but at the time it was VERY important to do my own prenatal care.  And now it's like oh yeah, btdt...I'll just let the doc take care of that if there is ever a next time .

Here is my birth story if you want to read it.

http://www.mothering.com/community/t/1277605/my-up-planned-hospital-birth 

[AlexisT]

BCs require that you have prenatal care, and often don't take late transfers either. They want to know you well and rule out any risk factors.

[JudiAU]

Birth centers only handle low risk births, and they verify your needs by providing prenatal care. They won't handle a birth for an unknown person with unknown medical needs, which is what you are asking. Whomever attends your birth adopts all of the risk of your birth, even if they would choose to their liability insurance would prevent it.

Hospitals won't refuse you if you are in active labor (but only active labor) but I think you would be very unahappy with your experience if you show up without a relationship and claiming that you provided your own prenatal care.

[MeTooMama]

I am very curious, that if you're doing your own care, why not just UC and birth at home? At the very least, I would take the care. You can always tell them no to any tests you decide are invasive and then birth at home. But, I thought I should go to the doctor after my first UC to give the baby a go over and they treated me like a villain until the doctors showed up and patted me on the back ROFL weirdest visit ever. Sometimes, those nurses can be downright cruel!

[flightgoddess]

Seriously, for a first pregnancy, you should have some realtionship with someone, since you've never experience these feelings before, and you do need the major tests (blood pressure check (for high BP), gestational diabetes) becuase if unchecked and they become a health problem (and you don't know its a health problem because you are doing 'self care') then they could be threat to your health , the baby's health, and even your survival of L&D, if there was something majorly wrong.

Home birth with a midwife sounds like it might fit for you. Shop around until you find someone that fits your style of laid backness.

Does insurance factor into your decisions at all? Or is this all out of pocket?