How do you leave an OB for homebirth? (on good terms)

[1babysmom]

This probably seems like a stupid question.  I know that I have the right to choose whatever care route I feel I need in my pregnancy.  So I know I CAN leave, but here's my situation...having never done this before...

I looove homebirth, and I have learned exactly how my body labors best and I know I can't fully achieve that in a hospital (at least not without a battle).  My first was a medicated hospital birth, but my last 2 babies were unassisted homebirths.  However, this pregnancy, after 4 miscarriages in 12 months (the last being at 9.5 weeks), I have decided to make an appointment with my old OB.  I am hoping that everything with this pregnancy is just fine, and if so, I'd like to proceed with a homebirth again.  However, if there is a problem that we can identify that might require more care, I'll gladly stick with him.  But I just don't want to me "medicalized" if everything is just fine, KWIM?

So I plan to go to 1 or 2 appointments with him, have some bloodwork and an ultrasound, and not only hope and pray we can confirm a healthy, sticky baby in there, but also to see if there is an obvious issue that we need to keep an eye on.  If not I'd like to switch to my midwife.  How do I go about it without burning bridges?  Do I need to talk to him personally?  Do I just call and cancel my next appointment and not make a new one?  Do I call and say we've switched providers? (and if so, do I give a reason?)  I am grateful for any care and answers he can provide me during this time, but as great of an OB as he is, I just don't feel that I can  have the pregnancy and birth experience that I need (and that is healthiest for me and baby) if I don't REQUIRE his assistance, you know?  So I guess I want to leave on terms where if I need to, I can come back to him in future pregnancies.  Am I thinking too much into this???  I'm a people pleaser (recovering!! LOL) so maybe that's part of why this bothers me so much?

The other thing I'm wondering is about billing...at the first appointment with him, they set up a payment plan based on your insurance that goes from that first appointment clear up until the last post-partum checkup.  So it covers everything.  I'm assuming that if I leave, I'll just get a bill for what I hadn't yet paid for (but received) or a refund for what I overpaid...but do I have to notify billing that we're leaving?

[XanaduMama]

Can't your MW order bloodwork and an ultrasound? That's what has happened with both of my last two pregnancies (where I've had a HB MW, no "shadow care"). This seems like the easiest and most sensible way to avoid even getting into the situation with the OB. Or you could just go to Planned Parenthood or your GP.

If you really want to see the OB for some reason, then you're perfectly entitled to go to one appointment without agreeing to any long-term contract or starting a payment plan. Just make arrangements to be billed for the appointments you actually go to.

[XanaduMama]

Ah--I missed that you're planning to UC. Then yeah--go for one or two visits, but tell them you're still shopping around for birth attendants (or just don't tell them anything, other than that you don't want to commit to a payment plan yet). Or, again, just get your GP to order bloodwork and refer you for a scan at 20w or whatever.

[1babysmom]

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Edited by 1babysmom - 3/19/13 at 8:07pm

[Soon2BeMom]

I was wondering this too.  I'm considering a homebirth with CNM, and if we go with her, I'll need to leave my traditional group OB/midwives.  I've already set up the payment plan there.  And I MUST leave on good terms because if I end up being transferred, I'll most likely be delivering at the hospital with one of the OBs from their practice.

Last pregnancy I saw the OBs there instead of the midwives (and was not pleased), so I'm waiting to talk with one of the midwives there to get a feel for how they do things before deciding about homebirth/CNM vs hospital/midwife.  I'm meeting the midwife there this week, and I'm not sure if I'm going to tell her that I'm considering a homebirth or not.  I'd love to ask her questions about home vs hospital birth, but I don't want to get into the scare tactics or anything that would put us on bad terms, you know?

[Shinyredstar]

While it would be more costly, couldn't you just continue to see the OB and then have an "accidental" home birth? Though I suppose there would be some commitment to the aftercare and that could kind of defeat the purpose.

[1babysmom]

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Edited by 1babysmom - 3/19/13 at 8:07pm

[MaeBird]

For what it's worth, I started my pregnancy at a big hospital birth and women's clinic (with midwives and OBs) at a friend's recommendation and quickly found that they were very high intervention (unexpected pregnancy, did not research providers as much in advance as I should have).  After an absolute debacle in which I couldn't reach ANYONE for advice when I was snowed in and very ill, I did some research and found an all midwife group with a much lower intervention rate.  To switch I just cancelled my next appointment with the first group, and made an appointment with the new people.  At the first appointment, they wanted to see the "first appointment" stuff (blood work, exams, etc.--in part because I had questions about it) so I filled out a simple form giving the old group permission to send my info to the new group.  The office staff handled it from there.  The first group had sent me a payment plan form, but I had never signed it, so when the transfer of care stuff was processed they just billed my insurance for the two appointments I'd been to and that was that.

I have no idea if that would work as far as "keeping good relations" since after the slew of problems I had I really didn't care if I offended the first group, but it was simple and painless from my point of view and from the insurance/billing point of view.