Homebirth and Midwives in California

[meganlauriana]

My husband and I are expecting our first child in May of 2013. I am 13 weeks and 3 days along and this last Thursday, told my OBGYN that I was looking into homebirth and birth center options. 

She told me she won't be my doctor if I'm even considering a homebirth; Which made me feel very supported. 

Anyways, I'm having a hard time finding a midwife, figuring out how to get a doctor to be my 'back up' just in case there is an emergency during pregnancy or delivery and we have to transfer. 

I guess it goes without saying that most of the time I get weird looks from people when I mention homebirth... So I'm hoping to find community and support here. Any information or advice you have would be great!

xoxo,

meg

[trimommy2009]

Congratulations!  I hope your pregnancy is going smoothly so far.  We are all here to support you in your journey to becoming a mother!

I can't say how it works in California, but I just had a home birth in Colorado and I interviewed three different midwives and each had their "preferred" hospital, but none had a backup OB.  Once we selected the midwife, we then pre-registered at the hospital she would perform a 'non-emergent' transfer to.  I just went in, filled out the paperwork and got in their system.  That hospital was about 20 minutes away.  There were two closer hospitals that were planned 'emergent' transfers.  I didn't register at either of those because I figured if I was arriving by ambulance it wouldn't really matter.  

I'd start by doing a web search for home birth midwifes near you, or reaching out to a couple natural child birth educators in your area.  Then I'd begin interviewing midwifes and make sure to ask how they handle transfers, if they have a backup, or preferred hospital.  Hope that helps a bit.  Other posters in your area might also have some midwife suggestions for you.  

[allisonrose]

I planned a homebirth in Cali (although it ended up being a hospital transfer). My understanding is that it is basically impossible for homebirth midwives to find OB back ups so the legal precedence is having a back up plan.

I did see an OB once when I had some spotting in the first trimester - I had seen that doctor for well woman care in the past. I did not mention I was considering a homebirth and she simply assumed she'd see me for the pregnancy. Some people do decide to see both a midwife and an OB: usually referred to as shadow care.

[babycatcher12]

Originally Posted by allisonrose 

I planned a homebirth in Cali (although it ended up being a hospital transfer). My understanding is that it is basically impossible for homebirth midwives to find OB back ups so the legal precedence is having a back up plan.
I did see an OB once when I had some spotting in the first trimester - I had seen that doctor for well woman care in the past. I did not mention I was considering a homebirth and she simply assumed she'd see me for the pregnancy. Some people do decide to see both a midwife and an OB: usually referred to as shadow care.

This. Most homebirth midwives that I know of, don't have an OB back up and most OBs won't continue caring for you if they know you're planning a homebirth. They're afraid of being sued. Most of the time if you get transferred you just get whichever OB is on call that day and the midwife goes with you. 

[Dr Stu]

Homebirth is and should be a choice for some, not all, well-informed women. Southern California has many safe choices including The Sanctuary Birth  Family Wellness Center where midwives collaborate with a home birthing obstetrician when indicated. You should check them out at www.birthsanctuary.com  Congratulations!

[IdentityCrisisMama]

Originally Posted by meganlauriana 

My husband and I are expecting our first child in May of 2013. I am 13 weeks and 3 days along and this last Thursday, told my OBGYN that I was looking into homebirth and birth center options. 

She told me she won't be my doctor if I'm even considering a homebirth; Which made me feel very supported. 

Anyways, I'm having a hard time finding a midwife, figuring out how to get a doctor to be my 'back up' just in case there is an emergency during pregnancy or delivery and we have to transfer. 

I guess it goes without saying that most of the time I get weird looks from people when I mention homebirth... So I'm hoping to find community and support here. Any information or advice you have would be great!

xoxo,

meg

My understanding (just from MDC and casual internet reading) is that doctors make the bulk of their money on a pregnancy at the birth so seeing a Dr. for "shadow" care is an expensive situation for them. I'm not making excuses for your OB's rudeness but wonder if that's not part of it. 

I have had 2 planned HBs - the first one in CA. I never considered shadow care/back-up care. I did end up transferring to a hospital for my first birth (in CA) and it was a fine experience. For me, when I imagine transferring during labor, it's difficult for me to imagine feeling like having a back-up Dr. being all that important to me. First, from my understanding of how most Drs. schedule births, the chances of you getting that Dr. seems low. Also, you're pretty distracted when you transfer (having a baby and all) and I wonder if "knowing our OB" would make all that much of a difference. 

Just my 2 cents. 

[Buzzbuzz]

Or it could be the OB views homebirth as a high-risk endeavor and does not want to seem to endorse it by her actions.

Or it could be that she doesn't want to be the deep-pockets for a lawsuit if the midwife screws the pooch.

[IdentityCrisisMama]

Originally Posted by Buzzbuzz 

Or it could be the OB views homebirth as a high-risk endeavor and does not want to seem to endorse it by her actions.

Or it could be that she doesn't want to be the deep-pockets for a lawsuit if the midwife screws the pooch.

Yes, probably. I would think that she has some pretty strong feelings if she is not willing to see a client for even considering HB. But, not all hospital birth MWs or OBs decline shadow care for the above reasons - even ones who think it's a valid choice may decline because they are spending a bulk of their care hours on a client who won't bring the big bucks by birthing with them. At least that's what I've read. 

I did see a hospital birth MW when very first pregnant with my DC #1 and, like the OP, I told her I was interested in HB. She told me that she, too, had homebirths and recommended me switch care to a HB MW and gave me the option to come see her if I changed my mind in favor of hospital birth.  This hombirthing, hospital birth MW did not, however, give me the option of shadow care. 

Either way, I was mainly trying to offer a different perspective on why the OP's first OB choice would be so dramatic. But it is probably more like what you say it is. I would go running from a doctor who threatened to drop me because of something I was thinking about - seems quite telling of their view of the role they play in client/patient care, no?  

[meganlauriana]

Thank you for all the great information!!!

I am canceling any further treatment with the doctors office, because of the way she reacted. It would be one thing to say that she didn't feel comfortable with homebirths and being a back-up OBGYN and then proceed to have a conversation with me about the different options and what having a birth with her would look like. 

Instead, she shut it down and said I'll transfer you out of this practice and shrugged her shoulders. That is not the kind of doctor or care I'm looking for, especially for my first time delivering! Even when you know the basics about pregnancy, I don't know how this will go for me and I'm a little scared. It'd be nice to have a doctor that would talk to me instead of just shutting down when other options are raised. 

Obviously, I'm new to all this, but I can't see how it is a problem for me to go to a doctors office for labs, the 20 week ultrasound and for tests like strep b and glucose and deliver with someone else. If my insurance and I paying for those appointments they are making money, even if they aren't making the 'big bucks' for the delivery. Some money is better than no money, right?

I also don't understand the logic behind her not wanting to get sued if an emergency happens with the midwife; She has nothing to do with the midwife. If we have an understanding or contract that I'm only using her practice for prenatal care and not delivery she wouldn't be liable at all. Please, fill me in if I am missing something here!

Also, the reason that I felt like having a back-up or shadow is because if something goes wrong and I am transferred, I am obviously going to be shaken. It would be nice to know that the hands I am going into are ones that know me and that I know. To know that they want the best for me and the baby and will do everything to get the best outcome. Imagining that I am transferred and rushed to the hospital and then seeing a face that isn't familiar or reassuring is adding to the stress of what is going on.

Honestly, I'm surprised that having a back-up isn't a norm for homebirth moms. Especially since a lot of them are big on the personal experience. Why spend all this time nurturing a relationship with a midwife and cultivating this environment of safety, relaxation and openness to welcome your baby into, and then be like, but if they transfer, they don't care about whose hands they are going into - especially for something as serious as surgery! I wouldn't go to just anyone unless I didn't have a say about it. If I do have some sort of a chance at controlling who cuts me open in anyway, I'm dang well going to do my research and attempt to line up the best.

Anyways, last night I called a midwife and had a great conversation with her. There are two licensed midwives and one nurse midwife in her practice and the nurse midwifes husband is an OBGYN. I have another call into another midwife that delivered nine of a family-friends eleven babies at home - shes been in practice for over 25 years. Once we settle on a midwife I will talk with her to figure out where I can go for those tests, ultrasounds and such. 

Sorry this reply was so long! :)

[IdentityCrisisMama]

I can try to explain these things as best as I understand -- but these are often just things I've picked up here and there. One of the things I love most about HB as a culture is that we seldom speak for others - not us pregnant mamas and not our midwives. Along those same lines, there as a great variety with HB MW's and how they practice and HB mamas and what we find acceptable on these boards. There are also some folks who post here that are not wholly in favor of HB and that's OK. HB is a choice that very much a choice that expects you to be a strong advocate for yourself and your care. Sounds like you're on track to do just that, wherever you decide to give birth. 

Quote:

I am canceling any further treatment with the doctors office, because of the way she reacted. It would be one thing to say that she didn't feel comfortable with homebirths and being a back-up OBGYN and then proceed to have a conversation with me about the different options and what having a birth with her would look like. 

I think you are right to leave care from this doctor. Homebirth is a valid choice and one that many women make. It is fine to disagree and to not want to be involved in the care of a woman who chooses that but it's not good care to shut down conversation. During your pregnancy and birth, there will be so very many questions that come up that you can not have a care provider who refuses to discuss things. 

Quote:

Even when you know the basics about pregnancy, I don't know how this will go for me and I'm a little scared. It'd be nice to have a doctor that would talk to me instead of just shutting down when other options are raised. 

You will find that care provider - don't worry! There are plenty of caring OBs and hospitalbirth and homebirth MWs out there. 

Quote:

Obviously, I'm new to all this, but I can't see how it is a problem for me to go to a doctors office for labs, the 20 week ultrasound and for tests like strep b and glucose and deliver with someone else. If my insurance and I paying for those appointments they are making money, even if they aren't making the 'big bucks' for the delivery. Some money is better than no money, right?

I can't speak for that for sure but I have heard that perhaps not. My point is that we don't know. I tend to think of pregnancy and birth care as a relationship and I know I would be uncomfortable if my care provider wasn't happy with our arrangement. You should know that the fee structure from a hospital birth care provider and a homebirth MW is quite different. Also, depending on your MW she may want to also do some of these tests and/or see the results, which could get tricky. I just don't know. 

Quote:

I also don't understand the logic behind her not wanting to get sued if an emergency happens with the midwife; She has nothing to do with the midwife. If we have an understanding or contract that I'm only using her practice for prenatal care and not delivery she wouldn't be liable at all. Please, fill me in if I am missing something here!

I think what Buzzbuzz was alluding to is that MWs in most states don't carry liability insurance so often if there is some sort of birth injury the family can't get any recourse from the midwife. It seems that in some cases folks think the MW was partially responsible, yet the doctor or hospital were held financially liable because they held insurance. So, for instance, if you had shadow care with this Dr. and birthed with the MW, transferred care to the Dr for whatever reason and had a poor outcome things get tricky.  

Quote:

Also, the reason that I felt like having a back-up or shadow is because if something goes wrong and I am transferred, I am obviously going to be shaken. It would be nice to know that the hands I am going into are ones that know me and that I know.

This is worth some research to see what your chances of seeing your back up doctor actually are. From the critiques I've heard of hospital care, women often give birth with a large group of care providers. I'm not sure though -- that would be a good question for your back-up doctor (if you find one). I have a feeling it wouldn't quite work as well as you think it may. 

Quote:

Honestly, I'm surprised that having a back-up isn't a norm for homebirth moms. Especially since a lot of them are big on the personal experience. Why spend all this time nurturing a relationship with a midwife and cultivating this environment of safety, relaxation and openness to welcome your baby into, and then be like, but if they transfer, they don't care about whose hands they are going into - especially for something as serious as surgery! I wouldn't go to just anyone unless I didn't have a say about it. If I do have some sort of a chance at controlling who cuts me open in anyway, I'm dang well going to do my research and attempt to line up the best.

I think this is a reality of care in this country. Honestly, I'm not sure if it works any differently in other countries. Most c-sections are emergency surgery. They aren't planned or timed and doctors have lives. Even if you can get to a place where you have a reasonable expectation that things will work as you planned, they may not. One silver lining is that c-section rate for HB mamas is quite low. Anyone have the stats for this mama? Ask a few HB MWs what their c-section rates are to get a better idea. 

Quote:

Anyways, last night I called a midwife and had a great conversation with her. There are two licensed midwives and one nurse midwife in her practice and the nurse midwifes husband is an OBGYN.

A MW partnership leaves you with some of the issues that you may fear. One of three MWs will come to your birth and you will have limited amount of time to get to know all three. This was how it was for me with my first birth - a two MW practice. The advantage is that you have less chance of having all your MWs busy. The down side is that you don't know who you're getting until the birth, you may have developed strong preferences by the time of delivery (I did) and it can be stressful to worry over who you're going to get. Did you ask these MWs whether the husband OB is willing to do shadow/back-up care? And if not, why? I'm sure if you're going to get a good answer it would be from these MWs. I'd love if you could share the answer as I'm a bit curious myself. 

     Quote:

have another call into another midwife that delivered nine of a family-friends eleven babies at home - shes been in practice for over 25 years. Once we settle on a midwife I will talk with her to figure out where I can go for those tests, ultrasounds and such. 

This sounds like my second MW. I LOVED having just one MW for my care - even if I did worry a little about what would happen if she had two births or a life issue during my delivery. MWs will just send you for your labs - no different from any OB's office really. That part is a no-brainer. 

Happy searching! 

[Buzzbuzz]

"Also, the reason that I felt like having a back-up or shadow is because if something goes wrong and I am transferred, I am obviously going to be shaken. It would be nice to know that the hands I am going into are ones that know me and that I know."

There are a lot of good reasons to have shadow care beyond familarity with a particular provider:

(1)  In case your pregnancy does not go normally (for example, any abnormality with the fetus, pre-eclampsia, pre-term labor, etc.) and you need to access a higher level of care than a midwife can provide.

(2)  In order to have comfort that you are really low-risk.  A midwife only makes the "big bucks" if she doesn't risk you out of a homebirth.  Sometimes, she may not match the typical "standard of care" in terms of the pre-natal testing she suggests (testing for GBS, gestational diabetes, dating ultrasounds, etc.)  It can be valuable to have a second opinion on the necessity of certain testing and whether your pregnancy is indeed low-risk.  For example, your midwife may believe that your breech baby is just a "variation of normal".  An OB will likely have a very different opinion and can discuss with you why.

(3)  In order to have a medical history, lab reports, etc. all available and at the hospital's fingertips in case of an emergency transfer.  They cannot rely on the medical records provided by the midwife.  This of course, assumes that the midwife actually keeps adequate records and brings them to the hospital when you transfer -- I have heard numerous stories where the midwife "forgets" the records in the rush of the transport.

[Buzzbuzz]

Also, just to mention, the later you go in your pregnancy before accessing OB care, the more difficult you may find it to get the OB of your choice. 

OBs are certainly aware of the importance of prenatal care and some may not be excited to take on a patient who may have had, in their view, either no or substandard prenatal care for the majority of the pregnancy while the OB assumes all the risk/liability of the delivery.

My sister thought about changing practices about 5 months into her pregnancy.  Let's just say that as a 39 year old woman pregnant with Mono-Di twins no practice was jumping at returning her calls!

[allisonrose]

Sorry quote doesn't work on my tablet.

"Obviously, I'm new to all this, but I can't see how it is a problem for me to go to a doctors office for labs, the 20 week ultrasound and for tests like strep b and glucose and deliver with someone else."

While under the care of my HB midwife she handled those things above. She was able to write orders for bloodwork from the local lab. She also ordered the 20 week ultrasound from a radiology place that she and othere midwives have experience referring people to. She did the strep b and glucose test in my own home (I drank plain sugar dissolved in water instead of Glucola). Asking about such things is probably a great interview question.

[CoBabyMaker]

A few people have sort of mentioned it but I just want to repeat something that I think is important.  If you transfer during a homebirth you will be seen by whatever Dr. is on call at the hospital.  The chances of finding a dr. you can call and will just pop down to the hospital to deliver your baby is VERY VERY slim. 

That being said, if you want a 20 week US  continue to see an OB until 20 weeks for that and then just stop going.  I did that with my last pregnancy.

[Banana731]

Originally Posted by Buzzbuzz 

...A midwife only makes the "big bucks" if she doesn't risk you out of a homebirth..

XD

I don't know any midwives that would claim to make "the big bucks." It's just not that lucrative a career.

[Buzzbuzz]

Some bucks are better than no bucks, right?

[meganlauriana]

Originally Posted by CoBabyMaker 

A few people have sort of mentioned it but I just want to repeat something that I think is important.  If you transfer during a homebirth you will be seen by whatever Dr. is on call at the hospital.  The chances of finding a dr. you can call and will just pop down to the hospital to deliver your baby is VERY VERY slim. 

That being said, if you want a 20 week US  continue to see an OB until 20 weeks for that and then just stop going.  I did that with my last pregnancy.

I know that it is more likely to have whatever doctor is on call in the event of a transfer. However, our town is small. We only have a few OBs that could be on call and the history of the OBs being available for an emergency is pretty good. I'm hoping that works to my advantage. Its worth it to me to try to have a back up even if a life event or another birth prohibits me from using my back up OB. My odds of having an OB I know are much better if I pursue it. 

[IdentityCrisisMama]

Originally Posted by meganlauriana 

I know that it is more likely to have whatever doctor is on call in the event of a transfer. However, our town is small. We only have a few OBs that could be on call and the history of the OBs being available for an emergency is pretty good. I'm hoping that works to my advantage. Its worth it to me to try to have a back up even if a life event or another birth prohibits me from using my back up OB. My odds of having an OB I know are much better if I pursue it. 

ML, it sounds to me like you would be most comfortable with either back-up or shadow care (I'm not 100% sure the distinction?). I know this thread kind of got off topic a bit but maybe we can help steer you in the direction of how to best arrange for your ideal birth situation.

If you are in such a small town that you have one hospital and just a few OB's, you are not going to have a huge pool to draw from. If I were you I would start with the OB/HB MW family and see if they can offer you what you need. Ask the some questions about how likely the option of transparent back-up care is in your town. If they tell you it's a no-way you could consider some sort of shadow care where you do not tell the OB you plan on HB. This is not something that I, personally, would be comfortable with but it IS an option if it's within your comfort level. One thing to consider is that the OB is likely going to know that you tried for a HB in the event of a transfer. She/he is going to need to know what happened at home that prompted you to come in. This is essential (IMO) for you to get quality care. So, you may know this person but they may be a bit 'irked'. It's something to consider if you choose shadow care in this way. 

I also urge you to really look into HB and things like the nature of transfers in your city. HB is certainly not for everyone and the quality of transfer care is, IMO, a really important factor in whether HB is a safe choice. From what I can tell, it matters less if you know your transfer OB than what the general climate is like in your area for HB transfers. Also, do some research into transfer rates with various MWs (especially for 1st time mothers!) and c-section rates for HBs. Look into what sorts of client care your local midwives offer -- can they give IV fluids, postpartum hemorrhage meds, oxygen and etc. Look into neonatal care safety. 

Also, have you considered your local hospitalbirth Midwives? This can be a nice middle-ground for mothers uncertain about traditional OB care and HB.  

[IdentityCrisisMama]

Originally Posted by Buzzbuzz 

Sometimes, she may not match the typical "standard of care" in terms of the pre-natal testing she suggests (testing for GBS, gestational diabetes, dating ultrasounds, etc.) 

This is a good point and I think it's an important consideration for someone who is a little on the fence about HB. It really can be a very different model of care. With my CA CNMs I felt quite a lot like I was at a OB's office. I mean it was very warm and there was a lot of nurturing and "getting to know eachother" but my care was very much guided  by the MWs. They advised about testing and etc. I think they had very typical "standard of care" that you would see in any OB's office. This was their "default". I was still encouraged to research everything and make my own decisions but they guided me in the direction of fairly mainstream care. 

With my CPM it was different. I was very much in charge and held responsible for my care and I guided what testing I wanted. This is a very different type of care. I happen to think that if we are going to be responsible for raising a child, we can darn well be responsible for our prenatal care and I liked feeling like the one in charge of my health and the health of my child. 

[IdentityCrisisMama]

Originally Posted by Buzzbuzz 

Some bucks are better than no bucks, right?

Originally Posted by Banana731 


XD
I don't know any midwives that would claim to make "the big bucks." It's just not that lucrative a career.

Originally Posted by Buzzbuzz 

A midwife only makes the "big bucks" if she doesn't risk you out of a homebirth. 

 

I'm putting a mod hat on here to ask that we not make this thread a debate over whether MWs take high-risk clients in order to sustain their practice. This is off topic on this thread. My mention of doctors not wanting to do shadow care was not meant to be a dig on doctors. I apologize if my comment was viewed that way and encouraged OT discussions about profit motives of care providers.