Question and new here...

[StacyL]

Hello everyone! I've lurked for a few days and now need some thoughts from all you homebirth Moms out there. This is my first baby, and my husband and I plan on having an unassisted homebirth. We have an insurance plan that doesn't allow me to choose my OB. So, I was assigned to someone who I don't like at all. He is not aware that I plan to homebirth, since he doesn't "do that." I believe that birth is a natural event, and if I'm healthy and not having any problems, then I shouldn't be subjected to a multitude of procedures. If it ain't broke, don't fix it - KWIM? So, I don't get a Doppler when I go in, (they did one at 13 weeks and HR was strong), I don't want vaginal exams, Glucose test, etc. I am having an ultrasound in three weeks - I'll be 24 weeks then.

My problem is this OB told me last week he should "fire me" as a patient because I didn't want to be Dopplered on my last visit. I don't like feeling like I have to fight with this doctor, who should be interested in my health, rather than imposing his will on me and telling me I can't turn down optional procedures.

My question is: What do I do? I think at some point I will have to just discontinue any kind of prenatal care with him. Is this common among women trying to homebirth? I don't have a choice of doctors. Now, I know my insurance will cover it if I ended up having to, God forbid, transfer to the hospital during my delivery. But, what do I do - just stop going to the doc near the end of the pregnancy when he's trying to make me do things I don't want to do?

Any thoughts would be greatly appreciated.

[cottonwood]

Hi Stacy, welcome to MDC!

I am planning a UC too, I'm at about 18 weeks (from conception.) I'm not currently seeing a medical professional for health care because, well, I'm not sick. I'd say that whether or not you continue to use a doctor depends on what you see yourself getting out of it. Is there a test or exam you want done that you can't do yourself? Or do you feel more comfortable having that record of prenatal care in case you have to transfer? Those are both valid reasons for continuing a relationship with a birth professional. As for avoiding things you don't want done, just say 'no'. If your doctor "fires" you, I assume your insurance will assign you a new one?

You might also consider finding a midwife sympathetic to your plans, and just paying her out of pocket for the things you want done.

[Faith]

Here are some ideas... Maybe someone else will have some better ones...

You only have one OB to choose from, but what about family practice doctors? They often do prenatal care, and you might find a good one.

Have you thought about getting on the medical card/Medicaid? I was on in it IL and I went to my first choice of doctors while pregnant.

Have you looked into midwives? IL has certified MWs that are covered by insurance (i.e. might accept the medical card) or might work it out with you otherwise. There are also wonderful direct-entry lay MWs there who provide inexpensive prenatal care, but they also usually attend the births.

I guess... If you are refusing all tests and having a UC, what good is it doing you to use a doctor at all? Just for the u/s? Just thinking maybe going to the OB is not worth your trouble, yk?

[StacyL]

Well, I don't see the point of getting a midwife since I want to birth unassisted, and it seems like (from what I've read) that midwives do quite a bit of intervention, even though you are in the home setting. There are two CNMW's at my OB's office, and it's always been better when I have seen them at the appointments, rather than the OB.

I guess the whole point of getting prenatal "care" was because it is my first pregnancy and I wanted to make sure I am having a normal pregnancy in order to go unassisted. That's the only reason why I agreed to the ultrasound - just to check the baby to make sure everything is normal. I guess that is me clinging to a last vestige of the "routine" procedures for birth these days - but, hey, this is my first baby so I consider myself lucky/brave to have even found my way to the idea of unassisted birth! Maybe I will be fortunate enough to NEVER have any hospital births.

I think I am just wondering about how much involvement there is of medical "professionals" in the world of UCers. Only to confirm pregnancy in the beginning to authorize your insurance coverage, should you have an emergency? Only to get an ultrasound? None?

Have any of you had an unassisted birth?

[Konur's Mom]

you should go read the UC threads. There are maqny who do not do any prenatal with UC. What exactly do you think a US will do? If there is a problem that a US can detect, what will you do? There is a lot of false positives with a US. I have a MW who is very hands off during labor and I am having no testing or US. I just don't see the point to be honest. There is nothing mw or ob can check for that you cannot. Just do your research on how to deal with different problems that can come up during labor and delivery.

[anothermama]

Hi Stacy.......

First of all, in my experience, the level of "interventions" a midwife will impose is directly related to where she practices........my experience has been that midwives who have hospital privaleges or practice in a practice with OBs are much like OBs.

HOWEVER! There are also a lot of low or non intervention midwives out there. My midwives do my prenatals and I'll probably continue with them through life for my well woman care. From what you are saying, I don't see how going to a midwife and getting little intervention is different that doing what you are doing......going to an OB.

If it's possible for you to pay out of pocket, you may want to really research the midwifery practices in your area. I would guess you'd be able to find a midwife who'd be willing to follow you for some prenatals and who would be supportive of your choice if it's the healthy one for you and your baby.


I've not had an UC, but my friends who have have sought out really "earthy" midwives, usually lay or direct entry midwives, who will support them and be a "back up" should they feel the need for extra support in labor.

[laurata]

So, let him fire you

Good riddance, eh? Seriously, though, if you call your insurance and tell them you are unhappy with your provider, they will likely find you a new one. And if you know of anyone who might be more in line with your thinking, there's no harm in asking, is this provider available?

Good luck with your decision. I found firing my hcps very freeing. I shouted for joy and danced around the room with my 3 yo, it was such a relief.

[cottonwood]

Stacy, I mentioned the midwife only because it sounds like you want some kind of outside monitoring of your health during pregnancy, and midwives can be much more amenable to non-mainstream choices, especially if they are in private practice and so not held to practice according to hospital policy. You're right, some midwives are as bad as doctors. But on the other hand some are reasonable, compassionate people.

You wrote: "I think I am just wondering about how much involvement there is of medical "professionals" in the world of UCers. Only to confirm pregnancy in the beginning to authorize your insurance coverage, should you have an emergency? Only to get an ultrasound? None?"

For my first UC, I had a midwife friend listen to and palpate my belly in late pregnancy, in order to get an idea of where the placenta was and position of the baby. That was the only professional involvement I had. I probably will do the same this time around.

I figure that if I had to go the hospital for emergency care, they could confirm the pregnancy right then and there; it seems kind of ridiculous that an insurance company would deny coverage because you hadn't had confirmation of pregnancy *before* the emergency.

[mollyeilis]

FYI, not all insurance companies require confirmation of pregnancy; mine didn't, and the person I call my primary care provider (I'm in a PPO so don't need one) thought I was strange for coming to her office to do that.

And my now-fired midwife, who was fully covered by my insurance company, never required one either. Since she certainly knows how to jump through the insurance hoops, she would have required a pg test if they did.

Just sayin' that not all insurance companies even require that.

I'm using midwives for my homebirth, but they are LMs and have agreed to sit out in the living room until I ask for them to come in (or sit in the bedroom if I'm in the living room LOL). It's my first birth. I haven't had a single doppler or ultrasound, either.

Next time though, possibility for a UC is high, once DH gets his birth feet 'wet', so to speak.

[laurata]

Originally Posted by mollyeilis

FYI, not all insurance companies require confirmation of pregnancy

I think those that do just need notification of pregnancy, though I could be wrong. I called my new insurance company, Blue Sheild, to find out if I needed to do anything special now that I'm pregnant. The lady said, "no, nothing special." So I asked, "So we just need to notify you after the baby is born?" And she said yes. I'll probably call again later on to confirm, just in case (Goddess forbid!) something happens that necessitates a hospital visit.

[jplain]

I have a simple solution regarding the Doppler. Ask him to use a fetoscope. That's a fetal stethoscope, shaped slightly differently than a regular stethoscope, but same principle. By 24 weeks he should be able to find the hb, as long as he has patience and the room is quiet. He probably has one gathering dust somewhere. But you can get your own and bring it in for him. In any case, you may want to get one for yourself - I purchased mine here: http://store.yahoo.com/allheart/om13fetal.html. Listening to the baby's hb can be fun!

I did see both traditional caregivers and homebirth midwives during my pregnancy. I won't do that again. It got awkward, and I felt deceptive as pregnancy went on, although I also felt entitled to go to the hospital provider for prenatal visits because insurance wasn't going to cover my homebirth. I waited till after I got the results of my GBS test, because I wanted to know whether or not I was positive, and then 'fired' my caregiver.

Good luck!
Carolyn

[CryPixie83]

Originally Posted by StacyL

My question is: What do I do? I think at some point I will have to just discontinue any kind of prenatal care with him. Is this common among women trying to homebirth? I don't have a choice of doctors. Now, I know my insurance will cover it if I ended up having to, God forbid, transfer to the hospital during my delivery. But, what do I do - just stop going to the doc near the end of the pregnancy when he's trying to make me do things I don't want to do?

Any thoughts would be greatly appreciated.

First of all- Hi to a fellow Central Illinois first-timer (I'm in Springfield)

I'm in pretty much the same situation you're in. I get state medical, so my choice of docs is slim pickins. I can't stand the doctor I'm with, though I do get a nice vibe from two of her associates. During my first visit I didn't even see the doc, I saw her NP who first commented on how "well-informed" I was and then told me flat out that home & water births were dangerous (especially for first time moms). I asked the OB about water births at the local hospital (basically just to see her reaction) and she said "we don't do water births".

So I've left the subject alone since then, and when asked which hospital I'm planning on delivering in I just tell them I haven't really given it much thought (and that's the truth). Well, I know my OB isn't going to like me much very soon since I'll be declining the GBS test and the regular internals. I'd love to tell her that my midwives will be assisting the birth at my home..but given Illinois' attitude towards midwives I keep my mouth shut.

I am trying to figure out how much longer I'll be seeing the OB. I'm in my 33rd week now and am perfectly happy with the care given to me by my midwives, honestly I only see the OB for DF's peace of mind. If I continue to see the doc throughout the entier pregnancy when it comes time to explain why I didn't go to the hospital to "deliver" my baby I'm going to tell them it didn't cross my mind

LOL I guess I'm not much help, but I wanted to let you know that you're not alone

[StacyL]

Deception

Carolyn and Crystal,

Thanks for your thoughts. I already asked for the fetoscope - the CNMW brought it to the office, and when the OB found out I wanted him to use it, he tried and heard nothing, which prompted him telling me he'd like to fire me as a patient. I have my ultrasound in three weeks, and I know they want to schedule me for a glucose test after that, which I really don't want either. So, maybe the ultrasound will be the end of the road, as far as my prenatal care goes.

It is just very distressing emotionally to have to be deceptive in the office about my intentions and desires, and not even feel like I have any sort of compassion-based relationship with my doctor so I can ask questions about pregnancy! This is my first, after all! I had to ask the women here, to distinguish between my baby movements and BH contractions, for Pete's sake! I mean, didn't these people become OB/GYN's in med school BY CHOICE?! : So, why don't they listen to their patients, and try to help them and give them what they want?

Stacy

[applejuice]

Originally Posted by jplain

I have a simple solution regarding the Doppler. Ask him to use a fetoscope.

Honest to G-d, I have never met an ob/gyn who knew how to use one.

Might be fun embarassing him though!:

They, male ob/gyns just love the gadgetry...and they leave the scans to the nurses and the assistants.

Men and their toys!

[applejuice]

Originally Posted by StacyL

This is my first, after all! I had to ask the women here, to distinguish between my baby movements and BH contractions, for Pete's sake! I mean, didn't these people become OB/GYN's in med school BY CHOICE?! : So, why don't they listen to their patients, and try to help them and give them what they want?

Stacy

Hate to alarm you, but most ob/gyns are not among the smartest in their medical school classes. The brightest usually go into internal medicine or cardiology which needs some intelligence. Ob/gyns are usually working with young healthy women who are pregnant, an healthy condition. That is what gets most of them by in their careers. Healthy women in a healthy condition.

They are not interested in you or your baby - honest! They practice defensive medicine and they are defending themselves, the hospital, the insurance company against YOU! The healthy patient.

Get a midwife before this joker calls CPS on you.

[2+twins]

I would seriously look into finding a midwife that works for YOU. There are of course going to be mw's out there that aren't your cup of tea, but likewise there are so many good ones. My midwifes are great and provided the level of "presence" that worked for me. I feel fairly certain that if I had wanted even less "presence" they would have happily obliged. My chiropractor opted for a lay midwife and saw her only a couple times during her pregnancy and then for the birth. She did all her own pee tests on her own at home and I think she had her own fetoscope (not sure about that though). I honestly think that if you're planning a UC you owe it to your baby to be as well prepared as possible, and that (IMO) includes finding out if there are possible complications or health concerns you'd need a heads up for. Wouldn't it be better to KNOW that you had gestational diabetes than not? I don't know - for me I would want to know. I personally wanted the 18-20 week ultrasound for both my babies because it gave me peace of mind that all the major stuff was checked out. I know there can be both false positives and negatives, but it did help put my mind at ease. If, for example, they saw that the spinal cord was exposed I would not want to have a homebirth at all (one of the very few reasons I'd actually opt for a hospital birth). I didn't do the AFP test (waaaaay too inaccurate for my taste) so the ultrasound, and then of course the birth, would be my only indication that the baby would need immediate care that could not be provided at home. I actually did have a UC with my last baby 6 months ago, but it was unplanned (just the UC part - not the home part) due to speed of the labor. I do firmly believe in the naturalness of birth so I wasn't too concerned with being alone for it, but I am thankful that there were no unforseen complications. I'm sure the ladies on the UC board can help you prepare a lot further.

[jplain]

Originally Posted by StacyL

I already asked for the fetoscope - the CNMW brought it to the office, and when the OB found out I wanted him to use it, he tried and heard nothing, which prompted him telling me he'd like to fire me as a patient.

Ah, bad patient you, embarrassing him like that! You forced him to admit that he is not a deity. True, most don't know how to use them very well, but I was hoping that it would buy you some time. I bet the CNM would be able to find it if you asked her to.

Carolyn

[CryPixie83]

Hehe, I had my prenatal with the midwives today and they asked if I preferred the doppler or the fetoscope... We chose fetoscope because DF likes to hear the baby's heartbeat (and today she had the hiccups so you could hear that too!), but I really appreciated that they asked... lol and the fact that they know how to use it!