How to "fire" CNM to have HB, without legal trouble?

[lincolnsmom]

I have, after searching for a LONG time, found a homebirth midwife to attend my birth, but I've been seeing a CNM for about half my pregnancy. I can't afford to pay both MWs, so I have to terminate care with the CNM, and I'm concerned because there's a very hostile homebirth climate in the state where I live right now. I don't know how to bring up the subject with the CNM without divulging too much information about the homebirth. I mean, she knows my due date, my address, and that I have one other son. Someone has brought up the idea that this puts the CNM in a difficult position of knowing one of her patients is planning something "alegal", which she might be ethically bound to report. On the other hand, what about patient confidentiality? What if she decided to call child protective services? The state medical board?

Another, more pressing problem, what if I need another ultrasound, lab work, or to be transferred late in the pregnancy, and I have no one to order the necessary tests?

Our last homebirth was all above board, licensed mw in another state, but this is all so underground and secret, I just don't know how to proceed ...

Any advice would be appreciated!

[ebethmom]

I was in a similar position - we switched to CPM for a homebirth at 28 weeks. I had been seeing a hospital based CNM prior to that.

I'm not sure if I handled my situation well. In hindsight, I probably told my CNM too much. I kept my usual appointment with my CNM and told her that we were switching to a homebirth midwife. My CNM did not say anything negative, but she did write "LAY MIDWIFE" in large letters across the bottom of my chart. And she asked for my midwife's name. When she copied my chart, she only copied the first page of charted information. She did not copy her notes.

BTW, homebirth in my state is not legal. I believe it is actually illegal.

You don't have to tell your CNM that you are planning a homebirth. You can tell her that you are switching practices.

About labwork, tests. . . does you CPM work with a supportive OB? My midwife refers clients to an OB at a hospital that is an hour from us. There is a closer doctor that supports natural childbirth and homebirth. If I had needed OB care, I would have gone to him. If we had needed emergency care during labor, we would have just transferred to a closer ER.

[valeria_vi]

but why can't you just tell her that you have found another provider and that's it. "I appreciate the care you have given me so far, but I have decided that someone else is a better fit for me, so I will no longer be your patient."
why do you have to tell her you're switching to a hb midwife???

[KariM]

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[WriterMama]

We did this very thing when I was 34 weeks pg with our first baby. I simply put in a call to the nurse (I guess I went the non-confrontational route ) and told her we were changing care providers and could I pick up a copy of my medical records. I think we had to send a signed letter requesting them so they would release the records to us. You could do that and request that they send a copy of the file to your address and then, you can hand deliver them to your new mw.

We didn't need another u/s, but perhaps your mw has contacts in the medical community that could help you out if that became an issue. Are you anticipating some problem for which that would be necessary? I know lots of moms forgo u/s all together.

Good luck!

[applejuice]

Originally Posted by ebethmom

BTW, homebirth in my state is not legal. I believe it is actually illegal.

Wow, having a baby at home is illegal in Kentucky, the home of the old Frontier Nursing Serivce?

A tiny bit OT, but I recall seeing a political cartoon in the Sacramento Bee over twenty years ago that showed the California Medical Commission knocking threateningly at the door of - the place where Mary and Joseph were cradling the newborn Jesus.

"Open up! We have reason to believe that you are having a homebirth here!"

Horrors!

[famousmockngbrd]

Things have changed quite a bit here since the days of the FNS, lol.

To my knowledge homebirth itself is legal here, but it's illegal to practice lay midwifery. You need a certificate or something to attend homebirths and the state refuses to issue them. The only legal form of midwifery here is a hospital-based CNM.

Which is ridiculous, because it puts women in the position of being able to legally birth at home, just not with an experienced, qualified attendant. :

[hmg7500]

up until nearly 31 weeks, i had been seeing a midwife based in a birth center practice, and had planned on birthing at the freestanding center. i realized, though, that while i like the midwives and the level of care they provided, i really wanted an uc. after stressing about how to tell my midwife, i finally just called and cancelled my appointments and said, "i'm transferring care," and they said okay! i don't think they are entitled to any more information than that.

[ebethmom]

[QUOTE=famousmockngbrd]
To my knowledge homebirth itself is legal here, but it's illegal to practice lay midwifery. You need a certificate or something to attend homebirths and the state refuses to issue them. The only legal form of midwifery here is a hospital-based CNM.
QUOTE]

Thanks for clarifying! That's what I meant to say. Someday, what I write will match what I actually know. I think it did before I had kids.

[famousmockngbrd]

:LOL I know that's what you meant! It's basically the same thing, it's a scare tactic used to intimidate women into having their babies at the hospital so it accomplishes pretty much the same goal.

[lincolnsmom]

I am wondering if there's anyone who has had to keep their midwife's identity a secret because of legal threats...this is our situation, and i don't know how i would get any medical care for the rest of my pregnancy or how I will arrange for a pediatrician after the baby is born without divulging how the baby was born...it is REALLY touchy legally around here, really touchy.

If I tell my CNM that I'm planning a homebirth, is she obligated to keep that confidential? If I get, say, a sinus infection that requires antibiotics (this is pretty common for me), can I just go to a walk in clinic and hope they don't say I need to see my "OB"?

[famousmockngbrd]

I think you should talk to your midwife about your concerns before you terminate with your CNM. I'm sure she has had to deal with these hurdles before.

My midwife has a CNM backup at a hospital about an hour from here. Yours may have one as well, someone she works with unofficially that she can contact if things go awry. Have you asked her what her policy is in case of a transfer?

Many CNMs are supportive of homebirth, regardless of the legality of it. Ask around and you should be able to find one who will work with you. Do you know anyone else who has had a homebirth you can talk to in your area, find out what they did? Maybe check the Finding Your Tribe forum and see if anyone there has done a homebirth who can direct you to a local CNM who is accepting of homebirths?

[famousmockngbrd]

Oh, and BTW - we interviewed several midwives in our search. One said if we had to go to the hospital, she would go with us as our doula. That way she could say she had been supporting us during our early labor at home and could give an update on our situation to the hospital staff. One (the one we eventually hired) said she would go to the hospital where her backup CNM practiced, an hour away, but would not go to any other hospital with us unless there was a life threatening emergency, in which case she would. When I told her I had lined up a local CNM as our backup, however, she was fine with that and agreed to go with us if we needed to transfer. (My DEM and my CNM backup know each other, they just are not "affiliated" with each other.)

ETA - I am continuing to see the CNM for prenatal care, as well as receiving prenatal care from the DEM. Ironic, isn't it, that I am so concerned about having an intervention-free birth yet my prenatal care is so intensive! LOL It's a bit much for me and my low risk pregnancy. Anyway, your DEM might have somebody she can contact to write an order for tests if she feels they are necessary during the prenatal period.

[cchrissyy]

When I started prenatal care with a hospital-based CNM practice, I told each MW I wasn't sure if I'd switch to homebirth. Each one was fine with that and recomended I be an "established patient" with her anyway, that with just 1 visit to her practice I was then documented to have had her care so if hospital transfer were necesray, I'd not be a stranger to the system, you know? I could check in as one of her patients and not just get whoever's on call.
Also I could go back to her for the ultrasound and labs, which may help with insurance paying.
At each visit, the MW would just ask if I'd decided about the HB or not. eventually, I decided to not switch- but there was no barrier if I ahd decided the other way.

[alexia_i_aa]

Originally Posted by lincolnsmom

I am wondering if there's anyone who has had to keep their midwife's identity a secret because of legal threats.

My mw practices openly in spite of threat of prosecution, however, I won't tell her name. Who needs to know? No one. She has some friendly OBs who can prescribe stuff if I need it. I'm making my own U/S appointment with no referral. When I go to the ped, I'm going to say I had a homebirth and that, no, I don't care to divulge who was my careprovider during pg.

Alexia

[TurboClaudia]

it makes me so sad to read of the secrecy you mamas who are awaiting the birth of your babes have to endure to protect your goal of birthing at home. it also makes me relieved that i live in a state that upholds legal status and licenses midwives to attend births at home. it gives me hope that other states will choose the same path and create a licensure for midwives and actually issue them.

peaceful pregnancy to you, mama...

warmly,
claudia

[mnnice]

I remember your earlier thread and I'm glad you found a homebirth practioner.

I am not so sure I just wouldn't schedule any more appointments. I started out with parallel care with a family practice doc and a traditional midwife (soon to be a LPM). Once I had the blood work done at the doctor's that I was after I just stopped coming. I also had an ultrasound scheduled to, but decided I really didn't want one and never rescheduled. If there were health concerns that records would be helpful to your current midwife I would try and secure them first.

My family practice doc was more homebirth friendly than most and I've since seen him in the grocery store and we gave each other a friendly hello.

[mommyto2]

I just went to court for birth certificate from a homebirth. They asked who was at the birth & I told them my midwifes name. It was horrible! The homebirth climate here is terrible & I may have gotten this wonderful woman in trouble (and I am less than 3 weeks from my due date.).
If you can keep the whole homebirth thing out of it, I would. Maybe it will jsut happen that you don't make it to the hospital & the midwife will be at your home (noone has to know). It should be fine. Just keep up with your current midwife if you can, or cancel your appointments & tell them you have switched to someone else. Good luck.
We have no back up plan for this birth & had none for dd. It was fine. As far as I can tell, they will do what they think is necessary either way, they will just like you less if they know you were planning a homebirth.

[Electra375]

Hi, I remember you posting about this issue.

I was "fired" from my OB, they assumed I'd find care with another OB -- not. As for testing, I had an ultrasound done at one of those fancy places that do it for pictures more than for anything medical. At the very least they can tell you the position of the baby and heart defect issues. It was about $180.

I switched care providers twice (insurance issues) before returning to my OB that delivered my ds2 adn subsequently terminated my care. I never told them I was leaving in person and not returning, eventually they billed the insurance for the office visits and sent me a bill for the co-pay per office visit. One doctor knew I was looking and the other office I wrote a letter to later stating their care was substandard and I was going elsewhere.

I was concerned about hospital transfer and the implications it had on my mw, but she was okay with what ever might happen. Having had 2 c/s my risk level for transfer certainly was higher than most mamas, but this mw almost exclusively has vbac mamas.

My DEM could do basic finger pricks for blood sugar and hemocrit. I don't see why you would need any major testing. My DEM also could send out GBS and PAPs to a place in a DEM friendly state, if I wanted to pay for it.

Talk to your homebirth mw and see what she advices you to do. She is the one working in the hostile environment and probably knows more about what one can and can't get away with.

I would advise not telling your CNM. Just say you would like your bill tallied and a copy of your records that you will not be seeking care here any longer. If they ask why, you could just say you found care that better suits your needs or that you are moving or you would rather keep your personal decisions private. If she was accepting insurance you might lie and say that your dh's job and insurance are changing on March 1st.

Since most of rural VA use to have DEM doing homebirths up until the mid '90s, we were pleasantly surprised how non-hostile it was getting a birth certificate. I did not ever reveal her name, it just isn't done in the environment DEM exist here in VA. Hopefully that will change if Gov. Warner signs into law the 2 bills that just passed the senate and house licensing CPMs!!!

I know your previous post were on a lot of the legal issues. I think I said "oops, we didn't make it in time." They can't hold you liable unless something goes wrong. I think you will find that any legal action taken on homebirthers has been when a baby or mother die.

I'm glad you found a homebirth mw. Do talk to her, she really should be more familiar w the system than us here. If she had any clients in your state, ask her if they wouldn't mind you calling them to ask them some of your questions. Nothing beats experience!

[Electra375]

Originally Posted by lincolnsmom

I am wondering if there's anyone who has had to keep their midwife's identity a secret because of legal threats...this is our situation, and i don't know how i would get any medical care for the rest of my pregnancy or how I will arrange for a pediatrician after the baby is born without divulging how the baby was born...it is REALLY touchy legally around here, really touchy.

If I tell my CNM that I'm planning a homebirth, is she obligated to keep that confidential? If I get, say, a sinus infection that requires antibiotics (this is pretty common for me), can I just go to a walk in clinic and hope they don't say I need to see my "OB"?

When I went to see my OB about a sinus infection I went thinking it would be covered by my insurance as baby care. Wrong, I was charged out the nose for it. I should have gone to my FP doctor. You can go to a FP or clinic and say either your insurance would cost more to see your OB, or your OB is too full and you need help now. There is no reason that a FP can't see you when you are pregnant for not pregnant related issues.

I also do not use a ped for my children's care, I use our FP. They asked how the birth was I said fine. I think they asked me something about the hospital and I said well I had her at home. My personal FP doctor asked who and I just said a mw from another state and he left it alone.

When we went of our birth certificate, we stated DH was the attending person he cut the cord. My DH said we had some of her friends over that had had babies to help out. Answered their questions that were on the birth certificate form and that was it.

You can also state to a FP or ped that you just moved from out of state and are seeking out new doctors. If your baby is fine, there really is no reason to get him or her checked out right away. As a matter of fact, my FP doctor does not even have records from my sons' ped office. It came up once and I never got the papers to him and it hasn't come up again.

IF you were to have an emergancy and go to the local hospital, it is best not to say you had a planned homebirth with a midwife. Er on the side of caution and say we just couldn't make it in time, but we're here now. I pre-registered at our local hospital and stated that my doctor was in another city 70 plus miles away. I told the L&D pre-admissions person that I just wanted to be covered incase I didn't think I would make it to Fairfax. She put me in the system as a "red" button meaning my doctor wasn't at this hospital. So at least if I did come in, I was in the system as responsible and my doctor wasn't in this town so the on-call doc would be called in.

So if your baby were in need of help, the same applies, just say your ped is ---- in ----city. Since it is obvious that ped will not be called in, the on-call ped will take over.

Why is your insurance coverage so far away? It's where my dh works. There are very few doctors on our insurance plan b/c my dh works over 50 plus miles from home.

Yes, I've played the be silent game. I made the story up in my head and stuck to it what ever it happen to be. You might even write it down so you don't forget. Do I like being dishonest, no of course not, but I don't feel my mw should have to pay either.