To tell your OB or not? - Page 2

[Peppamint]

Originally posted by applejuice
If you go to a sOB, and are honest w/ them about planning a homebirth, --- well, there have been court cases over the years in which the mother - to - be would refuse a c-sec, and then the sOB and/or hospital would make the fetus a ward of the court and have a court order to hold the mother against her will in the hospital.

It happens.

That's what made me nervous about telling my original OBs. I was glad insurance worked out to where I'm able to see an OB (once at 24w and once at 35-37w) who I can be honest with him (he's the midwife's backup OB). He respects my decision not to do the GD test and will not push me if I decide not to do the group b strep test.

The 'care' I received at the original 5 OBs office was nominal anyway... pee in cup, listen to heartbeat and listen to lecture on how if I didn't wean dd (then 19mo) she would be jealous of the baby. Hello?! Like she's not going to be jealous anyway if that's in her nature!

[Chelly2003]

[QUOTE]Originally posted by applejuice
[B]If you are planning a homebirth, then go to the appropriate practitioners. You can not have it both ways.[QUOTE]

Some of us HAVE to go to the sOB, because that is covered by our insurance, and for the birth part, well we're prepared to pay out of our pockets for, but if someone is just going to take my blood pressure, make me pee in a cup etc.... then let the insurance pay for the OB, the improtant part of BIRTH however - I'll pay for.

Chelly

[applejuice]

Homebirth and midwives were never covered by any insurance I had.

I had four home births. Only one was covered by insurance. The other three I paid out of pocket. That means all of the lab tests also.

You just have to get your priorities straight, and know what is important for you. This was important to me, so I paid for it.

You don't have to go anywhere you don't want to go. We are not in a totalitarian state. Yet.

[Ravin]

Well, I'm currently depending on medicaid, and since it doesn't pay for a CPM in TX, I'm stuck w/ OB or maybe a CNM for my prenatal care. BUT, I'm moving to AZ mid-pg, where I will see a midwife, and in that state Medicaid DOES reimburse for that, but even if it doesn't I'll pay out of pocket. (With any luck my DH will have a decent job by then and we'll be able to AFFORD it!!!)

[frogertgrl]

FWIW, I just ended a year long fight with my HMO (NOT a PPO!!) in their denial to pay for my homebirth.

Yeah, they told me I had to see a gOBlin for my prenatal.

Yeah, they told me I had to have a sOB in a supervisory role for my LM.

Yeah, they denied all claims for almost a year.

And I just received a certified letter from them saying that after careful review of everything I've sent them, they will pay for it all. This is completely inconsistent with their stated policies and my level of coverage with them.


I would not give up and I was smart about who I talked with, I had dates, times, person's name, exact quotes, etc. each time I contacted the HMO. I found vice presidents and sent them personal letters within the HMO, not satisfied with the run of the mill customer service rep.

I knew my states laws regarding birth. I knew exactly how much I'd saved the HMO. I knew birth stats and safety backward and forward. And I knew how to threaten their reputation.

I'm not a PhD or super intelligent person. But I'm determined and the more someone tells me 'nope', the more I dig in my heels.

I could have said, 'but I HAVE to see a sOB because my HMO pays for it.'

But then, I would have availed myself to the medical specialty with the lowest rate of evidence-based practices, let a physician build a personal medical record on me that can be used against me (even pee and blood tell tales and put women into a position of defending their choices or removing their choices), and at my most spiritually open time (pregnancy) make me deal with long waits in an office, procedures I didn't need and most importantly, lying about my intentions, even if I said nothing about my birth plans.

Everyone told me that I would end up paying for the birth out of pocket, to just give up 'cuz no HMOs ever pay for homebirths', etc.

Just because 'everyone' says it can't be done, doesn't make it true.

[mamabugx2]

oops

[Kat20]

I have always believed that if you want something done right, you should go to the right person. If natural childbirth is your "thing," (clearly, some women want pain medication from the beginning) you should be with a midwife (not necessarily a licensed CNM), in a birthcenter or at home.

OB-GYNS are surgeons intended for approximately 5-6 percent of women who are high risk, thus they speacialize in interventions. In this situation, you cannot have your cake and eat it, too or the best of both worlds because doctors and midwives are simply too different.

[birthinglau]

I agree that Drs. and midwives (in particular lay/HB midwives) fufill a completely different role than OBs do.

what I don't agree with is that is only possible to have one or the other. since they fufill different roles, they have different niches.

if I were a woman who needed to transport to the hospital (as did my midwife's last client in my area, for an unexpected footling breech in her case that could not be delivered safely vaginally at home) for an unforseen emergency I would NOT want to be the woman who is seen coming off the street, with no "medical" prenatal records, though she may have those done by the midwife, maybe some labs; in some states without the acknowledged support of her care provider that transported (in many places, these midwives must come along as "friends" not practitioners to avoid persecution from the medical board).

how is this woman going to be treated by the hospital, "failed homebirth" [read: dangerous choice] that she is?

how would she be treated if she had those magical records on file with the hospital, with a Dr. that had admitting privilages? does someone ask the woman what she wants to do when she gets to the hospital? no. they ask the dr. no matter if the dr. is a person familiar with the woman and her desires and plans and can advocate for her (this is where choosing your provider is important), or if the dr. is the resident on the floor who just happens to be available to deal with the crazy failed homebirth woman. is the woman herself in a position to actively advocate for herself? hopefully so, but if we are talking about severe PP hemmorage w/ blackouts, let's say, then maybe not.

I don't know a midwife around who wouldn't prefer to have a Dr. back her up if at all possible, to avoid a situation like this for mom AND midwife. the Farm midwives would never have been able to do what they do without the support of the Dr. that Ina May met in New Hampshire who gave her her first obstetric manual and taught her some basic birth skills, and the Dr. they later collaborated with in Summertown, TN. They still use Dr. backup now, BTW. My own midwife is familiar with the Drs. in her area, and states in her contract that she requests you do labs once in pregnancy, and will provide you with a list of Drs. if you request it. (Unfortunately for me, I fall outside her normal practicing area, 2 counties away, so I found my own person to do labs, be there in case of emergency transport).

Is that having your cake and eating it too?

-Lau

[lorijds]

Birthinglau--

no, we have never had a woman present for prenatal care, then have a birth with a HB midwife. The only homebirth midwives in the area at this point have pretty consistent back up...at least, there are a couple family practitioners in the area that are friendly to out-of-hospital birth (and as a result, have had many many people referred to them for prenatal as well as routine medical care...).

It hasn't happened very often, I think only a couple of times in the last couple of decades...and the last time it happened, the woman presented at our clinic at 41+ weeks; her boyfriends mom "had been at a few births before" and was "helping her out" during the pregnancy. But, when she went so overdue, the bf's mom got nervous and wanted her checked out. We did a routine prenatal, an NST, talked about potential outcomes, and scheduled her for a prenatal appointment the next week. She didn't show that next week, so we called and she said she had had her baby a couple of days before...11 pounds, 3 ounces at the pediatrician two days after birth! No tear. Sticky shoulders that she said her bf's mother had her go on her hands and knees and the baby slid right out. We saw her for her 2 week check, and they were both perfect and she was very happy with her birth experience.

She told me her bf's mom's name, and it wasn't a name I recognized....I know the names, at least, of all the lay midwives in the area. We asked her a couple of times if her bf's mom was a midwife, and every time she said no. She probably wasn't, then, but she knew enough to handle sticky shoulders, which was good.

I must say I was disappointed, though, for two reasons. First of all, she seemed like a neat gal, and I would have loved to have attended her birth. Also, I would have LOVED to see an 11+ pound babe born (first time mom, did I mention that? She was around 5'9", not overweight in the least, healthy diet and lifestyle...). I guess it is not about me, though, and I'm glad she was happy with her experience.

Our charges, by the way, are broken down based on what sort of client you are...occasionally we only provide prenatal care, or if you transport, fees will be prorated. When both our midwives lived near, we used to attend some home births, but you were charged the same as if you had a birth at our center; that is, you were still charged a facility fee, because we had to double staff, basically, if we had a home birth and a birth center birth at the same time. But we aren't staffed well enough now to be able to provide those services at this time. Hopefully in the future, though.

To the topic to tell your OB or not...I still think that under most circumstances it is a good idea to tell them; at the very least, I think you should seek some care...if only for the very reason stated, that if there is a transport, you already have established care and records. If there is any legal issues, at least you have proof that you sought out care and were healthy and proactive in your pregnancy.

Hopefully, if you are birthing with a homebirth midwife, she will be able to recommend docs to you. If not, well, i guess that is always your choice to seek "medical" care or not, and if you do, to tell them or not. I would feel out what your hb midwife thinks, and maybe go from there. If you are UCing, welll, no good advice here! I guess I'd try to find other UCers in the area and ask them!

[applejuice]

My experience has been that sOB's do not officially provide any kind of backup to any midwife or homebirther b/c they become a pariah in the medical community.

Some have UN-officially, but it often depends on the political climate at that point in time, and what their malpractice insurance dictates.

My experience w/ homebirth and backup goes back forty-three years. In 1960, my mother had had four UC home births (I was her first) attended by my Father. When my mother was pregnant w/ her fifth, a breech. She went to a highly regarded sOB who was excellent in delivering breeches vaginally. The sOB yelled at her and my Father when they told him how the others were delivered UC at home. He screamed - "Don't you know that is illegal?" ( It wasn't; he was lying!)

Anyway, she delivered my sister w/o any problems, and was released four hours after the delivery, which was unheard of in those days and is against federal law now.

I remember seeing her come home. It seems like yesterday.

[LukesMum]

"and was released four hours after the delivery, which was unheard of in those days and is against federal law now."


Is that true?? how can federal law say that??????

[lorijds]

I think that it is against the law to *make* someone leave before 48 hours; but you can request to leave sooner. I'm not sure if it is federal...I think it is state by state, but I am not certain. Once we transported someone, and they wanted to leave soon after the birth, and our doc dismissed them and they left about 6-8 hours after the babe was born. They probably would have left even sooner, but of course it took the staff a while to get the paperwork, etc in order and do the actual dismissal.

[birthinglau]

Applejuice-

you are correct, the political climate and malpractice ins. situation does affect whether an OB would back up a midwife or not. I still maintain that it _does_ happen, and quite regularly. sometimes out in the open, sometimes not.

there is a birthing center in taos NM w/ at least 2 OBs on staff, a husband and a wife team that I know of. the birth center is run by a CPM who also provides a reputable correspondance midwifery program, and the center is mainly staffed by midwives. those Drs. back the midwives up. and they do it openly. it does happen in some states, albeit only openly in those such as TN and NM where midwives and supporters have worked hard to open up the option of midwifery care for women.

also, I maintain that a UC birth is a different kind of bird than a midwife attended birth. both are healthy valid options that I firmly believe should be available for women and their partners, but they aren't exactly the same.

-Lau

[applejuice]

To Luke'smum:

There was an act of Congress that made it illegal to release a newly delivered woman w/in 48 hrs after birth.

I do not know if a woman can sign herself out against medical advice before 48 hours, but I know that now you cannot be made to leave.

I live here in SoCalifornia, and there were lots of midwives here 20 yrs ago, but now the climate has changed and the medical establishment keeps the midwives out. There are always a few, but not as strident as it was before.

[lorijds]

You can always sign yourself out AMA, of course, your insurance is unlikely to pay for any charges incurred.


However, if the woman wants to leave, the physician can release her (not AMA) before the 48 hour time period.

But she cannot be MADE to leave, that is correct.

This is my interpretation of the law. I'm pretty sure this is correct. Emphasis on "pretty sure!"

[crazy_eights]

Originally posted by applejuice
To Luke'smum:

There was an act of Congress that made it illegal to release a newly delivered woman w/in 48 hrs after birth.

I think what you mean is "discharge" as in "kick her out", not release. Where I work, we have women who decide to leave (I don't even think that it is AMA if they are out on post-partum and they can get the OB to write the discharge order) sooner than 48 hours, if not "all the time", frequently enough to know that it is not that difficult. We get women who aren't necessarily "natural birth" types who just find they can't sleep in the hospital (or we are making them crazy doing vital signs at 4 AM : ) and they decide to go home the next morning.

[Greaseball]

Is this only the rule in hospitals? A birth center once told me they require a minimum stay of only 6 hours. I don't know what the maximun stay is.

How long do home birth midwives generally hang around for?

[lorijds]

I assume birth centers and home birth midwives make their own rules. At our center, minimum stay is two hours, maximum is twelve hours. To be discharged mom must eat, drink, and pee, and we must be comfortable with her physical status and her understanding of the discharge instructions.

[Greaseball]

I hear that not only can you leave AMA, you can also stay AMA. Of course, this means your insurance most likely will not pay, but they can't make you leave.

[applejuice]

alittle OT...
Years ago, (about 30) a friend of mine delivered in a small town hospital. She had a good relationship w/her doctor who agreed to allow her to check out early after delivery if everything went well. It was supposed to be in her file.

Well she delivered, everything was glorious, and the doctor left the hospital immediately after the delivery for vacation. She wanted to leave as was agreed and discussed. The request was no where in her file, her doctor was "unavailable" and the staff refused to allow her to leave so she decided to sign out against medical advice. They then refused to give her her baby, a healthy newborn.

She could go home AMA, but the baby had to stay.

She refused to leave w/o the baby. She stood her ground.

The hospital then decided to allow her to take her baby home.

But she had to sign a form first. ...a form for the disposal of a dead infant. The hospital was covering their buts and being nasty also.

She had her next baby at home.