OK, so I want the best of both worlds...

[Individuation]

Here's the thing.

I have known since my dd was born that I'd do a HB the next time around. I'm only 1/2 crunchy---I eat all organic, but I vaxed, and so on. However, HB just seemed logical, natural, sane, etc.

Then I fell in love with my gyn (she's wonderful) and seriously thought about delivering with her at the hospital birth center for the next pregnancy. WELL, we're TTC now, and the birth center will not take someone with early-stage MS (in remission). So, I've spoken with my doctor and this is what I said, parphrased:

I'm absolutely certain I do not want a hospital birth. However, you're my girl and I'd really like to do my prenatal care here and deliver at home with a midwife. Can you cope with that idea? Also, if we discover the pregnancy is actually high-risk for another reason (pre-eclampsia, whatever) that makes a hospital birth necessary, I know I want you for my doctor. Would you be amenable to this?

She said, basically, yes she would, but she would not mention to her partners that she agreed to it as it could cause trouble for her. And she'd like you to keep me updated as to how things were going, especially if a hospital transfer seems likely, since she'd want to be ready.

Now, I'm trying to see if I can get the insurance to pay BOTH the dr. and the midwife.

Has anyone else had a doctor for prenatal care who knew about their homebirth plans? How did it work out? Am I trying to keep my bases a little TOO covered?

Man, I hate the US. Back in Europe I could have had my doc for prenatals and delivered at home without having to get special permission. Grrrrr....

[rere]

I did in the end.Well,actually where I live if you use a "legal" midwife she needs to have a backup dr. - at least that's the way I understood it.Anyway I had some questionable things going on with my platelette(sp?) levels and I ended up seeing a dr. who was actually great.She knew of my homebirth plans and was completely supportive of them but was happy to help me if I needed her.My insurance paid for her as well.Actually now that I think about it I saw two dr.s.In the beginning of my pregnancy I went to see the standard backup dr. that my midwife uses to establish a relationship.

Lots of people who have medical problems go to see different dr.s for their problem.And since pregnancy in this country is viewed as a medical issue I don't think it should be a problem for you to see more than one care provider.

Well,good luck to you.I think it should work out.

[anothermama]

I think thats very lucky of you to have found such a nice OB GYN! I don't think you can get double payment for prenatal visits, but if your insurance covers midwifery for delivery, there is no reason why you can't get your prenatals from one provider and get your delivery from another.

[boscopup]

I'm seeing an OB and CPM, but insurance is only covering the OB (I'll pay out of pocket for the midwife delivery). I don't think there'd be any way to get insurance to pay for two providers giving you the same service. BUT... You probably could get prenatal care with OB covered by insurance and get birth with midwife covered by insurance. You just wouldn't get prenatal care from midwife covered. Also, you'd need to talk to both parties about how they're doing their billing, so they don't try to do some global fee that covers prenatals and birth. They should be able to bill just like an OB would bill if you got to the hospital and another OB had to attend for whatever reason (ie, first OB is out of town or something). That happens all the time.

Insurance billing is screwy. Around here, I can't see a midwife and then go get one test or something done at an OB's. I tried last pregnancy to do that, and they wouldn't take me! I mean, you can lie, but I wasn't willing to do that. My current OB knows my midwife birthing plans. He'd rather me birth in a hospital, but he's not pushing real hard. Just asked last prenatal "Are you still planning to birth with the midwife?", and I said yes. He asked if a local doula (who happens to be my midwife's apprentice) had talked me into waterbirth at the hospital, since they'd just done their first one. I said no. I didn't say this, but I was thinking "No way would she try to talk me into birthing in a hospital!" But my OB didn't try to talk me into it or anything. He's great.

[zoebird]

sounds like a great idea to me. i hope that the insurance irons out the way that you want.

[sapphire_chan]

Your doctor should be able to bill the prenatal care as individual visits each visit rather than billing for general "maternity care".

[Individuation]

Thanks all...

I talked to the OB yesterday, and she was really trying to discourage the HB, saying that she would do everything she could to make the regular hospital maternity floor "as much like the birth center as possible" but admitted that it might be a problem given that "the nurses down their are used to getting mainly the high-risk women, and so that's kind of the culture they have."

I was pleased she was honest about the nurses. However, I'm pretty sure I'm not going to want to work with the OB if she spends the pregnancy really discouraging the HB idea. As it stands now, I'm going to do a first visit with her once I'm pg (baby dust please) and see what she says then. If I'm even a little bit uncomfortable, that's it.

FWIW, she's a wonderful GYN. The sweetest, calmest, most gentle doc I've ever had (usually I hate pap smears, with her I'm like "did you do it yet?") and I do not want to alienate her as a doctor, since I hope she'll be my GYN forever. Therefore, it might be best not to do prenatal care with her, since I'm likely to disagree about many things. I'm considering telling her VERY diplomatically that since I support the idea of midwife-assisted childbirth, I've decided simply to go that route if the pregnancy is uncomplicated, while making it clear that I feel fortunate to have her as my general doctor. Fewer insurance issues that way too.

[Emilie]

Yes. I would leave her to be your GYN. As natural birth friendly as she is.... doctors are there to look for complications. Really. So if you were going to all prenatal care with her you have a higher risk to being high risk- IMO.

[CJ 5]

Originally Posted by halalove

talked to the OB yesterday, and she was really trying to discourage the HB, saying that she would do everything she could to make the regular hospital maternity floor "as much like the birth center as possible" but admitted that it might be a problem given that "the nurses down their are used to getting mainly the high-risk women, and so that's kind of the culture they have."

She actually sounds like a very good OB to be that honest with you. I think most Dr.s would be far less honest and accomodating. I would appreciate that level of honesty I am not sure you could find another OB that would be that upfront and still "supportive" ( by that I mean most OBs are not going to jump at the HB idea regardless. I sould say they are a pretty rare breed)