Would my midwife get in trouble?

[mommajam]

I am GBS+. Considering my history with antibiotics, my chronic yeast problems, and now after all of the research I have been doing on this subject, I am convinced I do not want to get the antibiotics. The midwives would be fine with this as long as I have proof of a plan for the baby's care afterwards (i.e. a note from my pediatrician saying that he will be seeing the baby immediately and taking a blood test, or some other alternative directions). However, the back up doctor, the only one they have who takes my insurance, will not agree to this. The best he has offered is Diflucan after the baby is born... which I am not convinced I want to get either, although I have begun researching that as well. And which is not my only objection to the antibiotics.
We are currently trying to find if there is some way to resolve this situation in a way that is acceptable to everyone. In the meantime, if I go into labor before it is resolved (a possibility since I am 37 weeks now and have had two out of four babies come this early) I will have to get the antibiotics or, if I waive them, go to the hospital.

This is an absolutely WONDERFUL birth center and WONDERFUL midwives. They are trying to help me in every way possible, they are simply limited because of the policies they have to follow in order to stay in business. I really want them to stay in business. I also want to do what I think is best for my baby and myself. I am considering having an "oops" baby on purpose. I do not want to debate this on this thread, it is something I am discerning separately, but in doing so I want to know....
How likely are they to get in trouble, if at all, if I simply "have the baby too fast" and don't make it there on time? (This isn't only theoretical, either, since, although most of my births have been fairly long, one of them was only 2 1/2 hours -- I had the baby at the center only because I already happened to be there.) I would feel absolutely awful about lying to them, but then in this way they would be protected from any reproach from the back ups or insurance, right?

Is there a way that I can ask them this question and get an idea for what their procedure would be in this case (considering the GBS) without getting them in trouble for having a hint of what I might be considering or put them in a position to do something I know they don't want to (like, being legally required to write something on my chart or refuse to see me anymore or something like that?) We are in CA if that makes any difference.
Thanks,
M.

[Charmie981]

Would it be possible to treat the GBS herbally and have another test to see if you get a negative? I know it depends on if the practice/back-up have a "once +, always +" attitude.

As far as having the baby UC to avoid ABX, I can't say if the midwives would "get in trouble." My guess would be no, but I'm not in CA and what you've already described seems really crazy to me, so who knows . There are midwives on this board better qualified to answer that part of the question.

[mommajam]

Actually, a retest is one of the things that is in the works. Hopefully, I will be negative and this will all be a moot (sp?) point. However, I will not be able to retest until next week and then it takes a while for the lab results to come back. Considering my history it is very possible I may have the baby before then and I'm just trying to discern the best course of action. And, as I said, I haven't decided if a UC is the best course, but it is one of my options I like to look at everything very closely before making a decision, when possible.
Thanks for your response!

M.

[Sweeney]

Ok, so I'm getting that you're thinking of going unassisted?

You can try asking them if they provide care for women pursuing unassisted births. I was pleasantly surprised to find that a local CNM practice was very cool with doing that, they just wanted a waiver signed towards the end of pregnancy that said you understood that they wouldn't be attending your birth and waived them of all responsibility. CA might be different but the local Unassisted birth community can probably fill you in on how much everyone gets their panties in a twist over stuff like that. Here, the really good care providers just want you to be honest with them.

Out of curiosity, have you tried treating the GBS and being retested? Or finding another care provider with a more forgiving back up?

Good luck to you!

[Sweeney]

Wow! Obviously everyone else can type faster than I can!

[doctorjen]

I'm not a midwife, but a family doc, and but am sort of in the same position with having to have back up. The culture in my town is a lot different though - here, having a client refuse something would be the end of it. There tends to be a very conservative approach for a lot of things but client preferences tend to trump everything else. My back up wouldn't blink at me saying my client declined for anything, even though he'd flip if I myself made the decision to do something against current practice. I don't really get the reason why you can't decline antibiotics.

Also, if you were planning to UC and coming to me, if I knew it and didn't do something about it that would jeopardize my back up situation (I nearly lost my back up the one time I agreed to provide co-care for a homebirthing client) I wouldn't want to know about it (although after, I'd sure want to know that that's why you didn't call me for the birth and not just that you didn't like me!) You might ask around if you have other contacts in your birthing community and see what the general feeling is out there.

To me, a term woman, with a short duration of rupture of membranes is at really minimal risk of GBS transmission, and I worry the least about these folks. You are already term, will have spontaneous labor (I assume) and if no one's in there breaking your membranes hopefully you won't have prolonged rupture. I think you ought to be able to look at the risks/benefits and make that call yourself.

[Turtlemum]

When I read your first post I didn't think you meant going unassisted...I thought you meant, labour at home on your own and when you thought you were close to delivery, then you would call your midwives and they would have liitle or no time to administer the antibiotics? If that wasn't your plan, it is ssomething to consider rather than going UC if that wasn't what you wanted. Wishing you a happy birth!

[SublimeBirthGirl]

So your ped will write the note if you consent to abx for the baby after the birth? Couldn't you just say okay, fill the prescription, and not give it to him?

[mwherbs]

California has that law that says that you have a right to refuse anything- and a midwife can still care for you-- now that usually means some pretty clear cut informed consent-info very detailed stuff that you would have to acknowledge and seriously consider before you sign the consent- then depending on outcomes and the region you are in- would make for a problem or not- is she practicing legally other wise-- ie physician back-up in place? this is what is hanging most CA midwives- not compliant with the law.... and a problem draws attention to their existence...

[AbbieB]

Originally Posted by SublimeBirthGirl

So your ped will write the note if you consent to abx for the baby after the birth? Couldn't you just say okay, fill the prescription, and not give it to him?

Or get the prescription so the midwives feel OK and then never fill it.

This seems the best way to go. It lets the professionals CYA and you can still have their expertise if you need it. (Unless of course you really want to UC .)

I do not see how anybody could get in trouble if you just don't call when you are in labor.

And I agree with PP, don't let them know ahead of time you might UC. You could get dropped.

[cfiddlinmama]

I was under the impression that the Ped refused to waive to labor abx and instead wanted the mom to get Diflucan for her yeast problem. Is that correct? I think Diflucan is a drug to treat systemic yeast.
I'm really sorry that you are having to go through this. What a bunch of baloney. I don't really think the midwives could get into trouble if you had the baby too fast to make it to the birth center. You might run into some problems afterward if you transfer to the hospital or birth center for after care. Have you talked to the ladies on the Unassisted Childbirth subforum here? They might have some good advice for you. Wishing you a peaceful birth!

[mommajam]

Hi all,
Yes, the problem is not with the pediatrician. My ped has agreed to simply see the baby immediately (day of or next day depending on when the baby is born) for examination and observation and, if I want, to get blood drawn. Originally, the midwives were happy with this. However, the OB who is the only backup they have who will take my insurance has decided against this. They need his OK or else they can't let me go without the antibiotics during labor and not get into trouble (like, at the very least, lose him as a backup and they do need their backup doctors or else they cannot legally continue... I think this is the situation anyway). MY wonderful midwives really are doing everything they can for me so I can have the birth I want. They are even taking my blood to test for the presence of antibodies to GBS -- in case you haven't heard, a vaccination to GBS is in the works because, as it turns out, people make antibodies to the GBS that are actually transplacental and protect the baby. Of course, instead of making this widely known so that we, who have GBS, can be tested for the antibodies to find out if the antibiotics are actually necessary in our cases (a few women -- those who are in the higher risk categories, like having had a GBS urinary tract infection, etc, don't make an adequate amount of antibodies), the policy is simply to test for the presence of GBS and then treat with anti-biotics. All I did was mention to my midwife that they are working on a vaccine because we make antibodies and she jumped on that and said they would test my blood for their presence! The thing is, I have to be prepared with a plan in case I go into labor before the results come back (it's not a common test so the lab has to send it out and it could take a week or longer), which is not entirely unlikely, or, in case the OB backup just doesn't accept it and isn't budged... hence, my questions.

Although I hadn't considered it before, I think I have to mentally prepare myself for a UC because even though my basic plan IS to arrive just too late to get anything at the birth center, the reality is that by the time it gest serious enough for that, my body moves so fast I probably would NOT make it there on time. I'm leaving that decision for when the moment arrives.

I have found all of your responses very helpful. Thank you. Oh, and I have definitely been posting questions at the UC thread! Thanks for that suggestion, too.
M.

[Paige, CPM]

Dear M.,

I totally skimmed the postings so please forgive me if I missed this and you have already done it...

Have you met with the back up and tried to negociate with him the signing of a detailed informed consent...it is one thing to say no to the midwives, but to say no to the woman herself who is obviously knowledgable might be a differnt story to some docs...

Just a thought....good luck! Paige