Telling dual care OB about HB after the fact?

[Readergirl]

I am in a state that is not homebirth friendly. I'm receiving dual care, and I haven't told my doctors that I'm having a homebirth because I doubt they'd see me if I did.

Have any of you been in this situation, and if so, how did you tell your doctor that you'd had your baby at home, or did you tell him or her? I could just say that I wanted to labor at home as long as possible and that the baby came while I was at home, which is all true, but part of me just wants to tell them that I had a homebirth, even though I don't think they'll be pleased.

I'm due in a week and half, I just want to kind of have an idea of how I might deal with this. I could also send them a letter. I don't know if I'll end up having a postpartum visit with them either. I'd really rather just go see my gynecologist, if I needed to, since I really like her a lot. (She's not an OB any more though. She got out of it because of the malpractice insurance costs, from what I understand.)

Thank you!

[AKmoose]

I don't think they'll be pleased.

Hugs mama, but remember, it's YOUR body, YOUR birth - the only person who needs to be pleased is YOU. Especially since you say you don't plan on having a relationship with them, I don't see any reason to go back/write/tell a thing! Unless you're in a really small town place, I doubt they'll ever even ask. I switched from OB to midwife about 14 weeks with dd1. They never contacted me to see what happened!

Is there a reason you're still having dual care? If I were in your position, I wouldn't still be going, this close to term...just avoid their pressure, comments, and the general OB-vibe, since your midwives could attend a birth at this point. That would also let you concentrate on the birth you ARE having, not the one you're avoiding. Just my .02 Hope that doesn't come across too harsh - I mean it with only good intents!

[abc123xyz]

I had an OB back-up and I told him straight forward when he asked me that he was my back-up. I too, live in a homebirth unfriendly state but our midwife had a back-up doctor for blood panels and for any sort of complication that may have occured. I told him what I wanted the minute I went in. The first appointment I wanted my blood panel done and an ultrasound. The second appointment I wanted an ultrasound and a prescription for rhogam for after the baby is born should we need it. That was it. No other details were released. He fully understood he was my back-up and if he had a problem, I would have found someone else. Likely, they won't have a problem if they are getting paid :*) Good luck though...I would call around and ask before you make the appointment. If you know you are only going for one or two appointments, tell them that. You don't have to tell them you are homebirthing. Prenatal appointments are only important after 36 weeks to be honest but poor prenatal counseling on things like vitamins and nutrition are important from the begining. As long as you are getting this through a midwife, then don't worry about it. HIPPA protects you and doctor-patient confidentiality between you and your midwife protect you too!
Happy baby months!!!!!
~~*Kristina*~~ wife to Joe [] and expecting [] [:] 10-18-07 planning a [] and to [:] Living [:] and saying [] [] []
www.totsites.com/tot/3seawell

[Readergirl]

Thanks for your reply, AKmoose. I didn't take it the wrong way. I am still seeing the doctors at the advice of my midwife. She thinks that at least if I had to transfer, I'd have already preregistered at the hospital and would have a less stressful transfer. I do agree that it would be less stressful not to see the doctors at this point, though. I guess I'll just continue, though, since I've come this far. And, I don't care if they're pleased or not, I just don't like conflict and don't want to deal with any conflict with them. You're right. It doesn't matter what they think or whether they know what happened, really. I still don't know what I'll do.

[LoveChild421]

I just called the office and told the receptionist that the baby came so quick I just had him at home so she could cancel my last prenatal appt and scheduled for my 6 week check-up. They all were a bit amazed but treatedly me nicely.

[MarineWife]

I had dual care with my MW and an OB. I did not tell the OB that I was planning a homebirth for the same reason you fear. I quit seeing the OB in around 36 weeks, when they wanted me to start coming every week. My baby was born in June. The OB's office just called me Tuesday to check on me. The lady who called said she was going through their prenatal charts and realized they hadn't seen me since May and I was due in June and to please tell her I wasn't still pregnant. I told her I had my baby at home on June 9. She asked who delivered my baby, if my dh delivered him. I told her I delivered my baby. My dh wasn't even here. He is deployed. My MW, her assistant, my doula and my mom were all there. I didn't even tell the lady about my mom because she could even be charged with practicing medicine without a license, although she didn't do anything. I made it sound like I was alone. She asked if I ever went to the hospital, which I did not. My baby is almost 4 months old and has not been examined by a doc. She was flabbergasted. She actually couldn't speak. Eventually, she spoke and told me no one had ever told her anything like that before. She would write it in the chart. She asked if I felt the need to come in and be seen by one of the docs. I told her I did not. We are both perfect. I didn't tell her that, if I need anything, I'll see my MW.

[SublimeBirthGirl]

Where I live, you pretty much have to lie and pretend an "oopsie," which of course they'll see right through if you don't freak out and call 911 like a "normal" person. There are even practices here that dismiss you from their care permanently even for well-woman stuff if you use them for prenatal care then stay home. I didn't do any prenatal care with my homebirthed baby (outside of my own) but if I had, I'd have just lied. Otherwise I'm sure I would have been "fired."

[rad]

I'm doing dual care now with my family dr (who used to do homebirths) and a midwife because of the bleeding and subchorionic hemorhage I have this pg. Luckily, my dr knows very well that once everything is in the clear, I will be having a HB with the midwife. He knows he's just backing me up since she doesn't have easy access to u/s and such. So I feel very lucky I won't have to lie to him since we still take our kids to him for check ups. But I'd just lie and say the baby came way too fast if I had to and since we were both in perfect condition, I felt no need to head to the hospital.

[Readergirl]

Thanks, everyone. I just don't want to lie, but I really couldn't care less if they drop me, because I'm done seeing them when the baby comes anyway. I figure I could maybe go to my gynecologist or someone else if I needed a postpartum appointment with someone other than my midwife.

I guess I could just say that I wouldn't need my next appointment because the baby came while I was at home. I'd rather just not elaborate rather than go into the fact that I had a planned homebirth, although it might be good for them to hear that. I guess I could say I didn't see any need to come to the hospital, which is certainly true. I do feel the need to tell them something, rather than just not show up for my appointment... I don't know. It's too bad that it's even an issue.

[Yo Becca]

I saw a CNM attached to an OB office for shadow care. I had to go in after my HB and tell her what happened b/c I needed Rhogam. She was a bit surprised (she had provided very thoughtful, attentive prenatal care and I felt bad lying to her about my plans - I would love to have her attend my birth, but not so much I was willing to have the baby in the hospital). But she had a HB herself, so she wasn't upset and was actually very supportive. The OBs, however, were upset and refused to provide me with any follow-up care. My HB midwife completely abandoned me after my birth and provided no follow-up care (I had a 2nd degree tear, which got infected), so I needed to go back for post partum appts - I saw the CNM only.

I thought about lying and saying "baby just came fast at home!" - but decided to be honest b/c lying felt childish - and I wanted to represent a woman with a sucessful homebirth, for them to see it was okay. Good thing I didn't - b/c I had stitches, and that would have been hard to explain when I came back for a 4-week appt. It really makes me sad that instead of remembering me as an example of a sucessful homebirth, they will remember me as the woman who irresponsibly went with a lay midwife who abandoned me when I needed care - my story is one they can chat over the watercooler about why they DON"T support homebirth

[pigpokey]

Originally Posted by jkseawell

Likely, they won't have a problem if they are getting paid :*)

And herein may lie one of the problems you should be aware of:

The way that insurance plans pay out, they expect their "catch fee" when they agree to what the prenatal visit packages pay.

Some of the hostility towards this is probably economic -- they want the catch fee, they usually make less per hour on prenatals than catch fees, and they could have booked in a client who was actually going to birth with them instead of you.

And then there's the fear of getting stuck with a complication they believe they could have managed had you not been trying for a home birth before transfer ... and then getting sued over or just dealing emotionally with a bad outcome. I am not saying that's right and proper in doctoring, but it is a fear for them.

Certainly when possible, it is best to use a backup OB who voluntarily consents to the relationship.

Beyond that, if you have not legally obligated yourself to pay all the expected fees if you don't do the whole shebang with them*, you don't owe them the birth. In a sense, they are being affected by the same system that makes our choices more difficult to find than they should be.

*Some practices are having patients sign this kind of an agreement

[SublimeBirthGirl]

I think there's a certain amount of arrogance, too. They don't think anyone is capable of having a baby without them without extreme danger. It irks them whenever someone proves them wrong.

[heathenmom]

Originally Posted by LoveChild421

I just called the office and told the receptionist that the baby came so quick I just had him at home so she could cancel my last prenatal appt and scheduled for my 6 week check-up. They all were a bit amazed but treatedly me nicely.

LOL ... that's what I did, except I told them they could cancel my C/S. The receptionist was quite confused, and kept telling me that the hospital would handle all of that, because surely I had called an ambulance to come and get me and the baby. :

[MarineWife]

I'm changing my position. LIE, LIE, LIE! My OB's office called CPS on me. I just got a phone call from CPS today. They are coming out on Thursday for a home visit investigation.

[AlpineMama]

I'm worried about this too, especially since right now our whole family is on state insurance. It's the same reason I went to all my well baby visits with DS 1 and generally "played nice". As long as you're in their system and go by their rules, they're honestly very nice to you. But if you start to have a mind of your own... : That's why I'm planning on lying or not.

But in a way... I don't feel like I'm cheating them by going to see them, because honestly, I'm probably not going to know until the baby's coming who is going to deliver him/her. He/she could come early when I would feel better in a hospital, for example. I fully intend on having a homebirth but I am keeping my options open too.

It'll be AFTERWARDS that would present the problem for me. I wouldn't know what to say to them after the baby was born if I successfully managed to have a home birth. Then again they have in my chart that my last labor was very quick, so maybe they would be accepting of it. I think I would call them later that day to tell them I had given birth, and everything was OK. I would go in and see them real quick if they wanted me to, but I wouldn't rush there straight away either. Either that or I'd tell them I was fine but really tired and a bit sore, so I'd prefer to wait a few days. Since I am planning a birth center birth anyway, they're good with quick releases. I doubt they would want to send a healthy infant to NICU. Even last time, when they kept us a few days, they never separated us. I can't imagine they would separate us this time, regardless of where I gave birth. (Might just be the naive me talking though.)

[crunchy_mama]

I had dual care as well for #2. In my state it is a felony for lay midwives to do hb's (well a new law was passed after my birth but it currently has an injuction and is in the mo supreme court) but I digress.

I went to all my appts that were scheduled with my backup ob(although I often spaced them out as much as possible). This is the ob I used last time as he is the most liberal in the area- I had a great natural, intervention free hospital birth with him.

I had the baby at home with mw at 8:30 in the night. I called the ped the next daY to schedule a PKU. the nurse I talked to was a real pia, she was horrible quite frankly. Asking me who delivered and if a dr had seen me. Trying to get me to come in immediately. She put me on hold forever and I was honestly worried that I was going to get a CPS call (honestly the most stressful thing in my life and my house had burned down 2 days prior). However, my ped finally got on the phone and was completely and totally cool. Asked how the babe was pooping and peeing and how she looked, weighed etc. Just said to bring in the babe the next day. Dh and I read up on our legal rights and dh went in to register. I waited in the car until it was time so I wouldn't have to deal with the nurse, luckily I got the other nurse. When the ped came in he was just great and asked more about our house than anything. I just told them an abbreviated story that the baby came 8 minutes after my water broke (leaving out that I knew I had been in labor and my water just doesn't break until pushing). There ended up being another nurse in there that was a bit nosy but I just told her dh delivered. Everything worked out just fine.

With the ob I had already had an appt scheduled ( I was 39w5 days when she was born and had an appt scheduled the day of her birth but I rescheduled it for a few days later as I knew I would need to go in for the rhogram). When I went in the nurse took several looks at me and was very confused. the other nurse was so totally cool. Dr came in asked me what the story was and I told him she just came real quick and everything went great. Could not have been better.

However, I must say my mw had another client call my ob and ask if he would do backup care for a homebirth and he told her no. I am sure this is due to the legalities.

[RachelGS]

Originally Posted by MarineWife

I'm changing my position. LIE, LIE, LIE! My OB's office called CPS on me. I just got a phone call from CPS today. They are coming out on Thursday for a home visit investigation.

That's HORRIBLE. I'm so sorry. I'd immediately stock up on every book out there about homebirth safety, plus a whole notebook full of articles and links. If you need a copy of the ACOG article that shows their standard care to meet only 29% of research recommendations, I've got that and can email it to you.

[MarineWife]

Thanks. I don't think I need any info. It's prefectly legal and within my rights to have my baby at home in my state. I've been told not to try to sell homebirth to the investigator. I should just be nice and polite and forthcoming about information she asks about but not volunteer info. We have all seen docs since he was born. Plus, I had much more postnatal care from my MW than I ever would've gotten from the OB. We have a birth certificate that I applied for about a week after he was born. He is on our health insurance and has a pediatrician. I really cannot fathom exactly why the OB's office had to report me or what exactly they reported me for. If they were concerned about the baby, they could've easily verified that he is alive and well by calling his pediatrician who is listed in my OB chart.

[homewithtwinsmama]

Originally Posted by MarineWife

I had dual care with my MW and an OB. I did not tell the OB that I was planning a homebirth for the same reason you fear. I quit seeing the OB in around 36 weeks, when they wanted me to start coming every week. My baby was born in June. The OB's office just called me Tuesday to check on me. The lady who called said she was going through their prenatal charts and realized they hadn't seen me since May and I was due in June and to please tell her I wasn't still pregnant. I told her I had my baby at home on June 9. She asked who delivered my baby, if my dh delivered him. I told her I delivered my baby. My dh wasn't even here. He is deployed. My MW, her assistant, my doula and my mom were all there. I didn't even tell the lady about my mom because she could even be charged with practicing medicine without a license, although she didn't do anything. I made it sound like I was alone. She asked if I ever went to the hospital, which I did not. My baby is almost 4 months old and has not been examined by a doc. She was flabbergasted. She actually couldn't speak. Eventually, she spoke and told me no one had ever told her anything like that before. She would write it in the chart. She asked if I felt the need to come in and be seen by one of the docs. I told her I did not. We are both perfect. I didn't tell her that, if I need anything, I'll see my MW.

This was incredibly foolish of you. If you had just told her that your baby was seen by a pediatrician she would NOT have followed up on it and you would be fine. CPS very frequently takes babies when the charge is medical neglect from any doctor. You need to get the baby to a doctor ASAP even if its a clinic doctor, before CPS comes out. You need a doctor to say your baby is healthy and fine. Please, please do not think you can talk your way out of this. Drs are always believed before parents!

[MarineWife]

See my post above. He has been seen by a pediatrician. He just hasn't ever had a well baby check up with a doctor because I had postnatal care with my MW until 6 weeks PP. We don't vax so there was no need to take him in for those as often as they usually go. He is scheduled for one in a couple of weeks.

I can see that I was foolish to not tell the lady from the OB's office that he has since seen a doc but she didn't ask me that. She asked me if I went to a hospital right after birth and she asked me if I wanted to come in to their office for follow up care, which I declined.