Backup Dr. for homebirth

[Becky N.]

How has everyone dealt with finding a back-up doctor, or did you even bother with it? A midwife I spoke to out here said that some Dr.s will refuse to see you if you tell them you plan on a homebirth. She doesn't have anyone that she reccomends.

My only concern is the possibility of needing to transfer to an OB in case of complication during pregnancy. Obviously, if we have a problem during birth, we're just going to the nearest hospital to see whoever is on call.
I plan to see an OB or NP in my HMO for my pre-natal screening tests they do at the beginning of, or before, pregnancy (pap, breast exam, titers, all that fun stuff). - Only because then my insurance will pay for it. I have an OB that I like well enough, but have no idea how he feels about homebirh. Maybe it would just be easier to keep quiet and worry about problems if they occur.
Anyone have any thoughts?

[JaniceT]

I, too, was planning a home birth with a lay midwife (my dd will be 6 weeks old tomorrow), and I also had the same issue. I wanted to use an OB in tandem with the midwife, because the few tests I opted for with the OB were covered by insurance, and also like you I wanted to have someone on call in case of a transport to the hospital. The system worked out well at first, though I didn't tell my OB about my home birth plans, and my midwife was actually not happy about the arrangement -- she says that when her clients use OBs, she has to spend an awful lot of time doing damage control (the clients get scared by the negative/medical orientation of the doctors, and go to the midwife to be assured that everything is ok).

I ended up "firing" my OB about two months before the birth, since we came to a parting of the ways over the glucose test -- I refused it, and the OB put a lot of pressure on me, telling me I was going to kill my baby, etc. Not a good scene.

However, in retrospect I would have done the same thing -- used an OB -- though I would have done more research in finding someone who was more like-minded. In my case, I did end up; having to be transported to the hospital, and it was a bit of a nightmare (skyrocketing blood pressure during a hard, long labor, meconium in my waters, stopping the dilation at 6 cms). I ended up with an emergency c-section.

If I had to do it over again, I would actually done more as far as arranging a contingency plan. I would still go with the home birth idea, but I'd find an OB who knew about it and would be willing to work with me. In addition, I'd even go so far as to register with the hospital and take the hospital's childbirth classes and tours. One of the most upsetting things about my hospital transport is that the people at the hospital knew nothing about me -- we had to wait a full two hours once we arrived for them to be able to do anything to help me, because they had to run tests and get the information they needed to make the right decisions. If I had been registered with them and had been using an OB, they would have that information immediately. It was an excruciating two hours. In addition, the whole hospital scene wouldn't have been so unfamiliar and overwhelming -- as it was, I felt like some weird home birth intruder, and the nurses and doctors didn't quite know how to approach me during my recovery period. I just felt unprepared for the actual birth I ended up having, and I could have done a lot more to prepare myself beforehand, rather than just assuming that everything was going to be perfect.

Sorry for the long-winded story -- and I have the feeling my advice may not be so popular on these boards -- but my experience really taught me the importance of hoping for the best but planning for the worst.

Best of luck to you!!!!

[Becky N.]

Thanks, Janice. That would be my ideal situation- to find an OB who is willing to back me up. I just don't know if I'll find one that my insurance covers. I would like to approach my regular OB about it, but am worried that he'll freak and refuse to see me anymore.
I'm sorry you had such a difficult experience. That's another thing I've given a lot of thought to- how to deal with a birth that is not what I envisioned, if it happens that way. I want a homebirth because my son was born in a hospital and although the experience was in no way traumatic (for me, anyway- I know it was for my son) I just want to do it "right" next time.
BTW- did your midwife stay with you at all after you transferred? And did she charge you the same fee as if you would have delivered at home? I've always wondered how most midwives handle that (I haven't done any interviews yet- not even preg. yet!)
Best wishes to you and your baby. Take heart in the knowledge that you did the best you could possibly do to have the birth you wanted. You're way ahead of where I was with my son's birth- totally uneducated and oblivious to the fact that I even had any options. Only in retrospect did I learn- but you gave thought to what you wanted ahead of time.
Some things are just out of our hands. To totally be prepared for a homebirth, that's one thing I'm going to have to really come to grips with.

[JaniceT]

Hi again Becky N --

Yes, the midwife and her two apprentices did stay with me the entire time, though she wasn't allowed to be in the operating room with me (my dh was, however). I really appreciated her being there, even though her official role ended as soon as we entered the hospital. Yes, she did charge the entire amount, which I was a bit surprised about but knew in advance -- she had told me her policy way in the beginning. I must admit that I was a bit perturbed about the policy, since the home birth cost close to $3,000 -- I'd think that her policy should be to refund at least a portion of it. Oh well.

I do know that finding the right people to support you is crucial. When one wants to do things in a non-traditional way that gets more difficult. I know it took me three months to finally find a pediatrician that was compatible (I wanted a western medical doctor with a homeopathic specialty -- few and far between these days). If I had to do it over again I would love to work with this same midwife, but I doubt I could because she probably wouldn't tolerate my working with medical doctors and the hospital to such an extent.

Best of luck to you, too -- I think it's great that you're doing so much research before getting pregnant. I'm sure you'll have a wonderful experience!!!

[yaboobarb]

Don't Trust Your Doctor!

I am 37.5 weeks pregnant and my OB just dropped me this week as a back up DR.

I told him from 12 weeks of pregnancy that I was planning a Homebirth, and I asked him to be my " back up". He agreed, but he told me that "Officially I won't be 'back up' because of Insurance risk, but I will agree to be there for you if you end up in the Emergency Room. ( Really , he was agreeing to 'close his eyes to the fact of the homebirth, and be back up!)

I was happy because I trusted him and I liked him alot.

The midwife warned me that the Doctor would back out and get cold feet. She urged me in the beginning not to tell him about the home birth, and to recieve parrallel care. She said to just tell him that I wanted to "Labor at home for as long as possible" This way, she said, we could deliver at home and if we had problems, we could transfer to the Emergency Room to my trusted Dr.

No, No, No! I told her. This Dr is different! Firstly, I don't want to lie and bring that bad energy into my birth. Secondly, I like him and I trust him. He is a nice guy! I said....

Well. here I am at week 37.5 and I go into his office to see him on Tuesday and he tells me thathe cannot condone the Homebirth, AND he jsut checked with his malpractice insurance people and they tell him.... don't do it! Today ( 3 days later) I got his letter, dismissing me as his patient.

Although I am not a lying person, I am very sorry that I did not lie in the first place. So if there is anyone out there who is faced with the same circumstances.....NICE does not matter! No matter how nice your Dr is, if he has not supported a home birth before... Don't trust him and do what you can to cover yourself, and to ensure the birth of your choice without the dictation of others.

P.S.
In retrospect, I think he was KNEW thathe would not back me up, but he was hoping that I would back out of the home birth option (I am a first time mother), OR he was hoping something would go wrong before this point, and the point of home birth would be moot. :mad:

[sarahwebb]

I've got paralell care with a midwife and an OB. I'm not telling the OB, although I did ask very early on if he would be willing to back up a homebirth. He said probably not. At my last visit, I asked him to tell me what his idea of natural childbirth was, and we're really on different planets as far as natural birth goes. Had I obtained that knowledge sooner, I probably would have found another doc.

As for midwives charging full price if you have to transport, it never even occurred to me to ask mine for a discount. She's not taking on any other clients in the weeks surrounding my due date, she will go to the hospital with me as a "friend" if I need to transport, and any complications I might have with the birth will not be her fault. It doesn't seem fair to expect her to take less money when she's committing the same amount of time and resources if I transport and taking additional legal risks by coming with me.

Peace,
Sarah

[JaniceT]

Grrrrrrrrr -- yaboobarb, I'm so, so sorry to hear your news. I think some home birth midwife and medical doctor somewhere would make a whole lot of money and do a whole lot of business if they decided to go into practice together. I don't know why no one has thought of it before.

The good news is that you've had parallel care for this long, and hopefully nothing will go wrong from here on out (keep thinking good thoughts!). If you have insurance any hospital will accept you if things do go wrong -- the only thing is that you won't know the doctor who will be working with you. I know it must feel terrible, getting dropped like this at the last minute -- at precisely the time you need to feel the most safe and secure! But hang in there -- my thoughts are with you --

[yaboobarb]

Thanks for the warm sentiments Janice! I have been having a 'dumping of hormones' and I was REALLY feeling sorry for myself yesterday, seeing your post warmed me.

I know that this baby will "slip right out" and I have a GREAT birth team. My midwife is incredible and competent.

Good idea about the Dr and Midwife team (I was thinking that too!) But I think Insurance Company's dictate our care at this point.

My midwife mentioned that the only way Midwives would be welcomed by Dr's would be if we socialized medicine, and the Dr's got paid one price regardless... that way they would be happy to share the 'duties' of being with a women in labor (or even pawn it off on the midwife!)

I DID find a great Dr for the baby though! He does not take insurance (thus no insurance games) , his fee is good, and he will come to the home for the first exam. He is well versed, and cooperative in vaccination choices.

Thanks again for the support!

[Nyki]

Dear everyone on this string,
This is actually my first time on this web site and I am glad that I am here.
First off I am married to a wonderful man and am going to be a first time mother in June.
Second, I am a midwife of 8 years. There is no other occuapation that I have enjoyed as much as this.
I was reading what you all have written and it sounds so very common among what my ladies have expressed to me. You would like the reassurance of a doctor that you can trust and yet you would like the care of a midwife. I share your delima. So far, cautiously I might add, I have found a doctor that will deliver me at home knowing that I am a midwife. We needed some tests done at the beginning of the pregnancy and since I am a lay-midwife I could not do them myself. I am 30 weeks and things are looking very good. I have leveled with her from the beginning and with the CNM that she has working for her. One thing that I have noticed is that people in their profession really like you to be up front, honest and open with them. Even to the point of disagreeing. If they don't like that then you know that they are not the provider you need or want. The CNM told me that she wishes that more people knew what they want like I did and are educated enough to make informed decisions. In one way I do have an advantage over most of you and that is I have friends who are midwives and we all work together. That is a blessing and a "not-blessing" I know that if things fall apart with this dr. that I can call on one or all of them to help me out. Yet, I am trying as a midwife and mother-to-be to bridge the gap between our professions. We need them and they need us. One part of me wishes that I had some answers for you as to how to work with back-up OB's and yet there is the part of me that wants to stay far far away from them.
I guess the only advice I can really give you is to follow your heart and your feelings as to what is right for you. Trust that birth is a normal function and that many women have been able to do it and you can too.
Education on birth issues is a great advantage to your care and it empowers you to make good decisions. I encourage my ladies to read, educate, and plan on what they want.
I won't take up more of your time (right now )but I will be checking in here again soon.
Take Care and God Bless,
Nyki

[candiland]

My MW has a couple ob's that she consults with if need be... I don't really know of any docs here that will support homebirth, and I feel that the care from my MW is great; I wouldn't want to see a doc AND my midwife. If a med. emergency arose in my homebirth situation, we would head to the nearest ER... so it really wouldn't matter WHO her backup was, anyway! If I got toxemia, pre-e, something like that, I'd simply go to my on-again-off-again ob/gyn and tell them that I was planning a homebirth but developed complications and now needed an obstetrician's care.