Q for midwives - how would you feel...

[maybebaby]

I want to kind of get an idea what other mw's would feel in this situation...

I'm planning a homebirth with CPM's but they want me to have local backup (they're an hour away) so I've been doing parallel care with a CNM here in town.

At this point, I've not told the CNM I'm planning a homebirth. I feel badly about that. I feel like I should tell her, mainly because I really like her, she's not a medwife at all, and she does my normal well woman care so I don't want to royally offend her and lose her as my CNM.

She knows I had a homebirth last time, but has never asked me why I'm doing things differently this time (as far as she knows). My cpm's think she might "know" but doesn't want to ask because then she might have to drop me for this pg because of the OB's she works with.

What do you all think..how would you feel if you found out later a patient/client was also seeing another provider and not planning on following through with you? Since I'm so close to the end, I think I could safely tell her. I've already seen her throughout this pg so if I did have to transfer, they'd have some record of me, yk? I just don't like the idea of calling her after the fact and lying about things just happening "too fast" and not making it to the hospital...

Thanks for any input!!

[courtenay_e]

I did the same thing, and the hospital my favorite cnm works out of would really have given her a hard time. In the end, I DID have to do a transfer of care, and ended up birthing with her. I am so glad that I never told her...although she does "know"... She's a smart lady. In the end, I bled out ten days after the birth and REALLY needed the relationship with that OB office. And, as it was a clotting issue, not retained placenta, I will most likely seek her care again for the next birth(s) I have...we work well together, and in the end, I'm risking MYSELF out of a homebirth. I like my life too much to run the risk of bleeding out again. If you plan on having more kids, I'd tell her AFTERWARD that you waited too long and ended up with a homebirth, afterall...safer for HER not to tell her at all. If you are taking permanent measures to not get pregnant again, I might tell her afterward what the situation was...if you have a good relationship and she's not a medwife, she should understand. Just my opinion, having kinda been there!

[sevenkids]

Depending on the political climate of the state your birthing in, your CPM's could get in a whole heap of legal doo-doo if you told. Sometimes, other care providers would rather turn a blind eye to your birth choices and pretend they have no idea what your planning to do, for both their own licenses and others choices. Some, if they knew, would be horrified and want to turn the other in. If she knew, and her supervising OB found out that she knew, she could be forced to drop you from her care.
Is it really lying if you're protecting yourself, your cnm, and your cpms from possibly ugly legal repercussions?

[Apricot]

Could you ask her in a way that doesn't nail either of you down to the answer? Ask her if she would provide care to a "Friend" who was planning a homebirth but wanted OB back up.

[onlyboys]

You could also call up as a potential client and explain your situation anonymously to her. See if she is okay with it. If she's as cool as you say, I bet she's okay with it.

[maybebaby]

Thanks for the repos guys...

I guess I was assuming once I told her, I would no longer see her for this pg. That was what I was planning anyway, so as not to get her into any trouble with the OB's.

Ohio's status is sort of in limbo - cpm's aren't legal OR illegal so it's all grey area.

I guess my main concern is that the CNM will get upset and not want to continue as my care provider POST pg. If I could feel confident she really "knew" and was just turning a blind eye to it, I wouldn't feel so bad, yk?

I'll probably just keep up as is for now...it's only a few more visits anyway. And if she gets pissy about it, I can always find another caregiver for those once a year visits anyway...

I'm also not looking forward to evading them this last month - as much as she doesn't seem to be a total medwife, she has said that if they feel baby is big they'd want me to deliver early (induction) and, well, that's not going to happen. :p Though I think she has been "fudging" my fundal height so it doesn't look to be measuring as far ahead as it really is :thumb :lol

[courtenay_e]

I definately wouldn't tell her until after the birth, unless you don't care who takes care of you in the case of a transfer of care. I would think that, after all the time you've been going to her, you'd want someone familliar in the case of an emergent transfer of care, you know?

[jlpetitte]

As a future midwife (hopefully), I think I would feel hurt. I would want my clients to trust me and me to trust them. The midwives I have worked with get very close to their clients and I think they would feel misled.

[mwherbs]

allegal is illegal have any midwives been prosecuted in your state? I wouldn't tell the midwife or any back up provider my plans in an illegal state. what do your midwives recommend? they may want the midwife in place for you incase you do need to transfer care in labor or before labor-- that way you will still have a good provider-- is you tell her and then something happens you need back-up care for and she has already D/c 'd care then you may fall into having to see some physician you have never met.

[Charmie981]

Things to think about:

In a state where CPMs aren't licensed, you'll have to decide if you value your relationship with your CPM more than your relationship with your CNM.

It's nice to have that backup as an option, but a hospital can't refuse to treat someone who is in labor. In a transport, you WILL have a doctor and receive care (though not the greatest, possibly).

How will your CNM be paid if she doesn't attend the birth? I hate to bring money into the picture, but she does deserve to be paid for the care she's provided and some insurance (medicaid, I think) doesn't pay much or anything unless the birth is attended.

If you hope for her to be your backup provider, then I would think you should see her throughout the pregnancy. Most doctors wouldn't come in specifically for a person who was a patient but transferred out of their care. I don't know if CNMs would be the same way, but I suspect so.

[maybebaby]

Oh yeah, I definitely don't want to cause problems for my cpms! I love them dearly!! We've talked about the situation and they feel that likely she "knows" but can't really ask without opening a pandora's box...and I definitely wouldn't tell unless I'd talked it over with the CPM's again and got their feelings on backup, etc.. They actually have an OB who does their backup in the city they're in, but I coudn't travel an hour to see her as well knowing that her hospital isn't the one I'd have to transfer to anyway yk? I needed backup to be in my town, work thru the local hospital, etc..

jlpetitte, that's what I was worried about, I don't want her to feel hurt. I'm very concerned, probably overly so, about other's feelings...but at the same time I know HER hands are tied on some things at the hospital and a homebirth is really what I want and need.

mwherbs, yeah we've had at least one pretty high profile case where the mw (Frieda Miller) was prosecuted for having Pit, wouldn't release her source. While they're "legal" theres no regulating body in Ohio, which can make for pretty sticky situations....

Charmie981, omgosh, I'd never thought of that! I assumed she was getting paid for all the prenatals. I have Medicaid...shoot. Need to check that. Man, that will make me feel even worse!! :(

I'll keep seeing her because, as of our last discussion anyway, my CPM's really would like for me to have local backup in case of a transfer. I will look into the reimbursement thing though! Thanks ladies!

[sevenkids]

Charmie981, omgosh, I'd never thought of that! I assumed she was getting paid for all the prenatals. I have Medicaid...shoot. Need to check that. Man, that will make me feel even worse!!


Medicaid pays per visit, as oppossed to private insurance which pays global. She's getting paid after each prenatal.
I'm assuming your paying your cpm's out of pocket?

[Electra375]

I had a situation where the OB could not charge the global fee (they terminated my care and I went with a hb). I was charged for each visit I had with them and had a co-pay for each visit. I disputed the charges b/c it wasn't my decision to leave the practice and eventually they dropped it and I paid them nothing, my ins paid them part of the bill for the visits.

As for the CNM and CPM issue, VA was an allegal state as well. I kept my mouth shut to anyone. I was not doing back-up care b/c I was termintated from the OB's practice 10wks prior to my scheduled 3rd c/s -- nice huh? I opted for a hb instead of finding another provider to do a c/s -- I was asking questions to the OB about VBACing and then I was fired, so no incentive there to seek out another OB.

I met with a CNM for my annual last year, she knows I had a homebirth and if I were to have another baby -- I'd go to her for some care, PAP and ultrasound. I'd be upfront about it and if she couldn't see me for liability reasons, I would say thanks see you for my annual after the baby is born. VA just passed a bill that will eliminated the supervision of CNMs!!! YEAH...

I think it is easier to be upfront to start with rather than thinking about it later. But given the allegal CPMS nature in your state, you are better off saying nothing. Most CNM know the situation in their state and probably get that many women don't say anything for fear of damning their CPM or themselves.

If you see the CNM outside of the office in a non professional arena, mention your plans then, if you trust her. I would not mention stuff like that in an office due to liability and reporting responsibilities of medical professionals.

[maybebaby]

Shoot, I was going to call HHS today and "anonymously" ask the situation regarding their reimbursement if I switch to homebirth but I totally forgot. Glad to hear that she's likely getting paid. I know last time, I was seeing an OB/CNM (different practice) and I totally didn't gel with them and that's when I switched to a homebirth that time. He did get paid, I never got billed, etc..

This time I thought financially we couldn't swing another homebirth so planned on using this CNM all the way through and for the birth. I was almost halfway through before we figured we could do another homebirth (hence my reasoning for not being upfront about it from the beginning...ideally, I totally agree with you Electra375!)

sevenkids, yeah I'm paying the cpms out of pocket.

Again, thanks for all the feedback, gives me things to think about. It's funny, I guess I'd just figured since hb was alegal in Ohio that it was okay to talk about, I tell anyone about my hb :p guess I shouldn't really do that lol

electra, that's really crappy about your ob dropping you JUST for asking questions :irked: how annoying! And they wonder why so many of us are looking for other options!

[Sweeney]

Things are looking up for CPMs in Ohio right now- they've just been given the right to register birth certificates (again).

So In Ohio I think it depends on the CNM practice. Here in Cincinnati I've heard of CNMs that will knowingly give prenatal care for a woman planning an unassisted birth. It really is situation specific. What I did in my quest for information was ask general questions and mention no names :)

You might want to ask your CPMs how they feel about you giving out their name and if they know anything about the CNM you're seeing. That's probably the easiest way to find out how 'touchy' the medical community is in your area.

Good luck!

[maybebaby]

Kind of OT, but Sweeney, I was just told by my CPM's (who are very active in local and national midwifery org's) that in Ohio things are pretty sticky wrt birth certificates. The new info I was just given states I must have something from a doc or CNM stating I was pg, something showing that I gave birth and my own identification. (I like the idea of taking very graphic birth pics in to the courthouse lolol)

Last time, my cpm's *were* able to sign off on the birth cert, but this time they won't be.

Unless something changed in the last couple of weeks??

(I'm hoping so actually lol)

[Sweeney]

Yep. It just changed again.

Now for DEMs, you have to be registered with the state and you're able to do birth certificates for the next two years. After that you'll need the CPM credential. Twisted huh?

My Girlie was born this past January right after the change went through- it was horrible getting her a birth certificate. But apparently only babies born in Jan. and Feb. were affected. My midwive's recent clients have sailed through.

Hence why I'm optimistic about DEMs and homebirth in Ohio right now. We're having a meeting about possible legislation in Ohio next Sat. here in Cincinnati. I'll post a link to my post in Finding Your Tribe: Ohio

[Sweeney]

http://www.mothering.com/discussions/showthread.php?t=420586