Cross-posted in the Homebirth Forum.

Since we decided on a homebirth, I've felt very comfortable with the decision, so much that I decided to end the relationship with the CNM/OB place I was going to when I first found out I'm pregnant.

Now, last night I went to my first LLL meeting. While there I met a woman who's an LLL leader and a doula (call her B). She's worked with both my MW and the CNM's at the practice I was at before. She asked if I had a back-up plan, was I still going to have some care with the CNMs? She suggested it might be a good idea to keep them on, in case something does happen, I'm not at the mercy of "whoever's at the hospital we make it to." She says the CNMs (esp one in particular, A) are really great about striving to make a hospital transfer as HB like as possible.

Now, I'm very comfortable with my CPM. She's attended ~350 births, 5 of which were hospital transfers, only one for a c-section (a woman who had a septum in her uterus). Her partner, and back-up has attended many many births and has a similar record. I feel confident that it will work out ok... But I can't help but think (a nagging thought) that what B said has some validity. IF I do have to transfer, then someone who knows what I want would be better than whoever they have on staff.

BUT, I'm also very conscious and very aware (in my spiritual/physical view) that opening yourself to doubt can be the first step in something taking a wrong turn. My thought is that if I proceed with confidence in my CPM, not letting the doubt get to me, then things will go well. If I continue on with co-care from the practice, then that leaves me more open to the possibility that I will need them. Whereas, if I didn't co-care, that would leave me with less possibility of needing them.

This whole pregnancy has gone really smoothly for me. I feel part of that is due to the positive attitude I've had that I can, in fact, do this (part of it is also due to, I feel, good birthing genetics, my maternal gram had 8, my paternal gram had 7 amd my mom had 8 kids...). I am not sure that having co-care would be conducive, to keeping this mentality, but now that the notion's been brought up, I am starting to wonder. I don't want it to turn into doubt, so I guess I need some reassurance, wisdom, guidance, etc... What do you all think?

would your CPM not transfer with you to the hospital? that's what mine will do, and that's been enough reassurance for me. i understand what you're saying, tho, if i were to transfer i would LOVE to have the CNM that caught dd at the hospital. i also trust my CPM to facilitate my wishes for me, and know that she's not going to transfer me for a crappy reason. i don't think it would be necessary to have a CNM and a CPM. two cents! :D

In an emergency transfer situation, I would think you would still have little choice in who sees you. And I agree with you 100% about opening yourself up to doubt!

Most homebirth midwives will have a hospital preference for transfer- maybe you could talk to yours about that. I know that in our area there is one hospital that is very unfriendly about transfers, and another that has been great on those rare occasions.

i think you should talk to your mw about her back-up plan. i know my mw has one and has gone over it with me. she has a certain hospital she tranfers to where she is well known and welcome. in an emergency, you take the doctor on call, but she (mw) will never leave my side. her back-up doctors are on call at that hospital and, in case of transfer, she can call any one of them to meet us at the hospital. i have to opportunity to meet them at any point in my pg if i wish.

i think it's important for you to know what your mw's protocol is in case of emergency. it's not all on you to have back-up care planned.

i think you should talk to your mw about her back-up plan. i know my mw has one and has gone over it with me. she has a certain hospital she tranfers to where she is well known and welcome. in an emergency, you take the doctor on call, but she (mw) will never leave my side. her back-up doctors are on call at that hospital and, in case of transfer, she can call any one of them to meet us at the hospital. i have to opportunity to meet them at any point in my pg if i wish.

i think it's important for you to know what your mw's protocol is in case of emergency. it's not all on you to have back-up care planned.

:yeah:

Thanks all! I'm glad you're helping in this. I felt very confident that everything would go ok until this conversation yesterday. And not that it was exactly her fault, but sometimes I think the "what if something goes wrong" bug can get stuck in a person's head!!

Yes my MW does go in with me, as my advocate then, in a hospital transfer. She's well known at the hospital she goes to (she's pre-med and has been doing clinical work there). SO that's a bonus also. I felt fine with that before... but for some reason, the woman I met last night made me think that it wouldn't work the best. Although she had only the best to say about my MW... Needless to say, that left me feeling rather :dizzy:. I do feel that my best mindset is to approach the birth positively rather than with a what if...

Oh goodness I almost could have written this. Since we've let DH's family know that we're going to home birth they've all regailed us with "are you still going to have a hospital", "when something goes wrong will your midwife take you there"!!
AHHHh I don't need them to doubt me. DH doesn't understand why it upsets me. He just thinks they are being supportive. But I don't need the doubt. I believe that if you trust in yourself you can do it.
Sigh. I guess I should have expected this, they are sooo conservative.

Anyhow Teenytoona I agree don't let them cast any shadows on you. You will be strong and be able to succeed. But a backup plan is good, if only to get the naysayers off of your back!

I can't wait until Feb/ March when we can all start trading stories!

I do need to talk to my mw about one a little bit. Not bc I have doubts, I've had a homebirth before...but bc the hospitals in town are HORRID so I DO need to know which one we'd go to in the event of transfer so I know where it is. :lol

That said, some sort of loose plan can be calming, but I don't think I'd see two different care providers.

I have a transfer birth plan written up. I know that my midwife would stay with me in case of transfer (as would any of the other midwives in the area, CNM or CPM - cert has little to do with it!). I'm glad I wrote it but I try not to think about it very much!! If you pm me your email addy I'll send you what I have. I don't have a "back up" OB or anything like that.

I wouldn't want to see two providers either. It would probably be an extra expense, depending on your insurance, plus you'd have to deal with any scare tactics are the CNM/OB office. I imagine it can be nice to have someone you know at the hospital should you need to go, but it would probably only be worth it in the case of having an illegal hb midwife, and even then... Many midwives (CNMs, mostly, I'm guessing) have privileges at certain hospitals, meaning that they can not only stay with you as a support person, but also are still able to act as a provider in the hospital (helping to make decisions, etc.). At least if you have a midwife who will stay with you, that's good. I have to say, 5 transfers out of 350 is an amazing record! I almost don't believe it! It sounds like you are in good hands.

I have to agree with the pp who said that one never knows who one will get in an emergency transfer, but it sounds like your MW already knows folks in the hospital so she'll be a great advocate no matter what. Where I am, MW have NO privileges in hospital when transferring and in fact are sometimes met with a bit of disdain. So I would just not worry or think about it as if something will go wrong, just think of everything going the way that it is supposed to, that way, if you do end up transferring, even then things will go the way they are supposed to, kwim?

In a true emergency you'd be seen by the first available doctor, and if your back-up OB can't get to the hospital you'd be transferred to before you do, you'd most likely be seeing whoever's on call at the hospital. I agree with seeing what your mw's back-up plan is and how things have worked out in the transfers that she's done.

My mw's have a back-up OB and also catch babies at the hospital I'd be transferred to if baby was breech or some other non-emergency (their back-up OB, from what I understand, also does vaginal breech births), so I"m confident in the care I'd get if transferred for a non-emergency. In an emergency situation such as cord prolapse, I won't be caring WHO is helping to get my baby safely into the world and trust my midwives to advocate for me/my baby as needed.

Many moms in this situation find that thinking about what situations might arise that would cause them to tansfer to a hospital and what the most important things to them when they get there dictate what type of back-up care they require. If you'd only be transferring for a true emergency, then who your back-up OB is might not be as important as your MW's relationship with the docs/nurses at the facility you'd be transferred to, as even an OB that nods in agreement to everything you want during visits may not practice that IRL. If you see yourself possibly transferring for a reason that isn't a life-threatening emergency, which it doesn't seem you do, then you might then consider WHO would be attending your birth.

I've given it a bit more thinking and I really feel that going with my initial gut feeling on it (sticking with my MW, and no co-care or real back-up) will be the way to go. It's funny how someone can come along with a certain amount of credentials and make you wonder, uh-oh!

But at my SIL's shower yesterday, I told some of my cousins and aunts about the homebirth, and they all think it's so cool! I knew some of them would say that, but with so many of them being excited about it, I am too! The only drawback is that my MW says no visitors besides immediate family for the first week. But they said they'll deal with it. The more I talked about it, the more confident I feel, so I think I'm going to smash the doubt away, and resolve to the fact that I can do this!

Also, you're right mama_nym that in a true emergency I'd just get whomever was there when we go in, so back-up or no, it wouldn't probably come together then anyhow.

She does have an amazing record, BinahYeteirah. I think it's, in part, due to the fact that she's attended many Amish births, and I think they are far less likely to select the hospital for pain relief. But it also tells me that she's resourceful enough to find other ways around what could otherwise be a hospital transfer.

Thanks Mommas! I love the support we share here!:throb